1. 1. - Dr. Gajanan Pandit
2. 2. - Gait is defined as the systematic,rhythmic ,co-ordinated,semi-rotatorymovements of the lower limb,trunk,arm and head resulting in an interplaybetween loss and recovery of balance with constant change in the centre ofgravity causing forward propulsion of an organism in space.- Differs from spot march ---- rhythm present but no forward propulsion.- Human gait is Biped Gait.Each leg performs function alternatively.Hence,called Alternate Bipedalism.- It is a Heel-Toe Gait.Heel touches the ground first followed by toes and heelleaving the ground first followed by the toes.
3. 3. - STEP LENGTH :--Distance between right and left heel when step is taken.-Corresponds to length of foot + 25 cms.-In average adults,it is between 45-50 cms (15 inches).- STRIDE LENGTH :--Distance covered by the same heel after a stride is taken (27-32inches).-Varies according to the length of lower limb and height of theperson.
4. 4. - CADENCE :--Number of steps taken per minute (90-120 /min).- During normal walking, a linear distance of 5-10 cm is maintainedbetween midpoints of the feet.It is called Width of Base Support .- During normal walking, there is slight out-toeing i.e foot is placed at anangle to the vertical (angle between the line of progression andlongitudinal axis of the foot).It is about 8-15 degrees. Angle of ToeOut.- Slow run v/s Fast Walk :--In slow run,there is always a stage when both feet are off the ground.-In fast walk,there is always a stage when both feet are on the ground.
5. 5. CENTRE OF GRAVITY :-- Imaginary point at which all the weight of the body is concentratedat a given instant.- Lies 2 inches in front of the 2nd Sacral Vertebra.- Follows a smooth sinusoidal curve and oscillates no more than 2inches up and down and from side to side.
6. 6. - Human gait is Biphasic Gait.- Two phases :-(1) Stance Phase starts with foot contact and ends with foot lift off.Accounts for60% of the cycle.(2) Swing Phase - starts with foot lift off and ends with foot contact.Accounts for40% of the cycle.Double limb support that portion of the gait cycle when both feet are in contact withground.Centre of gravity is at its lowest point.Kinetic energy is the maximum.
7. 7. - HIP JOINT :-- flexion- adduction- external rotation- KNEE JOINT :-- initial flexion to clear off the ground- followed by gradual extension- ANKLE JOINT :-- initial plantar flexion resulting in push-off- then dorsiflexion to clear off the ground
8. 8. PATHOLOGICAL CLASSIFICATIONPathology PredominantlySymmetricalPredominantlyAssymetricalUpper motor neuron(UMN)DiplegiaQuadriplegiaHemiplegiaBrain Stem AtaxicLower motor neuron(LMN)Spina Bifida Femoral nerve palsySensory NeuropathyBasal Ganglia AthetoidCortical ApraxiaOrthopedic AnteversionTibial torsionCongenital Dislocation(CDH)Amputee Trans-tibialTrans-femoral
9. 9. ANATOMICAL CLASSIFICATIONRegion Sagittal Frontal TransverseFoot Toe flexion Pes planus/supinatus In/out-toeingAnkle Equinus, Drop footExcessivedorsiflexionClonusVarus/ValgusTibia Tibial TorsionKnee Stiff kneeRecurvatumAbnormal loadingVarus/ValgusFemur Femoral AnteversionHip Forward trunk flexion Tendelenberg signPelvis Anterior/posterior tilt RotationSpine Lordosis/kyphosis Duchenne sign ScoliosisArms Abnormal swing Lateral thrust
10. 10. FUNCTIONAL CLASSIFICATIONVelocity StrideLengthCadence StanceDurationStepLength(wrt.contralat.)Step Time(wrt.contralat.)StepWidthAntalgic Low Short Fast Short Long Short WideUnstable Low Short Low LongCompensatedNormal Short Fast ShortUncompensatedLow Short NormalApropulsiveReduced
11. 11. 1)Observational data :--videotape in frontal & lateral view.-view in slow motion.2) Gait parameters :--Cadence 90-120 steps/min-Step length 0.7-0.9 m-Walking velocity 60-90 m/min-Single limb support- 0.5-2 sec3) Kinematic data :--Linear & angular displacement of body segments in space is an importantaspect.-joint motion recorded with electrogoniometers..-most accurate photographic (cine) methods.
12. 12. 4) Force plate data :--represents ground reaction force of walking generated by a force plate,setin the floor of gait walkway.-information regarding resultant reaction force with vertical and horizontalcomponents, sheer force and torque vectors can be obtained.5) Kinesiological data :--broad term that combines motion,forces and muscle functions.6) Energetics :--deals with oxygen consumption during a specific task or activity.
13. 13. - 2 broad patterns :-(1) LIMPING denotes painful condition on the affected side.Patientavoids weight bearing on affected side (decrease in stance phase).(2) Lurching denotes variable failure of abduction mechanism.
14. 14. (1) ANTALGIC GAIT :-- Any gait which relieves pain is known as antalgic gait.Patientdoes not bear weight on the affected side.Therefore, body lurches tothe opposite side.- decrease stance phase- decrease step length- decrease stride length
15. 15. (2) TRENDELENBURG GAIT :--Abductor lever mechanism :--Ask patient to stand on one leg opposite side ASIS tends to dip down .-This is prevented by contraction of the abductors (gluteus medius &minimus) on the same side.-So ASIS level is maintained.Here body weight acts as load, hip joint as the fulcrum & abductors as the power.Defect in fulcrumi.e. fracture neck femur dislocation of hip Defect in power Opposite ASIS dips downi.e. Poliomyelitis i.e TRENDELENBURG SIGN POSITIVEGluteii paralysis
16. 16. TRENDELENBURG TEST +VE TRENDELENBURG TEST -VE
17. 17. (3) WADDLING GAIT :-When Trendelenburg sign is present bilaterally, it will result inswaying of the patient side to side on a wide base.This is called waddlinggait (duck gait).
18. 18. (4) HIGH STEPPAGE/FOOT DROP/EQUINUS GAIT :-During heel strike attempt,toes drop to the ground first due to the foot drop.Hence, to clear the ground,patient will flex hip and knee excessively, raises thefoot and slaps it on the floor forcibly.Common in foot drop due to muscle paralysis (common peroneal nervepalsy).
19. 19. (5) STAMPING GAIT :-In posterior column affection of the spinal cord,there is loss of joint,position & vibration sense.One is not able to percieve the distance offloor from the feet resulting in a hard thump.e.g tabes dorsalis,syringomyelia,diabetes mellitus,leprosy,etc.
20. 20. (6) SCISSOR GAIT :-Here one lower limb passes in front of the other lower limb due tomarked adductor spasm as seen in cases of cerebral palsy.
21. 21. (7) IN TOEING AND OUT TOEING :-When there is increased anteversion of femoral neck,there is internal rotationof the hip joint to contain femoral head in the acetabular cavity results ininternal rotation of the entire lower limb noted by inward pointing of the toes.This may persist or compensatory external torsion of tibia may occur.Hence,the toes point forward.In such a case, look at the patella.Due to femoral torsion,both patella point inwards rather than forwards KISSING PATELLA.Normal range of out toeing is from 8 15 degrees.Usually associated withlateral tibial torsion..results in CHARLIE CHAPLIN GAIT.
22. 22. (8) SHORT LIMB GAIT :-< 1.5 cm ----- compensated by pelvic tilt while walking.upto 5 cm ---- compensated by equinus.> 5 cm --------- patients body dips down on that side.
23. 23. (9) GLUTEUS MAXIMUS GAIT :-Due to gluteus maximus paralysis,it is not possible to extend thesupported hip in the swing phase.This is overcome by backwaedlurch of the trunk.Therefore, while walking, forward & backwardmovements of the trunk occur.Hence, also called as ROCKINGHORSE GAIT.
24. 24. (10) HAND TO KNEE/QUADRICEPS GAIT :-Normally ,to transmit weight of lower limb during midstance, the knee islocked by quadriceps contraction.If it is weak,locking is hampered & bucklingat knees will occur.Therefore, to stabilise the knee for weight bearing,patientplaces his hand in front of the knee and lower thigh region.e.g poliomyelitis
25. 25. (11) CALCANEUS GAIT :-Just before the swing phase,there is push off at the ankle joint byplantar flexion.This is absent in paralysis or rupture of tendo-achilles.Weightis largely borne by the heel & there is widening & thickening of heel.Foot isflat on the ground.Occurs with weakness of triceps surae or contracture of dorsiflexors ofankle.
26. 26. (12) SHUFFLING/FESTINANT GAIT :-Here, the patient takes short steps, has a stooping posture(flexed neck, trunk, hip, knee) and is propelled forward quickly as iftrying to catch up with the centre of gravity which is placed anteriorly.(13) ATAXIC/CEREBELLAR GAIT :-Here, there is loss of sense of balance.patient sways in differentdirections during ambulation.
27. 27. (14) HEMIPLEGIC GAIT :-There is rigidity in lower limb muscles due to UMN lesion.Therefore, extension at knee & plantar flexion at ankle prevail.Hence, there is circumduction of limb at hip while swinging the limbto achieve forward propulsion.
28. 28. (15) STIFF HIP GAIT :-In normal gait, 20 degree flexion occurs at the hip.In stiff hip, patientdoes not flex hip.To compensate, patient raises the pelvis & semi-circumductsthe limb to propel it forward.(16) STIFF KNEE GAIT :-Due to loss of flexion at knee,patient raises pelvis to clear off theground and swing sideways with circumduction to propel it forward.Lookslike that of a German Soldier marching.(17) FLAT FOOT :-There is affection of arches of the foot.Foot is flat on the ground.Thereis loss of spring in the gait.
29. 29. (1) BROAD BASED GAIT :-- Rare- Earlier seen in seamen due to habit of standing in boat with a broadbase to balance self (centre of gravity falls between two feet).(2) HELICOPOD GAIT :-- Legs & feet thrown in half circles as in hemiplegia.(3) LATHYRIATIC GAIT :--Combination of spasticity, hyperabduction & dragging of lower limb elements.(4) DRUNKERS/REELING GAIT :-- Irregular walk on a wide base,sideways swing without stability,tendency tofall with every step.- seen in drunken state or cerebellar inco-ordination.(5) KNOCK KNEE GAIT :-- Knees point & oppose each other while ankle & feet are kept apart.(6) GENU RECURVATUM GAIT :-- Hyperextension at knee.Seen in paralysis of hamstring (e.g polio).(7) CHARCOT GAIT :-- In hereditary ataxia.
30. 30. (1) ATHLETES GAIT :-At end of game,the players have a crouching attitude.This keepsthe centre of gravity as low as possible Prevents fatigue.(2) MOURNERS GAIT :-In a mourning ceremony,people of various height are present.But crowd moves together at the same pace.This can be done byaltering the cadence.However,this alteration cannot be sustainedfor a long time.Hence a tall person will alter his step length.he takesa step forward & then brings it back a bit.In such a case,there ismore expenditure of energy.
31. 31. (3) CRUTCH GAIT :-- Consider crutches & legs as four pointsEither crutches move togetheror legs move together.2 Point gait double amputee with crutches.crutches are put forward & then body swungforwards (swing to or swing through).3 Point gait when weight is allowed on one leg,crutches are put forward & limb follows withthe other limb off the ground.4 Point gait when limbs are allowed to bear weightbut are not strong enough to do so unaided.Crutches & legs alternatelyput forwards singly to achieve 4 point gait.