GAIT

Page 1

DEFINATION
Gait is forward propulsion of the body by the lower extremity with the coordinated rotated movements of the body segment. The lower extremity supports and carries the head, trunk, and arm. In short, it is a style, manner or pattern of walking. The walking pattern may differ from individual to individual. It depends on age, sex,mood of an individual or may be due to some diseases.

Page 2

GAIT CYCLE
Gait cycle is the activity, which occurs between the points of the initial contact of the same extremity two times.

Page 3

GAIT CYCLE DEFINATIONS

Step Length Distance between corresponding successive points of heel contact of the opposite feet Stride Length Distance between successive points of heel contact of the same foot Double the step length Step Duration - Time taken for completion of one step Stride Duration - It is the time taken for the completion of heel strike of one extremity to the heel strike of the same extremity once again.

Page 4

Page 5

GAIT CYCLE DEFINATIONS

Walking Base Side-to-side distance between the line of the two feet Also known as stride width Cadence Number of steps per minute = no. of step/minute

Page 6

GAIT CYCLE DEFINATIONS

Double limb support : - This is a period at which both the lower extremities having contact with the ground. - This is possible between the heel-off or toe-off of the the one extremity and the heel strike or foot flat of another extremity. Single limb support : - It is the period at which the single limb contacts the ground. - The single limb support is seen during the reference extremitites in the mid stance plase
Page 7

PHASES OF GAIT CYCLE

1. Stance phase: The activity, which occurs during the foot having contact with the ground.

Page 8

PHASES OF GAIT CYCLE

2 . Swing phase : The activity, which occurs during the foot when is not having the contact with the ground.

Page 9

 The traditional method and Ranchos Los Amigos (RLA) medical centre, California, defines activities, which occur during the stance phase and swing phase.

Page 10

ACTIVITIES OCCUR DURING STANCE PHASE

Traditional Method Heel strike Foot flat Mid-stance Heel-off Toe off RLA Initial contact Loading response Mid stance Terminal stance Pre-swing

Page 11

ACTIVITIES OCCUR IN SWING PHASE

Traditional method Acceleration Mid-stance Decelaration RLA Initial swing Mid-stance Terminal swing

Page 12

RLA METHOD ACTIVITIES THAT OCCUR DURING STANCE PHASE

1. Initial Contact : Heel of the loading extremity strike the ground. The moment when the (red) foot just touches the floor. Normally, the heel is the first part of the foot to touch the ground. o The hip is flexed, the knee is extended. o The ankle is dorsiflexed to neutral. o Meanwhile, the other leg (blue) is at the end of terminal stance .
Page 13

ACTIVITIES THAT OCCUR DURING STANCE PLASE

2. Loading response : Starts with the double contact and continues till the contralateral extremity clears the ground. The double stance period beginning when the foot contacts the floor and continuing until the other foot is lifted for swing. Body weight is transfered onto the forward (red) leg. o Phase 2 is important for shock absorption, weight-bearing, and forward progression. The opposite leg (blue) is in the pre-swing phase. The next task of the gait cycle is single limb support during which one limb must support the entire body weight and provide truncal stability while progression must be continued. Page 14

Page 15

ACTIVITIES THAT OCCUR DURING STANE PHASE

3. Mid stance: It begins when the contra lateral lower extremity clears the ground, and end when the body comes straight line to supporting limb. It begins with the lifting of the opposite foot (blue) and continues until body weight is aligned over the supporting foot. o The reference leg (red) advances over the stationary foot (red) by ankle dorsiflexion while the hip and knee extend. The opposite leg (blue) is advancing in its mid-swing phase.

Page 16

ACTIVITIES THAT OCCUR DURING STANE PHASE

4. Terminal stance : Starts from the end of the mid-stance to the initial contact of the contralateral lower extremity. Begins when the heel (red) rises and continues until the heel of the other foot (blue) hits the ground. Body weight progresses beyond the red foot as increased hip extension puts the leg in a more trailing position. The final task of the gait cycle is limb advancement, which requires foot clearance from the floor. The limb swings through three positions as it travels to its destination in front of the body.

Page 17

ACTIVITIES THAT OCCUR DURING STANE PHASE

5. Pre-swing : It is the period of the contralateral lower extremity initial contact and the reference extremity clears from the ground. It begins with the initial contact of the opposite foot (blue) and ends with ipsilateral toe-off (red). o Ground contact by the opposite (blue) leg causes the reference leg (red) to increase ankle plantar flexion, increase knee flexion, and decrease hip extension. Transfer of body weight from ipsilateral to opposite limb takes place.

Page 18

ACTIVITIES THAT OCCUR DURING SWING PHASE

1. Initial swing : It starts from the point of foot clearing from the ground to the maximum knee flexion of same extremity. Begins when the foot is lifted from the floor and ends when the swinging foot is opposite the stance foot. The leg (red) is advanced by increased hip flexion and increased knee flexion. The ankle only partially dorsiflexes to ensure ground clearance. It is during this phase that a footdrop gait is most apparent. The opposite leg (blue) is in mid-stance.
Page 19

ACTIVITIES THAT OCCUR DURING SWING PHASE

2. Mid-swing : It starts from maximum knee flexion to the vertical position of tibia. Continues from the end point of the initial swing and continues until the swinging limb is in front of the body and the tibia is vertical. o Advancement of the leg (red) is accomplished by further hip flexion. The knee is allowed to extend in response to gravity while the ankle continues dorsiflexion to neutral. The opposite leg (blue) is in late mid-stance.

Page 20

ACTIVITIES THAT OCCUR DURING SWING PHASE

3. Terminal swing : It is the period from the vertical position of tibia to the preparation of the initial contact of the heel. Begins when the tibia is vertical and ends when the foot touches the floor. o Limb advancement is completed by knee extension.

o The hip maintains its flexion.

o The ankle remains dorsiflexed to neutral.
Page 21

MUSCLE ACTIVITY DURING GAIT CYCLE

Page 22

MUSCLE ACTIVITY DURING GAIT CYCLE

Stance Phase: The gluteus maximus and hamstrings extend the hip early in the stance phase The hip flexors check this movement before toe-off The gluteus medius and minimus abduct the hip The hip medial rotators act in the first half of the stance phase Late in the stance phase the adductors and lateral rotators check the momentum generated by the former muscles

Page 23

MUSCLE ACTIVITY DURING GAIT CYCLE

Stance Phase: The quadriceps femoris acts at the beginning of the stance phase extending the knee The hamstrings flex the knee just before toe-off The dorsiflexors of the foot act immediately after heel strike to check plantar flexion under the force of gravity and bring the foot into full contact with the ground

Page 24

MUSCLE ACTIVITY DURING GAIT CYCLE

Stance Phase: The plantar flexors act throughout the second half of the stance phase powering the forward thrust of the body using the thigh and leg as a single unit The body is powered forward by the plantar flexors and hip extensors As the body weight comes onto the foot the intrinsic foot muscles contract to support the plantar ligaments

Page 25

MUSCLE ACTIVITY DURING GAIT CYCLE

Swing Phase: The hip flexors already function at the end of the stance phase continue into early swing phase along with the adductors and lateral rotators They are essentially silent in midswing relying on momentum of the thigh mass to bring the thigh forward

Page 26

MUSCLE ACTIVITY DURING GAIT CYCLE

Swing Phase: Thigh momentum is checked at the end of the swing phase by the hip extensors The hamstrings function late in the stance phase and continue into early swing phase to flex the knee The forward momentum of the limb in the swing results in the transition from flexion to extension at the knee with some assistance from the quadriceps muscles

Page 27

MUSCLE ACTIVITY DURING GAIT CYCLE

This momentum is checked by the hamstrings prior to heel strike Dorsiflexors and the ankle act throughout the swing phase

Page 28

ABNORMAL GAIT
Parkinson gait : The patient will have the posture which will be stooped over, leaned forward, and then will have a difficulty initiating the gait. When the gait is initiated, there are small steps, often theres a tremor associated with it, and as the gait progresses, there may be a picking up of speed, thats what is called as a festinating gait. And then in turning, the patient turns en bloc, i.e. as a statue moving around. And, then, again having difficulty starting the gait.

Page 29

ABNORMAL GAIT
Hemiplegic Gait : The patient has unilateral weakness and spasticity with the upper extremity held in flexion and the lower extremity in extension. The foot is in extension so the leg is "too long" therefore, the patient will have to circumduct or swing the leg around to step forward. This type of gait is seen with a UMN lesion

Page 30

ABNORMAL GAIT
Ataxic Gait : The patient's gait is wide-based with truncal instability and irregular lurching steps which results in lateral veering and if severe, falling. This type of gait is seen in midline cerebellar disease. It can also be seen with severe lose of proprioception (sensory ataxia)
Page 31

ABNORMAL GAIT
Steppage gait (High stepping gait/ Neuropathic gait) : This girl has weakness of the distal right lower extremity so she can't dorsiflex her foot. In order to walk she has to lift her right leg higher then the left to clear the foot and avoid dragging her toes on the ground.

Page 32

ABNORMAL GAIT
Waddling gait (Myopathic gait) With muscular diseases, the proximal pelvic girdle muscles are usually the most weak. Because of this the patient will not be able to stabilize the pelvis as they lift their leg to step forward, so the pelvis will tilt toward the non-weight bearing leg which results in a waddle type of gait.
Page 33

THE END
Page 34