Normal and Pathological Gait in the Elderly

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Normal and Pathological Gait in the Elderly

• Peggy R. Trueblood, PhD, PTCalifornia State
  University, Fresno

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Part IEFFECTS OF NORMAL AGING ON THE GAIT PATTERN
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Gait Cycle

• Largest unit used to describe gait
• Defined as foot contact to foot contact of same
  limb

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Stride

• Distance parameter between these two points
• Within a stride we have right and left step

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FLOOR CONTACT PATTERNS

• SWING PHASE (40)
• STANCE PHASE (60)
• - Initial Double Stance (10)
• - Single Limb Support (40)
• - Terminal Double Stance (10)

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Normal Gait is Dependent on

• Free passive joint mobility
• Appropriate timing of muscles
• Appropriate intensity of muscle action
• Normal sensory input (proprioceptive, vestibular,
  visual)

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Normal Aging

• Can produce muscle weakness
• Can affect visual, proprioceptive, and vestibular
  systems

• Should not affect range of motion
• Should not affect timing of muscle activity

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Muscle Weakness

• Hip extensors
• Knee extensors
• Plantarflexors
• Dorsiflexors

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Changes in Visual System

• Decrease in visual acuity
• Poorer depth perception
• Restriction of the visual field
• Increased susceptibility to glare

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Changes in Somatosensory System

• Increased sway with eyes closed
• Decreased reflexes at the joints
• Vibration and tactile sense
• decreases significantly after age
• 50, especially in the feet
• Impaired proprioception on neurologic exam

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Changes in Vestibular System

• Slower postural support
• responses
• Sway during standing
• increases with advancing
• age

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What are the consequences?
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COMMON GAIT ADAPTATIONS IN OLDER ADULTS
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SENSORY/BALANCE DYSFUNCTION

• Increase in double limb support
• Decrease in gait velocity
• Decrease in stride length
• Increase in step width

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MUSCLE WEAKNESS

• Subtle changes in gait cycle due to muscle
  weakness

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REVIEW PHASES OF GAIT CYCLE

• Comparing Young and Old

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WEIGHT ACCEPTANCE(Initial Contact Loading)

• Most demanding task in the gait cycle
• Three functional patterns needed
• - Shock absorption
• - Initial limb stability
• - Preservation of progression

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Key Muscle Groups

• Hip extensors
• Quadriceps
• Dorsiflexors

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SINGLE LIMB SUPPORTMidstance Terminal Stance

• One limb has the total responsibility for
  supporting body weight
• Progression of body weight must be continued

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Key Muscle Groups

• Lateral hip stabilizers (abductors)
• Trunk
• Quadriceps
• Plantarflexors

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LIMB ADVANCEMENT(Pre-Swing Swing)

• Preparatory posturing begins in stance
• Swing phase accomplishes
• - limb advancement
• - toe clearance
• - forward reach

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• forward propulsion of the body
• preparation of limb for weight acceptance

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Toe clears floor by 1 cm
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Key Muscle Groups

• Hip flexors
• Knee flexors
• Dorsiflexors
• Quadriceps and Hamstrings at Terminal Swing

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Normal Gait
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Summary of Major Gait Adaptations in Elderly
reduced velocity
shorter step
increased double support
flatter foot landing
reduced/weakened push-off