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Title:

Gait

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Hand piece : elbow flexed 30 degree, wrist max extension, finger fist. 2-3 FB from apex of axilla ... Elbow flexion 20 degree. Can release hand without loosing crutch ... – PowerPoint PPT presentation

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Title: Gait


1
Gait Gait Aids
2
Normal Gait Abnormal Gait
3
Gait
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4
Why we should know Normal Gait
If we have sound knowledge of the
characteristics of normal gait
We can accurately detect interprete
deviations from the normal gait pattern
5
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6
60
40
7
60
40
20-25
8
Stride width 5-10cm
Cadence 70-130 step/min
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14
Abnormal gait
  • Stance phase
  • Antalgic
  • Lateral trunk bending
  • Anterior trunk bending
  • Posterior trunk bending
  • Lordosis
  • Hyperextended knee
  • Excessive knee flexion
  • Excessive Genu Valgum or Varum

15
  • Inadequate Dorsi-flexion control
  • Insufficient Push-off
  • Abnormal walking base
  • Internal or external limb rotation
  • Excessive medial or lateral foot contact
  • Vaulting

16
  • Swing phase
  • Circumduction
  • Hip hiking
  • Internal or external limb rotation
  • Inadequate Dorsiflexion control
  • Abnormal walking base

17
Antalgic gait
  • Pain in stance phase knee, hip, foot pain

18
Lateral trunk bending
  • Hip abductor weakness
  • Hip dislocation, coxa vara, slipped capital
    femoral epiphysis
  • Hip pain
  • Perineal pressure
  • Involved limb relatively shorter
  • Compensation for abducted gait

19
Trendelenberg gait
  • Gluteus Medius Gait

20
Anterior Trunk Bending
  • Quadriceps weakness combined with weakness of
    gluteus maximus, gastrocnemius, or both

Pushing backward with the hand / lateral rotation
21
Posterior Trunk Bending
  • Gluteus Maximus (Lurch) Gait
  • Hip-extensor weakness
  • Knee ankylosis, spasticity or orthotic knee lock
  • Hip-extensor spasticity

22
Hyperextended knee
  • Quadriceps weakness
  • Capsular ligament laxity
  • Quadriceps spasticity
  • Plantar-flexion contracture or spasticity
  • Compensation for contralateral limb shortening
    (hip-flexion or knee-flexion contracture)

23
Excessive knee flexion
  • Knee-flexion or hip-flexion contracture
  • Knee-flexor spasticity
  • Uncompensated quadriceps weakness
  • Ankle ankylosis, pes calcaneus
  • Plantar-flexor weakness
  • Involved limb relatively longer

24
Steppage gait
  • Ankle dorsiflexor weakness compensate by
    exaggerated hip and knee flexion

Foot drop / dragging
25
Slap foot
  • Ankle dorsiflexor weakness early stance phase

26
Insufficient Push-Off
  • Flat foot gait
  • Plantar-flexor weakness
  • Rupture of the Archilles tendon or the triceps
    surae
  • Metatarsal pain, hallux rigidus

27
Internal or External Limb Rotation
  • Internal rotation
  • Biceps femoris weakness
  • spasticity
  • External rotation
  • Quadriceps weakness
  • Inner hamstring weakness
  • Spasticity

28
Abnormal walking base
  • Wide Base (gt 4 inch)
  • Hip-abduction contracture
  • Instability due to fear, proprioceptive deficit,
    cerebellar problem
  • Perineal pain
  • Genu valgum

29
  • Narrow base (lt 2 inch)
  • Spasticity
  • Genu varum

30
Vaulting
  • Swing-phase limb is relatively longer

31
Hip hiking
  • Increased ipsilateral length
  • hip -flexor or dorsiflexor weakness
  • hip, knee, ankle ankylosis or spasticity
  • insufficient hip or knee flexion
  • Contralateral shortness

32
Circumduction
  • Spasticity
  • Hip flexor weakness
  • Hamstring paralysis
  • Knee or ankle ankylosis / orthotic knee lock
  • Dorsiflexor weakness
  • Plantar-flexion contracture

33
Scissoring gait
  • In spastic CP with spasticity of adductor m.

34
Crouched Gait
  • Excessive flexion of hip and knee due to
    spasticity, muscle tightness or contracture
  • Spastic CP

35
Parkinsonian gait
  • Trunk ,head ,neck forward and knee flexed
  • wide base ,small shuffling step
  • trend to fall forward and to increase speed
    (festination)

36
Hemiplegic gait
  • Abnormal arm swing adduction with flexion at
    shoulder ,elbow ,wrist and fingers
  • extensor synergy of lower limb leg extension
    ,adduction and hip IR ,knee extension ,ankle and
    foot plantarflexion and inversion.

37
Gait aids
38
Purpose of gait aids
  • Increase area of support, maintain center of
    gravity over support area
  • Redistribute weight-bearing area

39
Requirements
  • ROM, muscle strength and endurance, coordination,
    trunk balance, sensory perception, mental status
  • Amount of weight-bearing permitted on lower limb

40
Requirements
  • Shoulder depressor latissimus dorsi, lower
    trapezius, pectoralis minor
  • Shoulder adductor pectoralis major
  • Shoulder flexor, extensor and abductor deltoid
  • Elbow extensor triceps
  • Wrist extensor ECR, ECU
  • Finger flexor FDS, FDP, FPL, FPB

41
Crutches
  • Body weight transmission with bilateral axillary
    crutches 80 of BW, nonaxillary crutches
    40-50 of BW
  • Good strength of upper limbs usually required
    more weight bearing and propulsion

42
  • Unilateral non/partial weight bearing eg
    fracture, amputee -gt 3-point gait
  • Bilateral partial weight bearing or
    incoordination/ataxia -gt 2 or 4-point gait
  • Bilateral weakness of lower extremities eg
    paraplegia -gt swing-to or through gait

43
  • Non-axillary crutches
  • Lofstrand/forearm crutches
  • Platform crutch
  • Wooden forearm orthosis (Kenny stick)
  • Triceps weakness orthoses (arm orthoses) eg Warm
    Spring, Everett, Canadian crutch

44
Axillary crutches
  • Crutch length measure anterior axillary fold to
    point 6 inches anterolaterally from foot or to
    heel plus 1-2 inches
  • Hand piece elbow flexed 30 degree, wrist max
    extension, finger fist
  • 2-3 FB from apex of axilla
  • Compressive radial neuropathies

45
Lofstrand/forearm crutches
  • Single aluminum tubular adjustable shaft,
    handpiece, forearm piece 2 inches below elbow,
    forearm cuff anterior opening (hinge)
  • Elbow flexion 20 degree
  • Can release hand without loosing crutch
  • Requires great skill, good strength of UEs, trunk
    balance

46
Platform crutch
  • Painful wrist and hand condition or elbow
    contractures, or weak hand grip
  • Platform, velcro strap
  • Elbow flexed 90 degrees

47
Crutch Gaits
  • Point gait stability, slow
  • Swing gait more energy, fast

48
Four-point gait
  • Good stability - at least 3 point contact ground
  • Ataxia or incoordination
  • Slowest, difficulty

49
Three-point gait/alternating two-point gait
  • Non-weight-bearing gait for lower limb fracture
    or amputation
  • 3-point PWB gait -gt required 18-36 more energy
    per unit distance than normal
  • NWB required 41-61more energy per unit distance
    than normal

50
Two-point gait
  • Faster than 4-point gait but less stability
  • Decrease both lower limbs weight-bearing

51
Swing-through gait
  • Fastest gait, requires functional abdominal
    muscles
  • Required increase of 41-61 in net energy cost (
    3-point NWB)

52
Swing-to gait
  • Both crutches -gt both lower limbs almost to
    crutch level

53
Canes
  • Body weight transmission for unilateral cane
    opposite affected side is 20-25
  • Gluteus medius weakness, or pathological at knee
    or ankle

54
  • Cane eliminate necessary gluteus medius force and
    reduces compressional force on hip

55
Measure tip of cane to level of greater
trochanter, elbow flexed 20-30 degree
56
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57
Walker/Walkerette
  • Wider and more stable base of support, but slow
    gait (interfere smooth reciprocal gait)
  • For patients requiring maximum assistance with
    balance, uncoordinated

58
  • Add wheels to front legs for who lack
    coordination or power in upper limbs

59
  • Front of walker 12 inches in front of patient
  • Shoulder relaxed and elbow flexed 20 degree
  • Three-point gait
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