The Gait Cycle

Patient Centred Practice 1 2010

Objectives

Develop an understanding of the components of normal gait

Discuss the measurement of gait and its application in practice

Activity – thinking about the differences in gait in different people

Walking

Walking or ambulation is the moving from one place to another

Gait is the manner or style of walking

a method of locomotion involving 2 legs,alternately, to provide both supportand propulsion, at least one foot being in contact with the ground at all times.

(Whittle 1991)

Gait

Human locomotion involves smooth advancement of the body through space with the least mechanical and physiological energy expenditure

Gait Cycle:

the time interval between 2 successive occurrencesof one of the repetitive events of walking.

The cycle comprises of:

2 components, stance and swing phases60% stance and 40% swing

Initial contact to terminal swing

Components of successful gait

Production of a basic locomotor rhythm. Support and propulsion of the body in the

intended direction. Dynamic balance control of the moving body. Ability to adapt the movement to changing

environmental goals and demands.

Common Characteristics of Gait

Step and stride length – dependent on age, size, build, usually symmetrical

Stride width or walking base – within pelvic circumference

Cadence and velocity – dependent upon age, size, body build

Rotation – occurs at approx T8 level, passive arm swing greater with speed

Vertical displacement – in time with steps, symmetrical

Gait Cycle

From: Whittle M W, 1991, Gait analysis, an introduction.

Initial contact

Also known as heel strike Onset of stance phase in gait Ankle in some dorsiflexion Knee in slight flexion (7 degrees) Knee medially rotates slightly Hip in 30 degrees flexion

Loading response

Ankle becomes less dorsiflexed Knee flexes slightly further to 20 degrees Abductor muscles of the hip are active to

stabilise pelvis and trunk Weight is transferred onto single limb

Mid stance

Begins as the opposite foot is lifted Ankle dorsiflexes to advance body over the

stationary foot Knee extends almost fully Hip extends

Terminal stance Begins as heel starts to rise Continues until the opposite limb makes

ground contact The body’s centre of mass advances forward Point of maximum hip extension Knee joint begins to flex

Pre swing

Final part of the stance phase Second period of double support Begins with ground contact by the opposite

limb Ankle plantarflexes to 20 degrees Knee flexes rapidly to 40 degrees Hip flexion increases

Initial swing

Commences at toe off Finishes as the advancing limb is level with

the stance limb Ankle dorsiflexes to allow foot clearance Knee flexes rapidly reaching a maximum of

60 degrees Hip flexion allows the limb to progress

forwards

Mid swing

Begins when the swing limb is opposite the stance limb

Finishes when swing limb is forward of stance limb

Ankle stays dorsiflexed Hip stays in flexion to ensure foot clearance Knee flexion reduces to 30 degrees

Terminal swing

Advancement of the thigh is stopped Knee continues to extend reaching maximal

extension of 0-5 degrees Ankle reduces the amount of dorsiflexion Prepares the limb for initial ground contact The gait cycle is completed

Ranges of Movement needed for Normal Gait

Hip Flexion Hip Extension Knee Flexion Knee Extension Ankle Plantarflexion Ankle Dorsiflexion

Line of walking or progression – path followed when walking, usually a straight line.

Step length - distances between successive points of alternate feet, e.g. Right heel to left heel. Mean step length in young adults 76.3cm.

Stride length - linear distances between successive points of the same foot e.g. Right heel to next placing of right heel.

Stride or step width - lateral distance between each foot (usually from midpoint of each heel)

Cadence number of steps/given time. Innormal young adults this is 112.5 steps/per minute.Arm swing occurs at 70 steps/min

Velocity distance covered over a given time.changes in velocity result fromalterations in stride length notcadence. Normal young adults 1.46m/second or 5.26 km/h

Step length x Cadence = Velocity

Foot angle angle of deviation of foot measured from a

straight line level with the centre of the heel, usually 7 - 15º. Can be called angle of toe out.

Measuring Gait

Gait is often measured in terms of the following parameters:

Speed over given distance e.g. 6m walk test Cadence – steps per minute Stride or step width Step length and equality between left and

right

Activity

Think about the gait of An elderly person A toddler

How will they differ? Base of support/step width Stride length Cadence Velocity

Elderly person’s gait

Toddler’s gait

ReferencesBronstein A M, Brandt T, Wollacott M, 1996, Clinical disorders of posture, balance

and gait, Arnold, London.

Carr J H, Shepherd R B, 2003, Stroke Rehabilitation – guidelines for exercise training to optimise motor skill, Butterworth Heinemann, London.

Edwards S, 2003, Treatment of Gait in Neurology, Nottingham, lecture notes.

Polak F, 2002, Gait Analysis, in Pitt-Brooke et al (Eds), (2002), Rehabilitation of Movement, chapter 8, p285 – 318, London, WB Saunders.

Shumway-Cook A, Woollacott M, (2007), Motor control: Translating research into clinical practice, Third edition, Lippincott Williams and Wilkins, Philadelphia, chapter 12 ‘Control of normal mobility’ p299 – 329.

Whittle M W, 1991, Gait analysis : An introduction, Butterworth Heinemann, London.