gait & gait aids associate professor shereen algergawy rheumatology and rehabilitation...
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Gait & Gait Aids
Associate professor shereen algergawy
Rheumatology and rehabilitation department
Normal Gait & Abnormal GaitNormal Gait & Abnormal Gait
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
60% 40%
60%40%
20-25%
Stride width 5-10cm
Cadence 70-130 step/min
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
Inadequate Dorsi-flexion control Insufficient Push-off Abnormal walking base Internal or external limb rotation Excessive medial or lateral foot contact Vaulting
Swing phase Circumduction Hip hiking Internal or external limb rotation Inadequate Dorsiflexion control Abnormal walking base
Antalgic gait
Pain in stance phase : knee, hip, foot pain
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
Trendelenberg gait
Gluteus Medius Gait
Anterior Trunk Bending
Quadriceps weakness combined with weakness of gluteus maximus, gastrocnemius, or both
Pushing backward with the hand / lateral rotation
Posterior Trunk Bending
Gluteus Maximus (Lurch) Gait Hip-extensor weakness Knee ankylosis, spasticity or
orthotic knee lock Hip-extensor spasticity
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)
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
Steppage gait
Ankle dorsiflexor weakness : compensate by exaggerated hip and knee flexion
Foot drop / dragging
Slap foot
Ankle dorsiflexor weakness : early stance phase
Insufficient Push-Off
Flat foot gait Plantar-flexor weakness Rupture of the Archilles tendon or
the triceps surae Metatarsal pain, hallux rigidus
Internal or External Limb Rotation
Internal rotation Biceps femoris weakness spasticity
External rotation Quadriceps weakness Inner hamstring weakness Spasticity
Abnormal walking base
Wide Base (> 4 inch) Hip-abduction contracture Instability due to fear, proprioceptive
deficit, cerebellar problem Perineal pain Genu valgum
Narrow base (< 2 inch) Spasticity Genu varum
Vaulting
Swing-phase limb is relatively longer
Hip hiking
Increased ipsilateral length: hip -flexor or dorsiflexor
weakness hip, knee, ankle ankylosis or
spasticity insufficient hip or knee flexion
Contralateral shortness
Circumduction
Spasticity Hip flexor weakness Hamstring paralysis Knee or ankle ankylosis /
orthotic knee lock Dorsiflexor weakness Plantar-flexion contracture
Scissoring gait
In spastic CP with spasticity of adductor m.
Crouched Gait
Excessive flexion of hip and knee due to spasticity, muscle tightness or contracture
Spastic CP
Parkinsonian gait
Trunk ,head ,neck forward
and knee flexed
wide base ,small shuffling s
tep
trend to fall forward and to i
ncrease speed (festination)
Hemiplegic gait
Abnormal arm swing : adduction wit
h flexion at shoulder ,elbow ,wrist an
d fingers
extensor synergy of lower limb: leg
extension ,adduction and hip IR ,kne
e extension ,ankle and foot plantarfl
exion and inversion.
Gait aids
Purpose of gait aids
Increase area of support, maintain center of gravity over support area
Redistribute weight-bearing area
Requirements
ROM, muscle strength and endurance, coordination, trunk balance, sensory perception, mental status
Amount of weight-bearing permitted on lower limb
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
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
Unilateral non/partial weight bearing eg fracture, amputee -> 3-point gait
Bilateral partial weight bearing or incoordination/ataxia -> 2 or 4-point gait
Bilateral weakness of lower extremities eg paraplegia -> swing-to or through gait
Non-axillary crutches Lofstrand/forearm crutches Platform crutch Wooden forearm orthosis (Kenny stick) Triceps weakness orthoses (arm
orthoses) eg Warm Spring, Everett, Canadian crutch
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
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
Platform crutch
Painful wrist and hand condition or elbow contractures, or weak hand grip
Platform, velcro strap Elbow flexed 90
degrees
Crutch Gaits
Point gait – stability, slow Swing gait – more energy, fast
Four-point gait
Good stability - at least 3 point contact ground
Ataxia or incoordination
Slowest, difficulty
Three-point gait/alternating two-point gait
Non-weight-bearing gait for lower limb fracture or amputation
3-point PWB gait -> required 18-36% more energy per unit distance than normal
NWB required 41-61%more energy per unit distance than normal
Two-point gait
Faster than 4-point gait but less stability
Decrease both lower limbs weight-bearing
Swing-through gait
Fastest gait, requires functional abdominal muscles
Required increase of 41-61% in net energy cost (= 3-point NWB)
Swing-to gait
Both crutches -> both lower limbs almost to crutch level
Canes
Body weight transmission for unilateral cane opposite affected side is 20-25%
Gluteus medius weakness, or pathological at knee or ankle
Cane eliminate necessary gluteus medius force and reduces compressional force on hip
Measure tip of cane to level of greater trochanter, elbow flexed 20-30 degree
Walker/Walkerette
Wider and more stable base of support, but slow gait (interfere smooth reciprocal gait)
For patients requiring maximum assistance with balance, uncoordinated
Add wheels to front legs for who lack coordination or power in upper limbs
Front of walker 12 inches in front of patient
Shoulder relaxed and elbow flexed 20 degree
Three-point gait