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Normal and Pathological Gait in the Elderly

Normal and Pathological Gait in the Elderly. Peggy R. Trueblood, PhD, PT California State University, Fresno. Part I EFFECTS OF NORMAL AGING ON THE GAIT PATTERN. Gait Cycle. Largest unit used to describe gait Defined as foot contact to foot contact of same limb. Stride.

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Normal and Pathological Gait in the Elderly

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  1. Normal and Pathological Gait in the Elderly Peggy R. Trueblood, PhD, PTCalifornia State University, Fresno

  2. Part IEFFECTS OF NORMAL AGING ON THE GAIT PATTERN

  3. Gait Cycle • Largest unit used to describe gait • Defined as foot contact to foot contact of same limb

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

  5. FLOOR CONTACT PATTERNS • SWING PHASE (40%) • STANCE PHASE (60%) - Initial Double Stance (10%) - Single Limb Support (40%) - Terminal Double Stance (10%)

  6. Normal Gait is Dependent on: • Free passive joint mobility • Appropriate timing of muscles • Appropriate intensity of muscle action • Normal sensory input (proprioceptive, vestibular, visual)

  7. Can produce muscle weakness Can affect visual, proprioceptive, and vestibular systems Should not affect range of motion Should not affect timing of muscle activity Normal Aging

  8. Muscle Weakness • Hip extensors • Knee extensors • Plantarflexors • Dorsiflexors

  9. Changes in Visual System • Decrease in visual acuity • Poorer depth perception • Restriction of the visual field • Increased susceptibility to glare

  10. 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

  11. Changes in Vestibular System • Slower postural support responses • Sway during standing increases with advancing age

  12. What are the consequences?

  13. COMMON GAIT ADAPTATIONS IN OLDER ADULTS

  14. SENSORY/BALANCE DYSFUNCTION • Increase in double limb support • Decrease in gait velocity • Decrease in stride length • Increase in step width

  15. MUSCLE WEAKNESS • Subtle changes in gait cycle due to muscle weakness

  16. REVIEW PHASES OF GAIT CYCLE • Comparing Young and Old

  17. WEIGHT ACCEPTANCE(Initial Contact & Loading) • Most demanding task in the gait cycle • Three functional patterns needed - Shock absorption - Initial limb stability - Preservation of progression

  18. Key Muscle Groups • Hip extensors • Quadriceps • Dorsiflexors

  19. SINGLE LIMB SUPPORTMidstance & Terminal Stance • One limb has the total responsibility for supporting body weight • Progression of body weight must be continued

  20. Key Muscle Groups • Lateral hip stabilizers (abductors) • Trunk • Quadriceps • Plantarflexors

  21. LIMB ADVANCEMENT(Pre-Swing & Swing) • Preparatory posturing begins in stance • Swing phase accomplishes: - limb advancement - toe clearance - forward reach

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

  23. Toe clears floor by 1 cm

  24. Key Muscle Groups • Hip flexors • Knee flexors • Dorsiflexors • Quadriceps and Hamstrings at Terminal Swing

  25. Normal Gait

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

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