1. Gait & Gait Aids • Associate professor shereen algergawy • Rheumatology and rehabilitation department

2. Normal Gait & Abnormal Gait

3. 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. 60% 40%

6. 60% 40% 20-25%

7. Stride width 5-10cm Cadence 70-130 step/min

12. 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

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

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

15. Antalgic gait • Pain in stance phase : knee, hip, foot pain

16. 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

17. Trendelenberg gait • Gluteus Medius Gait

18. Anterior Trunk Bending • Quadriceps weakness combined with weakness of gluteus maximus, gastrocnemius, or both Pushing backward with the hand/ lateral rotation

19. Posterior Trunk Bending • Gluteus Maximus (Lurch) Gait • Hip-extensor weakness • Knee ankylosis, spasticity or orthotic knee lock • Hip-extensor spasticity

20. 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)

21. 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

22. Steppage gait • Ankle dorsiflexor weakness : compensate by exaggerated hip and knee flexion Foot drop / dragging

23. Slap foot • Ankle dorsiflexor weakness : early stance phase

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

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

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

27. Narrow base (< 2 inch) • Spasticity • Genu varum

28. Vaulting • Swing-phase limb is relatively longer

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

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

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

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

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

34. 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.

35. Gait aids

36. Purpose of gait aids • Increase area of support, maintain center of gravity over support area • Redistribute weight-bearing area

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

38. 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

39. 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

40. 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

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

42. 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

43. 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

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

45. Crutch Gaits • Point gait – stability, slow • Swing gait – more energy, fast

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

47. 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

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

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

50. Swing-to gait • Both crutches -> both lower limbs almost to crutch level