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GAIT

GAIT. Margo Prim Haynes, PT, DPT, MA, PCS Mary Rose Franjoine, PT, DPT, MS, PCS 2009. Overview. Definitions Video of typical gait Developmental changes Gait cycle Ground reaction force vectors Atypical gait Lab . Learning Objectives.

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GAIT

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  1. GAIT Margo Prim Haynes, PT, DPT, MA, PCSMary Rose Franjoine, PT, DPT, MS, PCS 2009

  2. Overview • Definitions • Video of typical gait • Developmental changes • Gait cycle • Ground reaction force vectors • Atypical gait • Lab Margo Prim Haynes & Mary Rose Franjoine

  3. Learning Objectives At the conclusion of this lecture the learner will: • Describe the characteristics of early gait. • Describe the key developmental factors that influence the development and refinement of gait. 3 . Identify and describe the characteristics of typical gait differentiating components of stance phase from swing phase. 4. Visually identify key components of typical gait. 5. Describe the impact of ground reaction forces on the stance limb. 6. Discriminate typical from atypical components of gait. 7. Design intervention strategies to address key impairments that contribute to an atypical gait pattern. Margo Prim Haynes & Mary Rose Franjoine

  4. An Early Walker Video Clip Margo Prim Haynes & Mary Rose Franjoine

  5. Characteristics of Early Gait • BOS wider than hips, therefore hindfoot pronation (eversion) results • Contact with floor occurs with foot flat • Heel to toe gait develops by 2 yrs/ process complete by 3.5 yrs • Uneven step length Margo Prim Haynes & Mary Rose Franjoine

  6. Characteristics of Early Gait • Hyperextension of knees throughout stance phase • Greater ant.-post. pelvic movement • Less lateral (pelvic tilting ) & rotational pelvic movement Margo Prim Haynes & Mary Rose Franjoine

  7. Characteristics of Early Gait • Greater hip & knee flexion with abduction & external rotation of hip and tibia during swing phase Margo Prim Haynes & Mary Rose Franjoine

  8. Characteristics of Early Gait • Upper Extremities (UE) in high, medium, then low guard with improved trunk balance • Reciprocal arm swing developing at 18 months Margo Prim Haynes & Mary Rose Franjoine

  9. Kinematic Changes between 1 - 7 Years of Age • ↑ duration of single limb stance (esp. to 2.5 yrs) • ↑ walking velocity (esp. to 3.5 yrs) • ↓ cadence and its variability • ↑ step length (esp. to 2.5 yrs) • Ratio of body width to stride width: ↑s rapidly until 2.5 yrs, more slowly to 3.5 yrs, then plateaus Margo Prim Haynes & Mary Rose Franjoine

  10. Indicators of Mature Gait • Greater % time in single limb stance with increased limb length and stability • Increased velocity • Decreased cadence • Greater step length • Decreased base of support Margo Prim Haynes & Mary Rose Franjoine

  11. Gait Video Margo Prim Haynes & Mary Rose Franjoine

  12. 40% of cycle 60% of cycle Margo Prim Haynes & Mary Rose Franjoine Perry 1992

  13. Gait Cycle • Typical walking has 50-60 steps taken per minute • Two phases • Stance phase • Swing phase Margo Prim Haynes & Mary Rose Franjoine

  14. Stance Phase • Heel contact (weight acceptance) to toe off • 60% of gait cycle Margo Prim Haynes & Mary Rose Franjoine

  15. Swing Phase • Toe off to before heel strike • 40% of gait cycle Margo Prim Haynes & Mary Rose Franjoine

  16. Quiet Standing • Slow shifting of body weight between limbs due to cardiac dynamics & lack of absolute proprioception • Feet generally parallel • COG slightly anterior to the ankle joint • Tendency for trunk to move forward & plantarflexors (pf) must hold to stand in place • To move, pf must “let go” (very difficult for children to do with CP as they rely on extension to stay up) Margo Prim Haynes & Mary Rose Franjoine

  17. Stance Phase (60%) Initial contact Loading response Single limb stance Midstance Terminal stance Pre-swing=toe off Swing Phase (40%) Pre-swing Initial swing Midswing Terminal swing Functional Phases of Gait Margo Prim Haynes & Mary Rose Franjoine

  18. Initial Contact • The instant at which foot touches floor • Ankle locked in supination • Adduction, inversion, and plantarflexion Margo Prim Haynes & Mary Rose Franjoine

  19. Loading Response • Begins immediately after heel contact (heel strike) & continues until other foot is lifted for swing (foot flat) • Ankle unlocked in pronation (abduction, eversion, and dorsiflexion • Double Stance • Deceleration Margo Prim Haynes & Mary Rose Franjoine

  20. Single Limb Stance • Period of time when opposite limb is going through swing phase • Foot/ankle moves to locked position of supination preparing the foot and ankle for push off. Margo Prim Haynes & Mary Rose Franjoine

  21. Weight bearing Surface of Foot • At heel contact, weight is lateral to the midline of the heel • Weight moves forward in a straight line towards head of third metatarsal • Then weight shifts medially to allow push off from first metatarsal head when initial swing begins Margo Prim Haynes & Mary Rose Franjoine

  22. Weight Bearing Surface of foot Margo Prim Haynes & Mary Rose Franjoine

  23. Pre-Swing • Begins with initial contact of opposite limb and ends with ipsilateral toe-off Margo Prim Haynes & Mary Rose Franjoine

  24. Initial Swing • Begins with lift of the foot from the floor and ends when swinging foot is opposite the stance foot Margo Prim Haynes & Mary Rose Franjoine

  25. Midswing • Begins when swing limb is opposite stance limb and ends when swinging limb is forward and tibia is vertical Margo Prim Haynes & Mary Rose Franjoine

  26. Terminal Swing • Begins with vertical tibia and ends when foot contacts (strikes) the floor Margo Prim Haynes & Mary Rose Franjoine

  27. Sinusoidal Pattern • Limb motion during walking is based on maintaining a symmetric and low amplitude displacement of the center of gravity (COG) in the lateral and vertical directions. • Initial Contact • Double limb support • Midstance Margo Prim Haynes & Mary Rose Franjoine

  28. Sinusoidal Pattern Perry, 1992 Margo Prim Haynes & Mary Rose Franjoine

  29. Sinusoidal Pattern • COG: • Lowest during initial contact • Central and low during double limb support • Highest and most lateral in midstance • Moves 4 cm medial-lateral shift, 2 cm vertical shift Margo Prim Haynes & Mary Rose Franjoine

  30. Ground Reaction Force Vectors(GRFV) • Determines the stability or instability by relating alignment of GRFV to the joint centers • Ankle gains stability with 5° dorsiflexion • Three forces (body vectors) • Falling body weight • Ligamentous tension • Body vector as passive stability when the joints are hyperextended Margo Prim Haynes & Mary Rose Franjoine

  31. Body vector as passive stability when the joints are hyperextended Joints are locked by body weight vector on one side and ligamentous tension on the other. This explains the posture of the child with hypotonicity ← iliofemoral ligament Posterior oblique ligament → Perry 1992 Margo Prim Haynes & Mary Rose Franjoine

  32. Ground Force Reaction Vector Initial contact to loading Margo Prim Haynes & Mary Rose Franjoine Perry 1992

  33. Muscle Activation Perry 1992 Margo Prim Haynes & Mary Rose Franjoine

  34. Critical Events for: • Initial contact is heel first contact Margo Prim Haynes & Mary Rose Franjoine

  35. Critical Events for: • Loading response is hip stability, controlled knee flexion, and plantarflexion Margo Prim Haynes & Mary Rose Franjoine

  36. Ground Force Reaction Vector Perry 1992 Margo Prim Haynes & Mary Rose Franjoine b

  37. Muscle Activation (muscles are more balanced, therefore less hard work) Perry 1992 Margo Prim Haynes & Mary Rose Franjoine b

  38. Critical Events is: • Controlled tibial advancement to create a forward fall position. Margo Prim Haynes & Mary Rose Franjoine

  39. Ground Force Reaction Vector Perry 1992 Margo Prim Haynes & Mary Rose Franjoine c

  40. Muscle Activation Margo Prim Haynes & Mary Rose Franjoine Perry 1992 c

  41. Critical Events is to have • Ankle locked in dorsiflexion with heel rise; trailing limb • Ankle mobility • (This is where the children with plantarflexion contractures have problems) Margo Prim Haynes & Mary Rose Franjoine

  42. Gait Analysis • Observation • Pedograph • Motion analysis • Dynamic electromyography • Force plate recordings • Energy cost measurement Margo Prim Haynes & Mary Rose Franjoine

  43. Five Determinants of Gait • Lateral pelvic movement (gluteus medius prevents positive Trendelenberg) • Rotational pelvic movement (one side moves forward of the other side to minimize vertical shift of the COG, allows for stride length) • Knee flexion(allow for limb length adjustment) • Knee/ankle/foot interactions (minimizes the vertical shift of the COG) • Physiologic valgus (narrows BOS) Margo Prim Haynes & Mary Rose Franjoine

  44. Five Determinants of Gait • Lateral pelvic movement (gluteus medius prevents positive Trendelenberg) • Rotational pelvic movement (one side moves forward of the other side to minimize vertical shift of the COG, allows for stride length) • Knee flexion(allow for limb length adjustment) • Knee/ankle/foot interactions (minimizes the vertical shift of the COG) • Physiologic valgus (narrows BOS) Margo Prim Haynes & Mary Rose Franjoine

  45. Five Determinants of Gait • Lateral pelvic movement (gluteus medius prevents positive Trendelenberg) • Rotational pelvic movement (one side moves forward of the other side to minimize vertical shift of the COG, allows for stride length) • Knee flexion(allow for limb length adjustment) • Knee/ankle/foot interactions (minimizes the vertical shift of the COG) • Physiologic valgus (narrows BOS) Margo Prim Haynes & Mary Rose Franjoine

  46. Five Determinants of Gait • Lateral pelvic movement (gluteus medius prevents positive Trendelenberg) • Rotational pelvic movement (one side moves forward of the other side to minimize vertical shift of the COG, allows for stride length) • Knee flexion(allow for limb length adjustment) • Knee/ankle/foot interactions (minimizes the vertical shift of the COG) • Physiologic valgus (narrows BOS) Margo Prim Haynes & Mary Rose Franjoine

  47. Five Determinants of Gait • Lateral pelvic movement (gluteus medius prevents positive Trendelenberg) • Rotational pelvic movement (one side moves forward of the other side to minimize vertical shift of the COG, allows for stride length) • Knee flexion(allow for limb length adjustment) • Knee/ankle/foot interactions (minimizes the vertical shift of the COG) • Physiologic valgus (narrows BOS) Margo Prim Haynes & Mary Rose Franjoine

  48. Five Determinants of Gait • Lateral pelvic movement (gluteus medius prevents positive Trendelenberg) • Rotational pelvic movement (one side moves forward of the other side to minimize vertical shift of the COG, allows for stride length) • Knee flexion(allow for limb length adjustment) • Knee/ankle/foot interactions (minimizes the vertical shift of the COG) • Physiologic valgus (narrows BOS) Margo Prim Haynes & Mary Rose Franjoine

  49. Bibliography • Perry J: Gait Analysis Normal and Pathological Function, NJ: SLACK Inc. 1992 • Shumway-Cook & Woollacott: Motor Control Theory and Practical Applications, Baltimore: Williams & Wilkins, 1995 • Sutherland D: Gait Disorders in Childhood and Adolescence, Baltimore: Williams & Wilkins, 1984 • Weber & Weber: Mechanics of the Human Walking Apparatus, Berlin: Springer-Verlag, 1992 Margo Prim Haynes & Mary Rose Franjoine

  50. Original Template designed by: • Margo Prim Haynes, PT, DPT, MA, PCS • Jane Styer Acevedo, PT Margo Prim Haynes & Mary Rose Franjoine

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