Gait Flashcards
Phases of a normal gait
Stance Phase-When the foot is ON the ground
- 60% of time spent here (Double Stance)
- Heal Strike/Initial Contact
- Foot Flat/loading- most of the weight shifted to that leg
- Midstance/midstance-weight shifts forward
- Push off or Toe off/terminal stance
Swing Phase-When the foot is moving forward
- 40% of time spent here
- Acceleration/initial swing
- Midswing/midswing
- Deceleration/terminal swing – right before heel goes down
Points to assess
The knee should be flexed during all aspects of the stance phase EXCEPT for heel strike
The Pelvis and trunk shift laterally toward the weight bearing side
The average length of a step (toe to heal) is 15 inches, decreases with age, pain , fear, fatigue
The average adult has a cadence of 90-120 steps per minute (100 calories a mile)
- Energy conservation or fatigue
During the swing phase, the pelvis rotates forward about 40%, the opposite pelvis acts as a fulcrum instead of using the muscles
Propulsive or festinating gait
A stooped, rigid posture—the patient’s head and neck are bent forward
His flexed, stiffened arms are held away from the body; his fingers are extended; and his knees and hips are stiffly bent
During ambulation, this posture results in a forward shifting of the body’s center of gravity and consequent impairment of balance, causing increasingly rapid, short, shuffling steps with involuntary acceleration (festination) and lack of control over forward motion (propulsion) or backward motion
Common in Parkinson’s (slowly develops) and poisoning or drugs
Fall risk
Don’t ask them to go backwards
What to do with Propulsive Gait
Assist with ambulation
Instruct family and pt on safety
Provide and train with ADL equipment as needed
Refer to PT as needed
Freezing episode is common, sometimes need a bell or flash of light to get them moving again
Breaks stabilize the walker in standing or sitting
If you need normal breaks on your walker, you shouldn’t use a walker
If you can’t stop yourself, you need a pickup and put down walker.
Scissoring Gait
Resulting from bilateral spastic paresis (diplegia), scissors gait affects both leg and has little or no effect on the arms.
The patient’s legs flex slightly at the hips and knees, so he looks as if he’s crouching. With each step, his thighs adduct, and his knees hit or cross in a scissors like movement.
steps are short, regular, and laborious, may walk on toes or on the balls of his feet and may scrape his toes on the ground.
Common in: Low-level spinal injury or tumors, CP, MS
What to do: Are we likely to change it?
- Safety with ambulation aides and ADLS
- Can’t change it, must work with it
Waddling Gait
Ducklike walk
It may be present when the child begins to walk or may appear later in life.
The gait results from deterioration of the pelvic girdle muscles—primarily the gluteus medius, hip flexors, and hip extensors. Weakness in these muscles hinders stabilization of the weight-bearing hip during walking, causing the opposite hip to drop and the trunk to lean toward that side in an attempt to maintain balance. (Trendelenburg Sign)
Typically, the legs assume a wide stance and the trunk is thrown back to further improve stability, exaggerating lordosis and abdominal protrusion. In severe cases, leg and foot muscle contractures may cause equinovarus deformity of the foot combined with circumduction or bowing of the legs
Typical in Muscular dystrophy and some other spinal atrophy disorders
Occasionally seen with hip dysplasia
What to do?
- MD-safety and devices
- Other-refer to PT
Foot Drop Gait
Weakness of the anterior compartment (dorsiflexors)
Spasticity of the plantar flexors or contracture
Increased energy expenditure from compensating with a hip hiking or excessive hip flexion to clear foot during the swing phase, Foot Slap often occurs after the swing
One of the most common things we see in stroke patients
Unstable and more likely to fall
Active and passive insufficiency
What to do?
- AFO-using it, donning and doffing, with or without ambulation device…ESTIM units
- Safety and functional ambulation
- Refer to PT
Toe Walking Gait
Short hamstrings or Achilles tendon, coordination disorders, habit (idiopathic), muscle weakness (MD-Duchenne’s)
Common in CP kids, autism, developmental disorders
Normal (if no other problems) until about 2
What to do
- If habit or coordination, incorporate into treatment
- With CP or shortening, you might be involved in serial casting or stretching
- With Duchenne’s - adaptions
Ataxic or Spastic Gaits
Seen with CP and CVA’s, others
- Muscle imbalance or weakness
- Paralysis on one side – hemiplegic
- Might have spasticity or flaccid : “knee won’t lock”
- Uncoordinated, high risk of falls
- Ankle rolls over due to lack of strength
What to do?
- Device-walkers, AFO’s
- Assure safety
- Work with PT
How do OTs work with gait?
Not in pure form, but gait is necessary to do many functional things
Work with PT, Co-treat
Team treat
Safety
Adaptive Equipment
