Transcript The Benefits of Accessible Gardening: The Healing Reward

Gaits Not Gates
Carla Wilhite, OTR/L
Sherril York. Ph.D.
Oklahoma AgrAbility
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Goals & Objectives
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Describe normal gait phases and
components
Practice observational analysis
Determine mechanical consequences of
abnormal gait
Suggest justification documentation
examples
Present recommendations for improving
work performance
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What is Normal Gait?
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A series of losing and regaining balance
resulting in forward motion
Normal pattern assumes variety of forms
Disruptions in sequence of actions result
in anatomical or mechanical deviations
Some differences due to body type,
gender, pathology, or galactic origin
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Click on link below to see Alien song movie
http://home.quicknet.nl/qn/prive/sc.deering/MoviePages/Alien.html
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Gait Cycle
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Cycle extends from time heel contacts
ground until same heel contacts ground
again
Consists of two phases
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Stance
Swing
Consists of periods of single limb support
and double limb support
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Phases of Gait Cycle
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Stance phase–60% of cycle
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Initial contact/loading
Midstance
Terminal stance
Preswing
Swing phase–40% of cycle
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Initial swing
Midswing
Terminal swing
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Phases of Walking
Taken from Soderberg, G. (1986).
Kinesiology:Application to Pathological Motion
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Phases of Gait Cycle
Taken from Pribut, S. (2004). Gait Biomechanics.
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Weight Shift
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Weight shifts from
slightly lateral in the
heel at heel strike
Moves forward
between 1st and 2nd
long bone of foot
Exits through the
great toe at toe off
Taken from Pribut, S. (2004). Gait Biomechanics.
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Anatomy of a Walk
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Walking is a cyclic
movement
Head position should
remain relatively level
Arms and legs move
in opposition
Pelvis, and shoulders,
rotate forward-back
and up-down around
spine
Taken from Classic Walk Tutorial
http://www.rubberbug.com/tutorials.htm
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Anatomy of a Walk
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Feet and Legs
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Heel strike as weight
shifts to forward foot
Double limb support
Arms
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Move in opposition to
legs
Taken from Anatomy of Walking Tutorial
http://www.rubberbug.com/walking.htm
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Anatomy of a Walk
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Feet and Legs
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Weight is transferred
to forward foot, knee
flexes to absorb shock
Toe-off of back foot
occurs
Single limb support
Arms
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Move in reciprocal
motion to legs
Taken from Anatomy of Walking Tutorial
http://www.rubberbug.com/walking.htm
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Anatomy of a Walk
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Feet and Legs
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Forward knee extends
and lifts body
Weight on foot rolls
from outside to inside
Back leg begins swing
forward
Arms
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Move in reciprocal
motion to legs
Taken from Anatomy of Walking Tutorial
http://www.rubberbug.com/walking.htm
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Anatomy of a Walk
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Feet and Legs
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Free leg has now
moved forward in
prep. for heel strike
Weighted leg is
beginning propulsion
to toe-off
Arms
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Arms move like
pendulums in
opposition to legs
Taken from Anatomy of Walking Tutorial
http://www.rubberbug.com/walking.htm
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Anatomy of a Walk
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Feet and Legs
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Free leg now is
weighted at heel strike
Double limb support
Arms
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Opposite to leg
movement
Taken from Anatomy of Walking Tutorial
http://www.rubberbug.com/walking.htm
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Anatomy of a Walk
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With legs apart, the pelvis
and shoulders rotate in
opposite directions
around the spine
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As one leg moves past
the other, the pelvis and
shoulders move vertically
in opposite directions
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As the legs part, the
pelvis and shoulders
again rotate in opposition
Taken from Anatomy of Walking Tutorial 16
http://www.rubberbug.com/walking.htm
“Normal” Gait Lab
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Gain familiarity with gait sequence
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Demonstration of typical gait patterns
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Normal Gait Sequence
Click on link below to view normal gait
Downloaded from McGill Medical Gait Disorders site
http://sprojects.mmi.mcgill.ca/gait/normal/movie2.asp
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Gait Deviations
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Common Causes of Gait Deviations:
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Pain or discomfort during weight-bearing or
movement
Muscle Weakness
Limitations of joint movement
In-coordination of Movement
Changes in bone or soft tissue (including
amputations)
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Gait Deviations
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Pain or Discomfort: Clues
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Report of pain and location
May spend less time in weight-bearing phase
Grimacing
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Gait Deviations
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Muscle Weakness: Clues
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Broadened base of support
Shorter steps
Diminished arm swing
Difficulty with balance
Extensive weakness: inability to ambulate
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Gait Deviations
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Limitation of joint movement: Clues
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Arthritis pathology
Surgical procedures (instrumentation)
Disuse of a body part
(Can confirm joint limitation through
measurement and gait analysis)
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Gait Deviations
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In-coordination: Clues
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Spasticity
Hemiparesis
Hypertonia: Cannot selectively activate
muscle: see total flexion or total extension
patterns when moving limbs
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Gait Deviations
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Changes in bone or soft tissue: Clues
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Bone shortening after fracture
Congenital malformations
Scar tissue
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Gait Deviations
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Bottom Line: Anything that is not “normal”
gait (i.e. forward progression) is a gait
deviation.
Vs. “Functional” gait
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Pathology at Specific Joints
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Toes
 Extended
 Clawed
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Pathology at specific joints
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Ankle and Foot
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Forefoot contact
Foot-flat contact
Foot slap
Inversion/eversion
Drag
No heel off
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Pathology at Specific Joints
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Knee
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Limited flexion
Hyper or hypo
extension
Varus/valgus
Wobbling
Extension thrust
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Pathology at Specific Joints
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Hip
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Circumduction (multiple components)
Limits in flexion or extension
Problems with rotation
Problems with adduction or abduction
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Pathology at Specific Joints
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Pelvis
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Hiking
Posterior or anterior tilt
Dropping
Rotation problems
Trunk
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Back or forward lean
Lateral lean
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Pathology at Specific Joints
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Arms
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Decreased or absent
arm swing
Head and neck
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Kyphosis
Head forward posture
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Lab: Walking Experiences
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Place one foot directly in front of the other
Walk with a wide base of support
Walk with toes pointed out
Walk with toes pointed in
Take a shorter than normal stride
Walk with both arms beside body
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Popcorn and Movies
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Hemiplegia
Click on link below to see Hemiplegic gait
Downloaded from McGill Medical Gait Disorders site
http://sprojects.mmi.mcgill.ca/gait/hemiplegic/hemimovie.asp
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Drop Foot
Click on link below to see Drop foot gait
Downloaded from McGill Medical Gait Disorders site
http://sprojects.mmi.mcgill.ca/gait/footdrop/footmove.asp
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Parkinson’s
Click on link below to see Parkinson’s gait
Downloaded from McGill Medical Gait Disorders site
http://sprojects.mmi.mcgill.ca/gait/parkinson/movie1.asp
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Limp
QuickTime™ and a
Y UV420 codec decompressor
are needed to see this picture.
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Writing your observations
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Describing what you see.
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Estimate the “costs”
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What’s the functional problem? (Not DX)
What’s the impact of the problem?
What’s the recommendation (s)?
Energy expenditure=fatigue
Orthopaedic costs= mechanical wear and tear
Functional costs= Walking safety/stability/mobility
Refer for professional analysis (PT)
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Describing what you see
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“ Mr. Jones was observed walking today across
a level dirt and gravel surface between his home
and workshop. I observed the following
difficulties as he was walking” :
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Mr. Jones was using a quad cane to ambulate.
He was walking with a wide base of support.
While advancing his right leg while, his right forefoot
was striking the ground and he was circumducting his
leg.
He has a decreased step length and he walks very
slowly.
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Estimating the Costs…
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“Because Mr. Jones has difficulty in
walking from his home to the workshop, he
becomes more fatigued (energy cost), he
appears to be placing more weight over
his left leg to compensate for right sided
weakness (wear and tear), and he has
problems maintaining his balance while
walking to reach his workplace (functional
cost).”
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Referral
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“ Mr. Jones should be referred to a
physical therapist for a professional
analysis of his gait to determine if…
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He is using the appropriate assistive device.
He needs further remediation/improvement in
his gait.
To improve his balance and mobility for
functional activities.
To determine the need for orthotic devices.
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Recommendations and
Justification
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“Mr. Jones may need a powered mobility
device to enable him to get to his farm
work spaces to:
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Prevent physical fatigue.
Enable him to have increased mobility in
getting to his work locations.
Prevent secondary injury from additional
biomechanical stress on his non-affected
limb.
Keep him safer when moving from his home
to the worksite.
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Farm gait contexts
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Gait is dynamic. How does it change if:
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On uneven terrain?
Carrying a bucket?
Walking with a feed sack on one shoulder?
Slippery surfaces?
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Adaptations
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Personal assistive
device
Farm mobility device
Community mobility
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