Transcript Chapter 7 - Evaluation of Gaitx

Chapter 7
Evaluation of Gait
Copyright © 2015. F.A. Davis Company
Introduction
 “Walking has been described as a series of
narrowly averted catastrophes where the body
falls forward, then the legs move under the body to
establish a new base of support.”
 Gait analysis
 Functional evaluation of walking or running style
 Classic LE functional test
 Gait evaluation identifies
 Functional limitations
 Chronic pain related to physical activity
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Gait Terminology
 Step—sequence of events from a specific
point in the gait on one extremity to the
same point in the opposite extremity
 Step length—distance traveled between
the initial contacts of the right and left foot
 Step width—distance between the points
of contact of both feet
 Stride—two sequential steps
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Gait Terminology
 Cadence—number of steps taken per unit
time (i.e., steps per minute)
 Adults average = 107 +/– 2.7 steps per
minute
 Velocity—distance covered per unit time
(i.e., m/sec)
 Gait velocity—meters per second
 Gait cadence—steps per minute
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Gait Terminology
 Stride time—time required to complete a single
stride
 Stride length—linear distance covered in one
stride
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Gait Terminology
 Ground reaction force (GRF)
 Contact of the foot with the ground creates force yielding
vertical, anteroposterior (A/P), and mediolateral (M/L)
components
 Center of pressure (CoP)
 Shows the path of the pressure point under the foot during gait
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Phases of the Gait Cycle

With the right (facing) limb as an example,
two distinct phases occur

Weight-bearing (WB) stance phase
 Non–weight-bearing (NWB) swing phase


Legs alternate between supportive
(stance) and nonsupportive (swing)
Two points the body is supported by a
single leg

Midstance
 Terminal stance
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Phases of Gait
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Walking Gait Phases
 Efficient gait
 Minimal side-to-side
motion
 Maximal forward
motion
 Body rises and falls
approx. 5 cm
 Center of gravity
 Path is a sinusoidal
curve.
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More Terminology…
 Kinematic—the characteristics of
movement related to time and space (e.g.,
range of motion, velocity, and
acceleration); the effects of joint action
 Kinetic—the forces being analyzed; the
causes of joint action
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Stance Phase
 The weight-bearing
phase of gait; begins
on initial contact with
the surface and ends
when contact is
broken.
 High-energy phase
 Kinetic energy is
absorbed from the
ground and transferred
up the kinetic chain.
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 Five periods





Initial contact
Loading response
Midstance
Terminal stance
Preswing
Swing Phase
 The non–weightbearing phase of gait;
begins at the instant
the foot leaves the
surface and ends just
before initial contact.
 38% of gait cycle
 Low-energy phase
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 Three periods
 Initial swing
 Midswing
 Terminal swing
Muscle Activity During Gait
 Understanding muscle activity and ROM
aids in identifying impairments and
compensations associated with pathology.
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Running Gait Cycle
 Differences from
walking gait
 Flight phase—neither
foot is in contact with a
supportive surface
 No period of double
limb support

Vertical GRF
 2.0–6.0 x the body
weight

Stance phase time
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 As speed increases
there are changes in







Arm swing
Stride length
Cadence
Knee flexion ROM
Muscular force
Speed of contraction
Less up and down
motion
Ground Reaction Forces
(A) During walking; (B) during running.
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Stance Phase of Running Gait
 Stance phase
 Hip: Flexed to 50° and moves to extension
 Knee: Flexed to 30°, moves to 50° of flexion,
and then moves into extension
 Ankle: DF to 25° then moves to PF
 Subtalar: Supinates, pronates, then supinates
again
 Loading response and midstance period
occur more rapidly.
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Swing Phase of Running Gait
 Clears the NWB limb over the ground and
positions the foot to accept WB.
 Probability of injury is < stance phase
 Hamstrings eccentrically contract to slow knee
extension.
 Swing phase
 Hip: 10° of extension to 50° to 55° of flexion
 Knee: Full extension to 125° of flexion (sprinters) and
to 40° of flexion (preparing for contact)
 Ankle: 25° of PF to 20° of DF
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Gait Evaluation
 Two basic methods
 Qualitative assessment
 Observational gait analysis (OGA)
 Quantitative assessment
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Quantitative Gait Analysis
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Observational Gait Analysis
 Poor to moderate reliability
 Improves with experience, video equipment,
and use of OGA tools




Good observation
Auditory clues
Observe left and right sides separately
Self-selected pace
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Observational Gait Analysis
Guidelines
 Prepare the area and materials ahead of
time.
 Avoid clutter in the viewing background.
 Have the patient wear clothing that does
not restrict viewing of joints.
 Ensure that the patient is at a self-selected
walking pace; otherwise, gait will be
altered.
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Observational Gait Analysis
Guidelines
 Position yourself so you can view the
individual segments.
 Observe the subject from multiple views
but not from an oblique angle.
 Look at the individual body parts first, then
the whole body, then the individual parts
again.
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Observational Gait Analysis
Guidelines
 Conduct multiple observations or trials.
 Conduct the analysis with the patient
barefoot and wearing shoes.
 Label all video files.
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Observational Gait Analysis Findings
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Interventions
 Cue words or phrases during gait or exercise to
improve gait
 Footprints on the floor for visual feedback on
technique
 Hand on a body segment for kinesthetic feedback
 Orthotics
 Different shoes
 Strength training exercises
 Flexibility or ROM exercises
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Excessive Pronation
 Pronation is necessary for shock absorption.
 Pronation through a range > 15.5° has been linked with LE injury.
 Related to
 Genu valgum
 Leg-length discrepancy
 Pes planus
 Hip musculature imbalance
 Soft midsoles in shoes
 Exhibits
 Calcaneal eversion
 Lowering and elongation of medial longitudinal arch
 Increased pressure on the first MTP
 Wear pattern on shoe
 Medial knee pain
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Toe In or Toe Out

Found in midstance
or just after push-off
 Causes

Tibial rotation
 Hip rotation
 Excessive pronation
during stance (places
limb medial, lower leg
compensates = toe
out)
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 Toe in
 Stress on lateral soft
tissues (peroneus
longus)
 Toe out
 Stress on medial and
plantar structures
Shortened Step Length
 Causes
 Pain (hip, knee, or ankle)
 Shorten stride so as to not make symptoms worse
with larger impacts on contact
 Inadequate push-off (triceps surae)
 Inadequate pull-off (hip flexors)
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Shortened Stance Time
 Antalgic gait pattern (i.e., “limp“)
 Causes
 Pain
 Acute or chronic
 Avoid load absorption
 Recommendations
 Crutches
 Protective brace
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Unequal Hip Height
 Causes
 Leg-length discrepancy
 Weak gluteus medius
 Trendelenburg gait
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Asymmetrical Arm Swing
 Arm swing counterbalances hips and
pelvis
 Larger arm swing in running
 Causes
 Upper extremity injury
 Leg-length discrepancies
 Spine dysfunction
 Scoliosis
 Limited or exaggerated motion on one side of
hip or pelvis
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Plantarflexed Ankle at Initial Contact

Causes

Gastrocnemius spasticity
 Can

only keep ankle in PF
Drop foot
 Nerve

pathology that prevents DF
Hamstring pathology
 Keeping

muscle short eases pain
Knee joint pathology
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Flat Foot Stance
 Exhibits
 Absence of initial heel contact
 PF at the ankle is avoided in terminal stance
and preswing
 Causes
 Ankle sprain
 Gastocnemius sprain
 Soleus sprain
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Inadequate Ankle Plantarflexion Angle at
Push-Off
 Insufficient ankle PF at push-off
 Causes
 Inadequate strength (triceps surae)
 Acute ankle sprain (pain and swelling)
 Forefoot pathology
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Excessive Knee Flexion Ankle at
Contact
 Normally knee is near full extension at
contact during walking (running 21° to 30°)
 Causes

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


Pain
Hamstring strain
Hip adductor strain
Tight hamstring or spasm
Sciatic nerve pathology
 Herniated disk
 Piriformis syndrome
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Inadequate Knee Flexion Angle
During Stance
 Knee normally flexes to 20° during stance.
 Controlled by eccentric contraction of
quadriceps muscle
 Causes
 Quadriceps pathology
 Knee joint pain
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Inadequate Knee Flexion During
Swing
 During the swing phase, knee normally is
flexed to 30° to 60° during walking and
over 90° during running
 Causes




Hamstring pathology
Strains
Spasms
Sciatica
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Inadequate Hip Extension at
Terminal Stance
 Normally, hip extends as the body is
propelled forward.
 Causes
 Contracture of the hip flexors
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Forward Trunk Angle
 Indicates
 Low back pathology
 For example, herniated disk
 Weak and painful hip flexors
 Weak ankle plantarflexors
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