Gaits Not Gates Carla Wilhite, OTR/L Sherril York. Ph.D. Oklahoma AgrAbility 1 Goals & Objectives 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 2 What is Normal Gait? 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 3 Click on link below to see Alien song movie http://home.quicknet.nl/qn/prive/sc.deering/MoviePages/Alien.html 4 Gait Cycle Cycle extends from time heel contacts ground until same heel contacts ground again Consists of two phases Stance Swing Consists of periods of single limb support and double limb support 5 Phases of Gait Cycle Stance phase–60% of cycle Initial contact/loading Midstance Terminal stance Preswing Swing phase–40% of cycle Initial swing Midswing Terminal swing 6 Phases of Walking Taken from Soderberg, G. (1986). Kinesiology:Application to Pathological Motion 7 Phases of Gait Cycle Taken from Pribut, S. (2004). Gait Biomechanics. 8 Weight Shift 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. 9 Anatomy of a Walk 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 10 Anatomy of a Walk Feet and Legs Heel strike as weight shifts to forward foot Double limb support Arms Move in opposition to legs Taken from Anatomy of Walking Tutorial http://www.rubberbug.com/walking.htm 11 Anatomy of a Walk Feet and Legs Weight is transferred to forward foot, knee flexes to absorb shock Toe-off of back foot occurs Single limb support Arms Move in reciprocal motion to legs Taken from Anatomy of Walking Tutorial http://www.rubberbug.com/walking.htm 12 Anatomy of a Walk Feet and Legs Forward knee extends and lifts body Weight on foot rolls from outside to inside Back leg begins swing forward Arms Move in reciprocal motion to legs Taken from Anatomy of Walking Tutorial http://www.rubberbug.com/walking.htm 13 Anatomy of a Walk Feet and Legs Free leg has now moved forward in prep. for heel strike Weighted leg is beginning propulsion to toe-off Arms Arms move like pendulums in opposition to legs Taken from Anatomy of Walking Tutorial http://www.rubberbug.com/walking.htm 14 Anatomy of a Walk Feet and Legs Free leg now is weighted at heel strike Double limb support Arms Opposite to leg movement Taken from Anatomy of Walking Tutorial http://www.rubberbug.com/walking.htm 15 Anatomy of a Walk With legs apart, the pelvis and shoulders rotate in opposite directions around the spine As one leg moves past the other, the pelvis and shoulders move vertically in opposite directions 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 Gain familiarity with gait sequence Demonstration of typical gait patterns 17 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 18 Gait Deviations Common Causes of Gait Deviations: 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) 19 Gait Deviations Pain or Discomfort: Clues Report of pain and location May spend less time in weight-bearing phase Grimacing 20 Gait Deviations Muscle Weakness: Clues Broadened base of support Shorter steps Diminished arm swing Difficulty with balance Extensive weakness: inability to ambulate 21 Gait Deviations Limitation of joint movement: Clues Arthritis pathology Surgical procedures (instrumentation) Disuse of a body part (Can confirm joint limitation through measurement and gait analysis) 22 Gait Deviations In-coordination: Clues Spasticity Hemiparesis Hypertonia: Cannot selectively activate muscle: see total flexion or total extension patterns when moving limbs 23 Gait Deviations Changes in bone or soft tissue: Clues Bone shortening after fracture Congenital malformations Scar tissue 24 Gait Deviations Bottom Line: Anything that is not “normal” gait (i.e. forward progression) is a gait deviation. Vs. “Functional” gait 25 Pathology at Specific Joints Toes Extended Clawed 26 Pathology at specific joints Ankle and Foot Forefoot contact Foot-flat contact Foot slap Inversion/eversion Drag No heel off 27 Pathology at Specific Joints Knee Limited flexion Hyper or hypo extension Varus/valgus Wobbling Extension thrust 28 Pathology at Specific Joints Hip Circumduction (multiple components) Limits in flexion or extension Problems with rotation Problems with adduction or abduction 29 Pathology at Specific Joints Pelvis Hiking Posterior or anterior tilt Dropping Rotation problems Trunk Back or forward lean Lateral lean 30 Pathology at Specific Joints Arms Decreased or absent arm swing Head and neck Kyphosis Head forward posture 31 Lab: Walking Experiences 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 32 Popcorn and Movies 33 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 34 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 35 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 36 Limp QuickTime™ and a YUV420 codec decompressor are needed to see this picture. 37 Writing your observations Describing what you see. Estimate the “costs” 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) 38 Describing what you see “ 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” : 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. 39 Estimating the Costs… “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).” 40 Referral “ Mr. Jones should be referred to a physical therapist for a professional analysis of his gait to determine if… 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. 41 Recommendations and Justification “Mr. Jones may need a powered mobility device to enable him to get to his farm work spaces to: 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. 42 Farm gait contexts Gait is dynamic. How does it change if: On uneven terrain? Carrying a bucket? Walking with a feed sack on one shoulder? Slippery surfaces? 43 Adaptations Personal assistive device Farm mobility device Community mobility 44