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

Margo Prim Haynes, PT, DPT, MA, PCSMary Rose Franjoine, PT, DPT, MS, PCS

2009 Margo Prim Haynes & Mary Rose Franjoine

Overview

Definitions Video of typical gait Developmental changes Gait cycle Ground reaction force vectors Atypical gait Lab

Learning Objectives

At the conclusion of this lecture the learner will:1. Describe the characteristics of early gait.2. 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

An Early Walker

Video Clip

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

Characteristics of Early Gait

Hyperextension of knees throughout stance phase

Greater ant.-post. pelvic movement

Less lateral (pelvic tilting ) & rotational pelvic movement

Characteristics of Early Gait Greater hip & knee flexion

with abduction & external rotation of hip and tibia during swing phase

Characteristics of Early Gait

Upper Extremities (UE) in high, medium, then low guard with improved trunk balance

Reciprocal arm swing developing at 18 months

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

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

60% of cycle 40% of cycle

Perry 1992

Gait Cycle

Typical walking has 50-60 steps taken per minute

Two phases Stance phase Swing phase

Stance Phase

Heel contact (weight acceptance) to toe off 60% of gait cycle

Swing Phase

Toe off to before heel strike 40% of gait cycle

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)

Functional Phases of Gait

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

Initial Contact

The instant at which foot touches floor Ankle locked in supination

Adduction, inversion, and plantarflexion

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

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.

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

Weight Bearing Surface of foot

Pre-Swing

Begins with initial contact of opposite limb and ends with ipsilateral toe-off

Initial Swing

Begins with lift of the foot from the floor and ends when swinging foot is opposite the stance foot

Midswing

Begins when swing limb is opposite stance limb and ends when swinging limb is forward and tibia is vertical

Terminal Swing

Begins with vertical tibia and ends when foot contacts (strikes) the floor

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

2009 Margo Prim Haynes & Mary Rose Franjoine Perry, 1992

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

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

Body vector as passive stability when the joints are hyperextended

Joints are locked by bodyweight vector on one sideand ligamentous tensionon the other.

← iliofemoral ligament

Posterior oblique ligament →

Perry 1992

This explains the posture of the child with hypotonicity

Perry 1992

Ground Force Reaction Vector

Initial contact to loading

Muscle Activation

Perry 1992

Critical Events for:

Initial contact is heel first contact

Critical Events for:

Loading response is hip stability, controlled knee flexion, and plantarflexion

Perry 1992

Muscle Activation

(muscles are more balanced, therefore less hard work)

Perry 1992

Critical Events is:

Controlled tibial advancement to create a forward fall position.

Perry 1992

Muscle Activation

Perry 1992

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)

Gait Analysis

Observation Pedograph Motion analysis Dynamic electromyography Force plate recordings Energy cost measurement

Five Determinants of Gait1. Lateral pelvic movement (gluteus medius

prevents positive Trendelenberg)2. Rotational pelvic movement (one side moves

forward of the other side to minimize vertical shift of the COG, allows for stride length)

3. Knee flexion(allow for limb length adjustment)4. Knee/ankle/foot interactions (minimizes the

vertical shift of the COG) 5. Physiologic valgus (narrows BOS)

Five Determinants of Gait

1. Lateral pelvic movement (gluteus medius prevents positive Trendelenberg)

2. Rotational pelvic movement (one side moves forward of the other side to minimize vertical shift of the COG, allows for stride length)

3. Knee flexion(allow for limb length adjustment)

4. Knee/ankle/foot interactions (minimizes the vertical shift of the COG)

5. Physiologic valgus (narrows BOS)

Five Determinants of Gait1. Lateral pelvic movement (gluteus medius prevents positive

Trendelenberg)

3. Knee flexion(allow for limb length adjustment)4. Knee/ankle/foot interactions (minimizes the vertical shift of the COG) 5. Physiologic valgus (narrows BOS)

Five Determinants of Gait

1. Lateral pelvic movement (gluteus medius prevents positive Trendelenberg)

3. Knee flexion(allow for limb length adjustment)

4. Knee/ankle/foot interactions (minimizes the vertical shift of the COG)5. Physiologic valgus (narrows BOS)

Trendelenberg)2. Rotational pelvic movement (one side moves forward of the other side

to minimize vertical shift of the COG, allows for stride length)3. Knee flexion(allow for limb length adjustment)

4. Knee/ankle/foot interactions (minimizes the vertical shift of the COG)

Trendelenberg)2. Rotational pelvic movement (one side moves forward of the other side

to minimize vertical shift of the COG, allows for stride length)3. Knee flexion(allow for limb length adjustment)4. Knee/ankle/foot interactions (minimizes the vertical shift of the COG)

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

Original Template designed by: Margo Prim Haynes, PT, DPT, MA, PCS Jane Styer Acevedo, PT

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

gait margo prim haynes

gait cycle slide

pcs mary rose franjoine

refinement of gait

atypical components

atypical gait pattern

key components of typical

yrs uneven step length

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