3. Diagnosis of gait DeviationsDiagnosis of gait Deviations
Awareness of the functionalAwareness of the functional
limitationslimitations
Familiarity with normal functionFamiliarity with normal function
Trained eye or gait analysisTrained eye or gait analysis
systemsystem
Use the information forUse the information for
appropriate treatment regimenappropriate treatment regimen
4. GAIT-DEFINITIONGAIT-DEFINITION
Word meaning is manner ofWord meaning is manner of
walkingwalking
Highly controlled,coordinatedHighly controlled,coordinated
and repetitive series of limband repetitive series of limb
movements whose function ismovements whose function is
to advance the body fromto advance the body from
place to place with minimumplace to place with minimum
expenditure of energyexpenditure of energy
5. GAIT CYCLEGAIT CYCLE
One gait cycle is the movementOne gait cycle is the movement
of a single limb from heel strikeof a single limb from heel strike
(initial contact ) to next heel(initial contact ) to next heel
strikestrike
6. SUBDIVISIONS OF GAIT CYCLESUBDIVISIONS OF GAIT CYCLE
Stance phase and swing phaseStance phase and swing phase
Stance phase begins with initialStance phase begins with initial
contact of heel and ends with toecontact of heel and ends with toe
offoff
7. SUBDIVISIONS OF GAIT CYCLESUBDIVISIONS OF GAIT CYCLE
Initial contact occurs atInitial contact occurs at 0%0% andand 100%100% of gaitof gait
cycle and toe off occurs atcycle and toe off occurs at 60%60%
So stance phase is aboutSo stance phase is about 60%60% and swing phaseand swing phase
40%40% of gait cycleof gait cycle
8. STANCE PHASESTANCE PHASE
Period when foot is on the groundPeriod when foot is on the ground
Sub divisionsSub divisions
1) initial contact1) initial contact
2) loading response2) loading response
3) mid stance3) mid stance
4) terminal stance and4) terminal stance and
5) pre swing5) pre swing
9. INITIAL CONTACTINITIAL CONTACT
Occur atOccur at 0%0% of gait cycleof gait cycle
Principal objective of bodyPrincipal objective of body
is to position the footis to position the foot
correctly as it comes incorrectly as it comes in
contact with the floorcontact with the floor
Body is about to beginBody is about to begin
decelerationdeceleration
10. LOADING RESPONSELOADING RESPONSE
OccupiesOccupies 0 to 10%0 to 10% of gait cycleof gait cycle
Maintain smooth progressionMaintain smooth progression
while decelerating the body masswhile decelerating the body mass
as it travels from its zenith atas it travels from its zenith at
mid stance of opposite limbmid stance of opposite limb
Opposite limb toe off occurs atOpposite limb toe off occurs at
end of loading response . So thisend of loading response . So this
is a period of double limb supportis a period of double limb support
11. MID STANCEMID STANCE
Utilize momentum to maintainUtilize momentum to maintain
stability of the hip and kneestability of the hip and knee
while advancing the body overwhile advancing the body over
a stationary foota stationary foot
The centre of gravity hasThe centre of gravity has
reached its zenith and forwardreached its zenith and forward
velocity is minimumvelocity is minimum
Initial swing has begun onInitial swing has begun on
opposite sideopposite side
12. TERMINAL STANCETERMINAL STANCE
OccupiesOccupies 30 to 50% range30 to 50% range ofof
gait cyclegait cycle
Provide acceleration & toProvide acceleration & to
ensure an adequate stepensure an adequate step
lengthlength
Acceleration is provided byAcceleration is provided by
1)forward fall of centre of1)forward fall of centre of
mass of bodymass of body
2) concentric contraction of2) concentric contraction of
triceps suraetriceps surae
ConstitutesConstitutes 80 -85%80 -85% of totalof total
energy generatedenergy generated
13. PRE SWINGPRE SWING
OccupiesOccupies 50-60% range50-60% range
of gait cycleof gait cycle
Period of double limbPeriod of double limb
supportsupport
Goal is to prepare theGoal is to prepare the
limb for swinglimb for swing
Initial contact ofInitial contact of
opposite limb marksopposite limb marks
beginning of pre swingbeginning of pre swing
14. SWING PHASESWING PHASE
Limb is off the groundLimb is off the ground
Divided intoDivided into
1) initial swing1) initial swing
2) mid swing2) mid swing
3) terminal swing3) terminal swing
15. INITIAL SWINGINITIAL SWING
OccupiesOccupies 60-70% range60-70% range
of gait cycleof gait cycle
Critical function is toCritical function is to
allow foot clearance &allow foot clearance &
variable cadencevariable cadence
Varying cadenceVarying cadence
requires CNS control &requires CNS control &
precise timing of twoprecise timing of two
joint musclesjoint muscles
16. MID SWINGMID SWING
OccupiesOccupies 70 to 85% range70 to 85% range of gaitof gait
cyclecycle
Critical function is to maintainCritical function is to maintain
foot clearancefoot clearance
17. MID SWING (contd)MID SWING (contd)
Foot clearance dependsFoot clearance depends
on maintaining aon maintaining a
relatively level pelvis,relatively level pelvis,
sufficient hip flexion &sufficient hip flexion &
adequate ankleadequate ankle
dorsiflexiondorsiflexion
In normal gait footIn normal gait foot
clearance is only 0.87cmclearance is only 0.87cm
18. TERMINAL SWINGTERMINAL SWING
OccupiesOccupies 85-100%85-100%
rangerange of gait cycleof gait cycle
Function is decelerationFunction is deceleration
of shank & correct pre-of shank & correct pre-
positioning of foot forpositioning of foot for
contactcontact
Complete kneeComplete knee
extension & neutralextension & neutral
position of foot areposition of foot are
critical for heel strikecritical for heel strike
20. KINEMATICSKINEMATICS
It denotes movements observedIt denotes movements observed
and measured at the pelvis, hip,and measured at the pelvis, hip,
knee, and ankle during stanceknee, and ankle during stance
and swing phasesand swing phases
It can be observed in 3 planesIt can be observed in 3 planes
sagittalsagittal
coronalcoronal
transversetransverse
22. SAGITTAL PLANESAGITTAL PLANE
HIPHIP
• StanceStance –flexed at–flexed at
initial contactinitial contact
then extends fullythen extends fully
• SwingSwing – hip flexes– hip flexes
rapidly to pull therapidly to pull the
stance limb offstance limb off
the groundthe ground
23. SAGITTAL PLANESAGITTAL PLANE
KNEEKNEE
• StanceStance- At initial contact- At initial contact
knee flexesknee flexes 1515 deg. It thendeg. It then
extendsextends
• SwingSwing – At heel rise knee– At heel rise knee
begins to flex againbegins to flex again
reaching maximum flexionreaching maximum flexion
in early swing .Inin early swing .In
remainder of swing kneeremainder of swing knee
extends passivelyextends passively
24. SAGITTAL PLANESAGITTAL PLANE
ANKLEANKLE
• StanceStance – neutral at initial– neutral at initial
contact,then plantar flexescontact,then plantar flexes
5-10 deg as forefoot comes5-10 deg as forefoot comes
to rest on the ground.-to rest on the ground.-
FIRST ROCKERFIRST ROCKER
• Ankle dorsiflexes throughoutAnkle dorsiflexes throughout
mid stance as tibia movesmid stance as tibia moves
forward over plantigradeforward over plantigrade
foot –foot – SECOND ROCKERSECOND ROCKER
25. SAGITTAL PLANESAGITTAL PLANE
ANKLEANKLE(CONTD)(CONTD)--during terminalduring terminal
stance and pre swingstance and pre swing
ankle plantar flexes andankle plantar flexes and
heel rises to prepare forheel rises to prepare for
push off-push off- THIRD ROCKERTHIRD ROCKER
• SwingSwing – dorsiflexion to– dorsiflexion to
neutral position seenneutral position seen
26. CORONAL PLANECORONAL PLANE
PELVIS-each hemipelvisPELVIS-each hemipelvis
rises slightly during swingrises slightly during swing
phasephase
- stance phase hemipelvis- stance phase hemipelvis
drops slightlydrops slightly
- accentuated pelvic drop in- accentuated pelvic drop in
swing seen inswing seen in
trendelenburg gaittrendelenburg gait
28. TRANSVERSE PLANETRANSVERSE PLANE
Measure rotationMeasure rotation
Pelvis and hips rotate minimallyPelvis and hips rotate minimally
Tibia has a fixed external rotationTibia has a fixed external rotation
29. NEUROLOGICAL CONTROL OFNEUROLOGICAL CONTROL OF
GAITGAIT
Muscle actions programmed asMuscle actions programmed as
involuntary reflex arcs in EPSinvoluntary reflex arcs in EPS
Golgi tendon ,muscle spindle &Golgi tendon ,muscle spindle &
joint receptors producejoint receptors produce
neurologic feedbackneurologic feedback
Voluntary modulation of gaitVoluntary modulation of gait
made by interaction with motormade by interaction with motor
cortexcortex
Cerebellum - balanceCerebellum - balance
30. MUSCLE ACTIVITYMUSCLE ACTIVITY
Gait is maintained by gravity ,Gait is maintained by gravity ,
momentum and muscle contraction.momentum and muscle contraction.
Muscle contraction can beMuscle contraction can be
• 1)Concentric1)Concentric
• 2)Eccentric2)Eccentric
• 3)Isometric3)Isometric
31. MUSCLE ACTIVITYMUSCLE ACTIVITY
CONCENTRIC CONTRACTIONCONCENTRIC CONTRACTION
Muscle shortensMuscle shortens
generating power andgenerating power and
accelerationacceleration
Gastrocsoleus andGastrocsoleus and
iliopsoas are the primaryiliopsoas are the primary
accelerators of gaitaccelerators of gait
Concentric contraction ofConcentric contraction of
these occur at terminalthese occur at terminal
stancestance
32. MUSCLE ACTIVITYMUSCLE ACTIVITY
ECCENTRIC CONTRACTIONECCENTRIC CONTRACTION
Muscle lengthens despiteMuscle lengthens despite
electrical contractionelectrical contraction
These slow down & stabilize jointThese slow down & stabilize joint
motions during gaitmotions during gait
Eccentric contractionsEccentric contractions
outnumber concentricoutnumber concentric
contractions during gaitcontractions during gait
33. ECCENTRIC CONTRACTIONECCENTRIC CONTRACTION
Eg:- tibialis anterior muscleEg:- tibialis anterior muscle
contracts eccentrically atcontracts eccentrically at
initial contact to slow downinitial contact to slow down
plantar flexion of ankleplantar flexion of ankle
-gastrosoleus contracts-gastrosoleus contracts
eccentrically during 2eccentrically during 2ndnd
rocker to slow downrocker to slow down
dorsiflexiondorsiflexion
34. MUSCLE ACTIVITYMUSCLE ACTIVITY
ISOMETRIC CONTRACTIONISOMETRIC CONTRACTION
No change in length of muscleNo change in length of muscle
occursoccurs
Postural stabilisers like gluteusPostural stabilisers like gluteus
medius work in this modemedius work in this mode
More muscle activity occurs inMore muscle activity occurs in
stance phasestance phase
In swing momentum carries theIn swing momentum carries the
leg forwardleg forward
35. GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY
Prerequisites ofPrerequisites of
normalnormal
ambulation areambulation are
Stability atStability at
stancestance
Means ofMeans of
progressionprogression
Conservation ofConservation of
energyenergy
36. GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY
Bipedal gait is inherentlyBipedal gait is inherently
unstableunstable
and inefficientand inefficient
Quadrupeds run faster thanQuadrupeds run faster than
humans because vertebral andhumans because vertebral and
trunk muscles act to augmenttrunk muscles act to augment
stridestride
37. GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY
PROGREESSIONPROGREESSION
• Forward fall of theForward fall of the
centre of gravity ofcentre of gravity of
body from its highbody from its high
point at mid stancepoint at mid stance
to its low point atto its low point at
double supportdouble support
• Now potentialNow potential
energy is convertedenergy is converted
to kinetic energyto kinetic energy
38. GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY
PROGRESSION (contd)PROGRESSION (contd)
To raise the CG back to zenithTo raise the CG back to zenith
kinetic energy must be suppliedkinetic energy must be supplied
This is supplied by inertia ofThis is supplied by inertia of
swinging limb which in turnswinging limb which in turn
derives energy from plantarderives energy from plantar
flexors and hip flexors of thatflexors and hip flexors of that
limblimb
39. GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY
PROGRESSION (contd)PROGRESSION (contd)
In normal walkingIn normal walking 85%85% ofof
energy comes from plantarenergy comes from plantar
flexorsflexors
Energy expended in normalEnergy expended in normal
walking iswalking is 2.5 Kcal/min2.5 Kcal/min
This is less than twice the energyThis is less than twice the energy
spent while standing stillspent while standing still
--1.5Kcal/min1.5Kcal/min
40. GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY
ENERGY CONSERVATIONENERGY CONSERVATION
Energy is conserved in 3 waysEnergy is conserved in 3 ways
• Minimizing the excursion of C of GMinimizing the excursion of C of G
• Controlling momentumControlling momentum
• Active or passive transfer of energyActive or passive transfer of energy
between segmentsbetween segments
41. GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY
ENERGY CONSERVATIONENERGY CONSERVATION
Movement of a wheel is highlyMovement of a wheel is highly
efficient as C of G remains constantefficient as C of G remains constant
By three planes of pelvic movement ,By three planes of pelvic movement ,
rotation, tilt ,& obliquity combinedrotation, tilt ,& obliquity combined
with coordinated knee and anklewith coordinated knee and ankle
motion the vertical and horizontalmotion the vertical and horizontal
excursion are reduced toexcursion are reduced to 4.4cm4.4cm
42. GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY
ENERGY CONSERVATIONENERGY CONSERVATION
CONTROLLING MOMENTUMCONTROLLING MOMENTUM
*This conserves energy*This conserves energy
eg:-by maintaining theeg:-by maintaining the
ground reaction force in frontground reaction force in front
of the knee during the lastof the knee during the last
half of stance , an extensionhalf of stance , an extension
movement occurs whichmovement occurs which
allows it to remain stableallows it to remain stable
43. GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY
ENERGY CONSERVATIONENERGY CONSERVATION
ACTIVE OR PASSIVE TRANSFER OF ENERGYACTIVE OR PASSIVE TRANSFER OF ENERGY
• Passive flow of energy across jointsPassive flow of energy across joints
accounts for most of the energyaccounts for most of the energy
changes occuring at the distalchanges occuring at the distal
segments during initiation andsegments during initiation and
termination of swingtermination of swing
• In active transfer two joint musclesIn active transfer two joint muscles
play a major roleplay a major role
44. GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY
Interference with these mechanismsInterference with these mechanisms
increase energy consumptionincrease energy consumption
Eg:-fast walking –Eg:-fast walking – 60% inc60% inc
BK brace -BK brace - 10%10%
15 deg knee flexion contracture -15 deg knee flexion contracture -25%25%
BK amputee –BK amputee – 60%60%
AK amputee –AK amputee – 100%100%
crutches -crutches - 300%300%
45. DEVELOPMENT OF GAIT INDEVELOPMENT OF GAIT IN
CHILDRENCHILDREN
Toddlers walk with a wide basedToddlers walk with a wide based
gait, increased flexion of hip andgait, increased flexion of hip and
knees & arms held out to theknees & arms held out to the
sidessides
At 5 yrs child has developed aAt 5 yrs child has developed a
stable velocity patternstable velocity pattern
Adult gait pattern is attained byAdult gait pattern is attained by
7 yrs7 yrs
46. GAIT ANALYSISGAIT ANALYSIS
Systematic descriptionSystematic description
and assessment of qualities thatand assessment of qualities that
characterize human locomotioncharacterize human locomotion
Mainly used in pre operativeMainly used in pre operative
planning and documentation ofplanning and documentation of
post operative outcome inpost operative outcome in
patients with cerebral palsypatients with cerebral palsy
47. GAIT DEVIATIONSGAIT DEVIATIONS
Due to painDue to pain
weak muscleweak muscle
abnormal muscle activityabnormal muscle activity
joint abnormalitiesjoint abnormalities
Contractures around jointsContractures around joints
limb length discrepancieslimb length discrepancies
48. GAIT DEVIATIONSGAIT DEVIATIONS
1)antalgic gait1)antalgic gait - dec stance phase- dec stance phase
avoiding wt. Bearing on involved limbavoiding wt. Bearing on involved limb
2)Short limb gait2)Short limb gait – dipping of shoulder– dipping of shoulder
and pelvis on affected side & incand pelvis on affected side & inc
flexion of hip , knee and ankle offlexion of hip , knee and ankle of
opposite limb.opposite limb.
3)Trendelenburg gait3)Trendelenburg gait –patient lurches–patient lurches
on affected side & pelvis drops on oppon affected side & pelvis drops on opp
sideside
50. GAIT DEVIATIONSGAIT DEVIATIONS
4)Waddling gait4)Waddling gait – patient lurches– patient lurches
on both sides during walkingon both sides during walking
5)High stepping gait5)High stepping gait – patient– patient
flexes foot and knee excessivelyflexes foot and knee excessively
to clear the groundto clear the ground
51. GAIT DEVIATIONSGAIT DEVIATIONS
6)Scissoring gait6)Scissoring gait –– one legone leg
crosses directly over the othercrosses directly over the other
with each stepwith each step
7)Calcaneus gait7)Calcaneus gait –walks on–walks on
broadened heel with tendency tobroadened heel with tendency to
external rotation and genuexternal rotation and genu
recurvatum. No calcaneal pick uprecurvatum. No calcaneal pick up
and push offand push off
52. GAIT DEVIATIONSGAIT DEVIATIONS
8)Stiff hip gait8)Stiff hip gait – no movements– no movements
at affected hip , excessat affected hip , excess
movements in spine & unaffectedmovements in spine & unaffected
hiphip
9)Stiff knee gait9)Stiff knee gait – no flexion at– no flexion at
knee, so pelvis raised duringknee, so pelvis raised during
swingswing
53. GAIT DEVIATIONSGAIT DEVIATIONS
10)Gluteus maximus gait10)Gluteus maximus gait ––
patient lurches backwards due topatient lurches backwards due to
weak gluteus maximusweak gluteus maximus
11)Gluteus medius gait11)Gluteus medius gait – like– like
trendelenburg gaittrendelenburg gait
54. GAIT DEVIATIONSGAIT DEVIATIONS
12)Quadriceps gait /12)Quadriceps gait / hand to kneehand to knee
gaitgait –– patient stabilizes hips &patient stabilizes hips &
knee for weight bearing byknee for weight bearing by
leaning on affected side &leaning on affected side &
pressing over lower thigh by hispressing over lower thigh by his
handhand
55. CONCLUSIONCONCLUSION
Normal gait is designed by GodNormal gait is designed by God
Almighty to be efficient & all theAlmighty to be efficient & all the
priorities are met . In abnormalpriorities are met . In abnormal
gait these are lostgait these are lost
Studying the human gait hasStudying the human gait has
enabled us to define , documentenabled us to define , document
& analyze normal and abnormal& analyze normal and abnormal
human gait more accuratelyhuman gait more accurately