Gait. Maturation of Gait Beginning ambulation ( Infant s gait ) Upper Limb. Lower Limb

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1 Gait Terminology Gait Cycle : from foot strike to foot strike Gait Phase : stance (60%) : swing (40%) Velocity : horizontal speed along progression Cadence : no. of steps per unit time Step length : distance from one foot to the other Stride length: distance from initial contact to following initial contact

2 Maturation of Gait Beginning ambulation ( Infant s gait ) Upper Limb Arm abducted ( high guarded ) Elbow extended Little arm movement Lower Limb Toe strike first Hyper-flexed hips and knees Wide base Faster cadence More variability Less efficient Circumduction to clear foot

3 Maturation of Gait By 2 years Wide base diminishes Smoother movements Reciprocal arm swing Initial contact with heels Increased step length and walking velocity

4 Maturation of Gait By 3 years Adult kinematics Higher cadence and dimished stride length compared with adults

5 Maturation of Gait By 7 years Time-distance parameters reach adult values

6 Pre-requisities for Normal Gait ( Jacqueline Perry) Stability of the weight-bearing foot throughout the stance phase Clearnace of the non-weightbearing foot during the swing phase Appropriate pre-positioning during the terminal swing of the foot for the next gait cycle Adequate step length Energy conservation

7 Maturation of Gait Five Parameters of mature gait Single limb stance duration increases with age and maturity Walking velocity increases with age and limb length Cadence decreases with age and limb length Step length increase with age and limb length Ratio of inter-ankle distance to pelvic width decreases with age of maturation

8 Assessment Observational Gait Analysis Instrumented Gait Analysis

9 Observational Gait Analysis Posture Assessment Head to toe / toe to head Three different planes Gait Assessment Head to toe / toe to head Three different planes

10 Observational Gait Analysis

11 Observational Gait Analysis

12 Instrumental Gait Assessment Kinematics : Temporal stride measures of motion analysis : measurement of joint angles Kinetics : Analysis of forces or loads that cause motion : internal moment / external moment Electromyogram ( EMG ) Analysis of muscle activity Energy Consumption

13 Instrumental Gait Assessment

14 Instrumental Gait Assessment

15 Instrumental Gait Assessment

16 Instrumental Gait Assessment

17 Common Deviation Equinus Gait, Toe Walking : excessive ankle plantar flexion Cerebral Palsy ( Gastroc-Soleus spasticity ) Club Foot Idiopathic Tight Tendo Achilles Muscle disease ( eg. Duchenne muscular dystrophy ) Post-traumatic ( eg. Compartment Syndrome ) Limb Length inequality

18 Common Deviation Calcaneus Foot : excessive ankle dorsiflexion Low lumbar myelodsplasia Overlengthening of the heel cord in cerebral Palsy Compensation for forefoot pain

19 Common Deviation Steppage Gait : Increased knee flexion to facilitate limb clearance Myeloplasia ( Gastroc-Soleus weakness ) Charcot-Marie-Tooth disease ( weakness tibialis anterior ) Compensation for tibialis anterior weakness eg. Hemiplegia, Peroneal nerve injury Friedreich ataxia

20 Common Deviation Circumduction or Vaulting Gait : excessive abduction of hip with increased pelvis rotation and upward pelvic obliquity Limb-length discrepancy to clear long limb Cerebral Palsy : compensation for stiff knee / tight heel cord / abductor spasticity Scoliosis with pelvic obiquity Any cause of ankle or knee stiffnessv

21 Common Deviation Trendelenburg Gait : contralateral pelvic drop during stance phase Cerebral Palsy ( adductor spasticity ) Legg-Calvé -Perthes Disease Developmental Dysplasia of Hip Slipped capital femoral epiphysis Muscle disease

22 Common Deviation Maximus Lurching Gait : excessive trunk extension for compensation of gluteal maximus weakness Spinal Bifida Polio

23 Common Deviation in Cerebral Palsy ( Hemiplegia )

24 Common Deviation in Cerebral Palsy ( Spastic diplegia )

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