Presentation is loading. Please wait.

Presentation is loading. Please wait.

Gait & Gait Aids Associate professor shereen algergawy Rheumatology and rehabilitation department.

Similar presentations


Presentation on theme: "Gait & Gait Aids Associate professor shereen algergawy Rheumatology and rehabilitation department."— Presentation transcript:

1 Gait & Gait Aids Associate professor shereen algergawy Rheumatology and rehabilitation department

2 Normal Gait & Abnormal Gait

3 Why we should know “Normal Gait” If we have sound knowledge of the characteristics of normal gait We can accurately detect & interprete deviations from the normal gait pattern

4

5 60%40%

6 60% 40% 20-25%

7 Stride width 5-10cm Cadence step/min

8

9

10

11

12 Abnormal gait Stance phase  Antalgic  Lateral trunk bending  Anterior trunk bending  Posterior trunk bending  Lordosis  Hyperextended knee  Excessive knee flexion  Excessive Genu Valgum or Varum

13  Inadequate Dorsi-flexion control  Insufficient Push-off  Abnormal walking base  Internal or external limb rotation  Excessive medial or lateral foot contact  Vaulting

14 Swing phase  Circumduction  Hip hiking  Internal or external limb rotation  Inadequate Dorsiflexion control  Abnormal walking base

15 Antalgic gait Pain in stance phase : knee, hip, foot pain

16 Lateral trunk bending  Hip abductor weakness  Hip dislocation, coxa vara, slipped capital femoral epiphysis  Hip pain  Perineal pressure  Involved limb relatively shorter  Compensation for abducted gait

17 Trendelenberg gait Gluteus Medius Gait

18 Anterior Trunk Bending Quadriceps weakness combined with weakness of gluteus maximus, gastrocnemius, or both Pushing backward with the hand / lateral rotation

19 Posterior Trunk Bending Gluteus Maximus (Lurch) Gait Hip-extensor weakness Knee ankylosis, spasticity or orthotic knee lock Hip-extensor spasticity

20 Hyperextended knee Quadriceps weakness Capsular ligament laxity Quadriceps spasticity Plantar-flexion contracture or spasticity Compensation for contralateral limb shortening (hip-flexion or knee-flexion contracture)

21 Excessive knee flexion Knee-flexion or hip-flexion contracture Knee-flexor spasticity Uncompensated quadriceps weakness Ankle ankylosis, pes calcaneus Plantar-flexor weakness Involved limb relatively longer

22 Steppage gait  Ankle dorsiflexor weakness : compensate by exaggerated hip and knee flexion Foot drop / dragging

23 Slap foot  Ankle dorsiflexor weakness : early stance phase

24 Insufficient Push-Off Flat foot gait Plantar-flexor weakness Rupture of the Archilles tendon or the triceps surae Metatarsal pain, hallux rigidus

25 Internal or External Limb Rotation Internal rotation  Biceps femoris weakness  spasticity External rotation  Quadriceps weakness  Inner hamstring weakness  Spasticity

26 Abnormal walking base Wide Base (> 4 inch)  Hip-abduction contracture  Instability due to fear, proprioceptive deficit, cerebellar problem  Perineal pain  Genu valgum

27 Narrow base (< 2 inch)  Spasticity  Genu varum

28 Vaulting Swing-phase limb is relatively longer

29 Hip hiking  Increased ipsilateral length: hip -flexor or dorsiflexor weakness hip, knee, ankle ankylosis or spasticity insufficient hip or knee flexion  Contralateral shortness

30 Circumduction Spasticity Hip flexor weakness Hamstring paralysis Knee or ankle ankylosis / orthotic knee lock Dorsiflexor weakness Plantar-flexion contracture

31 Scissoring gait In spastic CP with spasticity of adductor m.

32 Crouched Gait Excessive flexion of hip and knee due to spasticity, muscle tightness or contracture Spastic CP

33 Parkinsonian gait Trunk,head,neck forward and knee flexed wide base,small shuffling step trend to fall forward and to increase speed (festination)

34 Hemiplegic gait Abnormal arm swing : adduction with flexion at shoulder,elbow,wrist and fingers extensor synergy of lower limb: leg extension,adduction and hip IR,knee extension,ankle and foot plantarflexion and inversion.

35 Gait aids

36 Purpose of gait aids Increase area of support, maintain center of gravity over support area Redistribute weight-bearing area

37 Requirements ROM, muscle strength and endurance, coordination, trunk balance, sensory perception, mental status Amount of weight-bearing permitted on lower limb

38 Requirements Shoulder depressor – latissimus dorsi, lower trapezius, pectoralis minor Shoulder adductor – pectoralis major Shoulder flexor, extensor and abductor – deltoid Elbow extensor – triceps Wrist extensor – ECR, ECU Finger flexor – FDS, FDP, FPL, FPB

39 Crutches Body weight transmission with bilateral axillary crutches = 80% of BW, nonaxillary crutches = 40-50% of BW Good strength of upper limbs usually required – more weight bearing and propulsion

40 Unilateral non/partial weight bearing eg fracture, amputee -> 3-point gait Bilateral partial weight bearing or incoordination/ataxia -> 2 or 4-point gait Bilateral weakness of lower extremities eg paraplegia -> swing-to or through gait

41 Non-axillary crutches  Lofstrand/forearm crutches  Platform crutch  Wooden forearm orthosis (Kenny stick)  Triceps weakness orthoses (arm orthoses) eg Warm Spring, Everett, Canadian crutch

42 Axillary crutches Crutch length : measure anterior axillary fold to point 6 inches anterolaterally from foot or to heel plus 1-2 inches Hand piece : elbow flexed 30 degree, wrist max extension, finger fist 2-3 FB from apex of axilla Compressive radial neuropathies

43 Lofstrand/forearm crutches Single aluminum tubular adjustable shaft, handpiece, forearm piece 2 inches below elbow, forearm cuff anterior opening (hinge) Elbow flexion 20 degree Can release hand without loosing crutch Requires great skill, good strength of UEs, trunk balance

44 Platform crutch Painful wrist and hand condition or elbow contractures, or weak hand grip Platform, velcro strap Elbow flexed 90 degrees

45 Crutch Gaits Point gait – stability, slow Swing gait – more energy, fast

46 Four-point gait Good stability - at least 3 point contact ground Ataxia or incoordination Slowest, difficulty

47 Three-point gait/alternating two-point gait Non-weight-bearing gait for lower limb fracture or amputation 3-point PWB gait -> required 18-36% more energy per unit distance than normal NWB required %more energy per unit distance than normal

48 Two-point gait Faster than 4-point gait but less stability Decrease both lower limbs weight- bearing

49 Swing-through gait Fastest gait, requires functional abdominal muscles Required increase of 41-61% in net energy cost (= 3- point NWB)

50 Swing-to gait Both crutches -> both lower limbs almost to crutch level

51 Canes Body weight transmission for unilateral cane opposite affected side is 20-25% Gluteus medius weakness, or pathological at knee or ankle

52 Cane eliminate necessary gluteus medius force and reduces compressional force on hip

53 Measure tip of cane to level of greater trochanter, elbow flexed degree

54

55 Walker/Walkerette Wider and more stable base of support, but slow gait (interfere smooth reciprocal gait) For patients requiring maximum assistance with balance, uncoordinated

56 Add wheels to front legs for who lack coordination or power in upper limbs

57 Front of walker 12 inches in front of patient Shoulder relaxed and elbow flexed 20 degree Three-point gait


Download ppt "Gait & Gait Aids Associate professor shereen algergawy Rheumatology and rehabilitation department."

Similar presentations


Ads by Google