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

2. Normal Gait & Abnormal Gait

3. We can accurately detect & interprete
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

5. 60%
40%

6. 60%
40%
20-25%

7. Stride width cm
Cadence step/min

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 41-61%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

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