1. Gait analysis

2. Visual gait analysis
Walk minimum 8m with different speed. It is simplest gait analysis but has serious limitations
1- transitory, no permanent record
2- eye can not observe high speed events
3- possible to observe the motion not the force
4- depend on the skills of the observer.

3. The best viewpoint for observation of gait abnormality
Side view : anterior and posterior trunk bending, increased lumbar lordosis, steppage, excessive knee flexion and extension, vaulting, insufficient push off and dorsiflexion control .
Front and behind view : circumduction, hip hiking, vaulting, abnormal foot contact , hip rotation and walking base

4. Anterior trunk bending Posterior trunk bending

6. Videotape examinations
Overcome two of the visual limitations,
1- transitory, no permanent record
2- eye can not observe high speed events
And confer the following advantages
3- reduce the number of walk the subjects need to do
4- show subjects how they are walking
5- used to teach visual gait analysis to someone else

7. General gait parameters
Cadence : no of steps/known period time sec is enough time
Stride length by direct measurement (foot print) or indirect from velocity and cadence
Step length, walking base, toe out angle, foot contact pattern.
Foot print ( water , talcum powder, and felt adhesive pads soaked in different colored dye and a stripe of paper )

8. Velocity : distance/time .( 6*10 m ) are enough
The subject should be to walk at their natural speed and their stride before measurements
Foot switches : to record timing of gait
Electrogoniometer

9. Force platform : with size 45X60cm 3D motion analysis system
Electromyography
Force platform : with size 45X60cm
3D motion analysis system

10. Walking aids Waling aids modify the gait pattern
Reduce pain in painful joint
Increased the functions
Gait training (underwater, between parallel bars, use assistive devices )

11. Canes
Canes are the means of forces transmitted to ground by the wrist and hand
They are used for the following purposes
1- to improve stability
2- to generate moment (on the opposed side )
3- to take part of the load from the leg

12. Types of canes Straight cane Tripod canes Tetrapod canes
L shape handle
U shape handle
Angular shaped handle
Adjustable in height

13. Crutches
They differ from canes, because they able to transmit significant force in the horizontal plane
Types of crutches
Axillary crutches, may add plateform
Forearm crutches or elbow crutches
Ortho crutches

14. Walkers (rollators) The most stable walking aids Types
1- regular walkers
2- adjustable walkers
3- folded walker
4- rolling walker
5- walker with plateform for forearm support
6- reciprocal walker

15. Gait pattern with walking aids
Gait with single aid
Three point swing through gait
Three point swing to gait (the feet are advanced by a much shorter distance and placed behind the level of crutches)
Four point gait
Three point gait
Two point gait

16. Planning for gait training
1- safety measures
Gait belt
Dry surface
Slippers or shoes
Therapist beside the affect side
Turning around the good leg

17. 2- point to start with
According to static and dynamic balance, starts from easy to hardest
Underwater
Use parallel bars
Walker
Crutches
Canes
Independent

18. 3- Weight bearing status
NWB
TTWB
PWB
WBAT
FWB
4- Mental status: good level of awareness and orientation to understand the instructions

19. 5- Preparing for the treatment area
Usage mirror
Draw line on the floor in case of dynamic balance
Decide the distance of walking
The level of the surface

20. Amputee gait
The mechanical coupling between the stump and the prosthetic limb can not be good as in the normal because
1- the lever arm between the hip and the socket is small
2- the relative motion between the stump and the socket
3- uncomfortable socket prevent applying large forces on the prosthetic limb

21. Up and down stairs
Up with good leg first and down with the affected one
With cane , Up with good leg first then cane then the affected one and vise versa going down
The same with the crutches

22. Thanks