1. Carla Wilhite, OTR/L Sherril York. Ph.D. Oklahoma AgrAbility
Gaits Not Gates
Carla Wilhite, OTR/L
Sherril York. Ph.D.
Oklahoma AgrAbility

2. Goals & Objectives Describe normal gait phases and components
Practice observational analysis
Determine mechanical consequences of abnormal gait
Suggest justification documentation examples
Present recommendations for improving work performance

3. What is Normal Gait?
A series of losing and regaining balance resulting in forward motion
Normal pattern assumes variety of forms
Disruptions in sequence of actions result in anatomical or mechanical deviations
Some differences due to body type, gender, pathology, or galactic origin

4. Click on link below to see Alien song movie
Alien Song movie by Victor Navone. Sung to the song “I will survive” by Gloria Gaynor.
Movie opens with a one eyed green alien character on a stool with head in hands.
Music starts and song begins. As song progresses alien walks with attitude and sings.
Words to the song:
At first I was afraid I was petrified
Kept thinkin' I could never live without you by my side;
But then I spent so many nights
Thinkin' how you did me wrong
And I grew strong
And so you're back from outer space
I just walked in to find you here with that sad look upon your face
I should have changed that stupid lock
I should have made you leave your key
If I'd've known for just one second you'd back to bother me
Go on now, go walk out the door
Just turn around now
('cause) you're not welcome anymore
Weren't you the one who tried to hurt me with goodbye
Did I crumble
Did you think I'd lay down and die?
Oh no, not.I. I will survive
Oh as long as I know how to love I know I'll stay alive;
I've got all my life to live,
I've got all my love to give and I'll survive,
I will survive. Hey hey.
It took all the strength I had not to fall apart
Kept trying' hard to mend the pieces of my broken heart,
And I spent oh so many nights
Just feeling sorry for myself. I used to cry
But now I hold my head up high
And you see me somebody new
I'm not that chained up little person still in love with you,
And so you feel like droppin' in
And just expect me to be free,
Now I'm savin' all my lovin' for someone who's lovin' me
Go on now.. etc.
Video ends with disco ball falling on alien.

5. Gait Cycle
Cycle extends from time heel contacts ground until same heel contacts ground again
Consists of two phases
Stance
Swing
Consists of periods of single limb support and double limb support

6. Phases of Gait Cycle Stance phase–60% of cycle
Initial contact/loading
Midstance
Terminal stance
Preswing
Swing phase–40% of cycle
Initial swing
Midswing
Terminal swing

7. Phases of Walking
This is a series of eight frames of black and white figures illustrating the phases of walking. The frames are:
1-initial swing
2-midswing
3-terminal swing
4-initial swing
5-loading response
6-midstance
7-terminal stance
8-preswing
Taken from Soderberg, G. (1986). Kinesiology:Application to Pathological Motion

8. Phases of Gait Cycle Taken from Pribut, S. (2004). Gait Biomechanics.
This is a graphic of the two phases of the gait cycle. Stance phase is 60% of the cycle and the swing phase is 40%. Further delineated are the subphases of the stance (contact, midstance, terminal stance or propulsion).
Taken from Pribut, S. (2004). Gait Biomechanics.

9. Weight Shift
Weight shifts from slightly lateral in the heel at heel strike
Moves forward between 1st and 2nd long bone of foot
Exits through the great toe at toe off
Picture shows how the weight is distributed on the foot from heel strike to toe-off. Weight moves from the lateral to the heel forward through the great toe at toe off.
Taken from Pribut, S. (2004). Gait Biomechanics.

10. Anatomy of a Walk Walking is a cyclic movement
Head position should remain relatively level
Arms and legs move in opposition
Pelvis, and shoulders, rotate forward-back and up-down around spine
This is an animated movie of a stick figure walking from a diagonal view. The movie is looped to show the symmetry and cyclic nature of walking.
Taken from Classic Walk Tutorial

11. Anatomy of a Walk Feet and Legs Arms
Heel strike as weight shifts to forward foot
Double limb support
Arms
Move in opposition to legs
Picture of a stick figure from a side view in the heelstrike subphase of walking. Color coded lines have been superimposed over the arms and legs to show relative positions of those segments to one another.
Taken from Anatomy of Walking Tutorial

12. Anatomy of a Walk Feet and Legs Arms
Weight is transferred to forward foot, knee flexes to absorb shock
Toe-off of back foot occurs
Single limb support
Arms
Move in reciprocal motion to legs
Picture of a stick figure from a side view in the loading to midstance subphase of walking. Color coded lines have been superimposed over the arms and legs to show relative positions of those segments to one another.
Taken from Anatomy of Walking Tutorial

13. Anatomy of a Walk Feet and Legs Arms
Forward knee extends and lifts body
Weight on foot rolls from outside to inside
Back leg begins swing forward
Arms
Move in reciprocal motion to legs
Picture of a stick figure from a side view in the midstance subphase of walking. Color coded lines have been superimposed over the arms and legs to show relative positions of those segments to one another.
Taken from Anatomy of Walking Tutorial

14. Anatomy of a Walk Feet and Legs Arms
Free leg has now moved forward in prep. for heel strike
Weighted leg is beginning propulsion to toe-off
Arms
Arms move like pendulums in opposition to legs
Picture of a stick figure from a side view in the heel lift subphase of walking. Color coded lines have been superimposed over the arms and legs to show relative positions of those segments to one another.
Taken from Anatomy of Walking Tutorial

15. Anatomy of a Walk Feet and Legs Arms
Free leg now is weighted at heel strike
Double limb support
Arms
Opposite to leg movement
Picture of a stick figure from a side view showing left heelstrike of the opposite leg. Color coded lines have been superimposed over the arms and legs to show relative positions of those segments to one another.
Taken from Anatomy of Walking Tutorial

16. Anatomy of a Walk
With legs apart, the pelvis and shoulders rotate in opposite directions around the spine
As one leg moves past the other, the pelvis and shoulders move vertically in opposite directions
Picture one shows a front view of a stick figure with legs apart and shoulder and pelvis level, alongside a top view of the stick figure with arrows showing the opposing front-back rotation of the shoulders and pelvis.
Picture two shows a front view of a stick figure with arrows showing the up and down rotation of the shoulders and pelvis, alongside a top view showing the shoulders and pelvis with no front-back rotation.
Picture three shows front view of a stick figure with the opposite foot stepping forward and the shoulders and pelvis level, alongside a top view of the stick figure with arrows showing the forward-back rotation of the shoulders and pelvis.
As the legs part, the pelvis and shoulders again rotate in opposition
Taken from Anatomy of Walking Tutorial

17. “Normal” Gait Lab Gain familiarity with gait sequence
Demonstration of typical gait patterns

18. Normal Gait Sequence Click on link below to view normal gait
Downloaded from McGill Medical Gait Disorders site

19. Gait Deviations Common Causes of Gait Deviations:
Pain or discomfort during weight-bearing or movement
Muscle Weakness
Limitations of joint movement
In-coordination of Movement
Changes in bone or soft tissue (including amputations)

20. Gait Deviations Pain or Discomfort: Clues Report of pain and location
May spend less time in weight-bearing phase
Grimacing

21. Gait Deviations Muscle Weakness: Clues Broadened base of support
Shorter steps
Diminished arm swing
Difficulty with balance
Extensive weakness: inability to ambulate

22. Gait Deviations Limitation of joint movement: Clues
Arthritis pathology
Surgical procedures (instrumentation)
Disuse of a body part
(Can confirm joint limitation through measurement and gait analysis)

23. Gait Deviations In-coordination: Clues Spasticity Hemiparesis
Hypertonia: Cannot selectively activate muscle: see total flexion or total extension patterns when moving limbs

24. Gait Deviations Changes in bone or soft tissue: Clues
Bone shortening after fracture
Congenital malformations
Scar tissue

25. Gait Deviations
Bottom Line: Anything that is not “normal” gait (i.e. forward progression) is a gait deviation.
Vs. “Functional” gait

26. Pathology at Specific Joints
Toes
Extended
Clawed
Photograph of the cross section anatomy of abnormal claw toe joint: subluxation of the metatarsophalangeal joint, superior dislocation at the PIP joint, and subluxation of the DIP joint.

27. Pathology at specific joints
Ankle and Foot
Forefoot contact
Foot-flat contact
Foot slap
Inversion/eversion
Drag
No heel off
Photograph: Posterior view of two legs. Left leg is showing pronation (the inner side of the foot is rolling under). Right leg is showing correction using orthotic.

28. Pathology at Specific Joints
Knee
Limited flexion
Hyper or hypo extension
Varus/valgus
Wobbling
Extension thrust
Photograph: From left to right: Normal knee anatomy, varus knees (bowlegged), and valgus knees (knock knees).

29. Pathology at Specific Joints
Hip
Circumduction (multiple components)
Limits in flexion or extension
Problems with rotation
Problems with adduction or abduction

30. Pathology at Specific Joints
Pelvis
Hiking
Posterior or anterior tilt
Dropping
Rotation problems
Trunk
Back or forward lean
Lateral lean
Photograph: Frontal view of a male pelvis and sacrum labeled from top to bottom: ilium, iliac crest, ischium, acetabulum, pubis.

31. Pathology at Specific Joints
Arms
Decreased or absent arm swing
Head and neck
Kyphosis
Head forward posture
Photograph: sagittal section of a kyphotic spine (on left) and normal spine (on the right). The kyphotic slide has a noticeable hump in the cervico-thoracic area.

32. Lab: Walking Experiences
Place one foot directly in front of the other
Walk with a wide base of support
Walk with toes pointed out
Walk with toes pointed in
Take a shorter than normal stride
Walk with both arms beside body

33. Popcorn and Movies
Illustration: Pistol Pete, Oklahoma State University Cowboys mascot, and his bowlegs in chaps.

34. Hemiplegia Click on link below to see Hemiplegic gait
Downloaded from McGill Medical Gait Disorders site
Video clip of older woman with right side hemiplegia sitting in chair with quad cane in her left hand. She rises from chair and walks across room from the left to right of screen and returns and sits in her chair.

35. Drop Foot Click on link below to see Drop foot gait
Downloaded from McGill Medical Gait Disorders site
Video clip of an elderly woman with left side drop foot. She is walking with the aid of a cane in her right hand and moves from the right to left side of the screen. As the subject walks one can note the exaggerated lifting of her left knee and hip to get the clearance needed for the dropping foot.

36. Parkinson’s Click on link below to see Parkinson’s gait
Downloaded from McGill Medical Gait Disorders site
Video clip of older woman with Parkinson’s sitting in chair at the left of the screen. An aide is standing on the woman’s left side . The subject rises from chair and walks across room from left to right with the aide walking along side lightly holding onto the subject’s left elbow. The subject is taking slow, short steps with no arm swing. The subject turns and returns walking from the right to left of screen and then sits down in her chair.

37. Limp
Video clip: Video clip of an elderly farmer pushing a wheel barrow. He has a noticeable limp while walking.

38. Writing your observations
Describing what you see.
What’s the functional problem? (Not DX)
What’s the impact of the problem?
What’s the recommendation (s)?
Estimate the “costs”
Energy expenditure=fatigue
Orthopaedic costs= mechanical wear and tear
Functional costs= Walking safety/stability/mobility
Refer for professional analysis (PT)

39. Describing what you see
“ Mr. Jones was observed walking today across a level dirt and gravel surface between his home and workshop. I observed the following difficulties as he was walking” :
Mr. Jones was using a quad cane to ambulate.
He was walking with a wide base of support.
While advancing his right leg while, his right forefoot was striking the ground and he was circumducting his leg.
He has a decreased step length and he walks very slowly.

40. Estimating the Costs…
“Because Mr. Jones has difficulty in walking from his home to the workshop, he becomes more fatigued (energy cost), he appears to be placing more weight over his left leg to compensate for right sided weakness (wear and tear), and he has problems maintaining his balance while walking to reach his workplace (functional cost).”

41. Referral
“ Mr. Jones should be referred to a physical therapist for a professional analysis of his gait to determine if…
He is using the appropriate assistive device.
He needs further remediation/improvement in his gait.
To improve his balance and mobility for functional activities.
To determine the need for orthotic devices.

42. Recommendations and Justification
“Mr. Jones may need a powered mobility device to enable him to get to his farm work spaces to:
Prevent physical fatigue.
Enable him to have increased mobility in getting to his work locations.
Prevent secondary injury from additional biomechanical stress on his non-affected limb.
Keep him safer when moving from his home to the worksite.

43. Farm gait contexts Gait is dynamic. How does it change if:
On uneven terrain?
Carrying a bucket?
Walking with a feed sack on one shoulder?
Slippery surfaces?

44. Adaptations Personal assistive device Farm mobility device
Community mobility
Photograph: An occupational therapist and a farmer with hemiplegia using a lofstrand crutch are preparing to walk away from a chair. The farmer is wearing a gait belt used for assisting him ambulate.