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GAIT. Margo Prim Haynes, PT, DPT, MA, PCS Mary Rose Franjoine, PT, DPT, MS, PCS 2009. Overview. Definitions Video of typical gait Developmental changes Gait cycle Ground reaction force vectors Atypical gait Lab . Learning Objectives.

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slide1

GAIT

Margo Prim Haynes, PT, DPT, MA, PCSMary Rose Franjoine, PT, DPT, MS, PCS

2009

overview
Overview
  • Definitions
  • Video of typical gait
  • Developmental changes
  • Gait cycle
  • Ground reaction force vectors
  • Atypical gait
  • Lab

Margo Prim Haynes & Mary Rose Franjoine

learning objectives
Learning Objectives

At the conclusion of this lecture the learner will:

  • Describe the characteristics of early gait.
  • Describe the key developmental factors that influence the development and refinement of gait.

3 . Identify and describe the characteristics of typical gait differentiating components of stance phase from swing phase.

4. Visually identify key components of typical gait.

5. Describe the impact of ground reaction forces on the stance limb.

6. Discriminate typical from atypical components of gait.

7. Design intervention strategies to address key impairments that contribute to an atypical gait pattern.

Margo Prim Haynes & Mary Rose Franjoine

an early walker
An Early Walker

Video Clip

Margo Prim Haynes & Mary Rose Franjoine

characteristics of early gait
Characteristics of Early Gait
  • BOS wider than hips, therefore hindfoot pronation (eversion) results
  • Contact with floor occurs with foot flat
    • Heel to toe gait develops by 2 yrs/ process complete by 3.5 yrs
  • Uneven step length

Margo Prim Haynes & Mary Rose Franjoine

characteristics of early gait6
Characteristics of Early Gait
  • Hyperextension of knees throughout stance phase
  • Greater ant.-post. pelvic movement
  • Less lateral (pelvic tilting ) & rotational pelvic movement

Margo Prim Haynes & Mary Rose Franjoine

characteristics of early gait7
Characteristics of Early Gait
  • Greater hip & knee flexion with abduction & external rotation of hip and tibia during swing phase

Margo Prim Haynes & Mary Rose Franjoine

characteristics of early gait8
Characteristics of Early Gait
  • Upper Extremities (UE) in high, medium, then low guard with improved trunk balance
  • Reciprocal arm swing developing at 18 months

Margo Prim Haynes & Mary Rose Franjoine

kinematic changes between 1 7 years of age
Kinematic Changes between 1 - 7 Years of Age
  • ↑ duration of single limb stance (esp. to 2.5 yrs)
  • ↑ walking velocity (esp. to 3.5 yrs)
  • ↓ cadence and its variability
  • ↑ step length (esp. to 2.5 yrs)
  • Ratio of body width to stride width: ↑s rapidly until 2.5 yrs, more slowly to 3.5 yrs, then plateaus

Margo Prim Haynes & Mary Rose Franjoine

indicators of mature gait
Indicators of Mature Gait
  • Greater % time in single limb stance with increased limb length and stability
  • Increased velocity
  • Decreased cadence
  • Greater step length
  • Decreased base of support

Margo Prim Haynes & Mary Rose Franjoine

slide11
Gait

Video

Margo Prim Haynes & Mary Rose Franjoine

slide12

40% of cycle

60% of cycle

Margo Prim Haynes & Mary Rose Franjoine

Perry 1992

gait cycle
Gait Cycle
  • Typical walking has 50-60 steps taken per minute
  • Two phases
    • Stance phase
    • Swing phase

Margo Prim Haynes & Mary Rose Franjoine

stance phase
Stance Phase
  • Heel contact (weight acceptance) to toe off
  • 60% of gait cycle

Margo Prim Haynes & Mary Rose Franjoine

swing phase
Swing Phase
  • Toe off to before heel strike
  • 40% of gait cycle

Margo Prim Haynes & Mary Rose Franjoine

quiet standing
Quiet Standing
  • Slow shifting of body weight between limbs due to cardiac dynamics & lack of absolute proprioception
    • Feet generally parallel
    • COG slightly anterior to the ankle joint
      • Tendency for trunk to move forward & plantarflexors (pf) must hold to stand in place
      • To move, pf must “let go” (very difficult for children to do with CP as they rely on extension to stay up)

Margo Prim Haynes & Mary Rose Franjoine

functional phases of gait
Stance Phase (60%)

Initial contact

Loading response

Single limb stance

Midstance

Terminal stance

Pre-swing=toe off

Swing Phase (40%)

Pre-swing

Initial swing

Midswing

Terminal swing

Functional Phases of Gait

Margo Prim Haynes & Mary Rose Franjoine

initial contact
Initial Contact
  • The instant at which foot touches floor
  • Ankle locked in supination
    • Adduction, inversion, and plantarflexion

Margo Prim Haynes & Mary Rose Franjoine

loading response
Loading Response
  • Begins immediately after heel contact (heel strike) & continues until other foot is lifted for swing (foot flat)
    • Ankle unlocked in pronation (abduction, eversion, and dorsiflexion
  • Double Stance
  • Deceleration

Margo Prim Haynes & Mary Rose Franjoine

single limb stance
Single Limb Stance
  • Period of time when opposite limb is going through swing phase
  • Foot/ankle moves to locked position of supination preparing the foot and ankle for push off.

Margo Prim Haynes & Mary Rose Franjoine

weight bearing surface of foot
Weight bearing Surface of Foot
  • At heel contact, weight is lateral to the midline of the heel
  • Weight moves forward in a straight line towards head of third metatarsal
  • Then weight shifts medially to allow push off from first metatarsal head when initial swing begins

Margo Prim Haynes & Mary Rose Franjoine

weight bearing surface of foot22
Weight Bearing Surface of foot

Margo Prim Haynes & Mary Rose Franjoine

pre swing
Pre-Swing
  • Begins with initial contact of opposite limb and ends with ipsilateral toe-off

Margo Prim Haynes & Mary Rose Franjoine

initial swing
Initial Swing
  • Begins with lift of the foot from the floor and ends when swinging foot is opposite the stance foot

Margo Prim Haynes & Mary Rose Franjoine

midswing
Midswing
  • Begins when swing limb is opposite stance limb and ends when swinging limb is forward and tibia is vertical

Margo Prim Haynes & Mary Rose Franjoine

terminal swing
Terminal Swing
  • Begins with vertical tibia and ends when foot contacts (strikes) the floor

Margo Prim Haynes & Mary Rose Franjoine

sinusoidal pattern
Sinusoidal Pattern
  • Limb motion during walking is based on maintaining a symmetric and low amplitude displacement of the center of gravity (COG) in the lateral and vertical directions.
    • Initial Contact
    • Double limb support
    • Midstance

Margo Prim Haynes & Mary Rose Franjoine

slide28

Sinusoidal Pattern

Perry, 1992

Margo Prim Haynes & Mary Rose Franjoine

sinusoidal pattern29
Sinusoidal Pattern
  • COG:
    • Lowest during initial contact
    • Central and low during double limb support
    • Highest and most lateral in midstance
    • Moves 4 cm medial-lateral shift, 2 cm vertical shift

Margo Prim Haynes & Mary Rose Franjoine

ground reaction force vectors grfv
Ground Reaction Force Vectors(GRFV)
  • Determines the stability or instability by relating alignment of GRFV to the joint centers
  • Ankle gains stability with 5° dorsiflexion
  • Three forces (body vectors)
    • Falling body weight
    • Ligamentous tension
    • Body vector as passive stability when the joints are hyperextended

Margo Prim Haynes & Mary Rose Franjoine

slide31

Body vector as passive stability

when the joints are

hyperextended

Joints are locked by body

weight vector on one side

and ligamentous tension

on the other.

This explains the posture of the child with hypotonicity

← iliofemoral ligament

Posterior oblique ligament →

Perry 1992

Margo Prim Haynes & Mary Rose Franjoine

slide32

Ground Force Reaction Vector

Initial contact to loading

Margo Prim Haynes & Mary Rose Franjoine

Perry 1992

slide33

Muscle Activation

Perry 1992

Margo Prim Haynes & Mary Rose Franjoine

critical events for
Critical Events for:
  • Initial contact is heel first contact

Margo Prim Haynes & Mary Rose Franjoine

critical events for35
Critical Events for:
  • Loading response is hip stability, controlled knee flexion, and plantarflexion

Margo Prim Haynes & Mary Rose Franjoine

slide36

Ground Force Reaction Vector

Perry 1992

Margo Prim Haynes & Mary Rose Franjoine

b

slide37

Muscle Activation

(muscles are more balanced,

therefore less hard work)

Perry 1992

Margo Prim Haynes & Mary Rose Franjoine

b

critical events is
Critical Events is:
  • Controlled tibial advancement to create a forward fall position.

Margo Prim Haynes & Mary Rose Franjoine

slide39

Ground Force Reaction Vector

Perry 1992

Margo Prim Haynes & Mary Rose Franjoine

c

slide40

Muscle Activation

Margo Prim Haynes & Mary Rose Franjoine

Perry 1992

c

critical events is to have
Critical Events is to have
  • Ankle locked in dorsiflexion with heel rise; trailing limb
  • Ankle mobility
  • (This is where the children with plantarflexion contractures have problems)

Margo Prim Haynes & Mary Rose Franjoine

gait analysis
Gait Analysis
  • Observation
  • Pedograph
  • Motion analysis
  • Dynamic electromyography
  • Force plate recordings
  • Energy cost measurement

Margo Prim Haynes & Mary Rose Franjoine

five determinants of gait
Five Determinants of Gait
  • Lateral pelvic movement (gluteus medius prevents positive Trendelenberg)
  • Rotational pelvic movement (one side moves forward of the other side to minimize vertical shift of the COG, allows for stride length)
  • Knee flexion(allow for limb length adjustment)
  • Knee/ankle/foot interactions (minimizes the vertical shift of the COG)
  • Physiologic valgus (narrows BOS)

Margo Prim Haynes & Mary Rose Franjoine

five determinants of gait44
Five Determinants of Gait
  • Lateral pelvic movement (gluteus medius prevents positive Trendelenberg)
  • Rotational pelvic movement (one side moves forward of the other side to minimize vertical shift of the COG, allows for stride length)
  • Knee flexion(allow for limb length adjustment)
  • Knee/ankle/foot interactions (minimizes the vertical shift of the COG)
  • Physiologic valgus (narrows BOS)

Margo Prim Haynes & Mary Rose Franjoine

five determinants of gait45
Five Determinants of Gait
  • Lateral pelvic movement (gluteus medius prevents positive Trendelenberg)
  • Rotational pelvic movement (one side moves forward of the other side to minimize vertical shift of the COG, allows for stride length)
  • Knee flexion(allow for limb length adjustment)
  • Knee/ankle/foot interactions (minimizes the vertical shift of the COG)
  • Physiologic valgus (narrows BOS)

Margo Prim Haynes & Mary Rose Franjoine

five determinants of gait46
Five Determinants of Gait
  • Lateral pelvic movement (gluteus medius prevents positive Trendelenberg)
  • Rotational pelvic movement (one side moves forward of the other side to minimize vertical shift of the COG, allows for stride length)
  • Knee flexion(allow for limb length adjustment)
  • Knee/ankle/foot interactions (minimizes the vertical shift of the COG)
  • Physiologic valgus (narrows BOS)

Margo Prim Haynes & Mary Rose Franjoine

five determinants of gait47
Five Determinants of Gait
  • Lateral pelvic movement (gluteus medius prevents positive Trendelenberg)
  • Rotational pelvic movement (one side moves forward of the other side to minimize vertical shift of the COG, allows for stride length)
  • Knee flexion(allow for limb length adjustment)
  • Knee/ankle/foot interactions (minimizes the vertical shift of the COG)
  • Physiologic valgus (narrows BOS)

Margo Prim Haynes & Mary Rose Franjoine

five determinants of gait48
Five Determinants of Gait
  • Lateral pelvic movement (gluteus medius prevents positive Trendelenberg)
  • Rotational pelvic movement (one side moves forward of the other side to minimize vertical shift of the COG, allows for stride length)
  • Knee flexion(allow for limb length adjustment)
  • Knee/ankle/foot interactions (minimizes the vertical shift of the COG)
  • Physiologic valgus (narrows BOS)

Margo Prim Haynes & Mary Rose Franjoine

bibliography
Bibliography
  • Perry J: Gait Analysis Normal and Pathological Function, NJ: SLACK Inc. 1992
  • Shumway-Cook & Woollacott: Motor Control Theory and Practical Applications, Baltimore: Williams & Wilkins, 1995
  • Sutherland D: Gait Disorders in Childhood and Adolescence, Baltimore: Williams & Wilkins, 1984
  • Weber & Weber: Mechanics of the Human Walking Apparatus, Berlin: Springer-Verlag, 1992

Margo Prim Haynes & Mary Rose Franjoine

slide50
Original Template designed by:
  • Margo Prim Haynes, PT, DPT, MA, PCS
  • Jane Styer Acevedo, PT

Margo Prim Haynes & Mary Rose Franjoine