Gait Cycle strengthening or stretching, electrical

Purpose of Gait Analysis stimulation, balance training, surgical

1. To assist with understanding the gait procedures, and medication will affect
characteristics of a particular disorder. gait
This includes the following:  Determining the effectiveness and fit of
 Obtaining accurate descriptions of gait devices or equipment selected in
patterns and gait variables typical of providing joint protection and support,
different conditions correcting deviations and dysfunctions,
 Identifying and describing gait deviations reducing energy expenditure, and
present, or typically present in specific promoting safe locomotive function.
disorders Gait terminologies
 Determining balance, endurance, energy The Gait cycle
expenditure, and safety - Fundamental unit of walking
 Determining the functional ambulation - Has both spatial (distance) and temporal
capabilities of the patient in relation to (time) parameters
functional ambulation demands of the - N WALKING  gait cycle  begins when
home, community, and work the heel of the reference extremity
environments contacts the supporting surface  ends
 Classifying the severity of disability when heel of the same extremity contacts
 Predicting a patient’s future status the ground again
2. To assist with movement diagnosis by: - IN ABNORMAL GAIT  feel may not be the
 Identifying and describing gait deviations first part of the foot to contact the
and de- scribing the differences between ground  gait cycle begins when some
a patient’s performance and the other portion of the reference limb
parameters of normal gait contacts the ground  ends with the
 Analyzing gait deviations and identifying next ipsilateral contact of the portion of
the mechanisms responsible for the foot with the ground
producing them - TWO PERIODS: stance and swing
 Examining balance, endurance, energy - N WALKING:
expenditure, and safety and determining o STANCE: 60% of gait cycle;
their impact on gait defined as the interval in which
3. To inform selection of intervention(s) by the reference foot is in contact
guiding the therapist in: with the ground
 Proposing appropriate treatment of o SWING: 40% of gait cycle; occurs
impairments that may improve gait when the reference limb is not in
performance contact with the ground
 Determining the need for adaptive, - Initial double limb stance  occurs at the
assistive, orthotic, prosthetic, protective, beginning of the gait cycle as weight
or supportive devices or equipment transfers onto the out- stretched
4. To evaluate the effectiveness of treatment reference limb from the trailing limb
and guide the therapist in: - Terminal double limb stance  occurs at
 Determining how interventions such as the end of stance as body weight
therapeutic exercise, endurance transfers from the trailing reference limb
activities, developmental activities, to the lead limb.
 (Initial double limb stance on the
reference limb corresponds with the
contralateral limb’s terminal double limb
stance.)
- Single limb support  arising between the
two double limb stance periods, is the
portion of the gait cycle when only one
limb supports body weight.
- The duration of each of these variables may
be measured, for example,:
o cycle time
o stance time (right and left)
o swing time (right and left)
o initial double limb stance time
o terminal double limb stance time
o and single limb support time
- stride  two steps, a right step and a left
step; is equal to a gait cycle
- step length is the distance from the point
of heel strike of one extremity to the
point of heel strike of the opposite
extremity
- stride length  distance from the point of
heel strike of one extremity to the point
of heel strike of another extremity
- stride time and step time  refers to the
length of time required to complete a
step and a stride, respectively
 Phases of Gait
Comparison of Gait terminologies
Ranchos Los Amigos Traditional
stance Initial Contact: Beginning of stance when heel or some other Heel Strike: Beginning of stance when
portion of foot contacts ground. Component of initial double heel first contacts ground
limb stance.
Loading Response: Body weight rapidly loads onto lead limb Foot Flat: Immediately follows heel
from trailing limb. Hip remains stable, knee flexes to absorb strike when sole of foot contacts floor
shock, and forefoot lowers to ground. Immediately follows
initial contact and is final component of initial double limb
stance. Ends when opposite limb lifts from ground for swing.
Mid Stance: Trunk progresses from behind to in front of ankle Midstance: Point at which body passes
over single stable limb. First half of single limb support. Starts directly over reference extremity.
when contralateral foot lifts from ground for swing.
Terminal Stance: Trunk continues forward progression Heel Off: Point following mid stance
relative to foot. Heel rises from ground and limb achieves when reference limb’s heel leaves
trailing limb posture. Second half of single limb support. Ends ground.
with contralateral initial contact

Swing Pre-swing: Body weight rapidly unloads from reference limb Toe Off: Point following heel- off when
and reference limb prepares for swing during this terminal only the reference limb’s toe is
double limb stance period. Starts with contralateral initial contacting ground
contact and ends at ipsilateral limb toe off.

Initial Swing: Starts when reference foot lifts from ground. Acceleration: Beginning portion of swing
Hip, knee, and ankle rapidly flex for clearance and from reference limb toe off to point
advancement during this initial 1/3 of swing. when reference limb is directly under the
body.
Mid Swing: Thigh continues advancing, knee begins to Mid swing: Portion of swing when
extend, and ankle achieves neutral posture during this middle reference limb passes directly below
1/3 of swing. body. Extends from the end of
acceleration to beginning of
deceleration.
Terminal Swing: During this final 1/3 of swing, knee achieves Deceleration: Portion of swing when
maximal extension and ankle remains at neutral in reference limb is decelerating in
preparation for heel first initial contact. Ends when foot preparation for heel strike
contacts ground.

STANCE PHASE: impact forces associated with body weight

Initial double limb stance (weight acceptance): loading onto the limb.
1. INITIAL CONTACT  when an outstretched *initial double leg stance ends when the
limb first hits the ground foot opposite the reference limb lift from
2. LOADING RESPONSE  body weight is the ground for swing.
rapidly accepted onto the outstretched limb; Single limb support (one limb being in
small wave of knee flexion helps dissipate the contact with the ground):
3. MIDSTANCE  body weight progresses b. knee continues to extend until
forward over a single stable limb observationally appears neutral
4. TERMINAL STANCE heel rises from the
ground, the leg achieves a “trailing limb” c. ankle remains as neutral in
posture, and the trunk advances well in front preparation for a heel first initial
of the reference foot. contact
SWING PHASE:
Terminal double limb stance (push-off):
5. PRE-SWING body weight transfers from
the trailing limb to the contralateral lead limb,
which is experiencing initial contact and
loading response;
- As the proportion of body weight supported
by the trailing limb diminishes, residual
energy stored in the Achilles tendon
during mid and terminal stance rapidly
plantarflexes the ankle despite a lack of
significant plantar flexor muscle activity
- The knee flexes to 40°, over half of the 60°
required for foot clearance during the
subsequent phase
- ----------------------------------------------------
6. Initial swing lifting of the foot from the
ground reflects the onset of the first phase of
swing; rapid flexion and hip ensue

7. mid swing 

a. thigh continues to advance into

flexion, achieving a peak of
approximately 25° relative to vertical

b. knee begins to extend

c. tibia achieves a characteristic vertical

position by the end of mid swing

d. ankle reaches neutral (0° dorsiflexion)

8. terminal swing

a. thigh flexion is curtailed

HIP: NORMATIVE SAGITTAL PLANE DATA AND IMPACT OF WEAKNESS
PHASE CHARACTERISTIC INTERNAL NORMATIVE MUSCLE EFFECT)S) OF POSSIBLE
JOINT POSITION JOINT ACTIVITY WEAKNESS COMPENSATION(S)
(THIGH RELATIVE MOMENT
TO VERTICAL)
Initial 20° flexion Extensor - Single joint hip extensors - Difficulty stabilizing - Decrease terminal
moment and abductors contract pelvis and hip joint swing hip flexion to
contact vigorously to stabilize leading to anterior limit demands on
Loading 20° flexion pelvis and trunk over tilt and increased weak hip extensors
response femur. Hamstring activity hip flexion in during initial contact
diminishing sagittal plane and loading
response
- If abductors weak,
contralateral pelvic - Posterior trunk lean
drop may occur. to reduce extensor
moment

- For weak abductors,

may lean trunk
laterally toward
stance limb to
reduce abductor
demands

Mid Neutral Extensor - Residual hamstring activity Contralateral pelvic May lean trunk
moment assists with hip extension drop laterally toward stance
stance transitions at beginning of phase limb to reduce
to flexor abductor demands
moment - Low- level abductor activity
stabilizes pelvis

Terminal 20° apparent Increasing Low amplitude tensor fascia Contralateral pelvic May lean trunk
hyperextension flexor lata activity drop laterally toward stance
stance (anatomical hip moment limb to reduce
joint does not allow abductor demands.
20° extension, but
hip appears to be
extended 20° due
to the combined
impact of hip
extension,
backward pelvic
rotation, and
anterior pelvic tilt
on thigh angulation
relative to vertical)
Pre- 10° apparent Flexor Rectus femoris assists with
hyperextension moment early thigh advancement
swing
Initial 15° flexion Flexor Iliacus, adductor longus, With profound hip -To facilitate limb
moment gracilis, and sartorius flexor weak- ness clearance, may
swing actively advance thigh (less than 2/5), may compensate with
exhibit limited hip ipsilateral hip hiking
flex- ion, thigh
advancement, and -excess hip abduction,
foot clearance or contralateral limb
KNEE: NORMATIVE SAGITTAL PLANE DATA AND IMPACT OF WEAKNESS
PHASE CHARACTERISTI INTERNA NORMATIVE MUSCLE EFFECT)S) OF POSSIBLE
C JOINT L JOINT ACTIVITY WEAKNESS COMPENSATION(S)
\ POSITION (THIGH MOMENT
RELATIVE TO
VERTICAL)
Initial Appears fully Brief flexor Low-amplitude Reliance on
contact extended moment hamstring activity posterior capsule
(semimembranosus, to stabilize joint
semitendinosus, biceps and to prevent
femoris [long head]) hyperextension
resists knee
hyperextension
Loading 20° flexion Extensor Eccentric vastii activity Unable to Avoid knee flexion
response moment (vastus intermedius, stabilize knee (as flexion increases
vastus lateralis, vastus during flexion vastii demand) by
medialis longus, and leading to limb use of
oblique) allows knee collapse.
flexion for shock ab- - (1) excess
sorption but prevents plantarflexion
collapse.
- or (2) forward trunk
lean to lessen knee
extensor moment

Mid Appears fully Extensor Vastii activity ceases

stance extended moment by middle of mid
transitions stance.
to flexor
moment
Terminal Appears fully Flexor
stance extended moment
Pre- 40° flexion Extensor Rectus femoris
swing moment modulates rate of knee
flexion.
Initial 60° flexion Extensor Biceps femoris [short Limited knee Compensatory hip
swing moment head], gracilis, and flexion for foot hike, excess hip
sartorius contribute to clearance flexion, or abduction
knee flexion. to assist clearance

Mid 25° flexion Flexor Hamstrings modulate

swing moment rate of knee extension
(and thigh
advancement).
Terminal Appears fully Flexor Hamstrings continue With profound Past retract of thigh
swing extended moment activity and vastii be- vastii weakness or extension thrust of
come active in prepa- (less than 2+/5) knee to ensure full
ration for demands of may see knee extension.
initial double limb inadequate knee
stance. extension in
terminal swing.
HIP: NORMATIVE SAGITTAL PLANE DATA AND IMPACT OF WEAKNESS
PHASE CHARACTERISTIC INTERNAL NORMATIVE EFFECT)S) OF POSSIBLE
JOINT POSITION JOINT MUSCLE ACTIVITY WEAKNESS COMPENSATION(S)
(THIGH RELATIVE MOMENT
TO VERTICAL)
Initial Neutral (0° dorsi- Dorsiflexor Pretibial muscles - Borderline weakness - With borderline
contact flexion) moment (tibialis anterior, (3+/5) may be weakness, may slow
Loading 5° plantarflexion achieves extensor digitorum accompanied by a foot gait to decrease
response peak during longus, extensor slap following a heel demands on pretibial
loading hallucis longus) first initial contact muscles during
response decelerate forefoot loading response
lowering and draw - Profound weakness
tibia forward following (2+/5 or less) may - Alternatively, may
initial contact. result in foot flat or contact ground with
forefoot initial contact if excess plantarflexion
pretibial strength is to decrease
insufficient for demands on pretibial
achieving neutral ankle muscles.

Mid 5° dorsiflexion Plantar flexor -Plantar flexors - Excess dorsiflexion - Shortened step
stance moment (gastrocnemius, length
Terminal 10° dorsiflexion reaches soleus, flexor - uncontrolled tibial
stance peak during digitorum longus, advancement - slower velocity to
terminal flexor hallucis reduce demands on
stance longus, tibialis
posterior, peroneus - delayed or absent calf muscles
longus, and heel-off
peroneus brevis)
progressively - However, if vastii are
increase activity weak (vastus
throughout two intermedius, vastus
phases to allow lateralis, vastus
controlled forward medialis longus, and
progression of tibia. oblique)  may avoid
excess dorsiflexion as
-Elastic energy stored it would contribute to
in Achilles tendon. excess knee flexion
and high demand on
weakened vastii.

Pre- 15° plantarflexion Planta rflexor -Calf muscles cease - Low or no heel-off Use of more proximal
swing moment in early pre-swing muscles to prepare
reaches - lack of rapid limb for
peak during - Stored elastic plantarflexion advancement and
terminal energy in Achilles clearance
stance tendon contributes to
rapid plantarflexion
as limb unloads

Initial 5° plantarflexion Low Pretibial muscles - Excess plantar - Hip hike

swing dorsiflexor elevate foot to neutral flexion and foot
Mid Neutral moment by mid swing and drag, particularly - excess hip
swing then maintain in that in mid swing flexion or
Terminal Neutral posture. abduction to
swing - Poor posture for assist with limb
subsequent initial clearance
contact
- contralateral
vault (excessive
plantar flexion)
to facilitate
reference limb
clearance