Observation
Why do we observe gait?
• Get a general sense of
mobility function
• Safety
• Identify potential deficits
• Plan physical examination
• Diagnostic value
• Outcome
Describe the Initial contact/heel strike
When the foot touches the ground, first phase of double support
Hip - 30 degree flexion, hip extensors, concentric
Knee - full extension, knee extensors, concentric
Ankle - dorsiflexors, eccentric
Describe the initial swing
--> Foot leaves the ground and limb moves forward
Hip - in flexion (hip flexors), concentric muscle contraction Knee - 40-60 degree flexion, knee flexors, concentric Ankle - moving to neutral, dorsiflexors, concentric
What do we observe?
- the overall picture (ie. shoes, surface, any aids being used etc)
- speed, step length, step width (ie. wide stance can be due to poor balance)
- walking posture (ie. trunk rotation, lateral flexion etc)
- what is happening at each joint (hip, knee, ankle)
- fine details (ie. what is happening at the pelvis or w/ the arms etc)
What is a timed up&go test?
Measures the time taken for a person to stand up from a chair, walk a short distance, turn around, walk back to the chair, and sit down again.
Measures gait + standing/turning components, functional mobility, dynamic balance against normative values & patient's previous attempts
What are common reference points when observing?
From side - alignment of ears (head position rleative to body); shoulders, pelvis, knees, feet, spinal curves)
From front - level of shoulders and hips; carrying angle of elbow; rotation. of hips, knees and feet
From behind - level of shoulder, level of scapula; level of pelvis, spinal curvature scoliosis
Describe the loading response/foot flat
- Body absorbs the impact of the foot
Hip - moving into extension, hip extensors, concentric
Knee - 10-15 degree flexion, knee extensors, eccentric
Ankle - 10-15 degree plantarflexion, dorsiflexors, eccentric
Describe the mid swing
correlates to mid stance phase on other leg
Hip - 30 degree hip flexion, hip flexors, concentric
Knee - knee begins to extend, knee flexors, eccentric
Ankle - neutral, dorsiflexors, concentric
Why can changes in gait occur?
• Musculoskeletal injuries or disorders, including osteoarthritis, fractures, strains and sprains
• Neurological Disorders, including stroke, Parkinson’s disease, Cerebral Palsy
What is a 6 minute walk test?
Measures the distance (in how many laps of a track) that a person can walk on a flat path in six minutes
Evaluates aerobic capacity, endurance against normative values
What is the difference between a step and a stride, and step width and cadence?
- step = initial contact of 1 foot until initial contact of the next foot
≠
stride = initial contact of 1 foot until that same foot makes initial contact again (aka 2 steps)
- step width = distance between both feet when they land
- cadence = nbr of steps per unit of time (mins)
Describe the Mid Stance
- Single support (standing on 1 leg)
- Transition from force absorption to propulsion
Hip - 0 degrees, hip extensors, concentric
Knee - extended, knee extensors, concentric
Ankle - plantargrade, plantar flexors, eccentric
Describe the end swing
just before foot makes contact w/ ground to start stance phase again
Hip - 30 degree hip flexion, hip extensors, concentric
Knee - knee extension, knee flexors, eccentric
Ankle - neutral, dorsiflexors, concentric
What is a 10-Meter Walk Test
Measures time to walk 10m (actually 14m but takes into account acceleration & deceleration of walking, timer starts after 2m and ends before last 2m)
Evaluates walking speed, step length, step width, stride length, cadence (steps per 1 minute) compared to avg walking speed of someone their age & gender
What is the stance phase?
begins when foot makes initial contact w/ the ground, (right leg always in contact w/ floor)
Purposes :
• Supports the upper body and prevents collapse
• Maintain balance
• Propulsion of the body
• Shock absorption
+ 2 periods of double stance (at start & end) : is where both feet are on ground
Describe the Terminal stance/Heel off
Body weight over the forefoot (heel is off the ground)
Hip - 10-15 degree extension, hip flexors, eccentric
Knee - slight flexion, knee flexors, concentric
Ankle -plantarflexion, plantarflexors, concentric
What is the swing phase?
begins when foot leaves the ground, (right leg is swinging)
Purposes :
Clear the foot from the ground (efficient process, clearing ground by only 1cm)
Prepare the foot for heel strike / initial contact
Describe the Pre-swing/Toe off
- final propulsion (driving leg forward)
Hip - moving into flexion, hip flexors, concentric
Knee - 35-40 degree flexion, knee extensors, eccentric
Ankle - 20 degree plantarflexion, plantarflexors, concentric