Gait Patterns
explain NWB, PWB, and WBAT
NWB - injured limb does not contact ground
PWB - injured limb can bear 50% body weight
WBAT - place as much weight on the limb as tolerable
what is step to and step through
step to - person steps to gait aid (cane/crutch)
step through - person steps past their gait aid (crutches/canes/modified gait patterns)
what do you have to make sure is on before someone is walking
gait belt
shoes
What are the subdivisions of stance AND swing?
Stance: Loading response, mid-stance, terminal stance, pre-swing
Swing: Initial swing, mid-swing, terminal swing
TRUE OR FALSE: Initial contact always happens with the heel. If the heel does not strike first, then the patient did not achieve the initial contact instantaneous event.
FALSE
1) Heel strike does NOT always occur in patients, but this does not mean that initial contact does exist
2) Some patients will contact the ground with the forefoot or flatfoot -- this is still initial contact, but you must define that heel strike did not occur
explain 2 point gait
bilateral ambulation aids
simultaneous reciprocal forward movement of ambulatory aid and clients opposite LE
full WB bilaterally
step 1 - R crutch/cane with L foot advances
step 2 - L crutch/cane with R foot advances
Can you PWB with one cane or 2 canes?
you cannot PWB with one cane or with 2 canes
what side should crutches and yourself be on for sit to stand
affected side - wider BOS - more preferable
yourself - opposite side as crutches
What are the two instantaneous events in gait and approximately what % of the gait cycle do these occur at?
2) Toe off (62%)
What are the 4 functions of locomotion?
1) Propulsion
2) Stance stability
3) Shock absorption (attenuation)
4) Energy conservation
explain 4 point gait
3 points of contact on the ground, 4 points moving separately
Full WB
alternate and reciprocal forward movement of the ambulatory aid then the clients opposite LE then the other aid then the other LE
step 1 - R crutch/cane advances
step 2 - left foot advances
step 3 - left crutch/can advances
step 4 - right foot advances
explain the downside of walking aids
increased risk of falling
how do you measure crutches (estimate and verification)
bonus point - how do you measure a walker
extra bonus point - how do you measure a cane
estimate - patient sitting and shoulders abducted 90 degrees, with one elbow extended and other flexed to 90 degrees measure from olecranon process of flexed elbow to tip of long finger on the other arm
verification - standing in good alignment, place crutch alongside trunk with axillary piece under arm, 2-3 finger widths from axillary crease, tip of crutch should be 2 inches lateral and 4-6 anterior to toe, hand piece should come to distal wrist crease
walker - rear legs opposite to midportion fo feet, handles of walker to wrist crease
cane - place cane parallel to femur and tibia and 2 inches from foot (not tripod) but same as crutches
What is defined as one full gait cycle?
The time period from one event (usually initial contact) of one foot to the next occurrence of the same event with the same foot
What are the 3 benefits of arm swing in locomotion?
1) Balance recovery
2) Energetic efficiency: reduces energy cost of walking
3) Ground reaction moments: associated with decreased moments
explain 3 point gait
full WB on one LE, NWB on contralateral LE
walker, crutches are advanced simultaneously with the clients affected LE, affected LE does not take any weight
what is the evidence for walking aids
increase step length, comfortable and maximal walking speeds, improved cadence and improved symmetry
what gait aids can be used for the different walking patterns
3 point gait (NWB) →
Gait aids that can be used: Axillary crutches, lofstrand crutches, standard walker (sometimes more stable for older adults).
Modified 3 point gait (PWB) →
Gait aids that can be used: Axillary crutches, lofstrand crutches, standard walker, roller walker with 2 wheels.
Modified 3 point (WBAT – i.e. an injury restricting WB within pain limitations) →
Gait aids that can be used: Axillary crutches, lofstrand crutches, elbow crutches, standard walker, roller walker with 2 wheels, 2 standard canes (difficult to take much weight off of the lower extremity, hard on wrists, not recommended).
2 point gait (full WB) →
Gait aids that can be used: 2 standard canes, all forms of crutches.
4 point gait (full WB) →
Gait aids that can be used: 2 standard canes, all forms of crutches.
Modified 2 point gait (full WB) →
Gait aids that can be used: 1 standard cane, 1 walkane, 1 quad cane, 1 crutch any kind.
Modified 4 point gait (full WB) →
Gait aids that can be used: 1 standard cane, 1 walkane, 1 quad cane, 1 crutch any kind.
In addition to the stance and swing phases of gait, there is also a rocker system to define the progression of gait. What is the specific name of all the rockers and what is the correct order for these rockers to occur in a normal population?
1st rocker = heel rocker
2nd rocker = ankle rocker
3rd rocker = forefoot rocker
4th rocker = toe rocker
List the 5 temporal and distance factors of gait
1) Velocity
2) Step length
3) Cadence
4) Stride length
5) Toe-out angle
explain modified 2 point, 4 point, 3 point
modified 4 point gait - 1 ambulation aid and used in hand opposite to LE needing support
step 1 - advance L cane
step 2 - advance R foot
step 3 - advance L foot
modified 2 point gait - 1 ambulation aid in hand opposite to leg that is impaired, simultaneous motion of cane and opposite leg
step 1 - advance L cane and R foot
step 2 - advance L foot
modified 3 point - PWB/WBAT the walker, crutches are advanced simultaneously with the clients affected LE, affected LE takes partial weight (DO NOT REMOVE GAIT AID)
what are the physical requirements for successful ambulation
1. balance - must have dynamic standing balance
2. must be able to tolerate an upright position
3. needs adequate strength in UE, trunk, and LE
4. endurance to go functional distances
5. cognitively capable to be safe
describe teaching a patient to do the stairs with crutches
therapist is always facing up steps whether going up/down (behind patient as ascend and in front as they descend)
ascending - unaffected leg leads (affected leg and crutches stay behind)
descending - affected leg and crutches lead
GOOD up to heaven BAD down to hell
When you add a cane on the opposite side of the impairment, what class of lever does it create? Why is this more beneficial than having the cane on the impaired side?
Creates a second class lever
Using a cane on the opposite side gives you a longer lever arm. This lever arm creates a torque that helps life and stabilize the pelvis, therefore reducing the work the weaker/impaired side must do. It is both mechanically more efficient and helps to reduce pain.
The excursion of the center of mass is important for energy expenditure/conservation during gait. When is the COM the lowest and when is the COM the most lateral?
Lowest at IC and TST; most lateral at MST