Transcript Gait Aids
Gait & Gait Aids Associate professor shereen algergawy Rheumatology and rehabilitation department Normal Gait & Abnormal Gait Why we should know “Normal Gait” If we have sound knowledge of the characteristics of normal gait We can accurately detect & interprete deviations from the normal gait pattern 60% 40% 60% 40% 20-25% Stride width 5-10cm Cadence 70-130 step/min Abnormal gait Stance phase Antalgic Lateral trunk bending Anterior trunk bending Posterior trunk bending Lordosis Hyperextended knee Excessive knee flexion Excessive Genu Valgum or Varum Inadequate Dorsi-flexion control Insufficient Push-off Abnormal walking base Internal or external limb rotation Excessive medial or lateral foot contact Vaulting Swing phase Circumduction Hip hiking Internal or external limb rotation Inadequate Dorsiflexion control Abnormal walking base Antalgic gait Pain in stance phase : knee, hip, foot pain Lateral trunk bending Hip abductor weakness Hip dislocation, coxa vara, slipped capital femoral epiphysis Hip pain Perineal pressure Involved limb relatively shorter Compensation for abducted gait Trendelenberg gait Gluteus Medius Gait Anterior Trunk Bending Quadriceps weakness combined with weakness of gluteus maximus, gastrocnemius, or both Pushing backward with the hand / lateral rotation Posterior Trunk Bending Gluteus Maximus (Lurch) Gait Hip-extensor weakness Knee ankylosis, spasticity or orthotic knee lock Hip-extensor spasticity Hyperextended knee Quadriceps weakness Capsular ligament laxity Quadriceps spasticity Plantar-flexion contracture or spasticity Compensation for contralateral limb shortening (hip-flexion or knee-flexion contracture) Excessive knee flexion Knee-flexion or hip-flexion contracture Knee-flexor spasticity Uncompensated quadriceps weakness Ankle ankylosis, pes calcaneus Plantar-flexor weakness Involved limb relatively longer Steppage gait Ankle dorsiflexor weakness : compensate by exaggerated hip and knee flexion Foot drop / dragging Slap foot Ankle dorsiflexor weakness : early stance phase Insufficient Push-Off Flat foot gait Plantar-flexor weakness Rupture of the Archilles tendon or the triceps surae Metatarsal pain, hallux rigidus Internal or External Limb Rotation Internal rotation Biceps femoris weakness spasticity External rotation Quadriceps weakness Inner hamstring weakness Spasticity Abnormal walking base Wide Base (> 4 inch) Hip-abduction contracture Instability due to fear, proprioceptive deficit, cerebellar problem Perineal pain Genu valgum Narrow base (< 2 inch) Spasticity Genu varum Vaulting Swing-phase limb is relatively longer Hip hiking Increased ipsilateral length: hip -flexor or dorsiflexor weakness hip, knee, ankle ankylosis or spasticity insufficient hip or knee flexion Contralateral shortness Circumduction Spasticity Hip flexor weakness Hamstring paralysis Knee or ankle ankylosis / orthotic knee lock Dorsiflexor weakness Plantar-flexion contracture Scissoring gait In spastic CP with spasticity of adductor m. Crouched Gait Excessive flexion of hip and knee due to spasticity, muscle tightness or contracture Spastic CP Parkinsonian gait Trunk ,head ,neck forward and knee flexed wide base ,small shuffling step trend to fall forward and to increase speed (festination) Hemiplegic gait Abnormal arm swing : adduction with flexion at shoulder ,elbow ,wrist and fingers extensor synergy of lower limb: leg extension ,adduction and hip IR ,knee extension ,ankle and foot plantarflexion and inversion. Gait aids Purpose of gait aids Increase area of support, maintain center of gravity over support area Redistribute weight-bearing area Requirements ROM, muscle strength and endurance, coordination, trunk balance, sensory perception, mental status Amount of weight-bearing permitted on lower limb Requirements Shoulder depressor – latissimus dorsi, lower trapezius, pectoralis minor Shoulder adductor – pectoralis major Shoulder flexor, extensor and abductor – deltoid Elbow extensor – triceps Wrist extensor – ECR, ECU Finger flexor – FDS, FDP, FPL, FPB Crutches Body weight transmission with bilateral axillary crutches = 80% of BW, nonaxillary crutches = 40-50% of BW Good strength of upper limbs usually required – more weight bearing and propulsion Unilateral non/partial weight bearing eg fracture, amputee -> 3-point gait Bilateral partial weight bearing or incoordination/ataxia -> 2 or 4-point gait Bilateral weakness of lower extremities eg paraplegia -> swing-to or through gait Non-axillary crutches Lofstrand/forearm crutches Platform crutch Wooden forearm orthosis (Kenny stick) Triceps weakness orthoses (arm orthoses) eg Warm Spring, Everett, Canadian crutch Axillary crutches Crutch length : measure anterior axillary fold to point 6 inches anterolaterally from foot or to heel plus 1-2 inches Hand piece : elbow flexed 30 degree, wrist max extension, finger fist 2-3 FB from apex of axilla Compressive radial neuropathies Lofstrand/forearm crutches Single aluminum tubular adjustable shaft, handpiece, forearm piece 2 inches below elbow, forearm cuff anterior opening (hinge) Elbow flexion 20 degree Can release hand without loosing crutch Requires great skill, good strength of UEs, trunk balance Platform crutch Painful wrist and hand condition or elbow contractures, or weak hand grip Platform, velcro strap Elbow flexed 90 degrees Crutch Gaits Point gait – stability, slow Swing gait – more energy, fast Four-point gait Good stability - at least 3 point contact ground Ataxia or incoordination Slowest, difficulty Three-point gait/alternating two-point gait Non-weight-bearing gait for lower limb fracture or amputation 3-point PWB gait -> required 18-36% more energy per unit distance than normal NWB required 4161%more energy per unit distance than normal Two-point gait Faster than 4-point gait but less stability Decrease both lower limbs weightbearing Swing-through gait Fastest gait, requires functional abdominal muscles Required increase of 41-61% in net energy cost (= 3point NWB) Swing-to gait Both crutches -> both lower limbs almost to crutch level Canes Body weight transmission for unilateral cane opposite affected side is 20-25% Gluteus medius weakness, or pathological at knee or ankle Cane eliminate necessary gluteus medius force and reduces compressional force on hip Measure tip of cane to level of greater trochanter, elbow flexed 20-30 degree Walker/Walkerette Wider and more stable base of support, but slow gait (interfere smooth reciprocal gait) For patients requiring maximum assistance with balance, uncoordinated Add wheels to front legs for who lack coordination or power in upper limbs Front of walker 12 inches in front of patient Shoulder relaxed and elbow flexed 20 degree Three-point gait