Gait Training - I

Normal Gait & Abnormal Gait

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Abnormal gait Stance phase Antalgic gait 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 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

Hyper-extended 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 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 Narrow base (< 2 inch) Spasticity Genu varum Genu valgum

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

Scissor 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.