1. دکترامیر هوشنگ واحدی متخصص طب فیزیکی و توانبخشی قسمت 1
Abnormal gait
دکترامیر هوشنگ واحدی
متخصص طب فیزیکی و توانبخشی
قسمت 1

2. pathologic gait is an inefficient mode of locomotion that usually requires considerably more energy than a normal gait.
Patients may adopt many kinds of abnormal movements to minimize their energy usage

3. Effects of pathological gait
Increased energy expenditure, body will use compensatory mechanisms to maintain balance
Position the center of gravity over the base of support
Use other body movements to allow clearance of foot and forward progression of body

4. Etiology of pathological gait
1. Muscle weakness
2. Contractures or deformities
3. Spasticity
4. Joint instability
5. Skeletal instability
6. Shortening (LLD)
7. Impaired motor control (from the brain)
8. Sensory loss
9. Pain

5. Classification of Gait Abnormalities
Anatomical Classification
Functional Classification
Pathological Classification

6. Anatomical Classification
Region
Sagittal
Frontal
Transverse
Foot
Toe flexion
Pes planus/supinatus
In/out-toeing
Ankle
Equinus, Drop foot Excessive dorsiflexion
Varus/Valgus
Tibia
Tibial Torsion
Knee
Stiff knee Recurvatum Abnormal loading
Femur
Femoral Anteversion
Hip
Forward trunk flexion
Tendelenberg sign
Pelvis
Anterior/posterior tilt
Rotation
Spine
Lordosis/kyphosis
Duchenne sign
Scoliosis
Arms
Abnormal swing

7. Functional Classification
Velocity
Stride Length
Cadence
Stance Duration
Step Length
Step Time
Step Width
Antalgic
Low
Short
Fast
Long
Wide
Unstable
Compensated
Normal
Uncompensated
Apropulsive
Reduced

8. Pathological Classification
Pathology
Predominantly Symmetrical
Predominantly Assymetrical
Upper motoneuron (UMN)
Diplegia Quadriplegia
Hemiplegia
Brain Stem
Ataxic
Lower motoneuron (LMN)
Spina Bifida
Femoral nerve palsy
Sensory
Neuropathy
Basal Ganglia
Athetoid
Cortical
Apraxia
Orthopedic
Anteversion Tibial torsion
Congenital Dislocation (CDH)
Amputee
Trans-tibial Trans-femoral

9. Abnormal gait in relation of anatomical abnormalities
Cortex : circumduction gait, Apraxic gait
Spinal cord: scissoring gait
Peripheral nerves: motor fiber foot drop,high step gait
sensory fiber : sensory ataxia
NMJ: waddling gait
Muscle: waddling gait
Basal ganglia: short step gait, Shuffling gait
Cerebellum: cerebellar ataxia,Tandem gait
Joint and bone: Limping gait

11. Antalgic Gait
Gait pattern in which stance phase on affected side is shortened
Corresponding increase in stance on unaffected side
avoidance of bearing full weight on the affected leg
limitation of range of movement

12. Antalgic gait Conditions associated
Trauma
Osteoarthritis
Pelvic girdle pain
Coxalgia
tarsal tunnel syndrome

13. Apraxic gait difficulty initiating a step freezing
feet almost stuck to floor
turn hesitation
shuffling gait
hypokinesia
muscular rigidity
grasp reflexes
possible resting tremor, dementia or urinary incontinence

14. Gait cadence disturbances
During all phase of gait cycle
Stride length and time spent on the affected limb differ from those in the contra lateral limb or from a normal gait
Pain of falling:
During stance phase patient takes a short, rapid step with the affected leg
Correspondingly, slower step with sound leg

15. Cadence Disturbances
Neurological disease:
Ataxia, cerebrovascular disorders, proprioceptive deficits and spasticity, impaired balance
Unequal length:
Skeletal shortening, contracture, tendon shrinkage, locked joints or ankle joint stops introduce asymmetry into the gait

16. Unilatera=Trendelenberg gait Bilateral = waddling gait
Lateral Trunk bending
Unilatera=Trendelenberg gait
Bilateral = waddling gait
Patient leans towards the affected stance leg as weight is transferred

17. Trendelenburg Gait
Weak hip abductors cannot do this and compensate by tilting trunk to weight bearing side, shifting CoG closer to hip joint
During stance phase in coronal plane
Pelvis tilts laterally towards the over stand leg

18. Common causes: 1.Painful hip 2.Hip abductor weakness
3.Leg-length discrepancy
4.Abnormal hip joint
5.Hip Abductor contracture
6.Hip dislocation