Gait pt. 2. Kinematic deviations

Key elements of gait (stance phase)

Extension at the hip with DF at the ankle to move the hip forward. Lateral horizontal shift of the pelvis to the stance side. Flexion at the knee during loading & again during terminal stance. Extension of the knee during mid stance. PF at heel contact, followed by DF (shank moving over the stance foot) then PF at push off

Key elements of gait (swing gait)

Flexion at the hip, knee and ankle. Drop in pelvis at toe-off on swing side. Rotation of pelvis forward on swing side. Extension of knee & DF of ankle just prior to heel contact

Gait parameters to document

Supervision/assistance. Distance. Equipment. Cadence/speed. Step length. BOS. Shoulder position. Arm swing. Trunk movement

Common kinematic deviations

Decreased hip extension in late stance. Increased lateral pelvic shift.Decreased lateral pelvic displacement. Hyperextending knee. Increased knee flexion. Decreased PF at toe off. Decreased hip flexion. Decreased knee flexion. Decreased knee extension prior to heel strike. Decreased dorsiflexion

Kinematic deviation cause: Decreased hip extension in late stance

Overactive hip flexors. Weak hip extensors. Tight flexors/contractures. Reduces contralateral step length. Increased knee flexion/weak quads. Reduced forward progression of limb (DF in stance phase)

Kinematic deviation cause: Increased lateral pelvic shift

Weak glute med. Reduced flexion / extension. Shortening / overactivity of abductors

Kinematic deviation cause: Decreased lateral pelvic displacement

Weak hip extensors. Reduced loading of stance leg

Kinematic deviation cause: Hyperextending knee

Weak hamstrings.Weak/overactive quads. Weak glutes. Df, overactive PF, pf contractures. Proprioceptive deficits

Kinematic deviation cause: Increased knee flexion

Weak quads. Knee flexor overactivity. Weak calves.Reduced DP. Pain. Reduced hip flexion. Tight hip flexors

Kinematic deviation cause: Decreased PF at toe off

Weak gastroc-soleus. Pain. Lack of foot proprioception. Reduced knee flexion. Reduced hip extension.

Kinematic deviation cause: Decreased hip flexion

Weak hip flexors. Reduced DF. Decreased push off at terminal stance

Kinematic deviation cause: Decreased knee flexion

Decreased knee flexors (h/s) strength. Overactive/spastic quads. Reduced pre swing knee flexion. Co-contraction. Poor push off. Overactive PF

Kinematic deviation cause: Decreased knee extension prior to heel strike

Weak quads. Reduced knee ROM. Decreased gait speed/momentum. Weak hamstrings. Hamstring overactivity

Kinematic deviation cause: Decreased dorsiflexion

Weak dorsiflexors. Overactive/shortening gastroc-soleus / PF. Reduce proprioception/ sensation. Decreased hip extension (affects mid stance > swing phase)

Kinematic deviation interventions

Strengthen whats weak. Eccentric strengthening / stretching for spasticity. Flexibility / joint mobs/ stretching for ROM. Task specific

Prevention of secondary impairments: Muscle length changes & joint stiffness

Stretches of calves. Gastroc - standing. Soleus - sitting/ STS training. Hip flexors - prone lying; over edge of bed stretch. Use of moon boot if required in bed (only when asleep). Joint mobilisations

Prevention of secondary impairments:overactivity /compensation of unaffected side

Facilitate even weight bearing during STS, standing, walking. Encourage active movement duriing bed mobility tasks

Prevention of secondary impairments: Learned non-use

Discourage use of walking aids in early stages, discourage use of propelling wheelchair with unaffected arm & leg - balance this with patient's independence

Secondary impairments to prevent

Muscle length changes & joint stiffness, overactivity /compensation of unaffected side, learned non-use