Gait Assessment and Intervention Techniques for Neurological Disorders

stance

60% of gait cycle

single support time

time on one leg

double support time

time on both legs

swing time

40% of gait cycle

cadence

steps per min
~110 for men and 116 for women

speed

men ~ 1.37 m/s and women ~ 1.24 m/s

What phase of the gait cycle do neuro patients spend x2 more time in?

double support time

stride length

initial contact to initial contact of one leg
4.8 ft men, 4.2 ft women

step length

initial contact of one leg to initial contact of the other
2.4 ft men, 2.1 ft women

How many inches is width of BOS?

2-4

How many degrees typically is angle of toe out?

7

List the three essential requirements for gait.

upright postural control
progression
adaptation

What is the typical progression we are looking for in gait

Rhythmic
Reciprocal
Smooth
Momentum

pattern generators

reflexive, promotes rhythmical stepping

What are pattern generators controlled by

Brainstem and spinal cord

What are descending influences controlled by

cerebrum, basal ganglia, cerebellum, and brainstem

What is sensory feedback controlled by

somatosensation, proprioception, vision, and vestibular

What causes increased cognitive demands during gait

Increasing complexity of environment, speed of movement, and difficulty of task

What are the major tasks associated with the gait cycle

Weight acceptance
Single limb support
Limb advancement

weight acceptance

shock absorbed, momentum preserved, foot flat position achieved

What two subphases make up the weight acceptance phase of the gait cycle?

initial contact, loading response

What three muscles have peak demand during weight acceptance?

quads, glutes, anterior tibialis

During weight acceptance, what type of contractions do all peak demand muscles perform?

eccentric

single limb support

controls tibial advancement/tibial tilting

What two subphases make up the single limb support phase of the gait cycle?

mid stance, terminal stance

What muscle group has peak demand during the midstance subphase of single limb support?

hip abductors

What muscle has peak muscle demand during the terminal stance subphase of single limb support?

gastroc

During midstance of single limb support, what type of contraction does the gastroc perform?

eccentric

During terminal stance of single limb support, what type of contraction does the gastroc predominantly perform?

isometric

During terminal stance of single limb support, what type of contraction do the hip abductors perform?

concentric

In which phase of the gait cycle does the tibia experience the greatest angle of tilt?

terminal stance

swing limb advancement

rapid hip/knee flexion, toe clearance

What two muscle groups have peak demand during swing limb advancement?

hip flexors, hamstrings

What is walking speed for physiologic walker

0.1 m/s
0.2 mph

What is walking speed for limited household

0.23 m/s
0.5 mph

What is walking speed for unlimited household

0.27 m/s
0.6 mph

What is walking speed for most-limited community

0.4 m/s
0.9 mph

What is walking speed for least-limited community

0.58 m/s
1.3 mph

What is walking speed for community

0.8 m/s
1.8 mph

What are some test and measures used for gait analysis

Gait speed
2,6,12 min walk test
TUG
Gait portion on Tinetti
DGI
Functional Ambulation Category (FAC)
Step/Stride length

functional ambulation system; nonfunctional - person cannot walk or requires help of 2+ people

0

functional ambulation system; dependent level 2 - person requires firm, continuous support with 1 person to help with carrying weight and balance (mod assist)

1

functional ambulation system; dependent level 1 - person needs continuous or intermittent support from 1 person to help with balance or coordination (CGA/min assist)

2

functional ambulation system; dependent on supervision - person requires verbal supervision or standby help from 1 person without physical contact

3

functional ambulation system; independent on level ground - person can walk independently on level ground but requires help on stairs, slopes or uneven surfaces

4

functional ambulation system; independent - person can walk independently anywhere

5

excessive knee flexion/buckling during weight acceptance causes

quad weakness, glute weakness, knee flexion contracture, hamstring spasticity, flexion synergy

excessive knee flexion/buckling during weight acceptance intervention

quad/glute strength, emphasize eccentric loading, knee stretching

excessive knee extension during weight acceptance causes

severe quad weakness, extension synergy, plantarflexor spasticity/contracture

excessive knee extension during weight acceptance intervention

eccentric strength of quads/glutes, ankle ROM, bracing

forefoot contact/foot slap during weight acceptance causes

PF contracture, DF weakness, spasticity

forefoot contact/foot slap during weight acceptance intervention

ankle ROM, DF strengthening, bracing, functional e-stim

excessive knee flexion in single limb support causes

knee flexion contracture, flexion synergy, poor knee control

excessive knee flexion in single limb support intervention

quad strength, knee ROM, inner knee control work

excessive knee extension in single limb support causes

quad weakness, PF contracture/spasticity

excessive knee extension in single limb support intervention

quad strength, inner knee control, ankle ROM, bracing

Trendelenburg Sign in single limb support causes

weak hip abductors/extensors

Trendelenburg Sign in single limb support intervention

dynamic hip strengthening, body weight support

poor terminal stance/trailing limb position in single limb support causes

weak, spastic, contracted PFs, hip flexor contracture, poor gait speed

poor terminal stance/trailing limb position in single limb support interventions

PF strengthening, hip ROM, increase gait speed

poor hip/knee flexion, circumduction during swing limb advancement causes

hip/knee flexor weakness, extension synergy, failure to achieve trailing limb posture, slow gait speed

poor hip/knee flexion, circumduction during swing limb advancement intervention

hip/knee flexor strengthening, manual assistance, increase gait speed

poor toe clearance/toe drag during swing limb advancement causes

hip/knee flexor weakness, extension synergy, failure to achieve trailing limb posture, slow gait speed, DF weakness, PF contracture/spasticity

poor toe clearance/toe drag during swing limb advancement intervention

hip/knee flexor strengthening, manual assistance, increase gait speed, DF strengthening, and functional e-stim