Gait Deviations

Overview of Gait Deviations

CLO 2: Analyze typical (normal) movement patterns and basic functional activities in varying environments across the lifespan.
7.1: Analyze typical gait using observational gait analysis terms from Rancho Los Amigos (RLA).
7.2: Describe aberrations from typical gait using gait parameters and RLA terminology.

Early Detection
- Identifying potential musculoskeletal problems early can prevent further complications and allow for timely interventions, which can improve patient outcomes.
- Regular assessments help in monitoring conditions that could develop into more serious issues.
Functional Assessment
- Evaluating overall mobility and balance provides insights into a patient’s functional capabilities, which is essential for determining rehabilitation needs.
- Understanding a patient’s functional limitations can aid in improving their daily activities and quality of life.
Intervention Planning
- Developing targeted treatment strategies tailored to individual needs is paramount in rehabilitation.
- Effective planning resonates well with patient engagement and adherence to therapy.
Outcome Measurement
- Assessing progress and effectiveness of interventions ensures that rehabilitation strategies are working and allows for adjustments as needed, enhancing patient care.

Musculoskeletal Impairments:
- Joint contracture/arthrodesis: limitations in joint mobility can significantly impact gait patterns.
- Body malalignments (bony): structural issues affecting the skeletal system can lead to compensatory gait mechanics.
- Weakness: lack of strength in specific muscle groups may hinder proper movement.
Motor Control Impairments:
- Motor planning & coordination issues can disrupt smooth transitions between gait phases.
Sensation Impairments:
- Hyper- or Hyposensitivity: altered skin sensitivity can modify gait patterns due to discomfort or apprehension.
- Impaired proprioception affects the body’s ability to know its position in space, crucial for balanced movement.
Pain or Discomfort:
- Pain resulting from injury or disease alters gait mechanics, often leading to compensatory strategies to avoid discomfort.

Evaluation Approaches
- Entering an evaluation with an expectation to find a deviation can bias observations; maintain an objective viewpoint.
- Observe gait with and without footwear to understand how different surfaces and support affect movement.
- Establish a reference extremity before starting observations to facilitate comparisons across trials.
- Organize the observation effectively to catch nuances in gait presentation.
- Ensure that the patient walks with natural gait mechanics, ideally mimicking their typical environment to elicit genuine movement patterns.
- Maintain a comfortable environment to reduce any anxiety that may influence gait performance.
- Position yourself strategically for the best possible view of the gait and joints involved.

Observation Timing
- Note specifically WHEN deviations occur: during the Swing or Stance phases and sub-phases (e.g., Initial Contact); this temporal detail is critical for diagnosis.
Describe Deviations
- Specify WHAT the deviation consists of (e.g., rapid ankle plantarflexion during loading response causing a foot slap) to document the parameters of concern clearly.
Impact on Functional Tasks
- Assess impact on weight acceptance, single-limb stance (SLS), and swing leg advancement to inform functional implications.
Hypothesize Causes
- Explore possible impairments causing the gait deviation (e.g., weak ankle dorsiflexors leading to foot slap) to inform rehabilitation strategy.
Associated Assessments:
- Include a range of motion assessment for joint flexibility evaluation, muscle strength evaluation for anti-gravity movement, muscle length testing for tightness and contractures, and balance evaluation for both static and dynamic stability.

Describe specific aberrations from typical gait using gait parameters and RLA terminology to provide concrete understanding.

Foot Drop
- Definition: Ankle remains plantarflexed during the swing phase.
- Characteristics: Increased plantarflexion of the ipsilateral ankle, possibly involving toe drag, leading to trip risks.
- Common Causes: Weak dorsiflexors or pes equinus (a deformity characterized by a plantarflexed foot).
Foot Slap & High Steppage
- Definition: Mild weakness of ankle dorsiflexors resulting in abrupt plantarflexion at the start of the stance phase.
- Characteristics: Producing a slapping sound upon heel strike due to a rapid drop.
- Common Causes: Common peroneal nerve palsy or distal peripheral neuropathy impacting muscle control.

Vaulting
- Definition: Raising on toes of the contralateral limb to clear the reference limb during the swing phase.
- Characteristics: Increased plantarflexion of the unaffected ankle contributes to compensatory mechanics.
- Common Causes: Leg length discrepancy, ankle joint stiffness, or pain from various causes may necessitate this alteration.
Hip Circumduction Gait
- Definition: The swing limb moves laterally from the midline into abduction before returning midline.
- Characteristics: Produces a circular leg motion paired with compensatory trunk rotation for limb clearance.
- Common Causes: Conditions like hemiplegia, hip joint stiffness, or pain affecting proper limb movement patterns.

Trendelenburg Gait
- Definition: Pelvic tilt occurs to the unaffected side during stance phase on the affected side, indicating weakness in the hip abductors.
- Characteristics: Noticeable pelvic tilt, which illustrates compensation by the lumbar spine and pelvis to maintain balance.
- Common Causes: Hip abductor weakness