· Definition: Series of rhythmical, alternating movements of the trunk & limbs which result in the forward progression of the center of gravity, & thereby forward movement of body.
· INTRODUCTION Human walking follows a repetitive pattern called the gait cycle. The gait cycle can be divided into two phases, (1) the stance phase when the lower limb is in contact with the ground and (2) the swing phase when the limb is lifted off in order to advance the body forwards. Stance phase accounts for 60% of the gait cycle & the swing phase contributes about 40%.
· Phases of Gait Cycle (8 phase model): See the figure as an attachment
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· Gait examination is very important in assessment of neurological & musculoskeletal disorders. It reveals involvement of various parts of he nervous system like cerebral cortex, extrapyramidal system, cerebellum, Lower motor neuron lesions like GBS, myopathies, muscular dystrophy & neuropathy. It also helps for analysis of various musculoskeletal disorders.
· It is important to observe the child walking & sometimes running for a distance of a few feet. Also, watch how he is getting up from floor & climbing the stairs.
· Thorough clinical observations of gait, careful history taking focused on gait & physical, neurological & orthopedic examinations are basic steps in categorization of gait disorders & serve as a guide for necessary investigations & therapeutic interventions.
· Abnormality in gait may be caused by
× Pain
× Joint & muscle range of motion limitation
× Muscular weakness/paralysis
× Neurological involvement (UMN, LMN).
× Leg length discrepancy.
· Antalgic gait (limping gait)
× Painful limb & therefore limp is adopted as to avoid pain on weight bearing structures.
× Stance phase is shortened.
× Common causes: Fractures, Tendinitis, Arthritis.
· Ataxic gait (Reeling gait) (Tandem gait)
× Most common manifestation of cerebellar damage.
× Often the first clinical sign of cerebellar disease.
× Wide base.
× Can not follow walking path in a straight line, but instead veers in different directions, giving the appearance of stumbling or drunkenness.
× Falls to the side of lesion.
× Frequent falling.
× Sometimes high - steppage gait pattern is also seen.
· Hemiplegic gait (Circumduction gait)
× With spastic type of hemiplegic leg.
- Hip into extension, adduction & medial rotation.
- Knee in extension & unstable.
- Ankle in a drop foot with ankle planter flexion & inversion (in both stance & swing phases).
× In order to clear the foot from the ground the hip & knee should flex.
× But the spastic muscles would not allow the hip & knee to flex for the floor clearance.
× So the patient hikes hip & bring the affected leg by making a half circle, circumducting the leg. Hence, the gait is known as ‘Circumductory gait’.
× No reciprocal arm swing.
× Step length tends to be lengthened on the affected side & shortened on the normal side.
· Scissoring Gait
× Results from spasticity of bilateral adductor muscles of hip.
× One leg crosses directly over the other with each step like crossing the blades of the scissor.
× Commonly seen in children with cerebral palsy of spastic diplegia type, arthrogryposis etc.
· High stepping gait (stamping gait)
× It is seen in patients with foot drop, weakness of foot dorsiflexion.
× There is an attempt to lift the leg high enough during walking so that foot does not drag on the floor.
× On bringing the foot to the ground, toes touch first & then heel. It results in high stepping gait when sudden sound, also called as stamping gait.
× It is due to paralysis of common peroneal nerve.
× It is seen in peripheral neuropathies, lesions of cauda equine etc.
· Trendelenburg gait
× It results due to weakness of gluteus medius muscle. It is called as ‘Trendelenburg gait’ or ‘lurching gait’ when one side is affected.
× The person sifts the trunk over the affected side during stance phase.
× When right gluteus medius or hip abductor is weak, it causes two things:
- The body leans over the left leg during stance phase of the left leg and
- Right side of the pelvis will drop when the right leg leaves the ground & begins swing phase.
× Shifting the trunk over the affected side is an attempt to reduce the amount of strength required of the gluteus medius to stabilize the pelvis.
× Causes
- Weak abductors (Poliomyelitis, DMD).
- Congenital dislocation of hip joint.
- Perthes disease.
· Waddling gait (Duck gait)
× Bilateral paralysis of gluteus medius muscle causes waddling or duck gait.
× The patient lurch to both sides while walking.
× The body sways from side to side on a wide base with excessive shoulder swing.
× It is seen in muscular dystrophies like Duchenne Muscular Dystrophy (DMD), Spinomuscular atrophy (SMA) etc.
· Short limb gait
× Shortening < 1.5 cm compensated by pelvic tilt & shortening upto 5 cm compensated by equines.
× Shortening > 5 cm, the patient dips his body on that side.
· Toe walking (Equinus Gait)
× May be normal in children upto age of 2 years.
× It is seen in children with spastic cerebral palsy & Duchenne muscular dystrophy.
· Festinate Gait (Short shuffling Gait): (Parkinson’s Gait)
× Seen in Parkinson’s disease.
× Because of rigidity, all the joints will go for a flexion position with spine stooping forward.
× This posture displaces the centre of gravity anteriorly.
× So in order to keep centre of gravity within limits, patient will walk with small, shuffling steps.
× Due to loss of voluntary control over the movement, the patient loses balance & walks faster as if he is chasing the centre of gravity. Therefore, it is called as ‘Festinate gait’. It is also called as ‘Shuffling gait’ due to his shuffling steps.
Excellent.! Gait describe in very simple language so anyone can understood. Otherwise it's very difficult.
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