GAIT ASSESSMENT

CONTENTS

Subject Page

A. Principles of gait assessment ..................................................

B. Gait assessment from different positions.................................
1- Task one: Lateral view ............................................
2- Task two Anterior view............................................
3- Task three Posterior..................................................
C. Common clinical abnormalities in gait....................................
1- Antalgic gait.............................................................
2- Leg length discrepancy
3- Muscle weakness or paralysis..................................
a- Gluteus medius...............................................
b- Psoas..............................................................
c- Gluteus maximus...........................................
d- Quadriceps.....................................................
e- Ankle dossiflexors.........................................
f- Ankle planter flexors......................................
4- Muscular contracture...............................................
a- Hip flexion contracture..................................
b- Knee flexion contracture................................
c- Ankle planter flexion contracture..................

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 Gait Assessment

A. Principles of clinical gait assessment:

- Gait analysis should begin with a gross, total body analysis looking at overall
posture, cadence, stride length, step length, arm swing, and the general velocity of
ambulation.

- Next determine the cause of the abnormality, in terms of identifying the segment
or segments involved and the phases of gait that are affected.

- Attention must be paid to the effect on other body segments that contribute to the
gait cycle.

- Accompanying compensations by other body parts so that the individual remains

able to walk.

- Gait should be analyzed with the patient both with and without footwear. In
addition, the footwear should be closely examined for patterns of wear.

The clinical application of that principles:

B- Gait assessment from different positions (Through Inspection):

Each task will taken 15 minutes to be teached to you and five minutes from yous to
be assessed.

1- Task one: Lateral view.

The lateral view allows the examiner to assess the following:

 Reciprocal arm swing

 Hip flexion and extension
 Knee flexion and extension
 Ankle dorsiflexion and plantar flexion

 Heel rise

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  Preswing
2- Task Two: Anterior view.

The anterior view allows the following examination:

 Reciprocal arm swing
 Rotation of shoulders and thorax
 Pelvic rotation
 Hip rotation and abduction-adduction
 Knee rotation and abduction-adduction
 Degree of toe-out
 Base of support measurement

3- Task Three: Posterior view.

The posterior view allows assessment of the following:

 Reciprocal arm swing
 Rotation of the shoulders and thorax
 Pelvic rotation
 Pelvic list
 Hip rotation and abduction-adduction
 Knee rotation and abduction-adduction
 Subtalar movement
 Heel rise
 Preswing
 Base of support

After the assessment of gait from different views you start notice the gait abnormality
and assess each of the following in a minute.

C- Common clinical abnormalities in gait:

1- Antalgic gait:

You should know this gait in a minute through the following defects:
1- decrease in the duration of stance of the affected limb.
2- Inability of the individual to bear weight through the painful limb.
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 3- There is a noticeable lack of weight shift laterally over the stance limb.
4- Decrease in the swing phase of the uninvolved limb.
5- Shorter step length on the uninvolved side.
6- Decreased cadence.
7- Decrease velocity of walking.

2- Leg length discrepancy:

You should know this gait in a minute through the following defects:

A. The side of the shorter limb:

1- The pelvis drops laterally in an attempt to lengthen the limb.
2- The gross appearance is that of the individual limping.
3- Supinate the foot on the short side to effectively lengthen the limb.
4- Vaulting.

B. The side of longer limb:

1- Exaggerated flexion in order to achieve swing-through.
2- Hip hiking.
3- Circumduction.

3- Muscle weakness or paralysis:

You should know this gait in a minute through the following defects:

a. Gluteus Medius:

An individual demonstrates a classic trendelenburg gait pattern in which the pelvis

drops on the unaffected side during single-limb support of the side of weakness.
Accompanying the pelvis drop on the unaffected side is a relative adduction of the
femur of the stance limb. Termed the "gluteus medius lurch", laterally flexing the trunk
over the affected limb in order to maintain the center of gravity over the base of support.

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This minimizes the torque due to body weight and hence the gluteus medius force
required to stabilize the pelvis.

b- Psoas:

Is reflected the patient's difficulty initiating swing-through to compensate for the

psoas weaknes, the individual rotates the limb externally at the hip and uses the hip
adductors to achieve swing-through exaggerated trunk and pelvis motion.

c- Gluteus maximus:

Results in inability to counter the flexion moment at the hip at the moment of initial
contact.

Compensate by quickly moving the trunk posterioriorly at initial contact to maintain

an upright posture during the gait cycle.

d- Quadriceps:

Compensation by:

1- Forward bending of the trunk combined with rapid plantar flexion of the ankle.
Create an extension moment at the knee with resulting hyperextension. If the hip
extensors and ankle plantar flexors are also weak.

2- Compensation occurs by the patient manually pushing the knee into extension at
initial contact.

f- Ankle dorsiflexors:
- Cause: drop foot.
- Result: toe drag, slap this slapping is the result of inability of the dorsiflexors to
decelerate and control contact of the foot with the floor.
- Compensation: steppage gait. The excessive hip and knee flexion compensates
for the dropfoot and allows swing-through of the affected limb to occur without
scuffing or dragging the toes on the floor "slap".

i. Ankle plantar flexors:

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 Cause:

1- The abnormalities in this gait are during the phase of single support because the
tibia and knee are not well stabilized.
2- Is no real propulsion.
3- The amount of time spent in the stance phase is diminished.
4- The smaller step length on the unaffected side.

Result: calcaneal gait pattern.

4- Muscular Contracture:

You should know this gait in a minute through the following defects:

a. Hip flexion contracture:

Result in a need for compensation to counteract the flexion moment at the hip at
the moment of initial contact.

1- Increasing the lumbar lordosis and backward bending of the trunk.

2- Simultaneous knee flexion may also be observed.

3- An assitive device to support the trunk may be necessary.

b. Knee flexion contracture:

Demonstrates:

1- Excessive dorsiflexion of the ankle from late swing phase to early stance of the
uninvolved limb.

2- The involved limb exhibits early heel rise in terminal stance.

c. Ankle planter flexion contracture:

Result in:

1- Early heal rise at mid and terminal stance.

2- Knee hyper extension at mid stance.

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 3- For word bending of trunk at mid to terminal stance.

- The clinical benefits and uses for this section:

 Enable you after being a therapist to make a good assessment of gait

problems.

 Enable the therapist to differentiate the diagnosis and determine the best
rehabilitation of patient and save the time and effort of therapist in treatment.

- The assessment tools for students: through the numbers or exams for each tasks:

ex.: if the task will take 10 point it will be subdivided into 4 sections as follows:

2.5 : For position of the therapist or student.

2.5 : For position of the patient.

2.5 : For order or assistance.

2.5 : for the results if the task is done.

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The normal gait phases:

A) Stance Phase.

B) Swing Phase.

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 The Antalgic Gait

In case of leg length discrepancy

Circumduction Gait Hip Hike Gait

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 Gluteus Medius Gait

Gluteus Maximus Gait

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Quadriceps Weekness Gait

Foot Slap

Foot Drag

High Steppage Gait

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