ABNORMAL GAIT

INTRODUCTION:

An abnormal gait is when a person’s walk is different from what would be classed as ‘normal’. Gait is another word for walking pattern. A person with an abnormal gait will have a distinctive change in their pattern of walking.

NORMAL GAIT:

Normal gait is a ‘normal’ walking pattern. Normal gait requires strength, balance, sensation and coordination. Heel strike to heel strike or one stride length is known as a gait cycle. There is always a slight variation in everyone’s pattern of gait.

The gait cycles consists of a stance phase and a swing phase.

Stance phase:
Heel strike
This is when the heel of the first foot makes initial contact with the floor. The main muscles used for heel strike are dorsi flexors (the ones that pull your toes up), hip flexors, Gluteus (bottom) and Hamstring (back of the thigh) muscles. Heel strike is the stage at which the walker is most stable.

Foot flat/mid stance
This is when the foot is flat on the ground. The foot takes the weight of the body and the body carries the weight forward. The main muscles used for this movement are hip extensors. There is also slight knee flexion. The body is least stable at this point.

Heel off, push off and toe off
This is when the heel lifts off the ground. The toes push up to lift the whole foot up clearing the foot off the floor. The main muscles involved are the hip extensors and plantar flexors (the ones that pull the toes down) along with the calf muscles.
Swing phase :
This stage occurs after heel off. The limb that is lifted off the floor moves forward and shortens. This allows for the foot to clear the ground. For a successful swing phase to occur there are three stages that must take place.

Acceleration
This is the force generated by the hip flexors (the muscles that pull the whole leg forward) these move the limb forwards.

Mid-swing
This is when the limb passes the stance limb. At this stage the limb is at its shortest to provide a good foot clearance.

Deceleration
This is the final part. The limb prepares for heel strike. The lower leg muscles help to control this.

CAUSES:

There are several common reasons that cause a person to have an abnormal gait these include:

Fracture
Neurological
Pain
Muscle weakness
Stiffness
Joint problems
Age related changes
Leg length discrepancy

TYPES OF ABNORMAL GAIT:

Foot drop(High stepping gait) – A person with foot drop is unable to raise their foot at the ankle. The muscles affected are the dorsi flexors (those that life the foot at the ankle) This is characterized in someone’s walking when their foot slaps down to the floor rather than being placed naturally. A person suffering from foot drop may have to excessively lift their hip to compensate for the inability to clear the foot properly.

Trendelenburg – is caused by weakness of the Gluteal (buttock) muscles. This weakness can lead to instability in a person. This is characterized by dropping of the pelvis to one side of the body whilst walking causing more knee flexion (bending of the knee) to clear the foot.

Parkinsonism(Stamping gait) – This is characterized by a shuffled walk. A person suffering from parkinsonism may find their steps become shorter. It is more common in someone suffering with later stages of Parkinson’s disease. They may have problems stopping, starting and turning around during walking. They may appear to be falling forward or in a forward flexed posture.

Circumduction(Heamiplegic gait) – This is characterized by dragging of the foot to try and clear it. Circumduction occurs because of a lack of movement at the knee (limited knee flexion) or a leg length discrepancy (one leg could be shorter than the other) Muscles affected are the knee flexors. e.g stroke.

Scissor gait – This is characterized by the legs being slightly bent at both the hip and the knee, when walking the thighs tend to cross each other similar to that of a scissor movement. Scissor gait is common in those with cerebral palsy and the person will tend to walk on their tip toes (plantar flexed). The muscles affected are the plantar flexors (pull your toes down), dorsi flexors (pull your toes up), abductors (muscles close to the hip that bring the whole leg away from the other leg) and adductors (muscles close to the hip that bring the whole leg towards the other leg) e.g cerebral palsy.

Sensory Ataxic – This is characterized by a heavy heel strike or unsteady stomping whilst walking. Postural instability (when someone finds it hard to balance in an upright position) is usually present. Sensory ataxia is caused by a loss of sensation in the joints.

Toe Walking – This characterized when someone walks on their toes tending not to place any weight on the heel part of their foot. Toe walking is commonly caused by muscle spasticity in the plantar flexor (those that pull your toes down) muscles.

PHYSIOTHERAPY MANAGEMENT:

Physiotherapists can analyse gait to diagnose of all the problem and identify the areas that require improvement.

Physiotherapy can be beneficial for abnormal gait in the following ways:

Improving balance.
Improving strength.
Help to be independent with daily activities indoors such as walking from bedroom to bathroom.
Reduce risk of falling.
Reduce risk of injury around your home.
Help to become independent with daily activities such as washing, dressing, cooking.
Allowing to continue independently.
Provide with advice and guidance on coping.
Help to understand why it have abnormal gait, how to improve it and provide treatment.
Help to gain confidence.

MEANS:

There are various treatments that physiotherapists may carry out for people with abnormal gait. A structured program to suit patient needs will be developed.

Physio treatment may involve:

Gait re-education.
Balance and co ordination work.
Lower limb strengthening exercise.
Hydrotherapy.
Mobility rehabilitation.
Active and passive movements.
Provide e appropriate Orthotics or equipment if necessary.
Advice and guidance on coping with abnormal gait.
Stretching exercises.
Risk assessments.

THOSE ABOVE ARE COLLECTED FROM SOME BOOKS AND WEBSITES..

THANK YOU,

SRIKUMARAN PHYSIOTHERAPY CLINIC & FITNESS CENTER

Comments

Jeganathan BPT said…

nice article sir..

May 21, 2021 at 8:58 AM

முதுகு வலி மற்றும் முதுகு தண்டுவட வலி உள்ளவர்களுக்கு கடைபிடிக்க வேண்டிய சில வழிமுறைகள்....

முதுகு வலி மற்றும் முதுகு தண்டுவட வலி உள்ளவர்களுக்கு கடைபிடிக்க வேண்டிய சில வழிமுறைகள் .... பொதுவாக முதுகு வலி என்பது இன்றைய காலகட்டத்தில் பல பேருக்கு மிக அதிகமாகவே காணப்படுகிறது. இவ்வாறு வலி இருக்கும் பொழுது என்ன மாதிரியான வழிமுறைகளை கடைப்பிடிக்க வேண்டும் என்பதை கீழே விரிவாக பார்க்கலாம். பொதுவாக முதுகு வலி ஆரம்பிக்கும் பொழுது அவற்றை உதாசீனப்படுத்தாமல் அருகில் உள்ள மருத்துவரை அணுகி ஆலோசனை பெறுவது மிகவும் முக்கியம். மேலும் முதுகு வலி ஏற்படும் பொழுது அவற்றுக்கு தேவையான மருத்துவம்(medical management), இயன்முறை மருத்துவம்(physiotherapy treatment), பயிற்சிகள்(exercises) அல்லது அறுவை சிகிச்சை(surgery) மற்றும் புனர்வாழ்வு சிகிச்சைகள்(Rehabilitation) போன்றவை தேவைப்படலாம். மேலே கண்ட மருத்துவத்தில் ஏதாவது ஒன்றை எடுத்துக் கொள்ளும் பட்சத்தில் மேலும் முதுகு வலி வராமல் பாதுகாத்துக் கொள்ளவும், நமது அன்றாட வேலைகளை தொடர்ந்து செய்யவும், மருத்துவ உபகரணங்களை பயன்படுத்திக் கொள்ளவும்...

BRONCHIECTASIS

INTRODUCTION: Bronchiectasis means abnormal dilatation of the bronchi due to chronic airway inflammation and infection. It is usually acquired, but may result from an underlying genetic or congenital defect of airway defences. CAUSES: Congenital • Cystic fibrosis • Primary ciliary dyskinesia • Kartagener’s syndrome (sinusitis and transposition of the viscera) • Primary hypogammaglobulinaemia Acquired • Pneumonia (complicating whooping cough or measles) • Inhaled foreign body • Suppurative pneumonia • Pulmonary TB • Allergic bronchopulmonary aspergillosis complicating asthma • Bronchial tumours CLINICAL FEATURES: ● Chronic cough productive of purulent sputum. ● Pleuritic pain. ● Haemoptysis. ● Halitosis. Acute exacerbations may cause fever and increase these symptoms. Examination reveals coarse crackles caused by sputum in bronchiectatic spaces. Diminished breath sounds may indicate lobar collapse. Bronchial breathing due to scarring may be heard in advanced disease. INVESTIG...

PARKINSON'S DISEASE

Parkinson's EtiologyParkinson's disease (PD) is a neurodegenerative disorder that mostly presents in later life with generalized slowing of movements (bradykinesia) and at least one other symptom of resting tremor or rigidity. Other associated features are a loss of smell, sleep dysfunction, mood disorders, excess salivation, constipation, and excessive periodic limb movements in sleep (REM behavior disorder). PD is a disorder of the basal ganglia, which is composed of many other nuclei. The striatum receives excitatory and inhibitory input from several parts of the cortex. The key pathology is the loss of dopaminergic neurons that lead to the symptom . It is the seconds most common neuro-degenerative condition in the world after Alzheimer's. The condition is caused by the slow deterioration of the nerve cells in the brain, which create dopamine. Dopamine is a natural substance found in the brain that plays a major role in our brains and bodies by messag...

லம்பார் ஸ்பாண்டிலோஸிஸ்(lumbar spondylosis)

முன்னுரை ல ம்பார் ஸ்பாண்டிலோஸிஸ்(lumbar spondylosis) எனப்படும் மருத்துவ பிரச்சினைகள் என்பது முதுகுப் பகுதியில் ஏற்படும் நீண்ட நாள் முதுகு வலி. இவ்வாறு ஏற்படும் முதுகு வலி முதுகு முள்ளெலும்பு பகுதியில்(vertebral coloum) உள்ள தட்டு அழுத்தப் படுவதினால்(disk compression) அல்லது முள்ளெலும்பு பகுதியின பிரதான பகுதி சற்று இடம் நகர்வதால(displacement) முதுகு வலி ஏற்படுவதற்கு வாய்ப்புகள் உள்ளதாக கூறப்படுகின்றன. சில சமயங்களில் முதுகு தண்டு மற்றும் எலும்பு பகுதிகள் தொடர்சிதைவு(degeneration) ஆகும் போதும், முதுகெலும்பு தட்டு பகுதி, முதுகெலும்பு மூட்டு(facet joints) பகுதி தொடர்ந்து பிரச்சனைக்கு உள்ளாக்கப்படும் பொழுதும் முதுகு வலி ஏற்படுகிறது. ஸ்பாணடிலோஸிஸ் என்பதை முதுகு எலும்பு தேய்மானம்(osteoarthritis) எ ன்று கூறலாம். இவ்வாறு முதுகு எலும்பு தேய்மானம், ல ம்பார்(lumbar vertebrae) எனப்படும் கீழ் முதுகு எலும்பு பகுதிகள், மேல் முதுகு எலும்பு பகுதிகள்(thoracic vertebrae), மற்றும் கழுத்து முதுகெலும்பு(cervical vertebrae) பகுதிகள் போன்றவற்றை பாதிக்கலாம். பொதுவாக ஸ்பாண்டிலோசிஸ் எனப்படு...

CARDIAC ARREST AND RESUSCITATION

INTRODUCTION: The leading causes of sudden death before old age, in people over the age of 44, are ventricular fibrillation from asymptomatic ischaemic heart disease or non-traumatic accidents such as drowning and poisoning. In people under the age of 38, the commonest causes are traumatic, due to accident or violence. In such instances death may be prevented if airway obstruction can be reversed, apnoea or hypoventilation avoided, blood loss prevented or corrected and the person not allowed to be pulseless or hypoxic for more than 2 or 3 minutes. If, however, there is circulatory arrest for more than a few minutes, or if blood loss or severe hypoxia remain uncorrected, irreversible brain damage may result. Immediate resuscitation is capable of preventing death and brain damage. The techniques required may be used anywhere, with or without equipment, and by anyone, from the lay public to medical specialists, provided they have been appropriately trained. Resuscitation may be divided in...

CARDIAC REHABILITATION

Introduction “Cardiac Rehabilitation is the process by which patients with cardiac disease, in partnership with a multidisciplinary team of health professionals are encouraged to support and achieve and maintain optimal physical and psychosocial health. The involvement of partners, other family members and carers is also important”. Cardiac rehabilitation is an accepted form of management for people with cardiac disease. Initially, rehabilitation was offered mainly to people recovering from a myocardial infraction (MI), but now encompasses a wide range of cardiac problems. To achieve the goals of cardiac rehabilitation a multidisciplinary team approach is required. The multidisciplinary team members include: Cardiologist/Physician and co-coordinator to lead cardiac rehabilitation Clinical Nurse Specialist Physiotherapist Clinical nutritionist/Dietitian Occupational Therapist Pharmacist Psychologist Smoking cessation counsellor/nurse Social worker Vocational counsellor Clerical Ad...

RELAXED POSITIONS FOR BREATHLESS PATIENTS

Relaxation positions for the breathless patient If patients can be taught how to control their breathing during an attack of dyspnoea, this can be of great benefit to them. The patient should be put into a relaxed position, and encouraged to do ‘diaphragmatic’ breathing at his own rate. The rate of breathing does not matter at this stage; it is the pattern of breathing that is important. As the patient gains control of his breathing he should be encouraged to slow down his respiratory rate. Any of the following positions will assist relaxation of the upper chest while encouraging controlled diaphragmatic breathing. They can be adapted to various situations in everyday life. HIGH SIDE LYING Five or six pillows are used to raise the patient’s shoulders while lying on his side. One pillow should be placed between the waist and axilla, to keep the spine straight and prevent slipping down the bed. The top pillow must be above the shoulders, so that only the head and neck are supp...

SRIKUMARAN PHYSIOTHERAPY & FITNESS CENTRE ( ஶ்ரீகுமரன் ‌‌‌‌பிசியோதெரபி & உடற்பயிற்சி மையம் )

Search This Blog