Visual gait analysis Walk minimum 8m with different speed.

It is simplest gait analysis but has serious limitations 1- transitory, no permanent record 2- eye can not observe high speed events 3- possible to observe the motion not the force 4- depend on the skills of the observer.

The best viewpoint for observation of gait abnormality

Side view : anterior and posterior trunk bending,
increased lumbar lordosis, steppage, excessive knee flexion and extension, vaulting, insufficient push off and dorsiflexion control . Front and behind view : circumduction, hip hiking, vaulting, abnormal foot contact , hip rotation and walking base

Anterior trunk bending Posterior trunk bending

Videotape examinations
Overcome two of the visual limitations, 1- transitory, no permanent record 2- eye can not observe high speed events And confer the following advantages 3- reduce the number of walk the subjects need to do 4- show subjects how they are walking 5- used to teach visual gait analysis to someone else

General gait parameters Cadence : no of steps/known period time. 10-15 sec is enough time Stride length by direct measurement (foot print) or indirect from velocity and cadence Step length, walking base, toe out angle, foot contact pattern. Foot print ( water , talcum powder, and felt adhesive pads soaked in different colored dye and a stripe of paper )

 Velocity : distance/time .( 6*10 m ) are enough The subject should be to walk at their natural speed and their stride before measurements

Foot switches : to record timing of gait

Electrogoniometer

 Electromyography Force platform : with size 45X60cm 3D motion analysis system

khaled-ayad@hotmail.com

Walking aids
Waling aids modify the gait pattern Reduce pain in painful joint Increased the functions Gait training (underwater, between parallel bars, use assistive devices )

Canes
Canes are the means of forces transmitted to ground by the wrist and hand They are used for the following purposes 1- to improve stability 2- to generate moment (on the opposed side ) 3- to take part of the load from the leg

Types of canes
Straight cane Tripod canes Tetrapod canes L shape handle U shape handle Angular shaped handle Adjustable in height

Crutches
They differ from canes, because they able to transmit significant force in the horizontal plane Types of crutches Axillary crutches, may add plateform Forearm crutches or elbow crutches Ortho crutches

Walkers (rollators)
The most stable walking aids Types 1- regular walkers 2- adjustable walkers 3- folded walker 4- rolling walker 5- walker with plateform for forearm support 6- reciprocal walker

Gait pattern with walking aids

Gait with single aid Three point swing through gait Three point swing to gait (the feet are advanced by a much shorter distance and placed behind the level of crutches) Four point gait Three point gait Two point gait

Planning for gait training

1- safety measures Gait belt Dry surface Slippers or shoes Therapist beside the affect side Turning around the good leg

2- point to start with According to static and dynamic balance, starts from easy to hardest Underwater Use parallel bars Walker Crutches Canes Independent

3- Weight bearing status NWB TTWB PWB WBAT FWB

4- Mental status: good level of awareness and orientation to understand the instructions

5- Preparing for the treatment area Usage mirror Draw line on the floor in case of dynamic balance Decide the distance of walking The level of the surface

Amputee gait
The mechanical coupling between the stump and the prosthetic limb can not be good as in the normal because 1- the lever arm between the hip and the socket is small 2- the relative motion between the stump and the socket 3- uncomfortable socket prevent applying large forces on the prosthetic limb

Up and down stairs

Up with good leg first and down with the affected one With cane , Up with good leg first then cane then the affected one and vise versa going down The same with the crutches