Professional Documents
Culture Documents
Department of Physical
Therapy
NEW YORK UNIVERSITY
Historical Perspective
COG located at S1 - S2
During preferred rate walking the COG
approximates a sinusoidal curve from the:
Sagittal perspective - no greater than a 2”
peak-to-valley excursion
Frontal perspective - no greater than a 2”
medial-to-lateral excursion
Path of the COG
Distortion of the Path of
the COG
Probably NOT!
Why?
Your gait control is on ‘automatic pilot’
Gait perturbations
Example: Someone walks across your path
from the side that you didn’t see
There’s a need to take immediate corrective
action to avoid a collision
Supraspinal centers appear to over-ride
the CPG and switch to a ‘manual control’
strategy
What Triggers a CPG?
Why?
Factors That Lead to the
Initiation of Gait
Assume right LE will advance first:
Questions:
Do diseases/injuries specifically manifest as
a stereotypical gait pattern?
or
Does the disease/injury lead to a
deterioration of control parameters which
cause gait deficits?
Response
Loss of abductors:
Static analysis - + Trendelenburg sign
Dynamic analysis - weakness o f abductors
manifests as ‘lurching gait’ (toward stance- side)
Analysis of Deficits
Abductors - Stance
Early stance Early stance
COG shifts away from weakness/absence
stance side LE Contra-lateral hip
Increases moment arm drops > 5-80
of COG relative to Compensation is to
stance side hip lean (‘lurch’) over
Stance side abductors stance-side LE
generate counter-
rotational torque to
prevent contra-lateral
from dropping > 5-80
Quadriceps - Stance
Analysis of Deficits
Quadriceps - Stance
Early stance (HS - FF) Early stance
Guides knee into 200 weakness/absence
of flexion eccentrically Inability to absorb energy
(controls unlocking of Buckling
the knee)
Late stance (HR - TO) Late stance
Controls for knee weakness/absence
Knee collapse into flexion
flexion (~400 at TO)
-premature flexion into
early swing - ‘rubber knee’
Pre-Tibial Group - Stance
Analysis of Deficits
Pre-tibial Group - Stance
Early stance (HS - FF) Early stance
Lowers forefoot to weakness/absence
floor eccentrically Forefoot slaps to the
After forefoot contacts floor - ‘drop-foot’ gait
floor- pull tibia Loss of forward pull of
forward over foot tibia
Plantar Flexors - Stance
Analysis of Deficits
Plantar Flexors - Stance
Late mid-stance Early stance
Concentrically pulls weakness/absence
tibia forward Loss of forward pull of
Late stance (HR - TO) tibia
Provides propulsive Loss of forward thrust
thrust during push off - poor transition to
early swing
Ankle Stability - Late
Stance
Quadcriceps
May prevent knee from unlocking during
interim between HS and FF
Knee maintained in extension leading to a
‘vaulting’ over stance limb or circumduction of hip
Disrupts (timing) transition to mid- and late stance
May prevent LE bending during swing phase
Spasticity & Gait
Examples
Plantar flexors
Increase in spastic tone may limit forward
rotation of tibia between MS and PO
May locate ground reaction force well behind knee
causing significant flexion moment during late MS
and knee buckling tendency
Ankle may be locked up during PO decreasing
propulsive thrust forward - inefficient
transition from TO to early swing
Spasticity & Gait
Examples
Hamstrings
May limit forward swing of LE - decreasing
step length
May prevent knee from reaching a terminally
extended position just prior to HS
Gait Training - Questions