Gait Assessment ofGait Assessment of Neurologically Challenged g y gPatients

Cathelyn Timple, PT, DPT, NCS, ATPCasa Colina Centers for Rehabilitation

ObjectivesObjectivesUnderstand normal gait mechanics and terminologyUnderstand normal gait mechanics and terminology

Recognize pathological gait patterns commonly associated with visual and vestibular deficits in neurologically challenged g y gpatients.

Administer the Functional Gait Assessment and the 10-Meter W lk T tWalk Test

Normal GaitNormal Gait“repetitious sequence of limb motion to move the body forward while simultaneously maintaining stance stabilitystability

Observational Gait AnalysisGait Analysis

•Qualitative visual description •Qualitative visual description of an individual’s upper and lower extremities, pelvis and

k dtrunk motions during ambulation.

Normal Human GaitNormal Human Gait

StrideStride

StanceStance

Weight AcceptanceWeight Acceptance Single Limb Support

Single Limb Support

SwingSwing

AdvancementLimbAdvancementLimb

Initial ContactInitial Contact Loading ResponseLoading Response

SupportSupport

Mid StanceMid Stance Terminal StanceTerminal Stance PreSwingPreSwing Initial SwingInitial Swing Mid SwingMid Swing Terminal SwingTerminal Swing

Normal Human GaitNormal Human Gait

STANCE: 62% SWING 38%

IC LR MSt TSt PSw ISw MSw TSw

Weight Single Limb Swing Limb AdvancementAcceptance Support

Stance PhaseStance Phase

Initial Contact (IC) The moment when the foot Initial Contact (IC): The moment when the foot contacts the ground

Stance PhaseStance Phase

Loading Response (LR) Weight is rapidly transferred Loading Response (LR): Weight is rapidly transferred onto the outstretched limb, the first period of double-limb support

Stance PhaseStance Phase

Mid Stance (MSt): The body progresses over a single Mid-Stance (MSt): The body progresses over a single, stable limb.

Stance PhaseStance Phase

Terminal Stance (TSt): Progression over the stance Terminal Stance (TSt): Progression over the stance limb continues. The body moves ahead of the limb and weight is transferred onto the forefoot.

Stance PhaseStance Phase

Pre Swing (PSw): A rapid unloading of the limb Pre-Swing (PSw): A rapid unloading of the limb occurs as weight is transferred to the contralateral limb.

Swing PhaseSwing Phase

Initial Swing (ISw): The thigh begins to advance as Initial Swing (ISw): The thigh begins to advance as the foot comes up off the floor.

Swing PhaseSwing Phase

Mid Swing (MSw): The thigh continues to advance as Mid-Swing (MSw): The thigh continues to advance as the foot comes up off the floor.

Swing PhaseSwing Phase

Terminal Swing (TSw): The knee extends the limb Terminal Swing (TSw): The knee extends; the limb prepares to contact the ground for Initial Contact.

Pathological Gait AnalysisAnalysis

Common Descriptive Terms for pAbnormal Gait

Antalgic HikingAntalgic

Ataxic

Hiking

Trendelenberg

Athetoid

Festinating

Toe Drag

Vaulting

Scissoring

Shuffling

Unstable

Extensor syngeryShuffling

Steppage

Extensor syngery

Flexor syngery

Qualitative Gait Analysis Form

Quantitative Gait Analysis

Functional Gait AssessmentFunctional Gait Assessment

Standardized test for assessing postural instability Standardized test for assessing postural instability during various walking tasks

10 item gait assessment based on the Dynamic Gait 10- item gait assessment based on the Dynamic Gait Index

Equipment Stop atch marked alking area shoe bo Equipment: Stopwatch, marked walking area, shoe box for obstacle, set of steps

S i g 0 f i i t t 3 f l Scoring: 0 for severe impairment to 3 for normal performance; maximum score possible is 30.

Functional Gait AssessmentFunctional Gait Assessment

Step over ObstacleGait Level Surface Step over Obstacle

Gait with Narrow Base of Support

Gait Level Surface

Change in Gait Speedpp

Gait with Eyes Closed

A b l B k d

Gait with Horizontal Head Turns

G h V l H d Ambulation Backwards

Steps

Gait with Vertical Head Turns

G it d Pi t TGait and Pivot Turn

Functional Gait AssessmentReference Group Data

Age N Min Max Mean SD CIAge N Min Score

Max Score

Mean SD CI

40-49 27 24 30 28.9 1.5 28.2-29.5

50 59 33 25 30 28 4 1 6 27 9 29 050-59 33 25 30 28.4 1.6 27.9-29.0

60-69 63 20 30 27.1 2.3 26.5-27.7

70-79 44 16 30 24.9 3.6 23.9-26.0

80-89 33 10 28 20.8 4.7 19.2-22.6

TOTAL 20 10 30 26.1 4.0 25.5-26.6

10-Meter Walk Test10-Meter Walk Test

Examines gait speedExamines gait speed

To administer test:M 10 d k d i h Measure a 10 meter course and mark ends with tape

Position subject 3 feet behind tape

Instruct the subject to walk at a comfortable rate until Instruct the subject to walk at a comfortable rate until he is 3 feet past the time line

Repeat up to 3 times and average the times

h b lk b b fInstruct the subject to walk as above , but as fast as possible

Repeat up to 3 times and average the timesp p g

10-Meter Walk Test10-Meter Walk Test

Comfortable (m/min) Maximum (m/min)

Gender/Decad

Men Women Men Womende

20s 83.6 84.4 151.9 148.0

30s 87.5 84.9 147.4 140.5

40s 88.1 83.5 147.7 127.4

50s 83.6 83.7 124.1 120.6

60s 81.5 77.8 115.9 106.460s 81.5 77.8 115.9 106.4

70s 79.5 76.3 124.7 104.9

CASE STUDY CASE STUDY

QUESTIONS????QUESTIONS????

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