Gait Assessment of
Neurologically
g y Challenged
g
Patients
Cathelyn Timple, PT, DPT, NCS, ATP
Casa Colina Centers for Rehabilitation
Objectives
Understand normal gait mechanics and terminology
Recognize pathological gait patterns commonly associated with
visual and vestibular deficits in neurologically
g y challenged
g
patients.
Administer the Functional Gait Assessment and the 10-Meter
W lk Test
Walk T t
Normal Gait
“repetitious sequence of limb motion to move the body
forward while simultaneously maintaining stance
stability
Observational
Gait Analysis
•Qualitative visual description
of an individual’s upper and
lower extremities, pelvis and
trunkk motions d
during
ambulation.
Normal Human Gait
Stride
Stance Swing
Weight Acceptance Single Limb
AdvancementLimb
Support
Initial Contact Loading Response Mid Stance Terminal Stance PreSwing Initial Swing Mid Swing Terminal Swing
Normal Human Gait
STANCE: 62% SWING 38%
IC LR MSt TSt PSw ISw MSw TSw
Weight Single Limb Swing Limb Advancement
Acceptance Support
Stance Phase
Initial Contact (IC):
(IC) The moment when the foot
contacts the ground
Stance Phase
Loading Response (LR):
(LR) Weight is rapidly transferred
onto the outstretched limb, the first period of double-
limb support
Stance Phase
Mid-Stance
Mid Stance (MSt): The body progresses over a single,
single
stable limb.
Stance Phase
Terminal Stance (TSt): Progression over the stance
limb continues. The body moves ahead of the limb
and weight is transferred onto the forefoot.
Stance Phase
Pre-Swing
Pre Swing (PSw): A rapid unloading of the limb
occurs as weight is transferred to the contralateral limb.
Swing Phase
Initial Swing (ISw): The thigh begins to advance as
the foot comes up off the floor.
Swing Phase
Mid-Swing
Mid Swing (MSw): The thigh continues to advance as
the foot comes up off the floor.
Swing Phase
Terminal Swing (TSw): The knee extends;
extends the limb
prepares to contact the ground for Initial Contact.
Pathological Gait
Analysis
Common Descriptive
p Terms for
Abnormal Gait
Antalgic Hiking
Ataxic Trendelenberg
Athetoid Toe Drag
Festinating Vaulting
Scissoring Unstable
Shuffling Extensor syngery
Steppage Flexor syngery
Qualitative Gait Analysis
Form
Quantitative Gait Analysis
Functional Gait Assessment
Standardized test for assessing postural instability
during various walking tasks
10- item gait assessment based on the Dynamic Gait
10
Index
Equipment: Stopwatch,
Equipment Stop atch marked walking
alking area,
area shoe box
bo
for obstacle, set of steps
Scoring:
S i g 0 ffor severe iimpairment
i t tto 3 ffor normall
performance; maximum score possible is 30.
Functional Gait Assessment
Gait Level Surface Step over Obstacle
Change in Gait Speed Gait with Narrow Base of
Support
pp
Gait with Horizontal
Head Turns Gait with Eyes Closed
Gait with
G h Vertical
V l Head
H d A b l
Ambulation B
Backwards
k d
Turns
Steps
G it and
Gait d Pivot
Pi t Turn
T
Functional Gait Assessment
Reference Group Data
Age N Min Max Mean SD CI
Score Score
40-49 27 24 30 28.9 1.5 28.2-29.5
50 59
50-59 33 25 30 28 4
28.4 16
1.6 27 9 29 0
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 Test
Examines gait speed
To administer test:
Measure a 10 meter course and
M d markk ends
d with
i h tape
Position subject 3 feet behind tape
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
Instruct the
h subject
b to walk
lk as above
b , but
b as fast
f as
possible
Repeat
p up p to 3 times and averageg the times
10-Meter Walk Test
Comfortable (m/min) Maximum (m/min)
Gender/Deca Men Women Men Women
d
de
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 77.8 115.9 106.4
70s 79.5 76.3 124.7 104.9
CASE STUDY
QUESTIONS????
REFERENCES
Hallemans A, Beccu S, Van Loock K, Ortibus E, Truijen S, Aerts P. Visual deprivation leads to gait adaptations that are age- and context-
specific: II. Kinematic parameters. Gait & Posture 30 (2009) 307-311.
H lb
Helbostad
d JL,
JL Vereijken
V ijk B B, Hesseberg
H b K, K Sletvold
Sl ld O.
O Altered
Al d vision
i i destabilizes
d bili gait i in
i older
ld persons. Gait
G i & Posture
P 30(2009) 233-238.
233 238
Kramers de Quervain IA, Simon SR, Leurgans S, Pease WS, McAllister D. Gait Pattern in the Earl Recovery Period after Stroke. J Bone
Joint Surg Am. 1996;78:1506-14.
Ochi F, Esquenazi A, Hirai B, Talaty M. Temporal
Temporal-Spatial
Spatial Feature of Gait after Traumatic Brain Injury. Journal of Head Trauma
Rehabilitation. April 1999;14(2):105-115.
Perry J. Gait Analysis: Normal and Pathological Function. Thorofare, New Jersey, SLACK Incorporated, 1992.
Schulmann DL, Godfrey B, Fisher AG. Effect of Eye Movements on Dynamic Equilibrium. Physical Therapy 1987:1054-1057.
Von Schroeder HP, Coutts RD, Lyden PD, Billings Jr. E, Nickel VL. Gait parameters following stroke: A practical assessment. Journal of
Rehabilitation Research and Development. February 1995; 32(1): 25-31.
Wade MG, Jones G. The Role of Vision and Spatial Orientation in the Maintenance of Posture. Phys Ther. 1997;77:619-628.
Zampieri C, Di Fabio RP. Balance and Eye Movement Training to Improve Gait in People With Progressive Supranuclear Palsy: Quasi-
Randomized Clinical Trial. Physical Therapy. 2008;88:1460-1473.
The Pathokinesiology Department and The Physical Therapy Department Rancho Los Amigos. Observational Gait Analysis Handbook. Los
Amigos Research and Education Institute, Inc; 1996.
