chapter 13 gait and posture analysis. overview it is not clear whether gait is learned or is...

Chapter 13Chapter 13

Gait and posture analysisGait and posture analysis

OverviewOverview

It is not clear whether gait is It is not clear whether gait is learned or is pre-programmed at learned or is pre-programmed at the spinal cord level. However, the spinal cord level. However, once mastered, gait allows us to once mastered, gait allows us to move around our environment in move around our environment in an efficient manner, requiring little an efficient manner, requiring little in the way of conscious thought, at in the way of conscious thought, at least in familiar surroundings. least in familiar surroundings.

The Gait CycleThe Gait Cycle

Walking involves the alternating action Walking involves the alternating action of the two lower extremitiesof the two lower extremities

The walking pattern is studied as a The walking pattern is studied as a gait cyclegait cycle– The The gait cyclegait cycle is defined as the interval of is defined as the interval of

time between any of the repetitive events time between any of the repetitive events of walking. Such an event could include of walking. Such an event could include the point when the foot initially contacts the point when the foot initially contacts the ground, to when the same foot the ground, to when the same foot contacts the ground againcontacts the ground again


The gait cycle consists of two periods: The gait cycle consists of two periods: stance and swingstance and swing– The stance periodThe stance period

Constitutes approximately 60% of the gait cycleConstitutes approximately 60% of the gait cycle Describes the entire time the foot is in contact Describes the entire time the foot is in contact

with the ground and the limb is bearing weightwith the ground and the limb is bearing weight Begins with the initial contact of the foot on the Begins with the initial contact of the foot on the

ground, and concludes when the ipsilateral foot ground, and concludes when the ipsilateral foot leaves the groundleaves the ground

The stance period takes about 0.6 sec during an The stance period takes about 0.6 sec during an average walking speedaverage walking speed


Swing periodSwing period– Constitutes approximately 40% of Constitutes approximately 40% of

the gait cyclethe gait cycle– Describes the period when the foot Describes the period when the foot

is not in contact with the groundis not in contact with the ground– Begins as the foot is lifted from the Begins as the foot is lifted from the

ground and ends with initial contact ground and ends with initial contact with the ipsilateral footwith the ipsilateral foot

Stance PeriodStance Period

Within the stance period, two tasks Within the stance period, two tasks and four intervals are recognizedand four intervals are recognized

The two tasks include weight The two tasks include weight acceptance and single limb supportacceptance and single limb support

The four intervals include The four intervals include loading loading responseresponse, , mid stancemid stance, , terminal terminal stancestance and and pre-swingpre-swing


Weight acceptanceWeight acceptance– The weight acceptance task occurs The weight acceptance task occurs

during the first 10% of the stance during the first 10% of the stance periodperiod The loading response interval begins as The loading response interval begins as

one limb bears weight while the other leg one limb bears weight while the other leg begins to go through its swing period. begins to go through its swing period. This interval may be referred to as the This interval may be referred to as the initial double stanceinitial double stance period and consists period and consists of the first 0-10% of the gait cycleof the first 0-10% of the gait cycle


Single Leg SupportSingle Leg Support– The middle 40% of the stance period is divided The middle 40% of the stance period is divided

equally into mid stance and terminal stanceequally into mid stance and terminal stance

The mid stance interval representing the first half of The mid stance interval representing the first half of the single limb support task, begins as one foot is the single limb support task, begins as one foot is lifted, and continues until the body weight is aligned lifted, and continues until the body weight is aligned over the forefootover the forefoot

The terminal stance interval is the second half of the The terminal stance interval is the second half of the single limb support task. It begins when the heel of single limb support task. It begins when the heel of the weight bearing foot lifts off the ground and the weight bearing foot lifts off the ground and continues until the contralateral foot strikes the continues until the contralateral foot strikes the groundground


Limb AdvancementLimb Advancement– Pre-swingPre-swing. . This interval begins with This interval begins with

initial contact of the contralateral initial contact of the contralateral limb and ends with ipsilateral toe-limb and ends with ipsilateral toe-off. As both feet are on the floor at off. As both feet are on the floor at the same time during this interval, the same time during this interval, double support occurs for the double support occurs for the second time in the gait cycle. second time in the gait cycle.

Swing Period Swing Period

Within the swing period, one task Within the swing period, one task and four intervals are recognizedand four intervals are recognized

The task involves limb The task involves limb advancementadvancement

The four intervals include The four intervals include pre-pre-swingswing, , initial swinginitial swing, , mid-swingmid-swing, , and and terminal swingterminal swing

Swing PeriodSwing Period

Limb AdvancementLimb Advancement– Pre-swing. Pre-swing. In addition to representing the In addition to representing the

final portion of the stance period and final portion of the stance period and single limb support task, the pre-swing single limb support task, the pre-swing interval is considered as part of the swing interval is considered as part of the swing periodperiod

– Initial swingInitial swing. This interval begins with the . This interval begins with the lift of the foot from the floor and ends lift of the foot from the floor and ends when the swinging foot is opposite the when the swinging foot is opposite the stance foot. stance foot.

Swing PeriodSwing Period

Limb AdvancementLimb Advancement– Mid-swingMid-swing. This interval begins as . This interval begins as

the swinging limb is opposite the the swinging limb is opposite the stance limb, and ends when the stance limb, and ends when the swinging limb is forward and the swinging limb is forward and the tibia is verticaltibia is vertical

– Terminal swingTerminal swing. This interval begins . This interval begins with a vertical tibia of the swing leg with a vertical tibia of the swing leg with respect to the floor, and ends with respect to the floor, and ends the moment the foot strikes the floorthe moment the foot strikes the floor

Gait parametersGait parameters

CadenceCadence– Cadence is defined as the number of Cadence is defined as the number of

separate steps taken in a certain timeseparate steps taken in a certain time– Normal cadence is between 90 and Normal cadence is between 90 and

120 steps per minute120 steps per minute The cadence of women is usually 6-9 The cadence of women is usually 6-9

steps per minute slower than that of men steps per minute slower than that of men Cadence is also affected by age, with Cadence is also affected by age, with

cadence decreasing from the age of 4 to cadence decreasing from the age of 4 to the age of 7, and then again in advancing the age of 7, and then again in advancing yearsyears

Gait parametersGait parameters

Stride lengthStride length– Step length is measured as the distance Step length is measured as the distance

between the same point of one foot on between the same point of one foot on successive footprints (ipsilateral to the successive footprints (ipsilateral to the contralateral foot fall).contralateral foot fall).

– Stride length, on the other hand, is the Stride length, on the other hand, is the distance between successive points of distance between successive points of foot-to-floor contact of the same footfoot-to-floor contact of the same foot

A stride is one full lower extremity cycleA stride is one full lower extremity cycle Two step lengths added together make the Two step lengths added together make the

stride lengthstride length

Characteristics of Characteristics of Normal GaitNormal Gait Gait involves the displacement of body Gait involves the displacement of body

weight in a desired direction utilizing a weight in a desired direction utilizing a coordinated effort between the joints of coordinated effort between the joints of the trunk and extremities and the the trunk and extremities and the muscles that control or produce these muscles that control or produce these motionsmotions

Any interference that alters this Any interference that alters this relationship may result in a deviation or relationship may result in a deviation or disturbance of the normal gait patterndisturbance of the normal gait pattern

Normal GaitNormal Gait

Five Five prioritiespriorities of normal gait of normal gait::– Stability of the weight bearing foot Stability of the weight bearing foot

throughout the stance periodthroughout the stance period– Clearance of the non-weight bearing foot Clearance of the non-weight bearing foot

during the swing periodduring the swing period– Appropriate pre-positioning (during Appropriate pre-positioning (during

terminal swing) of the foot for the next terminal swing) of the foot for the next gait cyclegait cycle

– Adequate step lengthAdequate step length– Energy conservationEnergy conservation

Center of Gravity Center of Gravity (COG)(COG) During the gait cycle, the COG is During the gait cycle, the COG is

displaced both vertically and displaced both vertically and laterallylaterally

Joint Motions in GaitJoint Motions in Gait

Trunk and Upper ExtremitiesTrunk and Upper Extremities– During the gait cycle:During the gait cycle:

The swing of the arms is out of phase with the The swing of the arms is out of phase with the legslegs

As the upper body moves forward, the trunk As the upper body moves forward, the trunk twists about a vertical axistwists about a vertical axis

The thoracic spine and the pelvis rotate in The thoracic spine and the pelvis rotate in opposite directions to each other to enhance opposite directions to each other to enhance stability and balancestability and balance

The lumbar spine tends to rotate with the pelvisThe lumbar spine tends to rotate with the pelvis The shoulders and trunk rotate out of phase with The shoulders and trunk rotate out of phase with

each other during the gait cycleeach other during the gait cycle


PelvisPelvis– For normal gait to occur, the pelvis For normal gait to occur, the pelvis

must both rotate and tiltmust both rotate and tilt


Sacroiliac JointSacroiliac Joint– As the right leg moves through the swing As the right leg moves through the swing

period, the position of the right innominate period, the position of the right innominate changes from one of extreme anterior rotation changes from one of extreme anterior rotation at the point of pre-swing to a position of at the point of pre-swing to a position of posterior rotation at the point of initial contactposterior rotation at the point of initial contact

– As the right extremity moves through the As the right extremity moves through the loading response to mid stance, the ilium on loading response to mid stance, the ilium on that side begins to convert from a posteriorly that side begins to convert from a posteriorly rotated position to a neutrally rotated position. rotated position to a neutrally rotated position. From mid stance to terminal stance, the ilium From mid stance to terminal stance, the ilium rotates anteriorly, achieving maximum position rotates anteriorly, achieving maximum position at terminal stance at terminal stance


Sacroiliac JointSacroiliac Joint– The sacrum rotates forward around The sacrum rotates forward around

a diagonal axis during the loading a diagonal axis during the loading response, reaching its maximum response, reaching its maximum position at mid stance (e.g., right position at mid stance (e.g., right rotation on a right oblique axis at rotation on a right oblique axis at right mid stance), and then begins right mid stance), and then begins to reverse itself during terminal to reverse itself during terminal stance stance


HipHip– Hip motion occurs in all three planes Hip motion occurs in all three planes

during the gait cycleduring the gait cycle KneeKnee

– The knee flexes twice and extends The knee flexes twice and extends twice during each gait cycle: once twice during each gait cycle: once during weight bearing and once during weight bearing and once during non-weight bearingduring non-weight bearing


Foot and ankleFoot and ankle– Ankle joint motion during the gait cycle occurs Ankle joint motion during the gait cycle occurs

primarily in the sagittal plprimarily in the sagittal planeane At initial contact with the ground the ankle is dorsiflexedAt initial contact with the ground the ankle is dorsiflexed During the loading response interval, plantar flexion During the loading response interval, plantar flexion

occurs at the talocrural joint, with pronation occurring at occurs at the talocrural joint, with pronation occurring at the subtalar joint the subtalar joint

At the end of the mid stance interval, the talocrural joint At the end of the mid stance interval, the talocrural joint is maximally dorsiflexed, and the subtalar joint begins to is maximally dorsiflexed, and the subtalar joint begins to supinatesupinate

From the mid stance to the terminal stance interval the From the mid stance to the terminal stance interval the foot is in supinationfoot is in supination

Once the ankle is fully close-packed, the heel is lifted by Once the ankle is fully close-packed, the heel is lifted by a combination of passive force and contraction from the a combination of passive force and contraction from the taut gastrocnemius, and the soleustaut gastrocnemius, and the soleus

Muscle ActionsMuscle Actions in Gait in Gait

Spine and pelvisSpine and pelvis– During the swing period, the semispinalis, During the swing period, the semispinalis,

rotatores, multifidus, and external oblique rotatores, multifidus, and external oblique muscles are active on the side toward which muscles are active on the side toward which the pelvis rotatesthe pelvis rotates

– The erector spinae and internal oblique The erector spinae and internal oblique abdominal muscles are active on the abdominal muscles are active on the opposite sideopposite side

– The psoas major and quadratus lumborum The psoas major and quadratus lumborum help to support the pelvis on the side of the help to support the pelvis on the side of the swinging limb, while the contralateral hip swinging limb, while the contralateral hip abductors also provide supportabductors also provide support


KneeKnee– During the swing period, there is very little During the swing period, there is very little

activity from the knee flexorsactivity from the knee flexors– The knee extensors contract slightly at the The knee extensors contract slightly at the

end of the swing period prior to initial end of the swing period prior to initial contact. During level walking the contact. During level walking the quadriceps achieve peak activity during the quadriceps achieve peak activity during the loading response interval (25% maximum loading response interval (25% maximum voluntary contraction) and are relatively voluntary contraction) and are relatively inactive by mid stance as the leg reaches inactive by mid stance as the leg reaches the vertical position and ‘locks’, making the vertical position and ‘locks’, making quadriceps contraction unnecessaryquadriceps contraction unnecessary


HipHip– During the early to mid portion of the swing During the early to mid portion of the swing

phase, the iliopsoas is the prime mover with phase, the iliopsoas is the prime mover with assistance from the rectus femoris, sartorius, assistance from the rectus femoris, sartorius, gracilis, adductor longus, and possibly the gracilis, adductor longus, and possibly the tensor fascia latae, pectineus, and the short tensor fascia latae, pectineus, and the short head of the biceps femoris during the initial head of the biceps femoris during the initial swing intervalswing interval

– In terminal swing, there is no appreciable In terminal swing, there is no appreciable action of the hip flexors when ambulating on action of the hip flexors when ambulating on level ground. Instead the hamstrings and level ground. Instead the hamstrings and gluteus maximus are strongly active to gluteus maximus are strongly active to decelerate hip flexion and knee extensiondecelerate hip flexion and knee extension


HipHip– The adductor magnus muscle supports hip The adductor magnus muscle supports hip

extension and also rotates the pelvis extension and also rotates the pelvis externally toward the forward legexternally toward the forward leg

– In mid stance, coronal plane muscle activity In mid stance, coronal plane muscle activity is greatest as the abductors stabilize the is greatest as the abductors stabilize the pelvis. The muscle activity initially is pelvis. The muscle activity initially is eccentric as the pelvis shifts laterally over eccentric as the pelvis shifts laterally over the stance leg. The gluteus medius and the stance leg. The gluteus medius and minimus remain active in terminal stance minimus remain active in terminal stance for lateral pelvic stabilizationfor lateral pelvic stabilization


KneeKnee– Hamstring involvement is also Hamstring involvement is also

important to normal knee functionimportant to normal knee function. . The The co activation of the antagonist muscles co activation of the antagonist muscles about the knee during the loading about the knee during the loading response aid the ligaments in response aid the ligaments in maintaining joint stability, by maintaining joint stability, by equalizing the articular surface equalizing the articular surface pressure distribution, and controlling pressure distribution, and controlling tibial translation.tibial translation.


Foot and ankleFoot and ankle – During the beginning of the swing During the beginning of the swing

period, the tibialis anterior, extensor period, the tibialis anterior, extensor digitorum longus (EDL), extensor digitorum longus (EDL), extensor hallucis longus (EHL), and possibly hallucis longus (EHL), and possibly the peroneus tertius contract the peroneus tertius contract concentrically with slight to moderate concentrically with slight to moderate intensity tapering off during the intensity tapering off during the middle of the swing pmiddle of the swing perioderiod


Foot and ankleFoot and ankle– At the point where the leg is At the point where the leg is

perpendicular to the ground during perpendicular to the ground during the swing period, the tibialis the swing period, the tibialis anterior, EDL and EHL group of anterior, EDL and EHL group of muscles contract concentrically to muscles contract concentrically to dorsiflex and invert the foot in dorsiflex and invert the foot in preparation for the initial contact preparation for the initial contact


Foot and ankleFoot and ankle– Following initial contact, the anterior tibialis Following initial contact, the anterior tibialis

works eccentrically to lower the foot to the works eccentrically to lower the foot to the ground during the loading response intervalground during the loading response interval

– Calcaneal eversion is controlled by the eccentric Calcaneal eversion is controlled by the eccentric activity of the posterior tibialis, and the anterior activity of the posterior tibialis, and the anterior movement of the tibia and talus is limited by the movement of the tibia and talus is limited by the eccentric action of the gastrocnemius and soleus eccentric action of the gastrocnemius and soleus muscle groups as the foot moves towards mid muscle groups as the foot moves towards mid stancestance

– Pronation occurs in the stance period to allow for Pronation occurs in the stance period to allow for shock absorption, ground terrain changes, and shock absorption, ground terrain changes, and equilibrium equilibrium


Foot and ankle Foot and ankle – The triceps surae become active again from The triceps surae become active again from

mid stance to the late stance period mid stance to the late stance period contracting eccentrically to control ankle contracting eccentrically to control ankle dorsiflexion as the COG continues to move dorsiflexion as the COG continues to move forwardforward

– In late stance period the Achilles tendon is In late stance period the Achilles tendon is stretched as the triceps surae contracts and stretched as the triceps surae contracts and the ankle dorsiflexesthe ankle dorsiflexes

– At this point the heel rises off the ground and At this point the heel rises off the ground and the action of the plantar flexors changes from the action of the plantar flexors changes from one of eccentric contraction, to one of one of eccentric contraction, to one of concentric contractionconcentric contraction

Influences on GaitInfluences on Gait

PainPain PosturePosture Flexibility and the amount of available joint Flexibility and the amount of available joint

motionmotion Endurance - economy of mobilityEndurance - economy of mobility Base of SupportBase of Support Interlimb coordinationInterlimb coordination Leg-lengthLeg-length GenderGender PregnancyPregnancy

Influences on GaitInfluences on Gait

ObesityObesity AgeAge Lateral and vertical displacement of Lateral and vertical displacement of

the COGthe COG Properly functioning reflexesProperly functioning reflexes Vertical Ground Reaction ForcesVertical Ground Reaction Forces Medial-Lateral Shear ForcesMedial-Lateral Shear Forces Anterior-Posterior Shear Forces Anterior-Posterior Shear Forces

Specific Deviations of Specific Deviations of Individual JointsIndividual Joints HipHip

– Inadequate powerInadequate power– Inadequate or inappropriate range of Inadequate or inappropriate range of

motionmotion– MalrotationMalrotation

Specific Deviations of Specific Deviations of Individual JointsIndividual Joints KneeKnee

– The common problem at the knee The common problem at the knee during the stance period is during the stance period is excessive flexion. During the swing excessive flexion. During the swing period, the most common error is period, the most common error is due to inadequate motiondue to inadequate motion

Specific Deviations of Specific Deviations of Individual JointsIndividual Joints Foot and ankleFoot and ankle

– There are three broad types of There are three broad types of errors of the foot and ankle in the errors of the foot and ankle in the stance and swing periods:stance and swing periods: MalrotationMalrotation Varus or valgus deformityVarus or valgus deformity Abnormal muscle momentsAbnormal muscle moments

Abnormal Gait Abnormal Gait SyndromesSyndromes In general gait deviations fall In general gait deviations fall

under four headings: under four headings: – Those caused by weaknessThose caused by weakness– Those caused by abnormal joint Those caused by abnormal joint

position or range of motionposition or range of motion– Those caused by muscle contractureThose caused by muscle contracture– Those caused by painThose caused by pain

Abnormal Gait Abnormal Gait SyndromesSyndromes Antalgic GaitAntalgic Gait

– The antalgic gait pattern can result from The antalgic gait pattern can result from numerous causes including joint numerous causes including joint inflammation or an injury to the muscles inflammation or an injury to the muscles tendons and ligaments of the lower tendons and ligaments of the lower extremityextremity

– The antalgic gait is characterized by a The antalgic gait is characterized by a decrease in the stance period on the decrease in the stance period on the involved side in an attempt to eliminate the involved side in an attempt to eliminate the weight from the involved leg and use of the weight from the involved leg and use of the injured body part as much as possible injured body part as much as possible

Abnormal Gait Abnormal Gait SyndromesSyndromes Equinus GaitEquinus Gait

– Equinus gait (toe-walking), one of Equinus gait (toe-walking), one of the more common abnormal the more common abnormal patterns of gait of patients with patterns of gait of patients with spastic diplegia, is characterized by spastic diplegia, is characterized by forefoot strike to initiate the cycle forefoot strike to initiate the cycle and premature plantar flexion in and premature plantar flexion in early stance to midstanceearly stance to midstance

Abnormal Gait Abnormal Gait SyndromesSyndromes Gluteus maximus GaitGluteus maximus Gait

– The gluteus maximus gait, which results The gluteus maximus gait, which results from weakness of the gluteus maximus, is from weakness of the gluteus maximus, is characterized by a posterior thrusting of characterized by a posterior thrusting of the trunk at initial contact in an attempt to the trunk at initial contact in an attempt to maintain hip extension of the stance legmaintain hip extension of the stance leg

– The hip extensor weakness also results in The hip extensor weakness also results in forward tilt of the pelvis, which eventually forward tilt of the pelvis, which eventually translates into a hyperlordosis of the spine translates into a hyperlordosis of the spine to maintain postureto maintain posture

Abnormal Gait Abnormal Gait SyndromesSyndromes Quadriceps GaitQuadriceps Gait

– Quadriceps weakness can result from a Quadriceps weakness can result from a peripheral nerve lesion (femoral), a spinal peripheral nerve lesion (femoral), a spinal berve root lesion, from trauma, or from berve root lesion, from trauma, or from disease (muscular dystrophy)disease (muscular dystrophy)

– Quadriceps weakness requires that forward Quadriceps weakness requires that forward motion be propagated by circumducting motion be propagated by circumducting each leg. The patient leans the body each leg. The patient leans the body toward the other side to balance the center toward the other side to balance the center of gravity, and the motion is repeated with of gravity, and the motion is repeated with each stepeach step

Abnormal Gait Abnormal Gait SyndromesSyndromes Spastic GaitSpastic Gait

– A spastic gait may result from either A spastic gait may result from either unilateral or bilateral upper motor neuron unilateral or bilateral upper motor neuron lesionslesions

Spastic hemiplegic (hemiparetic) gaitSpastic hemiplegic (hemiparetic) gait. . This type This type of gait results from a unilateral upper motor of gait results from a unilateral upper motor neuron lesion and is frequently seen following a neuron lesion and is frequently seen following a completed strokecompleted stroke

Spastic paraparetic gait. This type of gait results Spastic paraparetic gait. This type of gait results from bilateral upper motor neuron lesions (e.g., from bilateral upper motor neuron lesions (e.g., cervical myelopathy in adults and cerebral palsy cervical myelopathy in adults and cerebral palsy in children)in children)

Abnormal Gait Abnormal Gait SyndromesSyndromes Ataxic GaitAtaxic Gait

– The ataxic gait is seen in two The ataxic gait is seen in two principal disorders: cerebellar principal disorders: cerebellar disease (cerebellar ataxic gait) and disease (cerebellar ataxic gait) and posterior column disease (sensory posterior column disease (sensory ataxic gait)ataxic gait)

Abnormal Gait Abnormal Gait SyndromesSyndromes Steppage GaitSteppage Gait

– This type of gait occurs in patients with a This type of gait occurs in patients with a foot dropfoot drop

– A foot drop is the result of weakness or A foot drop is the result of weakness or paralysis of the dorsiflexor muscles due to paralysis of the dorsiflexor muscles due to an injury to the muscles, their peripheral an injury to the muscles, their peripheral nerve supply, or the nerve roots supplying nerve supply, or the nerve roots supplying the musclesthe muscles

– The patient lifts the leg high enough to The patient lifts the leg high enough to clear the flail foot off the floor by flexing clear the flail foot off the floor by flexing excessively at the hip and knee, and then excessively at the hip and knee, and then slaps the foot on the floorslaps the foot on the floor

Abnormal Gait Abnormal Gait SyndromesSyndromes Trendelenburg GaitTrendelenburg Gait

– This type of gait is due to weakness of the This type of gait is due to weakness of the hip abductors (gluteus medius and hip abductors (gluteus medius and minimus)minimus)

– The normal stabilizing affect of these The normal stabilizing affect of these muscles is lost and the patient muscles is lost and the patient demonstrates an excessive lateral list in demonstrates an excessive lateral list in which the trunk is thrust laterally in an which the trunk is thrust laterally in an attempt to keep the center of gravity over attempt to keep the center of gravity over the stance legthe stance leg

Abnormal Gait Abnormal Gait SyndromesSyndromes Parkinsonian GaitParkinsonian Gait

– The parkinsonian gait is characterized by a The parkinsonian gait is characterized by a flexed and stooped posture with flexion of flexed and stooped posture with flexion of the neck, elbows, metacarpophalangeal the neck, elbows, metacarpophalangeal joints, trunk, hips, and kneesjoints, trunk, hips, and knees

– The patient has difficulty initiating The patient has difficulty initiating movements and walks with short steps movements and walks with short steps with the feet barely clearing the ground. with the feet barely clearing the ground. This results in a shuffling type of gait with This results in a shuffling type of gait with rapid steps rapid steps

Abnormal Gait Abnormal Gait SyndromesSyndromes Hysterical GaitHysterical Gait

– The hysterical gait is non-specific and The hysterical gait is non-specific and bizarrebizarre

– It does not conform to any specific organic It does not conform to any specific organic pattern with the abnormality varying from pattern with the abnormality varying from moment to moment and from one moment to moment and from one examination to anotherexamination to another

– There may be ataxia, spasticity, inability to There may be ataxia, spasticity, inability to move, or other types of abnormalitymove, or other types of abnormality

– The abnormality is often minimal or absent The abnormality is often minimal or absent when the patient is unaware of being when the patient is unaware of being watched or when distractedwatched or when distracted

PosturePosture

Good posture is a subjective term Good posture is a subjective term reflecting what the clinician reflecting what the clinician believes to be correct based on believes to be correct based on ideal models.ideal models.

Generally speaking muscles can Generally speaking muscles can be subdivided into:be subdivided into:– Postural musclesPostural muscles– Phasic musclesPhasic muscles

PosturePosture

The ability to main correct posture The ability to main correct posture is related to a number of factors, is related to a number of factors, which includes but is not limited to:which includes but is not limited to:– Energy costEnergy cost– Strength and flexibilityStrength and flexibility– Structural deformitiesStructural deformities– DiseaseDisease– PainPain

chapter 13 gait and posture analysis. overview it is not clear whether gait is learned or is...

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