Basic Assessment

Gait Cycle & Gait Analysis

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Gait analysis

Gait Cycle & Gait Analysis

Gait analysis can be part of your functional assessment. You would most likely choose to do a gait analysis when for example, walking was your patient’s specific complaints that you have recorded during history taking. When you do gait analysis, it is wise to look at the patient from the front, the back, and the side. It can also be beneficial to record the gait analysis on video to show it in slow motion and to discuss your findings with your patient.

Before we start getting into analysis itself. Let’s talk about the gait cycle. We are going to focus on the right gait cycle. Meaning we are going to follow the right leg during the full stride. We should begin by defining steps and strides. A step starts with the initial contact of one foot. And ends with the initial contact of the other foot. A stride starts with the initial contact of one foot. And ends with the next initial contact of that same foot. So it is made out of two steps.

Now let’s begin by looking at the two phases of the gait cycle. First, there’s the Stance Phase. It accounts for 60% of the full gait cycle. During Stance Phase, the right foot is always in contact with the floor. Hence the term stance. In the Swing Phase, which makes up 40% of the gait cycle. The right leg is swinging. During Stance Phase, the right leg has to complete different tasks. With the Heel Strike, the leg has to accept the weight of the body. This so-called Loading Response. It marks the first 10% of the gait cycle.
The Loading Response ends once the contralateral foot lifts off the ground. We are now single limb support. Here, you can differentiate further. After Load Response, up until the point of Heel Off, we are in so-called Mid-Stance. So far we have reached 30% of a full gait cycle. The heel of the right foot starts to lift while the contralateral leg has initial contact with the ground. This period is called the Terminal Stance. We have reached 50%of the gait cycle and we are almost through the Stance Phase. While the contralateral leg is proceeding to make full contact with the ground. The right leg lifts off further off the ground. This is the so-called Pre-Swing and we have reached 60% of the gait cycle. The stance phase is now complete and we start the Swing Phase.

The only task now is right limb enhancement until the next heel strike. We subdivide the Swing Phase into the Initial Swing – from toe-off until the feet are adjacent. We are now at 73% of the gait cycle. Following the Initial Swing is the short period called Mid-Swing. And it lasts until the tibia is vertical. We have reached 87% of the gait cycle. The last period, the so called Terminal Swing, ends with the heel strike of the right leg. Take a look at this overview.

Gait phases

To analyze gait in physiotherapy one can make use of the Nijmegen Orthopaedic Gait Analysis Form.It is a check list to assess certain aspects of the body during gait.And it is important to compare left and right. You would ask the patient to walk at his or her normal pace.

Kai is walking 3km/h, which is an average walking speed. A general aspect to assess, whether there is a shortened stance phase or not. It is usually the most obvious deviation from normal gait

For example, the patient who is limping will have a shortened stance phase for sure. Focusing on the trunk Check whether the trunk is anterior or posterior to the hips or is lateral flexion is present. In some patients, the arm swing might also be reduced.

Next up, one should look at the pelvis and whether posterior rotation is excessive. Your patient might have to expose landmarks for you to assess this item.

At the hips, check the amount of extension and whether that is reduced. Do the same for the knee.

Also, assess the knee flexion movement and check whether it is absent.

Furthermore, check for normal ankle plantarflexion, which might be reduced.

Lastly, you could also inspect the amount of internal or external rotation of the leg.

If you are really interested in gait and running injuries, check out our online course on Running Rehab.

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References

Brunnekreef JJ, Van Uden CJ, van Moorsel S, Kooloos JG. Reliability of videotaped observational gait analysis in patients with orthopedic impairments. BMC musculoskeletal disorders. 2005 Dec;6(1):1-9.

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