Marcha Patologica

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CHAPTER 21

Gait

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opposite leg. The trunk rotates forward as the leg progresses through the swing phase. Arms swinging in opposition to trunk rotation control the amount of trunk rotation by providing counterrotation. The head should be erect, shoulders level, and trunk in extension. Whenanalyzing someone’s gait, it is best to view the person from both the side and the front (and sometimes the back). Step length, arm swing, position of head and trunk, and the activities of the lower leg are usually best viewed from the side. Width of walking base, dip of the pelvis, and position of the shoulders and head should be viewed from the front or back.

Abnormal (Atypical) Gait
Thecauses of an abnormal gait are numerous. It may be temporary, due to a sprained ankle, or permanent, following a stroke. There can be great variation depending upon the severity of the problem. If a muscle is weak, how weak is it? If joint motion is limited, how limited is it? As with all causes of abnormal motion, severity or degree of involvement will always result in a range of variations fromminor ones to major ones. There are many methods of classifying abnormal gait. The following is a listing of abnormal gaits based on general cause or basis for the abnormality: Muscular weakness/paralysis Joint muscle range-of-motion (ROM) limitation Neurological involvement Pain Leg length discrepancy

Age-Related Gait Patterns
Not all gait patterns that don’t comply with “normal” gaitcharacteristics are the result of pathology. The walking patterns of young children and elderly adults have characteristic differences from the walking pattern of younger adults. These are considered age-related, not pathological, changes. The differences seen in young children tend to disappear as they get older. They tend to walk with a wider walking base, cadence is faster, and stride length is shorter.Initial contact with the floor is with a flat foot, as opposed to heel strike. Their knees remain mostly extended during stance phase. In other words, they tend to take more steps that are shorter and choppy in a faster period of time. They also have little or no reciprocal arm swing. This is easy to observe as a child walks with an adult. Even in the absence of pathology, an elderly adult’swalking pattern undergoes change. Although there is not universal agreement on the reasons for these changes, it is generally felt that security and fear of falling are major contributors. Typically, older adults lose muscle mass, are less active, and often have poorer hearing and vision. It should be recognized that the effects of age are relative to many factors such as health, activity level, andeven attitude. Some 70-year-old people may appear “older” than others ten or more years their senior. Given all of these qualifiers, some general statements can be made regarding the changes in the walking pattern of elderly individuals. They tend to walk slower, spending more time in stance phase. Therefore, there are longer periods of double support. They take shorter steps, thus, verticaldisplacement is less. They walk with a wider base, and so have greater horizontal displacement. There are fewer, or slower, automatic movements, which may be another factor increasing the chance of stumbling or falling. In turn, this may contribute to increased toe-floor clearance.

Muscular Weakness/Paralysis
Depending upon the cause or severity of the condition, muscle weakness can range from slightweakness to complete paralysis, in which there is no strength at all. Generally speaking, with muscle weakness, the body tends to compensate by shifting the center of gravity over, or toward, the part that is involved. Basically, this reduces the moment of force (torque) on the joint, lessening the muscle strength required. Obviously, the portion of the gait cycle affected will be that portion...