Introduction:
Walking is one of the most consistent yet flexible actions we perform, individuals displaying the same qualitative pattern of movement. In simple words gait is define as the pattern of walking of an individual and it varies from person to person. Just as standing up is essential to independence so also is walking. The ability to walk independently is a life enriching activity and the most efficient way of getting from one place to another in the course of our daily lives.
The human gait is an extremely complex mechanism, it involves perfect synchronisation of various body systems in general with nuero-muscular and musculoskeletal systems in particular. The physical therapist has the total responsibility of gait training which becomes absolutely essential to critically observe and analyse the pattern of gait.
The major requirements for successful walking are
➤ Production of a basic locomotive rhythm
➤ Support & propulsion of the body in the intended direction
➤ Dynamic balance control of the moving body
➤ Ability to adapt the movement with the demand & goal
During each gait cycle the center of gravity(CG) is constantly displaced, disturbing the balance of body. Coordinated action of the muscles and the adaptations of the skeletal components restore the CG by controlling its displacement without much exertion. Locomotion in the real sense involves first disturbing the balance and then regaining it. To understand this complicated mechanism, it is necessary to know the following
1. Phases of gait cycle
2. Kinematics of gait
3. Kinetics of gait
Phases of gait cycle- Every gait cycle is divided into a stance phase and a swing phase, which commences at heel contact and toe off. Each leg in turn has a stance phase when the upper body moves forward from behind the foot on the ground to in front of the foot, and a swing phase when the leg swings forward from behind the pelvis. There is also a brief double support phase when both feet are in contact with the support surface.
The Stance phase is longer and occupies 60% of gait cycle whereas swing phase lasts for the remaining 40% of gait cycle. The length of time of double support period is directly related to the cadence. It decreases with the increase of cadence and is absent during running. The stance phase is further divided into 3 stages
(a) Heel strike (occupy up to 15% of gait cycle)
(b) Mid stance (from flat foot to maximum dorsiflexion)
(c) Push off ( body is propelled forward)
In the stance phase of walking the lower limb's principal functions are
1. Support
2. Balance
3. Propulsion
4. Absorption
In the swing phase lower limb's main function is to clear the foot from the ground and to prepare the foot for its landing on the support surface
Kinematics of Gait:
Kinematics is the term used to describe movement itself independent of internal and external forces. A wide variety of measurement techniques have been used to quantify kinematic variables and include video based motion analysis system, electro goniometry, electro myographic data. So is the study of pattern of angular movements and their excursion by smooth coordinated muscle control.
Kinetics of Gait:
Kinetics is concerned with individual muscle forces, the forces producing displacements of the segments of lower limb are muscular, gravitational and interactive with ground reaction forces.
Gait assessment:
There are various methods for the assessment and evaluation of gait, some of them are as follows:-
1.Electrogoniometric method
2.Observational method
3.EMG method
4.Spatial and temporal measurement method
5.Multichannel functional stimulation method
6.The force studies method
7.Photographic method
8.Combination of various methods
Gait Abnormalities:
Analysis of an individual's walking pattern is very complex, yet physical therapist must do this in the clinic in order to be able to plan an appropriate training program for individuals with movement dysfunction. Some of the abnormal gait are as follows
➤ Trendelburg gait or Gluteus medius dip gait → weakness of hip abductors muscle with dropping of the pelvis on the opposite side with lateral flexion of the trunk and head on the affected side.
➤ Antalgic gait → This type of gait is commonly seen in person with lower limb injury and the pain arising from hip, knee, ankle or foot causes stance period reduction of the painful leg. At the onset of stance phase the person jerks his head, arms and trunk downwards. Common gait deviations in certain diseases like Parkinson's disease, Stroke hemiplegic and Duchenne muscular Dystrophy(DMD) are easily identified because of their gait pattern.
➤ High Stepping gait → This gait occurs due to weakness of dorsiflexors muscle of leg which produces foot slapping at the early stance and foot drop at the swing phase.
➤Weakness of quadricep muscle → There is forcible extension of knee at heel strike which is done by using hand on thigh position. At mid stance, knee can be drawn backward by hip extensor as well as by gastro-soleus muscle on weight bearing by producing equinus foot.
➤Weakness of hamstring muscle→ gait is disturbed and it may give rise to genu recurvatum due to repeated posterior thrust of weight bearing.
Gait Training:
Your Physical Therapist will give you gait training according to the type of deformity you have, so it is important to note that gait training should be started after the first evaluation of a patient and not only when the patient is allowed to stand and walk. So gait training consist of 5 phases and they are
1.Pre gait training assessment and evaluation
2.Detection of the restricting factors
3.Therapeutic measures
4.commencement of gait training
5.independence in other activities of ambulation
Physical Therapy for Gait:
Physical therapist plays a major role in gait training by emphasis on muscles of lower limb by weight bearing and strengthening. Since these muscles provide the basic support, balance and propulsion functions. Physical therapy may have to be practised to elicit contraction of a muscle or to strengthen a weak muscle group. The position in which muscles are activated may not be of any consequence in the early stage of training, since such exercises are designed to get weak or inactive muscles to twitch and generate force. However, for muscles to be able to both generate and time the necessary muscle force in the synergy required for walking or stair walking, it is clear that closed chain(foot on support surface) actions must be practised repetitively, frequently and under different environmental and speed conditions.
Conclusion:
Physical Therapist are to be part of rehabilitation in the twenty first century for gait training, it is time for a paradigm shift to a more scientifically based walking rehabilitation. So there has to be a training guidelines designed to increase lower limb muscle strength and optimize walking performance.
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