Mark David S.

Basco, PTRP
Faculty
Department of Physical Therapy
College of Allied Medical Professions
University of the Philippines Manila
At the end of the session, you should be able
to:
 Explain the importance of studying gait in

PT and OT
 Identify fundamental requirements of

normal gait
 Define the phases and sub-phases of gait

and tasks accomplished by these

At the end of the session, you should be able
to:
 Describe gait in terms of kinematic and

kinetic variables
 Explain the “determinants” of gait
 Describe changes in aging
 Describe effects of common pathological

conditions on gait
 Appreciation of our own locomotor ability
 Knowledge of gait is important in

understanding human function

 Knowledge of gait can aid in identifying

abnormalities and, thus, care needs of

patients in PT and OT
 Equilibrium and Locomotion

 Others
◦ Intact musculoskeletal system
◦ Normal muscle tone
◦ Intact sensory system
 Tasks accomplished by gait
 Gait cycle:

◦ Phases
◦ Sub-phases
 Time and distance parameters of gait
 Relationships among gait variables
Tasks accomplished by gait
 Weight acceptance
 Single limb support
 Limb advancement
Gait cycle phases
 Gait cycle, stride, step
 Stance

◦ Single limb support (SLS)

◦ Double limb support (DLS)
 Swing
Gait cycle sub-phases (STANCE)
 Initial contact
 Loading response
 Midstance
 Terminal stance
 Preswing
 Initial contact
 Loading response
 Midstance
 Terminal stance
 Preswing
Gait cycle sub-phases (SWING)
 Initial swing
 Midswing
 Terminal swing
 Initial swing
 Midswing
 Terminal swing
 Traditional terminology
◦ Heel strike (HS)
◦ Foot flat (FF)
◦ Midstance (MSt)
◦ Heel off (HO)
◦ Toe off (TO)
 Traditional terminology
◦ Acceleration (Acc)
◦ Midswing (MSw)
◦ Deceleration (Dec)
Time and distance gait variables
 Stride length and stride time
 Step length and step time
 Stance time and swing time
 SLS time and DLS time
 Base / step width
Time and distance gait variables
 Foot angle
 Gait velocity: free, fast, slow
 Cadence
 Period of “double float”
Relationships among some variables
 Gait velocity and cadence
 Gait velocity and step length
 Gait velocity and SLS time
 Gait velocity and DLS time
The equivalent of heel strike in the Rancho
Los Amigos terminogy is:

A. Initial contact

B. Loading response

C. Preswing

D. Initial swing
This sub-phase of stance occurs from the time
the contralateral foot gets into contact with the
ground until the reference foot lifts off the
ground:

A. Terminal stance

B. Preswing

C. Loading response

D. None of the above

With an increase in gait velocity, the
following will increase logically, EXCEPT:

A. Cadence

B. Step length

C. DLS time

D. None of the above

 Description of joint motions that occur
during gait

 Ideally, description should encompass all

three planes of motion

 Often, sagittal motions are described

(simplistically)
 HS – FF 0 – 15 deg p/flex

 FF – MSt 15 deg p/flex –

10 deg d/flex

 MSt – HO 10 – 15 deg d/flex

 HO – TO 15 deg d/flex –
20 deg p/flex

O’ Sullivan, S.B., & Schmitz, T.J. (2001). Physical rehabilitation:

Assessment & treatment. Philadelphia; F.A. Davis.
 Acc – MSw d/flex - neutral

 MSw – Dec neutral

O’ Sullivan, S.B., & Schmitz, T.J. (2001). Physical rehabilitation:

Assessment & treatment. Philadelphia; F.A. Davis.
 HS – FF 0 – 15 deg flex

 FF – MSt 15 deg flex –

5 deg flex

 MSt – HO 5 deg flex - neutral

 HO – TO 0 – 40 deg flex

O’ Sullivan, S.B., & Schmitz, T.J. (2001). Physical rehabilitation:

Assessment & treatment. Philadelphia; F.A. Davis.
 Acc – MSw 40 – 60 flex

 MSw 60 deg flex – 30 deg flex

 Dec 30 deg flex - neutral

O’ Sullivan, S.B., & Schmitz, T.J. (2001). Physical rehabilitation:

Assessment & treatment. Philadelphia; F.A. Davis.
 HS – FF 30 deg flex

 FF – MSt 30 – 5 deg flex

 MSt – HO-TO 5 deg flex - 10 deg ext

 Acc - MSw 20 – 30 deg flex

 MSw – Dec 30 deg flex

O’ Sullivan, S.B., & Schmitz, T.J. (2001). Physical rehabilitation:

Assessment & treatment. Philadelphia; F.A. Davis.
At the moment of HS, the ankle is normally in
this many degrees of dorsiflexion:

A. 20

B. 10

C. 5

D. None of the above

Using traditional terminology, the highest
amount of knee flexion during normal
(comfortable) gait is observed in:

A. Toe off

B. Acceleration

C. Midswing

D. Deceleration
Normally, the hip must extend to at least this
many degrees during HO – TO to aid limb
advancement:

A. 10

B. 20

C. 30
 Ground reaction forces

 Electromyographic activity
Ankle dorsiflexors
 Just after initial contact

 Swing phase
Ankle plantarflexors
 Loading response

 Preswing
Knee extensors
 Loading response

 Preswing (slight)
◦ Rectus femoris
Knee flexors
 Terminal swing to initial contact

 Initial swing
Hip extensors
 Terminal swing to initial contact
Hip flexors
 Initial swing
Hip abductors
 Loading response through midstance
Hip adductors
 Preswing ; Initial swing
Back extensors
 At initial contact (both sides)
Peak activity of the knee extensors occur in:

A. Loading response

B. Midstance

C. Terminal stance

D. Preswing
At initial contact, the erector spinae on both
sides are active to check:

A. Trunk flexion

B. Trunk lateral flexion

C. Hip flexion

D. None of the above

Intuitively, peak activity of the ankle
plantarflexors should occur in:

A. Initial contact

B. Loading response

C. Terminal stance

D. Preswing
 Reduce maximum COM height of the body
during midstance

 Increase minimum COM height of the body

at heel-strike and toe-off
 Pelvic rotation
 Pelvic obliquity or “list”
 Knee flexion in the stance phase
 Ankle rockers
 Transverse rotation
 Genu valgum
Pelvic rotation
Pelvic obliquity or “list”
Knee flexion in the stance
phase
Ankle rockers
Ankle rockers
Transverse
rotation (1)
Transverse
rotation (2)
Genu valgum
 Gender; age
 Sensory conditions
 Demands / purpose of the task
 Environmental constraints
 Mood / psychological state
Dimensions of mobility (Patla & Shumway-Cook
1999)
Post-OTPT102 exam: which one represents
you?
 Physiological decline of multiple systems in
the body

 Effects of chronic conditions

 Effects of acute conditions

Common observable changes*
 Decreased:

◦ GAIT velocity
◦ STEP length
◦ Arm swing
◦ PELVIC rotation
◦ ANKLE motions
Common observable changes*
 Increased:

◦ Cadence
◦ DLS time
◦ Postural sway
The COM of the body normally translates a
total of ____ cm in the coronal plane:

A. 2

B. 4

C. 6

D. None of the above

Gait changes observed in aging is / are
considered to be primarily a function of:

A. Acute health conditions

B. Chronic health conditions

C. Normal decline of physiological functions

D. All of the above

Common causes of abnormal gait
 Pain
 Muscle weakness
 Soft tissue or contracture
 Abnormal muscle tone
Common causes of abnormal gait
 Lower limb length discrepancy
 Impaired proprioception / kinesthesia
 Impaired balance or motor control
Some patterns of abnormal gait
 Antalgic gait
 Equinus gait
 Stiff knee gait
 Waddling gait
Some patterns of abnormal gait
 Hemiplegic gait
 Parkinsonian gait
 Scissors gait
 Ataxic gait
This abnormal gait pattern typically results when
there is generalized muscle weakness in one
side of the body:

A. Antalgic

B. Hemiplegic

C. Equinus

D. None of the above

In an antalgic gait pattern, the following
would be expected to decrease, EXCEPT:

A. SLS time – affected limb

B. DLS time

C. Preswing – affected limb

D. None of the above

Generalized reflex hyperactivity of the lower limb
muscles, the hip adductors in particular, often
result in this abnormal gait pattern:

A. Equinus

B. Parkinsonian

C. Ataxic

D. None of the above

EACH GROUP must bring:
 Kinesiology attire
 2 – 3 ink markers
 Masking tape
 Measuring tape
 Stopwatch
 1m x 6m walkway
 Pair of sunglasses
 Piece of wood
 Small pebble
 I would like to acknowledge
Prof. EJ Gorgon, MPhysio, PTRP for
the powerpoint slides used in this
presentation.

Gait is a complicated subject to learn and study. It is

strongly encouraged that you do extra reading. For
references that you could use, do not hesitate to seek
consult.
The depth and quality of learning that you
would get from this college does not
entirely depend on the faculty and the
instructional materials used...

Most of it depends...

On the passion that you put into learning and

your perseverance to rise up against the
challenges and difficulties you would
encounter.