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CHAPTER OBJECTIVES

CHAPTER OBJECTIVES

At the completion of this chapter, the reader will be able to:

  1. Summarize the various components of the gait cycle.

  2. Apply the knowledge of gait components to gait analysis.

  3. Perform a comprehensive gait analysis.

  4. Categorize the various compensations of the body and their influences on gait.

  5. Recognize the manifestations of abnormal gait and develop strategies to counteract these abnormalities.

  6. Describe and demonstrate a number of abnormal gait syndromes.

  7. Make an accurate judgment when recommending an assistive device to improve gait and function.

  8. Describe and demonstrate the various gait patterns used with assistive devices.

  9. Evaluate the effectiveness of an intervention for a gait dysfunction.

  10. Summarize the components of a postural assessment.

  11. Perform a thorough posture assessment.

  12. Recognize the most common manifestations of abnormal posture.

  13. Make an accurate judgment when recommending postural adjustments.

  14. Evaluate the effectiveness of a postural adjustment.

OVERVIEW

OVERVIEW

The assessment of symmetry within locomotion and posture is critical in the evaluation of neuromusculoskeletal dysfunction. For most individuals, gait or posture is an innate characteristic, as much a part of their personality as their smile. Indeed, many people can be recognized in a group by their gait or posture. The purpose of this chapter is to describe the various components of gait and posture and to provide the clinician with the necessary tools for the analysis of each.

Gait and the Gait Cycle

The lower kinetic chain has two main functions: to provide a stable base of support (BOS) in standing and to propel the body through space with gait. During gait, the body follows the least restrictive pathway in the most efficient manner.1 In order to maintain this efficiency, the body attempts to maintain a level center of gravity (COG) in all planes.1 While maintaining a static equilibrium of forces, the objective with mobility is to create and control dynamic, unbalanced forces to produce movement.2 Gait is thus an example of controlled instability. It is not clear whether gait is learned or is preprogrammed at the spinal cord level. However, once mastered, gait allows us to move around our environment in an efficient manner, requiring little in the way of conscious thought, at least in familiar surroundings. The evolution of bipedal gait has allowed the arms and hands to be free for exploration of the environment. Even though gait appears to be a simple process, it is prone to break down.

Gait is initiated grossly in the spinal cord and then fine-tuned by the higher brain centers.2 Pain, weakness, and disease can all cause a disturbance in the normal rhythm of gait. However, except in obvious cases, abnormal gait does not always equate with impairment.

In addition to neural input, normal human gait also involves a complex synchronization of the cardiopulmonary and muscular systems in which the cardiopulmonary system produces the energy required ...

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