At the completion of this chapter, the reader will be able to:
Summarize the various components of the gait cycle.
Apply the knowledge of gait components to gait analysis.
Perform a comprehensive gait analysis.
Categorize the various compensations of the body and their influences on gait.
Recognize the manifestations of abnormal gait and develop strategies to counteract these abnormalities.
Describe and demonstrate a number of abnormal gait syndromes.
Make an accurate judgment when recommending an assistive device to improve gait and function.
Describe and demonstrate the various gait patterns used with assistive devices.
Evaluate the effectiveness of an intervention for a gait dysfunction.
Summarize the components of a postural assessment.
Perform a thorough posture assessment.
Recognize the most common manifestations of abnormal posture.
Make an accurate judgment when recommending postural adjustments.
Evaluate the effectiveness of a postural adjustment.
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.
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. While maintaining a static equilibrium of forces, the objective with mobility is to create and control dynamic, unbalanced forces to produce movement.
1Gait 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. 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 breakdown. Although individual gait patterns are characterized by significant variation, three essential requirements have been identified for locomotion: progression, postural control, and adaptation:
- Progression. The fall that occurs at the initiation of gait so that an individual must take the first step is controlled by the central nervous system (CNS).
3The CNS computes in advance the required size and direction of this fall toward the supporting foot. Progression of the head, arms, and trunk is initiated and terminated in the brain stem that maintains a central pattern generator (CPG) through the spinal cord (see
Chapter 3). The locomotor CPG produces self-sustaining patterns of stereotype motor output resulting in gait-like movements. In addition, gait relies on the control of the limb movements by reflexes. Two ...