Introduction to normal gait

Dr. Ahmed Mohamed Mostafa

LECTURER OF PHYSICAL THERAPY FOR PEDIATRICS
FACULTY OF PHYSICAL THERAPY
MERIT UNIVERSITY.
 Walking
• Is the body's natural means of moving from one location
to another.

• Efficiency depends on free joint mobility and muscle

activity that is selective in timing and intensity.

 Gait
• Is the medical term used to describe human locomotion, or the
way, the manner, and the style that we walk. Every individual
has a unique gait pattern.

• Bipedal locomotion, or gait, is a functional task requiring

complex interactions and coordination among most of the
systems and joints of the body, particularly of the lower
extremity.
 Definition
• Physiological Definition:
• It is a mechanism that depends upon integrated action
musculoskeletal, peripheral and central nervous systems, visual,
vestibular, auditory, and sensory-motor systems.

• The degree of integration determines the different gait patterns.

Any defect of any part of them or all of them will lead to
pathological gait.
• Mechanical Definition:
• It is a form of bipedal locomotion as there is an alternating
action between the lower extremities.

• Gait is the result of a series of rhythmic alternating movements

of arms, legs, and trunk which create a forward movement of
the body.
 Prerequisites of gait
• For a person to be able of normal walk he must have the ability to:

1. Maintenance of support of HAT against gravity (HAT is Head,

Arms, and Trunk which constitutes about 75 % of total body
weight)

2. Maintenance of upright posture and balance.

3. Control of the limb movement to achieve safe ground clearance of

the toes and gentle heel contact.
 Normal gait
Movements that produce locomotion for humans including
(walking, running, swimming, cycling, [Link])

Characteristics:
- Energy-economical, particularly walking

- Flexibility to cope with different speeds, surfaces, [Link].

- Sophisticated Control Mechanisms (bipedal gait inherently unstable)

 Gait Cycle
• It includes activities that start by heel contact the ground of one foot till
the next heel contact of the same foot. During gait cycle each lower
extremity passes by two phases (stance phase and swing phase).
Gait cycle subphases
 1-Stance phase

It begins when one extremity contacts the ground and ends

when the foot of that extremity lifts off the ground. It is called (the
supporting phase) or (the weight-bearing phase). (60% of the gait
cycle)
It is divided to 5 sub-phases:
Initial contact (or heel strike): It refers to the instant at which the
foot just touches the floor. This phase occurs at about 2% of GC.
Loading response (or foot flat): occurs when the foot fully contacted
with the ground (extend from 2% to 8-10% of gait cycle).

Midstance: Occurs when the body weight is directly over the

supporting lower extremity. (Extend 10% to 30% of GC).

Terminal stance or heel off: the period when the heel of the reference
extremity leaves the ground. (From 30% to 50% of GC).
Preswing (or toe off): Occurs when the toe of the reference extremity
is in contact with the ground (from 50 % end by 60 % of GC).

Rancho Los Amigos

Swing phase (non-weight bearing)
Start by the toe of one extremity leaving the ground and end
just prior to heel strike of the same extremity. It represents 40%
of gait cycle.
The three phases of swing phase are:
Initial swing or acceleration: It is the period of time from the toe of the
one extremity leaves the ground to the midswing of the same limb (It
extends from 60% to 75% of GC).
Midswing: It is the period of time when the extremity passes directly under
the body. The ipsilateral extremity reaches vertical tibial position just
before the end of midswing (from 75% to 85 % of GC).
Terminal swing or deceleration: It is the period of time from the end of
midswing to the point just before initial contact. The knee is extending in
preparation for a new heel strike. (from 85% to 100% of GC).
 Intervals of Gait cycle
The following example is for right lower limb to explain the
intervals during one gait cycle of normal speed.

A- Stance is subdivided into three intervals:

1-Initial double support.
2-Single limb support.
3-Terminal double support.
Gait cycle intervals
B- The swing phase has one interval:
it is the time at which one foot is not on the floor, so the right lower
limb in the example is in the swing phase (ipsilateral limb) while the
contra-lateral limb is in mid-stance and terminal stance. The timing of
this division is 40%. So one gait cycle for one lower extremity (right)
of normal speed includes four intervals; the stance phase includes
three intervals (60%) and the swing phase (40%) has one interval.
Intervals of gait cycle
 Basic terms
Stride: a complete gait cycle, measured from one heel strike to the next heel
strike of the same foot

Step: interval from heel strike of one foot to subsequent heel strike of the
other foot

• Therefore: 1 stride = 2 steps

• The terms “stride” and “step/pace” may refer to any of the following
properties of the relevant movement: time duration. distance covered
.number
The temporal sequence of the gait cycle or stride shows complete right
(shaded bars) and left strides.
HC heel/initial contact; TO toe-off; R right; L left.
 Double limb support
• The areas of overlap between HC and TO represent periods of
double limb support, which synchronize with the occurrence of
pre-swing on the trailing limb and loading response on the
leading limb.
• In the case of the right stride, initial double limb support (lasting
∼10% of the stride) occurs from RHC to LTO, and terminal
double limb support (lasting ∼10% of the stride) occurs from
LHC to RTO.
 The Main Tasks of the Gait Cycle

Tasks required to be achieved during each gait cycle

Heel contact Loading response
1. Weight acceptance: during HC, LR = 10% of the gait cycle

2. Single limb support: during Midstance and Terminal stance

(opposite swing phase) = 40% of the gait cycle.

3. Limb advancement: during Pre-swing, IS, MS, TS = 50% of the gait

Initial,mid,terminal swing
cycle
(1) Weight acceptance
• Most demanding task in the gait cycle

• involves the transfer of body weight onto a limb that has just
finished swinging forward and has an unstable alignment.

• Shock absorption and the maintenance of a forward body

progression
 (2) single limb support
• One limb must support the entire body weight

• The same limb must provide truncal stability while bodily

progression is continued.

(3) Limb advancement

• Requires foot clearance from the floor

• The limb swings through three positions as it travels to its

destination in front of the body.
Gait cycle timing and walking velocity
The precise duration of the gait cycle intervals varies with
the person’s walking velocity.

As the walking speed increases, the swing phase becomes

longer, and the stance phase and double limb phases become
shorter.
 During a running gait cycle, there are two periods of float
when neither foot is in contact with the ground. This results in
decreased time in the stance phase and increased time in the
swing phase.
Normal walking and running
Running gait cycle
Methods to increase walking speed. A illustrates the longer step length used to increase walking
speed. B illustrates the shorter gait cycle duration (faster walking cadence) used to increase
walking speed. It also illustrates that at the faster walking speed, a smaller percentage of the gait
cycle is spent in double-limb support (16% at fast speed compared with 24% at free-speed
walking).
Spatial and temporal variables
 Time-distance variables
Time-distance variables are derived from the temporal and spatial occurrence of
the stance and swing phases.
✓Stride time refers to the time it takes to perform a single stride.

✓Stride length refers to the distance covered by a stride in the direction of

locomotion.

✓Step is defined as the occurrence of an event on one foot until the next
occurrence of that same event on the opposite foot.

✓Step length refers to the distance covered by a step in the direction of

locomotion.
✓Two sequential steps comprise a stride.

✓Although step variables may differ from right to left within an individual, stride
variables will remain constant regardless of whether stride is delineated by right
or left initial contacts because stride consists of the sums of right and left steps.

✓Step width refers to the distance covered by a step perpendicular to the direction
of locomotion as measured from the points of contact on the heels.

✓Cadence is a measure of step frequency that is defined as the number of steps

taken per unit time and is usually expressed in steps per minute.

✓Velocity is defined as the distance covered in the direction of locomotion per unit
time and is usually expressed in meters per second.
 Average Normal Values for Walking
✓Walking speed: 1.37 m/sec (3 mph)

✓Step rate: 1.87 steps/sec (110 steps/min)

✓Step length: 72 cm (28 inches)

It must be emphasized, that all values (spatial, temporal,

kinematic, and kinetic variables) obtained from the
measurements of walking vary based on walking speed.