Gait Training Health Article

Definition

Gait training refers to helping a patient relearn to walk safely and efficiently. Gait training is usually done by rehabilitation specialists who evaluate the abnormalities in the person's gait and employ such treatments as strengthening and balance training to improve stability and body perception as these pertain to the patient's environment. Gait training often incorporates the use of such assistive devices as parallel bars, walkers or canes to promote safe and proficient ambulation. In order to walk again without assistance, the patient will need mental attentiveness and adequate sensation, coordinated with adequate musculoskeletal functioning and motor control.

Purpose

A person's gait is a pattern of stepping or walking that is specific to that individual. Gait training is needed to help a specific patient gain proficient and safe ambulation within and outside the home with or without an assistive device. Patients usually require gait training if there is some lower trunk or lower limb dysfunction. This dysfunction is often associated with neurological or orthopedic impairment. Complications that may require gait training include:

• muscle weakness
• deformity
• spasticity (the presence of abnormal involuntary muscular contractions)
• loss of sensation due to injury or disease that results in inaccurate sensory information and unsafe or inefficient motion
• pain in the weight-bearing joints of the lower extremities, which causes distortion of normal gait

These complications may result from injury to or amputation of the lower extremities; surgery; osteoarthritis or other disorders of the weight-bearing joints; muscular dystrophy; muscle atrophy due to long periods of inactivity or bed rest; lesions of the brain or spinal cord; or changes in perception and other body functions that are part of the aging process.

Normal gait

In order to understand gait training, the reader may find a descriptive outline of normal human gait helpful. Human gait is measured from heel strike to heel strike, also known as the gait cycle or "one stride." The gait cycle has two phases, the stance (about 60% of the cycle)

KEY TERMS

Ataxia—Loss of muscular coordination.

Cadence—The rhythm of a person's walk.

Double stance—The point in the gait cycle at which both feet are touching the ground. It is also sometimes called double support time.

Gait—A person's habitual pattern of walking or stepping.

Gait cycle—A unit of measurement used in evaluation of gait abnormalities. The gait cycle consists of two phases, stance and swing, and is measured from heel strike to heel strike (the length of one stride).

Gait velocity—The speed of a person's walk.

Muscular dystrophy—An inherited disease characterized by progressive wasting of the muscles.

Osteoarthritis—A degenerative joint disease that causes inflammation and pain in the peripheral and spinal joints.

Spasticity—A condition marked by sudden abnormal involuntary muscle contractions, with associated hyperactivity of deep tendon reflexes. It may be associated with rigidity.

and the swing (about 40%). The point at which the body's weight is transferred from one foot to the other, when both feet are touching the ground, is called double stance or double support time. The speed of a person's walk is called the gait velocity, and the rhythm of their walk is called the cadence. Cadence is usually related to the length of the person's leg and their overall height; short people typically take smaller steps at a more rapid cadence while taller people take larger steps at a slower cadence.

Deviations in gait

Deviations from normal gait can occur in any portion of the lower extremity. Common abnormalities include:

• Ankle/foot. Deviations of stance include foot slap and foot flat. Deviations of swing include toe drag (foot drop).
• Knee. Abnormalities of stance include hyperextension of the knee. Abnormalities of swing include limited flexion of the knee.
• Hip. Deviations of swing include circumduction and "hip hiking."
• Trunk. Deviations of stance include lateral lean (Trendelenberg gait), backward lean (gluteus maximus gait), and forward lean.
• Other. Ataxia (loss of muscular coordination) and antalgia (limping from pain).

Deviations can occur together as a group of compensations for one impairment. For example, a patient's gait may show foot drop as well as hip hiking.