Occupational Therapy: Mobility and Gait

Mobility & Gait

• Mobility and gait are discussed.
• This presentation is by Jennifer Krysa, an occupational therapist.

Terminology

• Functional mobility, ambulation, and gait are discussed.

Terminology Continued

• Cadence is frequency.
• Step length is the distance traveled by one foot.
• Stride length is double the step length.
• Step width is the distance between the heels.
• Stride length is 3 feet (92 cm).
• Right step length is 18 inches (46 cm).
• Left step length is 18 inches (46 cm).
• Step width between heels is 2-4 inches (5-10 cm).

Functional Mobility

• Bed mobility, transfers, wheelchair mobility, and ambulation.

Ambulation

• Is ambulation an occupation?

Ambulation - Purpose

• To get somewhere
• Part of activities of daily living (ADLs)
• Exercise
• Leisure
• Productivity
• Social expectation of independence

Base of Support (BOS)

• Base of support (BOS) is the area of the body and/or mobility devices in contact with the ground or another surface.
• A stance with feet side-by-side creates a small base of support.
• A bigger base of support will make someone more stable.

Centre of Gravity (COG)

• Centre of gravity (COG) is the point in which weight is distributed evenly in all directions.

Gait Cycle

• Repeating pattern of lower extremity movements that propel the body forward.
• One gait cycle is the time between two occurrences of the same event (e.g., heel strike).
• Each gait cycle includes two phases: stance phase (60%) and swing phase (40%).

Stance Phase

• Heel strike (beginning of heel hitting the ground)
• Foot flat (entire foot in contact)
• Midstance (body passes over the stance leg)
• Heel off (heel raises from the ground)
• Toe off (end of propulsion and stance phase)

Swing Phase

• Acceleration (the pelvis rotates forward and the hip and knee flex to quickly move the swing leg forward).
• Midswing (hip and knee flex further to ensure the foot clears the ground as it passes the stance leg).
• Deceleration (the pelvis rotates forward, hip flexes, and knee extends to prepare for heel strike).

Ground Reaction Force (GRF)

• The force exerted on a limb by the ground during contact.
• Vectors create direction of movement (external).
• Muscles act to create internal moment equilibrium.
• GRF rises and falls below body weight between heel strike and toe off.

Pelvis during ambulation

• Anterior during swing
• Elevates with weight shift loading; depresses with swing
• Towards stance leg in midstance
• Results in a sine wave

Models

• Inverted pendulum (walking)
• Spring-mass (running)
• Walking is more dynamic

More to the Story

• Neural command & sensory feedback
• Muscle-tendon dynamics
• Musculoskeletal geometry
• Skeletal dynamics
• Acceleration, velocities, angles

Developmental

• Developmental functional mobility: Rolling (4-5 months), Creeping, Crawling (6-8 months), Sitting without support (6-8 months), Stepping, Pulling into stand (9-10 months), Cruising, Walking (11-15 months).

Early Toddler Gait

• Wide-based
• High cadence
• Short stride length
• Hips in ER.

Development of Gait

• 2 years: heel strike & reciprocal arm swing present.
• Short single leg stance phase.
• Ankle response limited.
• 3 years: mature gait pattern.
• 7-8 years: independent control of each anatomical segment.

Pathological Gait

• Causes: Medications, Pain, Weakness, Altered tone, Impaired balance, Fatigue, Joint stiffness, Overall health, Specific medical conditions
• Effects: Trunk sway, Change in weight-bearing, Altered leg or arm swing, Circumduction, Knee dysfunction, Toe drag, Decreased heel strike, Gravitational insecurity, Postural effects

Antalgic Gait

• Decreased stance phase on affected leg; swing phase unaffected.
• Decreased swing phase of unaffected leg.
• Cause: Pelvis, hip, knee, ankle, or foot.

Ataxic Gait

• Wide-based; uncoordinated
• Lurching & staggering
• Exaggerated movements
• Cause: usually cerebellar dysfunction (stroke, tumor, Multiple sclerosis)
• Associated with neurodegenerative diseases
• Includes EtOH misuse

Choreiform

• Hyperkinetic
• Excessive movements
• Balance unaffected

Diplegic Gait

• Bilateral L/Es more than bilateral U/Es.
• Flexion at hips & knees.
• Tight adductors, walking on toes.
• Swinging gait on both sides.
• No arm swing; arms in guard position.

Hemiplegic Gait

• L/E circumduction
• Arm carried across the trunk
• Cause: Paralysis or profound weakness on one side (CVA, Cerebral palsy, TBI).

Myopathic Gait

• Waddling: sway from side to side and hip drops each step.
• Causes: Weakness of hip girdle muscle
• Congenital hip dysplasia
• Muscular dystrophies
• Spinal muscular atrophy

Neuropathic Gait

• Foot drop with high stepping (equine)
• Foot slaps the ground
• Cause: inability to dorsiflex ankle (CVA, TBI, trauma)

Parkinsonian Gait

• Hypokinetic
• Neck, trunk, and knees are flexed
• Short shuffling steps
• Decreased heel strike
• Decreased arm swing
• Festinating

Scissor Gait (Neurogenic Gait)

• Narrow or crossed L/Es due to tight adductors
• Cause: spastic paralysis of adductors

Trendelenburg Gait

• Weakness in hip abductors (gluteus medius & minimus).
• Unable to stabilize during stance phase & trunk shifts over affected hip.
• Pelvis on swing leg side drops.

Outcome Measures

• Timed Up & Go (TUG): Measure of mobility; quick, easy, well-tolerated; good test-retest reliability; from sitting, walk 3 m, turn and walk back, and sit.
• 6 Minute Walk Test: Tests endurance/exercise tolerance (submax exertion); distance covered in 6 minutes.
• 10 Metre Walk test: Measure of gait speed; statistically significant correlations between gait speed and falls, frailty, and functional independence.
• 3 Metre backward Walk test (3MBWT): Walking backwards requires protective reflexes, proprioception, balance, and neuromuscular control; vital for self-care occupations.
• Dynamic Gait Index: Client must maintain walking balance during tasks (walking on level, head turns, stairs, step over, step around).
• GAITRite: Electronic walkways, cameras, and laptop.

Considerations

• Footwear
• Test environment
• Gait aides
• Level of assist
• Weight-bearing status
• Independent
• Standby Assist
• Contact Guard Assist
• 1 Person Assist
• 2 Person Assist
• Non WB (NWB)
• Feather WB (FWB)
• Partial WB (PWB)
• WB as tolerated (WBAT)
• Full

Using the OT Lens

• Assess context in which ambulation is to occur (physical, e.g., flooring, transitions, need to carry objects)
• Home modifications.
• Explore relationship between occupations and ability to mobilize and set collaborative goals (shovel snow, walk backwards to toilet, walk sideways to go to movies).

OT Lens - 2

• Fabricate/consult on footwear & L/E orthoses.
• Leg length discrepancy.
• Off-load wounds.
• Footdrop AFO or toe strap.
• Accommodate traumatic injury.
• Splinting to preserve nerve function and/or tendon length.

OT Lens - 3

• Education
• Energy conservation
• Pain management
• Falls prevention
• Risk mitigation

OT Lens - 4

• Apply psychosocial training to address:
• Cognition
• Perceptual disturbance
• Anxiety
• Hallucinations, and illusions

OT Lens - 5

• Hand & U/E rehab to enable manipulation of gait aid handle.
• Adapt gait aid interfaces to suit needs of individual (grip, sensory, etc.).

Explore the essential concepts of mobility and gait as presented by occupational therapist Jennifer Krysa. This quiz covers key terminology, definitions, and the significance of ambulation in daily activities, including functional mobility. Test your knowledge on the nuances of gait parameters and their implications for independence.