Walk This Way: Gait Training for Functional Improvement

For most of us, walking just happens. We don’t spend time thinking about moving our bodies forward and we typically don’t worry about it. But for those with an illness or injury or who are overweight, in pain or deconditioned, walking across the room may seem the same as climbing a mountain. Decreased efficiency, increased energy expenditure, decreased balance and increased fall risk are all the possible results of an altered gait.

In the rehabilitation setting, gait training optimizes standing, walking and running for patients with functional deficits. The advantages of gait training are numerous and include: muscle and joint strengthening; balance and posture improvement; endurance building; muscle memory development; leg retraining for repetitive motion; increased mobility overall; and a lower risk of falls.

Gait observation identifies those deficits that guide lower-limb rehabilitation and determines where, when and how imbalances and asymmetries are present.  Stance time and step/stride length are a few important measures to measure functional improvements.

Gait involves a repetitive pattern of steps and strides that could be defined as a controlled fall with forward progress at the Center of Gravity. The gait cycle is the combination of  closed kinetic chain and the open kinetic chain activities. The two main phases of gait are:

  • Stance phase: This is about 60% of the gait cycle, with heel strike, mid-stance, terminal stance
  • Swing phase: This is about 40% of the gait cycle with acceleration and deceleration

Oftentimes, gait observation is done only with the human eye, but today’s rehabilitation technology advances can help to more accurately measure stance time and step/stride length, which will help functional outcomes and help provide objective data. This will be helpful to gain insurance coverage for ongoing therapy. Using software and technology to analyze gait will provide more data points, which enables a better assessment and better treatment planning.

Analyzing and Rehabilitating Gait

Whether doing gait observation by the subjective human eye or with the help of rehabilitation technology, the process is the same:

  • Analyze gait pattern
  • Identify problematic phase
  • Observe movement dysfunction
  • Test hypotheses for cause
  • Establish treatment plan

Some data to gather in Observational Gait Analysis are:

  • Step Length: The distance between heel contact on both feet. In other words, the right step length should equal the left step length.
  • Stance Time: The interval at which the foot is on the ground. Stance is divided into four parts: heel strike to foot flat; foot flat through mid-stance; mid-stance through heel off; and heel off to toe off. Double leg support is 20% and single leg support is 40% of stance time.
  • Walking Speed: The distance covered by the body over time. There are cultural variation, but the average person’s walking speed is 3 mph/5kph.
  • Gait Kinematics: Low muscle demand, efficiency and multiplanar movement are the ideal. As walking speed increase, the stance phase and double leg support should decrease and the swing phase should increase.

With gait needing the integration of bone, muscle and nervous system, a pathological or abnormal gait results when there is a defect in any of those body systems. A pathological gait reinforces poor motor patterns, which can lead to a compensatory gait that can be difficult to unlearn. Gait issues often lead to decreased mobility, which in turn can lead to increased sitting and a decrease in cardiovascular health, lower-extremity strength and dynamic stability/balance. With gait being a multiplanar movement, the patient may have pelvic rotation, lower extremity internal/external rotation, foot pronation/supination, lateral tilt/trunk lean, and trunk flexion issues to address. Video analysis and technology can help the clinician provide a more thorough evaluation of all the problem areas that need to be addressed. Normalizing gait through physical rehabilitation involves a patient care plan where proper stance precedes normal swing, where there is proper weight shift and where there is equal stance time and step length on both lower extremities. A gait training plan should encompass hip extensors, knee extensors, and ankle plantar flexors and dorsiflexors. Significant weakness in any of these muscle groups will adversely affect the gait pattern. Also improving walking speed may advance a patient’s overall health and function, balance and cardiovascular conditioning, and decrease falls.

No doubt walking is good for us, but walking well is even better.