Gait Patterns and Ambulation Aids
Gait patterns are determined by the patient's status ( WB restrictions, musculoskeletal/neuromuscular impairments, safety) and the environmental constraints. As we discuss weight bearing status, we will integrate specific gait patterns to address the stability, mobility and safety needs of the patient.
What is a "point" in an adaptive gait pattern?
- a point is when there is an episode of weight acceptance during a single gait cycle
- two point - use of two crutches or canes; cane moves forward simultaneously with contralateral limb. Each step = one point
- three point - use of walker or bilateral crutches; assistive device ― affected LE — unaffected LE. Assistive device and each LE are considered separate points
- four point - reciprocal pattern with use of bilateral crutches. Each AD and LE are considered separate points in the gait cycle
Weight Bearing Status
Weight bearing status can be physician ordered, established by the PT, and/or modified during treatment based on the patient response. A physician's order for weight bearing status is in place until changed/updated by the MD/PCP. Radiographic or other diagnostic imaging, mobility status, and patient response (pain, safety) are all considered in clinical decision making for weight bearing activities.
Pre-gait activities
- sit to stand - facilitated weight shift in sagittal plane, trunk control, LE strengthening, endurance, and motor planning
- weight shifting in standing - facilitated weight shift in frontal plane; able to progress from double UE to single UE to no UE support in static standing
- dynamic loading and unloading of limb for proprioception in reciprocal activation
Summary Table of WB status
|
Weight bearing status |
Description |
Gait Pattern |
Pattern description |
|
NWB |
No weight on the extremity |
Three-Point |
Use of walker or two crutches; Step to Step through Aid is advanced alternately with affected limb |
|
PWB, also TTWB TDWB |
Partial weight bearing |
Three-One-Point or Modified Three Point |
Use of walker or two crutches; Heel touch or flat foot with a fixed or proprioceptively-determined amount of WB in the affected limb Aid is advanced simultaneously with affected limb |
|
WBAT |
Weight bearing As tolerated |
Three-One-Point, Four point, or two point (progress from most to least support from aid)
|
Use of walker, wheeled walker, or bilateral ambulation aids (crutches, canes); progression to more reciprocal pattern is dependent on patient safety, strength, confidence, and symptoms |
|
FWB |
Full weight bearing |
Four point, or two point |
Use of walker or bilateral ambulation aid Reciprocal pattern (slow to fast progression) |
|
Unequal WB |
Hemi pattern |
Modified four-point Modified two-point |
Use of one ambulation aid (crutch, cane, hemi walker) or for patients with functional use of one upper extremity LE and aid advance alternately (four-point) or simultaneously (two-point) ; aid is typically used on the contralateral side |
Benefits of contralateral positioning
- reduces forces of abductors at contralateral hip
- ground reaction force from floor through cane counteracts contralateral pelvic tilt during swing
- result is decreased joint compression forces at the hip
Bilateral Involvement Considerations
Use a patient-centered approach to critically assess which side of the body will most benefit from the cane. Specific considerations include:
- comfort
- balance/endurance effects
- overall changes in gait deviations
- safety (surfaces, stairs, outdoor ambulation needs)
- grip strength
- possibility for bilateral cane use
