Structures observational and instrumented gait analysis with deviation identification and intervention planning. Use when analyzing gait patterns, documenting gait deviations, or planning gait interventions.
Structures observational and instrumented gait analysis including temporal-spatial parameters, kinematic deviation identification by gait phase, and assistive device assessment. Links gait deviations to underlying impairments and intervention planning using Rancho Los Amigos observational gait analysis methodology.
Gait is the primary indicator of functional mobility and the most visible measure of rehabilitation outcome. Gait analysis determines assistive device prescription, orthotic needs, surgical candidacy (e.g., selective dorsal rhizotomy, tendon lengthening), fall risk, and community ambulation potential. Payers require objective gait documentation for medical necessity of locomotion training (CPT 97116). Legal proceedings rely on gait analysis to establish permanent impairment and lost earning capacity. Poorly documented gait assessments that use vague descriptors ("antalgic gait") without specifying the phase, deviation, and underlying cause fail to support clinical decisions. This skill produces systematic, phase-by-phase gait documentation.
Before beginning gait analysis, confirm:
Required clinical questions:
Required documents:
Measure and document the fundamental gait metrics:
Measurement methods:
Use the Rancho Los Amigos observational gait analysis system. Analyze each phase from pelvis through foot:
Stance phase (60% of gait cycle):
| Phase | Normal Event | Common Deviations | Possible Causes |
|---|---|---|---|
| Initial contact | Heel strike with ankle at neutral | Foot flat or forefoot contact | Dorsiflexor weakness, spasticity, neuropathy |
| Loading response | Controlled knee flexion to 15 degrees | Excessive knee flexion or hyperextension | Quad weakness (flexion), quad spasticity or plantar flexor weakness (hyperextension) |
| Midstance | Single limb support, trunk over stance limb | Trendelenburg (pelvis drops contralateral) | Hip abductor weakness (glut med <3+/5) |
| Terminal stance | Heel rise, hip extends past neutral | Inadequate hip extension, early heel-off | Hip flexion contracture, plantar flexor weakness |
| Pre-swing | Knee flexion begins, push-off | Absent push-off, inadequate knee flexion | Plantar flexor weakness, knee joint restriction |
Swing phase (40% of gait cycle):
| Phase | Normal Event | Common Deviations | Possible Causes |
|---|---|---|---|
| Initial swing | Hip flexion, knee flexion to 60 degrees | Circumduction, hip hiking, vaulting | Foot drop (dorsiflexor weakness), stiff knee |
| Mid-swing | Limb advances, tibia vertical | Foot clearance failure, toe drag | Foot drop, inadequate knee flexion |
| Terminal swing | Knee extends, ankle dorsiflexes for heel strike | Knee hyperextension snap, foot slap | Quad spasticity, dorsiflexor weakness |
Document current device and appropriateness:
Device hierarchy (most to least support):
Fit verification:
Use standardized ambulation scales:
Functional Ambulation Categories (FAC):
Timed walking tests:
Community ambulation criteria:
For each identified gait deviation, document the chain:
Example format: "Deviation: Right Trendelenburg sign during left swing phase. Underlying impairment: Right hip abductor strength 3-/5 (MMT). Functional impact: Limits ambulation distance to 150 ft due to compensatory trunk sway and fatigue. Intervention: Hip abductor strengthening (sidelying, standing, resistance band) progressing from gravity-eliminated to full resistance; lateral step-ups; gait training with verbal cueing for pelvic control."
Prioritize deviations by:
Before finalizing gait analysis documentation: