Gait Deviations is one of the most perplexing ADL's to figure out.
There are so many components that contribute to an efficient gait pattern, determining a patient's dysfunction can be extremely challenging when it come to treating walking problems.
Your patient will just not walk right. Or even better, they will walk perfectly out of your clinic after a session, and walk back in using their same old dysfunctional pattern.
I was dealing with this when I worked with my family member years ago. We were rehabbing at my home in spring time. After treatment, his home program would be to walk along the perimeter of the deck holding on the the railing with one hand and use the cane with the other.
He gait pattern was beautiful.
When he walked with the rolling walker on the sidewalk or 2 canes in the house, he reverted back to what I call his ugly gait:
- A small step length
- Narrow base of support
- Bent knee walking style.
- Slow deliberate cadence
What was going on?
He presented with what I call a Non Structural Dysfunction that was causing his Gait Deviation. What that means is that there wasn't a lack of range of motion due to an anatomical structure or tissue restriction that was physically blocking his range of motion that was causing the Ugly Gait.
It was something else.
Non-Structural Dysfunctions could be due to one of the following reasons:
- Inflammation
- Alignment
- Upper Motor Neuron or Lower Motor Neuron Disease or Injury
- Psychological Dysfunction including Fear
- Severe Atrophy
I realize now that my family members primary dysfunction was not a lack of range of motion, strength or even balance, it was a lack of confidence.
I was treating the wrong thing.
In addition to treating his physical symptoms, I should have also been doing things to boost his confidence and ease his fears.
