The detailed nature of gait analysis as performed by physical therapists is a skill set I learned to appreciate, when much to my dismay a very outspoken PT informed me during my first day in her building, “You walk like a man!”
She found my stride quite comical and then proceeded to break down exactly what her trained eye saw including a wide base of support, supination at the ankles, coxa varus of the hips and a slight shuffling gait pattern.
Normal gait is defined as a series of rhythmical, alternating movements of the trunk and limbs which result in the forward progression of the center of gravity. Gait deficits can place individuals at increased risk for falls, which are a major health concern among older adults, with more than one third of older adults falling each year and more than 95% of hip fractures being caused by falls. Furthermore, research has shown us that gait pattern can be a predictor of many key areas for the individuals we serve in skilled nursing facilities including:
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Poorer short-term memory and executive function has been associated with slow gait speed during simple single gait tasks
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Early motor changes associated with aging predict cognitive decline suggesting that a “motor signature” can be detected in pre-dementia states
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Slow walking speed has been shown to predict dementia
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Shuffling gait pattern in addition to freezing gait often influence ability to navigate small obstacles in individuals with Parkinson’s disease
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Gait control is a complex brain process with recent reviews confirming the importance of the central nervous system to gait in non-demented older adults
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Global cognition has been shown to longitudinally predict gait speed decline
Skilled PT evaluations assess key areas affecting gait pattern including base of support, swing phase, stance phase, heel strike, toe off, stride length and cadence. In addition, PTs assess and treat gait patterns across a variety of surfaces including level surfaces, uneven surfaces, stairs, curbs and ability to negotiate obstacles in order to promote individuals safe return to prior levels of function. Individuals who are not immediately appropriate for gait task may be able to participate in pre-gait interventions aimed at improving weight bearing, static standing balance and ability to spontaneously right self.
Per Current Procedure Terminology (CPT®) 97116 Gait Training may be indicated for:
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A cerebral vascular accident resulting in impairment in the ability to ambulate, now stabilized and ready to begin rehabilitation
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Musculoskeletal trauma, requiring ambulation reeducation
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A chronic, progressively debilitating condition for which safe ambulation has recently become a concern
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An injury or condition that requires instruction in the use of a walker, crutches or cane
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A patient fitted with a brace or lower limb orthosis or prosthesis and requires instruction in ambulation
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A condition that requires retraining in stairs/steps or other uneven surfaces appropriate to home and community function (ramps, inclines, curbs, grass, etc.)
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Instructing a caregiver in appropriate guarding and assistive techniques
Consider the benefit of following the paths of your residents would follow throughout the day. Did you walk in a straight line only? Did you have to take a backward step—what about to avoid an obstacle, what about to back up to a transfer surface, what about to pull out a chair in the dining room? Did you have to side step-what about to line up to a transfer surface, what about to negotiate around an obstacle? Did you go on an outing with a family member and have to negotiate a ramp, curb or stairs? Did you go outside and have to negotiate uneven sidewalk or a door threshold?
Renee Kinder, MS, CCC-SLP RAC-CT, is a clinical specialist at Evergreen Rehabilitation in Louisville, KY.
