waddling gait / myopathic gait / gait training / myopathic gait treatment / waddling gait treatment

waddling gait / myopathic gait
 Introduction : -

 It is a bilateral pelvic girdle weakness, typically seen in muscular dystrophy characterized by weakness of the proximal muscle of the pelvic girdle mainly the abductors of the hip.

There will be hyperextension of the trunk with shoulder thrust backward and abdomen been protuberant.

Causes

•  Duchenne’s muscular dystrophy
•  GB syndrome
•  Spinal muscular atrophy
•  OA of hip

Role of hip abductors – in waddling gait

The gluteus medius originates on the ilium (between ant. and post. gluteal lines), eventually terminating on the lateral surface of the greater trochanter.

Its contraction pulls the two insertion sites toward one another, thus elevating the opposite side of the pelvis.

 Its weakness causes contralateral sagging of the pelvis (Trendelenburg Sign)

Gait analysis

During stance phase: The weakness of proximal muscles of hip girdles, will interferes with the stability of the pelvis during walking

During swing phase: The failure to stabilize pelvis, it will produces exaggerated rotation of the pelvis with each steps

The hip are slightly flexed as a result of weakness of hip extension and there is an exaggerated lumbar lordosis.

PT Management

A. Strengthening programs

• Active ROM to the hip joint: the movement involves hip flexion, hip extension, hip adduction, hip abduction and rotation
• Primarily target the muscles that are responsible for gait, weakness of  muscles can lead to variety of abnormality.
• The muscle to be strength while walking is gluteus maximus and  hamstring  for hip extension, quadriceps for knee extension, soleus &   gastrocnemius   for ankle planterflexion and dorsiflexion to step forward.
• Progressive resisted exercise using weight cuff, theraband, resistance tube  

B. Functional balance exercise

Static exercise:      Sit to stand

                               Stand on both leg with or without support

                               Stand with eye open and close

Dynamic exercise: Straight walking

                                Tandem walking

                                Side walking      

C. Gait training

•  Parallel bar walking by placing a mirror in front of the patient this will provide a feedback to the patient to correct the postures.
• Make patient to walk without support
•  During walk promote heel strike at initial contact with the floor
• Prevent hip dropping and stabilize the pelvis