– Gait Assessment

  • See before and after gait videos at bottom of this page

Gait Assessment: Step 1

Gait analysis is fascinating, and it can be broken down into a very complex set of components. However, for our purposes in assessing a person with Parkinson’s, we will focus on a few particular aspects of gait. These areas include:

  • Stride length
  • Stride synmetry
  • Velocity
  • Is the stride rhythmical or are the feet shuffling?
  • Is one (or are both) feet dragging or scuffing?
  • Reciprocal arm swing (including observation of trunk and hip rotation during gait)
  • Does one arm swing than the other?
  • How is their posture?
  • What is their head position?
  • Where are their eyes focused?
  • Are they walking in a straight line or are they swerving?
  • When turning around to return to starting position, what does the rotation look like?

For the initial part of this assessment, have your client wear their normal footwear. Find an area where you can observe your client from an anterior and posterior point of view. It also helps to have an area where they can walk uninterrupted for at least 25 feet (the longer the distance, the better). This allows them to get into a flow of movement, which will help you to analyze more effectively.

Special notes:

  • Obviously, your client/patient must be able to walk in order to perform this assessment.
  • Even if they use a cane or walker, be sure to perform this assessment. You will soon see why we don’t mind if they use a cane or walker during the initial gait analysis.
  • Ask permission to video record as they walk. Recording gait is especially important and helps to document a baseline starting point, but their comfort and privacy is more important.
  • Once you have permission to video record, hold the camera in a position where you can record from directly behind them at starting point. Have your client walk to a designated point, rotate, and return to starting point.
    Special note:
  • SAFETY FIRST! Rotations are often-times a trigger for freezing of gait, which increases fall risk. Be sure that your client can safely rotate and return to starting position. If rotations are an issue, have another person or secure item at the opposite end of room to ensure your client has a solid object to grasp if rotation presents difficulty.
  • Cue your client to walk naturally, as if no one is watching and as if they are not trying to look good or impress you.
  • I generally do not use treadmills for a gait assessment with people who have movement disorders. While some may move well on a treadmill, others will have great difficulty. Humans were not born to walk on treadmills. We are designed to move across a surface rather than having a surface move underneath us. Treadmills tend to create unnatural movement and can present quite a challenge for many.
  • My exception for using a treadmill is in the event we wish to capture a direct lateral view of the client. This can be helpful in showing a more complete view of reciprocal arm swing, posture, and show us whether the client moves through the 5 phases of gait optimally. We will discuss phases of gait in a subsequent section of the book.

Be sure you have your client do enough walking, so you get enough information. Take notes and jot down what you see based on the list above.

Once you have gotten the data you need, have them sit down and take a break.

Gait Assessment: Step 2: Add a Wake-up Call to the Nervous System and Brain

In the previous chapter, you learned about benefits of plantar skin stimulation. For this next step in assessing gait, it is time to wake up the plantar skin nerves, nervous system, and brain. We will achieve this by installing a pair of Naboso textured insoles in your client’s shoes.

Naboso insoles can easily be trimmed to fit your client’s shoes. Once you have installed the insoles with the textured side facing up, have your client put on the shoes, but WITHOUT wearing socks. It is imperative that they do not wear socks. They will be barefoot in their shoes. Exceptions to not wearing socks would be if a person has open sores on their feet. In this case, thin socks should be worn.

Next, have your client walk around a little bit and get an idea of what the insoles feel like. At this point, you are ready to implement the next part of gait assessment.

To ensure that you have useful assessment data, do NOT tell your client what you expect to see. If you tell them the insoles are likely to improve movement, they may walk unnaturally, trying to impress you. You want to observe their natural gait pattern without giving them expectations of any kind.

Special note for movement professionals: if you do not have Naboso textured insoles or products available, have your client take of their shoes and socks and walk around barefoot for a few minutes. Any type of flooring will work to stimulate the plantar skin nerves and wake up the nervous system and brain. If you happen to have turf available, it’s a great surface to use. If you have an outside area where it is safe to walk, grass makes for a nice surface to use (and – it is outdoors, and research shows that moving barefoot outdoors is highly beneficial for many reasons. More about this later).

Additionally, I highly recommend ordering a few pairs of Naboso insoles. Your clients and patients will be grateful that you have them available. To order, go to the book support website and visit the Naboso tab.

Gait Assessment: Step 3 Reassess

Now, go back to the same exact area where you first observed and recorded gait. Use your camera and instruct your client to walk the exact same pathway as before, including the same starting, rotation, and stopping points. To the best of your ability, hold your camera the same distance from and at the same angle as the first video recording. This allows for the best comparing of side by side videos.

Again, observe the following and note the differences:

  • Stride length
  • Stride symmetry
  • Velocity
  • Is the stride rhythmical or are the feet shuffling?
  • Is one (or are both) feet dragging or scuffing?
  • Reciprocal arm swing (including observation of trunk and hip rotation during gait)
  • Does one arm swing more than the other?
  • How is their posture?
  • What is their head position?
  • Where are their eyes focused?
  • Are they walking in a straight line or are they swerving?
  • When turning around to return to starting position, what does that rotation look like?

What did you see? What did gait look like with insoles in their shoes? My guess is that you saw some type of improvement or perhaps several improvements in the areas listed above. Take detailed notes about your observations. What you see is especially important, but what your client FEELS is far more important.

Now, prior to divulging what you saw, ask your client what they felt. There is a good possibility you’ll hear things like: I felt safer, more secure, more stable, more balanced, more in control, etc.

Next, talk with your client about your observations. Have a discussion around what you observed and what they felt. How is their emotional and mental state after using insoles compared to walking in normal footwear?

Again, in at least 90% of the PD population, we see instant improvements in gait when using the Naboso textured insoles. Even more exciting is when we see a more positive mental and/or emotional state as a result of moving better. The feeling of hopelessness and depression often accompany Parkinson’s. Sometimes, it only takes one very small tool or technique to improve movement. With this improvement usually comes a more positive mental and emotional state. We see it all the time all over the world at our live workshops. Walk better, feel more positive, and regain a sense of hope that you can live a better quality of life.

Here are several before and after gait videos. To the left in each video, the patient is wearing their normal footwear. On the right, they have Naboso textured insoles in their shoes (and they are not wearing socks).

Guillain-Barré Syndrome
Parkinson’s disease
Generalized Dystonia
Parkinson’s: using Naboso insoles. 1st time running in 17 years
Parkinson’s: from barely walking on a treadmill, to walking, to running, to going back to work! (using Naboso insoles)
6 weeks post brain surgery. Naboso insoles allowed her to move better and walk unassisted for the first time since her surgery
Parkinson’s disease
Parkinson’s disease
Parkinson’s disease