Gait Analysis 16th June

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DefinitionDefinition

Human gait is bipedal, biphasic,Human gait is bipedal, biphasic,

forward propulsion of centre of gravity,forward propulsion of centre of gravity,in which there is alternate sinuousin which there is alternate sinuous

movement of different segments of themovement of different segments of the

body, with least expenditure of energy.body, with least expenditure of energy.


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WHY???!!WHY???!!

DiagnosisDiagnosis

Plan TreatmentPlan Treatment

Results of treatmentResults of treatmentComparison of different modalities ofComparison of different modalities of

treatmenttreatment

Orthosis and prosthesis manufacturingOrthosis and prosthesis manufacturingand to render scientific basis to newer andand to render scientific basis to newer and

innovative productsinnovative products


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Normal Gait Pre-requisitesNormal Gait Pre-requisites

EquilibriumEquilibrium-ability to assume upright-ability to assume upright

posture and maintain balance.posture and maintain balance.LocomotionLocomotion-ability to initiate and maintain-ability to initiate and maintain

rhythmic stepping.rhythmic stepping.Muskuloskeletal integrity-Muskuloskeletal integrity-normal bonenormal bone

joint and muscle function.joint and muscle function.Neurological control-Neurological control-visual ,auditoryvisual ,auditory

vestibular and sensory motor inputvestibular and sensory motor input


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GAIT CYCLEGAIT CYCLE

A single gait cycle or stride is defined:A single gait cycle or stride is defined:Period when ONE foot contacts the ground toPeriod when ONE foot contacts the ground to

when that same foot contacts the groundwhen that same foot contacts the ground

againagainEach stride has 2 phases:Each stride has 2 phases:Stance PhaseStance Phase -60% of the gait cycle-60% of the gait cycle

Foot in contact with the groundFoot in contact with the groundSwing PhaseSwing Phase -40% of the gait cycle-40% of the gait cycle

Foot NOT in contact with the groundFoot NOT in contact with the ground


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STANCE PHASESTANCE PHASE

When the foot is in contact with the groundWhen the foot is in contact with the ground

Stance phase has 5 parts:Stance phase has 5 parts:

1.Initial Contact1.Initial Contact (Heel Strike)(Heel Strike)2.Loading Response2.Loading Response (Foot Flat)(Foot Flat)

3.Midstance3.Midstance

4.Terminalstance4.Terminalstance(heel off + push off)(heel off + push off)5.Pre-Swing5.Pre-Swing(toe off)(toe off)


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SWING PHASESWING PHASE

When foot is NOT contacting the groundWhen foot is NOT contacting the ground

Limb advancement phaseLimb advancement phase3 parts of swing phase:3 parts of swing phase:

-Initial swing-Initial swing

-Midswing-Midswing

-Terminal swing-Terminal swing


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GAIT PARAMETERSGAIT PARAMETERS

(CADENCE PARAMETERS)(CADENCE PARAMETERS)

Step lengthStep length distance between two feet duringdistance between two feet duringdouble limb support, it is measured from the heeldouble limb support, it is measured from the heelof one foot to heel of contralateral footof one foot to heel of contralateral foot

Stride lengthStride length -distance one limb travels during-distance one limb travels during

the stance and swing phase, it is measured fromthe stance and swing phase, it is measured fromthe point of foot contact at the beginning ofthe point of foot contact at the beginning ofstance phase to the point of contact by the samestance phase to the point of contact by the samefoot at the end of swing phasefoot at the end of swing phase

Step timeStep time amount of time used to completeamount of time used to completeone step lengthone step length CadenceCadence number of steps taken per minutenumber of steps taken per minuteWalking velocityWalking velocity -distance traveled per minute-distance traveled per minute


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Murray et al. determined parameters ofMurray et al. determined parameters of

gait in nondisabled men.gait in nondisabled men.

Mean duration of the gait cycle -Mean duration of the gait cycle -

1.031.03

secondsseconds..

The steps per minute - 117 (90-120 steps)The steps per minute - 117 (90-120 steps)

Average comfortable walking speed wasAverage comfortable walking speed was2.8 miles per hour.2.8 miles per hour.

Average stride length -Average stride length - 70-82 cm70-82 cm


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LAW OF PHYSICS:LAW OF PHYSICS:

Centre of gravity of body mass should fallCentre of gravity of body mass should fall

within its base of support to retain itswithin its base of support to retain its

stabilitystability


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Smoothness of gait:Smoothness of gait:

Stance leg must support the centre ofStance leg must support the centre of

gravity and provide active extension ofgravity and provide active extension of

hip and knee to help the swing leg tohip and knee to help the swing leg to

clear the groundclear the ground


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Study of human locomotionStudy of human locomotion

Walking consists of a series of gaitWalking consists of a series of gait

cyclescyclesA single gait cycle is known as a STRIDEA single gait cycle is known as a STRIDE

GAIT ANALYSISGAIT ANALYSIS


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CLINICAL GAIT ANALYSISCLINICAL GAIT ANALYSIS

OBSERVATIONAL GAIT ANALYSISOBSERVATIONAL GAIT ANALYSIS

3D GAIT ANALYSIS3D GAIT ANALYSIS

OBSERVATIONAL GAIT ANALYSISOBSERVATIONAL GAIT ANALYSIS

Pt should be viewed from the front, side,Pt should be viewed from the front, side,and behindand behind


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3D GAIT ANALYSIS3D GAIT ANALYSIS

Kinematics -movementKinematics -movement Kinetics -forces related to movementsKinetics -forces related to movements

Ground reaction forces (GRF)Ground reaction forces (GRF) Moment or torque - a turning force that results inMoment or torque - a turning force that results in

angular change of position of a segment/jointangular change of position of a segment/joint Power - a function of joint angular velocity andPower - a function of joint angular velocity and

joint moment; rate of doing workjoint moment; rate of doing work Electromyography (EMG) -recording ofElectromyography (EMG) -recording of

myoelectrical activitymyoelectrical activity


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KINEMATICSKINEMATICS

Denotes the motion observed andDenotes the motion observed and

measured at pelvis, hip, knee, ankle andmeasured at pelvis, hip, knee, ankle and

footfoot

Done in three planesDone in three planes

-sagittal plane-hip flexion ,extension-sagittal plane-hip flexion ,extension

-coronal plane-hip abduction,adduction-coronal plane-hip abduction,adduction-transverse plane-rotation hip,tibia,feet-transverse plane-rotation hip,tibia,feet


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MUSCLES ACTING DURINGMUSCLES ACTING DURING

WALKINGWALKING

Concentric contraction- - muscle shortens onConcentric contraction- - muscle shortens on

stimulation, generates power and acceleratesstimulation, generates power and accelerates

body forward.body forward.-gastrosoleus contracts to lift the-gastrosoleus contracts to lift the

heel off the groundheel off the ground

-iliopsoas contracts flexing the hip-iliopsoas contracts flexing the hipand pulling the stance phase limband pulling the stance phase limb

off the groundoff the ground


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MUSCLES ACTING DURINGMUSCLES ACTING DURING

WALKINGWALKING Eccentric contraction- muscle lengthens onEccentric contraction- muscle lengthens on

stimulation, slows down and stabilises jointstimulation, slows down and stabilises jointmotionmotion

-tibialis anterior-contracts at initial-tibialis anterior-contracts at initial

contact ,firing during plantar flexioncontact ,firing during plantar flexionas the foot is lowered to ground,as the foot is lowered to ground,

so the foot is gently lowered to groundso the foot is gently lowered to ground

-gastrosoleus-contracts eccentrically-gastrosoleus-contracts eccentrically

through the stance phase controlling thethrough the stance phase controlling the

rate of dorsiflexion of anklerate of dorsiflexion of ankle


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SAGITTAL PLANESAGITTAL PLANE

Pelvis is tilted 15 degrees, minimal motion of thePelvis is tilted 15 degrees, minimal motion of theanterior tilt as each leg is advanced forward.anterior tilt as each leg is advanced forward.

Hamstrings tight: More posterior tiltHamstrings tight: More posterior tilt Knee: More complex patternKnee: More complex pattern Deviations: Hyperextension in stance phase ifDeviations: Hyperextension in stance phase if

the heel cord is tight, flexion in stance due tothe heel cord is tight, flexion in stance due tohamstring tightness, inability to flex the knee inhamstring tightness, inability to flex the knee inswing phase due to inappropriate rectus femorisswing phase due to inappropriate rectus femoris

action, quadriceps gaitaction, quadriceps gaitAnkle: First Rocker, Second Rocker, ThirdAnkle: First Rocker, Second Rocker, Third

RockerRocker


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CORONAL PLANECORONAL PLANE

Pelvic ObliquityPelvic Obliquity

Each hemipelvis rises slightly during swingEach hemipelvis rises slightly during swing

phase to augment the ability to advancephase to augment the ability to advance

the swing limb, this is associated with athe swing limb, this is associated with a

contralateral hemipelvis fall.contralateral hemipelvis fall.

Adducts during stance phase.Adducts during stance phase.

Accentuated in CP.Accentuated in CP.


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TRANSVERSE PLANETRANSVERSE PLANE

Pelvis and hips rotate minimally duringPelvis and hips rotate minimally during

gait, Tibiae are mildly externally rotated.gait, Tibiae are mildly externally rotated.

FOOT PROGRESSION ANGLE: AngleFOOT PROGRESSION ANGLE: Angle

the foot makes with the path the subject isthe foot makes with the path the subject is

walking.walking.

Normally: 10-15 degreesNormally: 10-15 degrees


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PATHOLOGICAL GAITSPATHOLOGICAL GAITS


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GAITS IN CPGAITS IN CP True EquinusTrue Equinus -distal spasticity (Gastrosoleus spasticity)-distal spasticity (Gastrosoleus spasticity)

Equinus Genu recurvatumEquinus Genu recurvatum

Jump GaitJump Gait

Spasticity of hamstrings and hip flexors, equinus + hip and knee inSpasticity of hamstrings and hip flexors, equinus + hip and knee inflexion + ant. pelvic tilt + exaggerated lumbar lordosis + knee stiffflexion + ant. pelvic tilt + exaggerated lumbar lordosis + knee stiff

Crouch gaitCrouch gait Excessive dorsiflexion or calcaneus at ankle +Excessive dorsiflexion or calcaneus at ankle +excessive flexion at knee and hip + ant. pelvic tiltexcessive flexion at knee and hip + ant. pelvic tilt

May be Iatrogenic due to isolated lengthening of TA (w/o correctingMay be Iatrogenic due to isolated lengthening of TA (w/o correctinghamstring & iliopsoas spasm)hamstring & iliopsoas spasm)

Scissoring gaitScissoring gait

Adductor musculature spasm, Flexion + int. rotation deformityAdductor musculature spasm, Flexion + int. rotation deformity

Can bring the swing limb up to the stance limbCan bring the swing limb up to the stance limb

Cadence parameters are grossly decreasedCadence parameters are grossly decreased


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CROUCH GAITSCISSORING GAIT


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TRENDELENBERG GAITTRENDELENBERG GAIT

Functional weakening of abductorFunctional weakening of abductor

mechanismmechanism

Standing on affected side pelvisStanding on affected side pelvis

drop to normal sidedrop to normal side

To compensate patient lurches to affectedTo compensate patient lurches to affected

sideside
http://guardian.curtin.edu.au/cga/archives/25-9-97/back.mov


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GAIT IN BILATERAL HIPGAIT IN BILATERAL HIP

DISEASESDISEASES

Waddling gaitWaddling gait

Bilateral trendelenbergBilateral trendelenberg

CDHCDH

COXA VARACOXA VARA


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SHORT LIMB GAITSHORT LIMB GAIT

Shift to same sideShift to same side

Pelvis tilt downward with dipPelvis tilt downward with dip

Equal period on each sideEqual period on each sideSupinate foot or toe walkSupinate foot or toe walk

Flex knee and hip on normal sideFlex knee and hip on normal side

Raise pelvis on normal side in swingRaise pelvis on normal side in swingphase hip hiking to clear groundphase hip hiking to clear ground


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GLUTEUS MAXIMUS GAITGLUTEUS MAXIMUS GAIT

GL. MAXIMUS - Terminal swing-GL. MAXIMUS - Terminal swing-

opposite side gluteus maximus locksopposite side gluteus maximus locks

hip in extension on wt bearing sidehip in extension on wt bearing side

Weakness - pelvis thrust forward andWeakness - pelvis thrust forward and

trunk backward shift COG backwards -trunk backward shift COG backwards -

increased lordosisincreased lordosis

Patient lurches back &forth over thePatient lurches back &forth over the

hipships


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CALCANEAL GAITCALCANEAL GAIT

Gastrosoleus contracts eccentricallyGastrosoleus contracts eccentrically

throughout the second rocker, hencethroughout the second rocker, hence

controlling excessive dorsiflexion.controlling excessive dorsiflexion.

Weakness of gastrosoleusWeakness of gastrosoleus


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STIFF HIP GAITSTIFF HIP GAIT

No flexion of hip during walkingNo flexion of hip during walking


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QUADRICEPS GAITQUADRICEPS GAIT

Weakness of QuadricepsWeakness of Quadriceps

PoliomyelitisPoliomyelitis

Hand to Knee GaitHand to Knee Gait


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STEPPAGE GAITSTEPPAGE GAIT

Foot dropFoot drop


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Other Pathological GaitsOther Pathological Gaits

CEREBELLAR ATAXIA: WIDE BASED REELING GAIT (DRUNKENCEREBELLAR ATAXIA: WIDE BASED REELING GAIT (DRUNKENSOLDIERS GAIT)SOLDIERS GAIT)

HEMIPARETIC : CIRCUMDUCTION GAITHEMIPARETIC : CIRCUMDUCTION GAIT PARKINSONISM: FESTINENT GAITPARKINSONISM: FESTINENT GAIT MARCHE A PETIT PAS: DEMENTIA / FRONTAL LOBEMARCHE A PETIT PAS: DEMENTIA / FRONTAL LOBE

SYNDROMESSYNDROMES MYOPATHIC GAIT: EXAGGERATED HIP MOVEMENTSMYOPATHIC GAIT: EXAGGERATED HIP MOVEMENTS MULTIPLE SCLEROSIS/ VIT B 12 DEFICIENCY:MULTIPLE SCLEROSIS/ VIT B 12 DEFICIENCY:

CORTICOSPINAL + PROPRIOCEPTION : SPASTICITY + ATAXIA :CORTICOSPINAL + PROPRIOCEPTION : SPASTICITY + ATAXIA :JIGGLING/ BOBBLY GAITJIGGLING/ BOBBLY GAIT

HYPERKINETIC GAIT : CHOREA (GROTESQUE DANCING ANDHYPERKINETIC GAIT : CHOREA (GROTESQUE DANCING AND

PRANCING)PRANCING) CAUTIOUS SENILE GAIT: VELOCITY DECREASES, STEPSCAUTIOUS SENILE GAIT: VELOCITY DECREASES, STEPS

SHORTEN AND BASE WIDENSSHORTEN AND BASE WIDENS MAGNETIC GAIT (GAIT APRAXIA)MAGNETIC GAIT (GAIT APRAXIA)


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Gait Analysis 16th June