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VU University Medical Center Amsterdam The Netherlands Clinical Gait Analysis dr. ir. Jaap Harlaar [email protected] www.vumc.nl/revalidatie

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Page 1: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

VU University Medical CenterAmsterdam The Netherlands

Clinical Gait Analysis

dr. ir. Jaap Harlaar

[email protected]/revalidatie

Page 2: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

Human Movement Laboratory

Department of Rehabilitation Medicine

VU UniversityMedical Center

Amsterdam

Page 3: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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casus

Page 4: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Goal setting vs. tools

• problems with specific activities• >> goal setting at this level• specific interventions might work• movement analysis: biomechanics

Page 5: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

External Factors

Personal factors

Function / Anatomy

(Impairments)

Activities(Disabilities)

Participation(Handicaps)

Disease

International Classification of Functions(ICF)

Page 6: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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DecisionDisability assessment

General aim of treatment (disability level)no treatment

DecisionMovement analysis

Specific treatment

nestedComplete decision scheme

Page 7: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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casus

Page 8: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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GAIT

Gait and movement analysis in clinical practice of rehabilitation medicine

Page 9: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Goal of walking

• To go from one place to another

• Walking speed, Energy & Safety

HOW ? By repeatedly placing one foot in front of the other

Page 10: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Footsteps

Stridelength = StepRight + StepLeft

Left steplengthRight steplength

Page 11: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Footsteps (asymmetric)

Stridelength = Right step + Left step

Left steplengthRight steplength

Page 12: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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www.gaitrite.com

Measure footsteps

Page 13: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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www.gaitrite.com

Measure footsteps

Page 14: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Goal of walking

Walking speed [m/s]

3.6 km/h = 1 m/s

Cadence [ steps/min]

Stridelength [m]

x / 120 =

Page 15: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Walking speed=stride length*cadence

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

1.80

2.00

0 20 40 60 80 100 120 140 160

Step rate (steps/min)

Strid

e le

ngth

(m)

0.25 m/s0.50 m/s0.75 m/s1.00 m/s1.25 m/s1.50 m/s1.75 m/s2.00 m/s

1.50 x 60 / 120 = .75

1.00 x 90 / 120 = .75

Page 16: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Body length and stride length

Page 17: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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What is the optimal stridelength ?

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

0.90

1.00

0 20 40 60 80 100 120 140 160

Step rate (steps/min)

Stri

de le

ngth

/ Bo

dy L

engt

h 0.25 m/s0.50 m/s0.75 m/s1.00 m/s1.25 m/s1.50 m/s1.75 m/s2.00 m/s

StrideLengthBodyHeight =0.008 * StepRate

Page 18: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Energy

Walking speed

Cadence

Stridelength

x Energy Cost

Statute

Page 19: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Energy measurements during gait

• (ambulatory) oxygenrecording

• one ml O2 / min• = 5 cal / min • = 20 J/min

Page 20: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Human gait is very efficient...

optimal:~3.4 J/kg.m

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How far can you walk on a pastry ?

250 kcalEnergy cost at optimal speed= 0.8 cal/kg.meter

250.000/(0.8*70)=4,5 km

Page 22: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Metabolic Energy Measurement

Page 23: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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casus

Page 24: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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One stride lasts from initial foot contact until the next ipsilateral initial foot contact

the gaitcycle

Page 25: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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normalized time: 0 % - 100 %

the gaitcycle (2)

Page 26: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Heelstrike & Toe-off

Page 27: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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the gaitcycle (3)

0 % -- stance -- 60 % -swing-100%

Page 28: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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the gaitcycle (4)

-- 50 % --

LEFT SWING LEFT STANCE

RIGHT SWINGRIGHT STANCE

Page 29: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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the gaitcycle (5)

LEFT SWING LEFT STANCE

RIGHT SWINGRIGHT STANCE

RIGHT SINGLE SUPPORT

LEFT SINGLE SUPPORT

DOUBLE SUPPO

RT

DOUBLE SUPPO

RT

DOUBLE SUPPO

RT

Page 30: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Functional division of gait phases(after J. Perry)

Stride (gait cycle)

Stance Swingperiods

WeightAcceptance

Single LimbSupporttasks

LimbAdvancement

InitialContact

LoadingRespons

e

MidStance

Terminal Stance

PreSwing

InitialSwing

MidSwing

Terminal Swing

phases

Page 31: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Initial Contact 0 %

Page 32: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Loading Response 0-10 %

Page 33: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Functional division of gait phases(after J. Perry)

Stride (gait cycle)

Stance Swingperiods

WeightAcceptance

Single LimbSupporttasks

LimbAdvancement

InitialContact

LoadingRespons

e

MidStance

Terminal Stance

PreSwing

InitialSwing

MidSwing

Terminal Swing

phases

Page 34: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Midstance 10 - 30 %

Page 35: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Terminal Stance 30 - 50 %

Page 36: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Functional division of gait phases(after J. Perry)

Stride (gait cycle)

Stance Swingperiods

WeightAcceptance

Single LimbSupporttasks

LimbAdvancement

InitialContact

LoadingRespons

e

MidStance

Terminal Stance

PreSwing

InitialSwing

MidSwing

Terminal Swing

phases

Page 37: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Pre-Swing 50 - 60 %

Page 38: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Initial-Swing 60 - 73 %

Page 39: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Functional division of gait phases(after J. Perry)

Stride (gait cycle)

Stance Swingperiods

WeightAcceptance

Single LimbSupporttasks

LimbAdvancement

InitialContact

LoadingRespons

e

MidStance

Terminal Stance

PreSwing

InitialSwing

MidSwing

Terminal Swing

phases

Page 40: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Mid-Swing 73 - 87 %

Page 41: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Terminal-Swing 87 - 100 %

Page 42: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

42

Functional division of gait phases(after J. Perry)

Stride (gait cycle)

Stance Swingperiods

WeightAcceptance

Single LimbSupporttasks

LimbAdvancement

InitialContact

LoadingRespons

e

MidStance

Terminal Stance

PreSwing

InitialSwing

MidSwing

Terminal Swing

phases

Page 43: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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The gait cycle

M.Whittle

Page 44: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

8. terminal swing7. midswing6. initial swing5. preswing

4. terminal stance3. midstance2. load response1. initial contact

filenaam STUDY:

videorapport loopanalysedatum opname:

rechts links

/ /

xxxSYxxx.sty

BewegingsLaboratorium

Page 45: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Observational GaitAnalysis formRancho Los Amigos Medical Centre

Page 46: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Edinburgh GAIT Scoring Table

Page 47: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Error sources in observational kinematic analysis

• Subjective

• estimation error

• out of plane (2D vs. 3D)

Page 48: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Estimation of joint angles

How well do we perform ?

148 º 24 º

Page 49: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Estimation of joint angles

How well do we perform ?

148 º 24 º

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Projection error

Page 51: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Projection error

Page 52: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Projectionerror (2)

0 10 20 30 40 50 600

20

40

60

80

100

120

140

160

180

angle of observation

obs

erve

d an

gle

Page 53: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Earliest 3D movement analysisBraun & Fischer 1895

Page 54: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Multiple 2D projections

Page 55: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Calibrate the projectioncalibration frame

15 points are known in the real (3D) world

DirectLinear Transformation

Videobased systems: SYBAR, SIMI, PEAK, . . . .

Page 56: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Automated marker tracking and 3D reconstruction of marker position

Multiple (2+) stroboscopic InfraRedcamera's using reflective markers on the body

Vicon, MotionAnalysis, Elite, Qualysis,. . .

Page 57: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Automated marker tracking and 3D reconstruction of marker position (2)

Active InfraRed markers 3D camera ('s)

CODAmotion, OptoTrak, . . .

Page 58: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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markerrecording

segmentidentification

Body model anatomicalreference

clinicalconvention

kinematicsmarker-cluster n

kinematicsmarker-cluster 1

kinematics

kinematicsanatomical segm. #1

joint-kinematics

anatomical segm. #2

Page 59: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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3D Kinematics software

Matlabwww.bodymech.nl

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Page 61: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Clinical Feasibility

Page 62: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Clinical Feasibility

Page 63: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Clinical Feasibility

Page 64: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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INFORMATION

?

=

KNOWLEDGE

Page 65: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

Observational analysis of pathological movement

Page 66: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Muscle function during movement

Reprinted from: Inman et al. (1981)

Page 67: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Electro Myo Gram (EMG)

Electrode mounted amplifier

differential lead-off

EMG is the summation of many asynchronous Motor Unit Action Potentials

Page 68: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Relation EMG and Muscle Force

Raw EMG

Smoothed Rectified EMG @ 2 Hz

Isometric muscle force

Page 69: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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the SYBAR system

Page 70: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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the SYBAR system

display

Page 71: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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casus

Page 72: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Groundreaction force

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Page 74: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Net joint moment

Moment =

F x r

Page 75: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Estimated net joint momentversus inverse dynamics

Moment =

F x r

Boccardi et al. (1981)

Page 76: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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What therapeutic intervention is needed ?

Page 77: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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DecisionDisability assessment

General aim of treatment (disability level)no treatment

Decisionfunction analysis

Specific treatment

Evaluation of treatment at two (nested) levels

increased walking speed, decreased PCI

decreased ankle moment at heelstrike

Page 78: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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What therapeutic intervention is needed ?

Page 79: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Complex Clinical Cases

Page 80: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Dynamicsexternalmoments andforces

Kinematics- positions- angles- derivatives

Antropometrics:•mass•inertal moments•jointlocations•muscle attachments

Joint andmuscle function

- net moments- estimated

muscle forces

Inverse dynamics model

Page 81: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Problem statement

Physical examination yields angles

The measure should address muscle length

The reference values are based on normal gait

Page 82: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Method

• Application of a geometrical musculo-skeletalmodel SIMM (Delp et.al 1995)

• input 1: joint angles during physical examination

• input 2: joint angles during normal gait

• output: muscle length (origo-insertion)

• all lengths are normalized to anatomical position(=100 % )

Page 83: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Results: m. Rectus Femoris (1)

•Figure 6.2

Figure 6.1

Page 84: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Results: m. Rectus Femoris (2)

100,0%102,0%104,0%106,0%108,0%110,0%112,0%114,0%116,0%118,0%120,0%

0 12 24 36 48 60 72 84 96 108 120

Page 85: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Length m. Rectus Femoris during gait

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Results: m. Rectus Femoris (3)

95%97%99%

101%103%105%107%109%111%113%

0 8 16 24 32 40 48 56 64 72 80 88 96 %gait

stance swing

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Discussion

• “Passive” muscle length is not the sole cause to contractures during gait

• Muscle length during movement and EMG should be considered

• Warning: validity of the model• Documentation of examination protocols

(standardisation) using modeling software animations creates awareness of muscle length testing

Page 88: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Imaging•Clinical question

•Functional analysis

•Muscle-bone model•(invers)

•visualization

•function•structure

•load•(intended) therapeutical intervention

•musle-bone model•(forward)

•movement

Page 89: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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casus

Page 90: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Models (1)

Page 91: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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Models (1)

Page 92: Clinical Gait Analysis - TU Delft OCW · PDF fileClinical Gait Analysis ... Functional division of gait phases (after J. Perry) Stride (gait cycle) ... Edinburgh GAIT Scoring Table

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functional load and loading capability of the upper extremity

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Upper extremity

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Upper extremity (2)