gait analysis

EVALUATION EVALUATION OF GAITOF GAIT

EVALUATION IN ATHENS

Diagnosis of gait DeviationsDiagnosis of gait Deviations

Awareness of the functional Awareness of the functional limitationslimitations

Familiarity with normal functionFamiliarity with normal function Trained eye or gait analysis Trained eye or gait analysis

systemsystem Use the information for Use the information for

appropriate treatment regimenappropriate treatment regimen

GAIT-DEFINITIONGAIT-DEFINITION Word meaning is manner of Word meaning is manner of

walking walking Highly controlled,coordinated Highly controlled,coordinated

and repetitive series of limb and repetitive series of limb movements whose function is movements whose function is to advance the body from to advance the body from place to place with minimum place to place with minimum expenditure of energy expenditure of energy

GAIT CYCLEGAIT CYCLE

One gait cycle is the movement One gait cycle is the movement of a single limb from heel strike of a single limb from heel strike (initial contact ) to next heel (initial contact ) to next heel strikestrike

SUBDIVISIONS OF GAIT CYCLESUBDIVISIONS OF GAIT CYCLE

Stance phase and swing phase Stance phase and swing phase Stance phase begins with initial Stance phase begins with initial

contact of heel and ends with contact of heel and ends with toe offtoe off

SUBDIVISIONS OF GAIT CYCLESUBDIVISIONS OF GAIT CYCLE Initial contact occurs at Initial contact occurs at 0%0% and and 100%100% of gait of gait

cycle and toe off occurs at cycle and toe off occurs at 60%60%

So stance phase is about So stance phase is about 60%60% and swing phase and swing phase 40%40% of gait cycle of gait cycle

STANCE PHASESTANCE PHASE

Period when foot is on the groundPeriod when foot is on the ground Sub divisionsSub divisions

1) initial contact1) initial contact

2) loading response 2) loading response

3) mid stance3) mid stance

4) terminal stance and4) terminal stance and

5) pre swing5) pre swing

INITIAL CONTACTINITIAL CONTACT

Occur at Occur at 0%0% of gait cycle of gait cycle Principal objective of Principal objective of

body is to position the body is to position the foot correctly as it comes foot correctly as it comes in contact with the floor in contact with the floor

Body is about to begin Body is about to begin decelerationdeceleration

LOADING RESPONSELOADING RESPONSE

Occupies Occupies 0 to 10%0 to 10% of gait cycle of gait cycle Maintain smooth progression Maintain smooth progression

while decelerating the body while decelerating the body mass as it travels from its zenith mass as it travels from its zenith at mid stance of opposite limbat mid stance of opposite limb

Opposite limb toe off occurs at Opposite limb toe off occurs at end of loading response . So this end of loading response . So this is a period of double limb is a period of double limb supportsupport

MID STANCE MID STANCE Utilize momentum to maintain Utilize momentum to maintain

stability of the hip and knee stability of the hip and knee while advancing the body over while advancing the body over a stationary foota stationary foot

The centre of gravity has The centre of gravity has reached its zenith and forward reached its zenith and forward velocity is minimumvelocity is minimum

Initial swing has begun on Initial swing has begun on opposite sideopposite side

TERMINAL STANCETERMINAL STANCE Occupies Occupies 30 to 50% range30 to 50% range of of

gait cyclegait cycle Provide acceleration & to Provide acceleration & to

ensure an adequate step lengthensure an adequate step length Acceleration is provided byAcceleration is provided by 1)forward fall of centre of 1)forward fall of centre of

mass of bodymass of body 2) concentric contraction of 2) concentric contraction of

triceps surae triceps surae Constitutes Constitutes 80 -85%80 -85% of total of total

energy generatedenergy generated

PRE SWINGPRE SWING

Occupies Occupies 50-60% range50-60% range of gait cycleof gait cycle

Period of double limb Period of double limb supportsupport

Goal is to prepare the Goal is to prepare the limb for swinglimb for swing

Initial contact of Initial contact of opposite limb marks opposite limb marks beginning of pre swingbeginning of pre swing

SWING PHASESWING PHASE Limb is off the groundLimb is off the ground Divided intoDivided into

1) initial swing1) initial swing

2) mid swing 2) mid swing

3) terminal swing3) terminal swing

INITIAL SWINGINITIAL SWING

Occupies Occupies 60-70% range60-70% range of gait cycle of gait cycle

Critical function is to Critical function is to allow foot clearance & allow foot clearance & variable cadence variable cadence

Varying cadence Varying cadence requires CNS control & requires CNS control & precise timing of two precise timing of two joint muscles joint muscles

MID SWINGMID SWING

Occupies Occupies 70 to 85% range70 to 85% range of gait of gait cyclecycle

Critical function is to maintain Critical function is to maintain foot clearancefoot clearance

MID SWING (contd)MID SWING (contd)

Foot clearance depends Foot clearance depends on maintaining a on maintaining a relatively level pelvis, relatively level pelvis, sufficient hip flexion & sufficient hip flexion & adequate ankle adequate ankle dorsiflexiondorsiflexion

In normal gait foot In normal gait foot clearance is only 0.87cmclearance is only 0.87cm

TERMINAL SWINGTERMINAL SWING Occupies Occupies 85-100% 85-100%

rangerange of gait cycle of gait cycle Function is deceleration Function is deceleration

of shank & correct pre- of shank & correct pre- positioning of foot for positioning of foot for contactcontact

Complete knee Complete knee extension & neutral extension & neutral position of foot are position of foot are critical for heel strikecritical for heel strike

Linear measurements- ( cadence Linear measurements- ( cadence or temporal parameters )or temporal parameters )

Step lengthStep length Stride lengthStride length Step timeStep time CadenceCadence Walking velocityWalking velocity

KINEMATICSKINEMATICS It denotes movements observed It denotes movements observed

and measured at the pelvis, hip, and measured at the pelvis, hip, knee, and ankle during stance knee, and ankle during stance and swing phasesand swing phases

It can be observed in 3 planes It can be observed in 3 planes

sagittalsagittal

coronalcoronal

transversetransverse

SAGITTAL PLANESAGITTAL PLANE

The pelvis tilts approximately The pelvis tilts approximately 1515 degree degree

SAGITTAL PLANESAGITTAL PLANEHIPHIP

•StanceStance –flexed at –flexed at initial contact initial contact then extends fully then extends fully

•Swing Swing – hip flexes – hip flexes rapidly to pull the rapidly to pull the stance limb off stance limb off the ground the ground


KNEEKNEE• StanceStance- At initial contact - At initial contact

knee flexes knee flexes 1515 deg. It then deg. It then extends extends

• SwingSwing – At heel rise knee – At heel rise knee begins to flex again begins to flex again reaching maximum flexion reaching maximum flexion in early swing .In remainder in early swing .In remainder of swing knee extends of swing knee extends passively passively


ANKLEANKLE• Stance Stance – neutral at initial – neutral at initial

contact,then plantar flexes contact,then plantar flexes 5-10 deg as forefoot comes 5-10 deg as forefoot comes to rest on the ground.- to rest on the ground.- FIRST ROCKERFIRST ROCKER

• Ankle dorsiflexes throughout Ankle dorsiflexes throughout mid stance as tibia moves mid stance as tibia moves forward over plantigrade forward over plantigrade foot – foot – SECOND ROCKERSECOND ROCKER

SAGITTAL PLANESAGITTAL PLANE ANKLEANKLE(CONTD)(CONTD)--during terminal during terminal

stance and pre swing stance and pre swing ankle plantar flexes and ankle plantar flexes and heel rises to prepare for heel rises to prepare for push off- push off- THIRD ROCKERTHIRD ROCKER

• SwingSwing – dorsiflexion to – dorsiflexion to neutral position seen neutral position seen

CORONAL PLANECORONAL PLANE PELVIS-each hemipelvis PELVIS-each hemipelvis

rises slightly during swing rises slightly during swing phase phase

- stance phase hemipelvis - stance phase hemipelvis drops slightlydrops slightly

- accentuated pelvic drop in - accentuated pelvic drop in swing seen in swing seen in trendelenburg gaittrendelenburg gait

CORONAL PLANE CORONAL PLANE (CONTD)(CONTD)

HIP- HIP- StanceStance phase – phase – slight adduction slight adduction occursoccurs

- - Swing Swing – abduction – abduction seenseen

TRANSVERSE PLANETRANSVERSE PLANE

Measure rotationMeasure rotation

Pelvis and hips rotate minimally Pelvis and hips rotate minimally

Tibia has a fixed external rotationTibia has a fixed external rotation

NEUROLOGICAL CONTROL OF NEUROLOGICAL CONTROL OF GAITGAIT

Muscle actions programmed as Muscle actions programmed as involuntary reflex arcs in EPSinvoluntary reflex arcs in EPS

Golgi tendon ,muscle spindle & Golgi tendon ,muscle spindle & joint receptors produce joint receptors produce neurologic feedback neurologic feedback

Voluntary modulation of gait Voluntary modulation of gait made by interaction with motor made by interaction with motor cortexcortex

Cerebellum - balanceCerebellum - balance

MUSCLE ACTIVITYMUSCLE ACTIVITY

Gait is maintained by gravity , Gait is maintained by gravity , momentum and muscle contraction. momentum and muscle contraction. Muscle contraction can beMuscle contraction can be

• 1)Concentric 1)Concentric

• 2)Eccentric 2)Eccentric

• 3)Isometric3)Isometric

MUSCLE ACTIVITYMUSCLE ACTIVITYCONCENTRIC CONTRACTIONCONCENTRIC CONTRACTION

Muscle shortens Muscle shortens generating power and generating power and accelerationacceleration

Gastrocsoleus and Gastrocsoleus and iliopsoas are the primary iliopsoas are the primary accelerators of gaitaccelerators of gait

Concentric contraction of Concentric contraction of these occur at terminal these occur at terminal stancestance

MUSCLE ACTIVITYMUSCLE ACTIVITY ECCENTRIC CONTRACTION ECCENTRIC CONTRACTION

Muscle lengthens despite Muscle lengthens despite electrical contraction electrical contraction

These slow down & stabilize joint These slow down & stabilize joint motions during gait motions during gait

Eccentric contractions Eccentric contractions outnumber concentric outnumber concentric contractions during gaitcontractions during gait

ECCENTRIC CONTRACTIONECCENTRIC CONTRACTION

Eg:- tibialis anterior muscle Eg:- tibialis anterior muscle contracts eccentrically at contracts eccentrically at initial contact to slow down initial contact to slow down plantar flexion of ankle plantar flexion of ankle

-gastrosoleus contracts -gastrosoleus contracts eccentrically during 2eccentrically during 2ndnd rocker to slow down rocker to slow down dorsiflexiondorsiflexion

MUSCLE ACTIVITY MUSCLE ACTIVITY ISOMETRIC CONTRACTION ISOMETRIC CONTRACTION

No change in length of muscle No change in length of muscle occursoccurs

Postural stabilisers like gluteus Postural stabilisers like gluteus medius work in this modemedius work in this mode

More muscle activity occurs in More muscle activity occurs in stance phasestance phase

In swing momentum carries the In swing momentum carries the leg forward leg forward

GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY

Prerequisites of Prerequisites of normal normal ambulation are ambulation are

Stability at Stability at stance stance

Means of Means of progression progression

Conservation of Conservation of energyenergy


Bipedal gait is inherently Bipedal gait is inherently unstable unstable

and inefficient and inefficient Quadrupeds run faster than Quadrupeds run faster than

humans because vertebral and humans because vertebral and trunk muscles act to augment trunk muscles act to augment stride stride

GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCYPROGREESSIONPROGREESSION

• Forward fall of the Forward fall of the centre of gravity of centre of gravity of body from its high body from its high point at mid stance point at mid stance to its low point at to its low point at double supportdouble support

• Now potential Now potential energy is converted energy is converted to kinetic energyto kinetic energy

GAIT ENERGY AND EFFICIENCY GAIT ENERGY AND EFFICIENCY PROGRESSION (contd)PROGRESSION (contd)

To raise the CG back to zenith To raise the CG back to zenith kinetic energy must be supplied kinetic energy must be supplied

This is supplied by inertia of This is supplied by inertia of swinging limb which in turn swinging limb which in turn derives energy from plantar derives energy from plantar flexors and hip flexors of that flexors and hip flexors of that limb limb

GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCYPROGRESSION (contd)PROGRESSION (contd)

In normal walking In normal walking 85%85% of energy of energy comes from plantar flexors comes from plantar flexors

Energy expended in normal Energy expended in normal walking is walking is 2.5 Kcal/min2.5 Kcal/min

This is less than twice the This is less than twice the energy spent while standing still energy spent while standing still --1.5Kcal/min1.5Kcal/min

GAIT ENERGY AND EFFICIENCY GAIT ENERGY AND EFFICIENCY ENERGY CONSERVATIONENERGY CONSERVATION

Energy is conserved in 3 waysEnergy is conserved in 3 ways

• Minimizing the excursion of C of GMinimizing the excursion of C of G• Controlling momentumControlling momentum• Active or passive transfer of energy Active or passive transfer of energy

between segmentsbetween segments


Movement of a wheel is highly Movement of a wheel is highly efficient as C of G remains constantefficient as C of G remains constant

By three planes of pelvic movement , By three planes of pelvic movement , rotation, tilt ,& obliquity combined rotation, tilt ,& obliquity combined with coordinated knee and ankle with coordinated knee and ankle motion the vertical and horizontal motion the vertical and horizontal excursion are reduced to excursion are reduced to 4.4cm4.4cm


CONTROLLING MOMENTUMCONTROLLING MOMENTUM

*This conserves energy *This conserves energy

eg:-by maintaining the eg:-by maintaining the ground reaction force in ground reaction force in front of the knee during the front of the knee during the last half of stance , an last half of stance , an extension movement occurs extension movement occurs which allows it to remain which allows it to remain stablestable

GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCYENERGY CONSERVATIONENERGY CONSERVATION

ACTIVE OR PASSIVE TRANSFER OF ENERGYACTIVE OR PASSIVE TRANSFER OF ENERGY

• Passive flow of energy across joints Passive flow of energy across joints accounts for most of the energy accounts for most of the energy changes occuring at the distal changes occuring at the distal segments during initiation and segments during initiation and termination of swingtermination of swing

• In active transfer two joint muscles In active transfer two joint muscles play a major roleplay a major role


Interference with these mechanisms Interference with these mechanisms increase energy consumptionincrease energy consumption

Eg:-fast walking – Eg:-fast walking – 60% inc60% inc BK brace - BK brace - 10%10%

15 deg knee flexion contracture -15 deg knee flexion contracture -25%25%

BK amputee – BK amputee – 60%60%

AK amputee – AK amputee – 100%100%

crutches - crutches - 300%300%

DEVELOPMENT OF GAIT IN DEVELOPMENT OF GAIT IN CHILDRENCHILDREN

Toddlers walk with a wide based Toddlers walk with a wide based gait, increased flexion of hip and gait, increased flexion of hip and knees & arms held out to the knees & arms held out to the sides sides

At 5 yrs child has developed a At 5 yrs child has developed a stable velocity pattern stable velocity pattern

Adult gait pattern is attained by Adult gait pattern is attained by 7 yrs7 yrs

GAIT ANALYSIS GAIT ANALYSIS

Systematic descriptionSystematic description

and assessment of qualities that and assessment of qualities that characterize human locomotioncharacterize human locomotion

Mainly used in pre operative Mainly used in pre operative planning and documentation of planning and documentation of post operative outcome in post operative outcome in patients with cerebral palsypatients with cerebral palsy

GAIT DEVIATIONSGAIT DEVIATIONS

Due to pain Due to pain weak muscle weak muscle abnormal muscle activity abnormal muscle activity joint abnormalitiesjoint abnormalities Contractures around jointsContractures around joints limb length discrepancieslimb length discrepancies


1)antalgic gait1)antalgic gait - dec stance phase - dec stance phase avoiding wt. Bearing on involved limbavoiding wt. Bearing on involved limb

2)Short limb gait2)Short limb gait – dipping of shoulder – dipping of shoulder and pelvis on affected side & inc and pelvis on affected side & inc flexion of hip , knee and ankle of flexion of hip , knee and ankle of opposite limb.opposite limb.

3)Trendelenburg gait3)Trendelenburg gait –patient lurches –patient lurches on affected side & pelvis drops on on affected side & pelvis drops on opp sideopp side

Goddess trying to avoid Short lomb gait


4)Waddling gait4)Waddling gait – patient lurches – patient lurches on both sides during walkingon both sides during walking

5)High stepping gait5)High stepping gait – patient – patient flexes foot and knee excessively flexes foot and knee excessively to clear the groundto clear the ground


6)Scissoring gait 6)Scissoring gait –– one leg one leg crosses directly over the other crosses directly over the other with each stepwith each step

7)Calcaneus gait7)Calcaneus gait –walks on –walks on broadened heel with tendency to broadened heel with tendency to external rotation and genu external rotation and genu recurvatum. No calcaneal pick up recurvatum. No calcaneal pick up and push offand push off


8)Stiff hip gait8)Stiff hip gait – no movements – no movements at affected hip , excess at affected hip , excess movements in spine & movements in spine & unaffected hipunaffected hip

9)Stiff knee gait9)Stiff knee gait – no flexion at – no flexion at

knee, so pelvis raised during knee, so pelvis raised during swing swing


10)Gluteus maximus gait10)Gluteus maximus gait – – patient lurches backwards due to patient lurches backwards due to weak gluteus maximusweak gluteus maximus

11)Gluteus medius gait11)Gluteus medius gait – like – like trendelenburg gaittrendelenburg gait


12)Quadriceps gait / 12)Quadriceps gait / hand to knee hand to knee gaitgait – – patient stabilizes hips & patient stabilizes hips & knee for weight bearing by knee for weight bearing by leaning on affected side & leaning on affected side & pressing over lower thigh by his pressing over lower thigh by his handhand

CONCLUSIONCONCLUSION

Normal gait is designed by God Normal gait is designed by God Almighty to be efficient & all the Almighty to be efficient & all the priorities are met . In abnormal priorities are met . In abnormal gait these are lostgait these are lost

Studying the human gait has Studying the human gait has enabled us to define , document enabled us to define , document & analyze normal and abnormal & analyze normal and abnormal human gait more accuratelyhuman gait more accurately

THANK YOUTHANK YOU

gait analysis

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