gait project

8/14/2019 gait project

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GAIT 13

INTRODUCTION:Gait: It is the pattern of movementof thelimbsof animals, includinghumans,

during locomotion over a solid substrate.

Most animals use a variety of gaits, selecting gait based onspeed, terrain,the need tomaneuver, and energetic efficiency.

Different animal species may use different gaits due

to differences inanatomythat prevent use of certain gaits,

or simply due to evolved innate preferences as a result of habitatdifferences.

While various gaits are given specific names, the complexity of biologicalsystems

and interacting with the environment make these distinctions 'fuzzy' atbest.

Gaits are typically classified according tofootfallpatterns, but recentstudies often prefer definitions based on mechanics.

The term typically does not refer to limb-based propulsion through fluidmediums such as water or air,

but rather to propulsion across a solid substrate by generating reactiveforces against it

(which can apply to walking while underwater as well as on land).

Due to the rapidity of animal movement, simple direct observation is

rarely sufficient to give any
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GAIT 14insight into the pattern of limb movement. In spite of early attempts toclassify gaits based on

footprints or the sound of footfalls, it wasn't until Eadweard Muybridge and

tienne-Jules Mareybegan taking rapid series of photographs thatproper scientific examination of gaits could begin.

Gait Training:Definition:

Gait training refers to helping a patient relearn to walk safely andefficiently.

Gait training is usually done by rehabilitation specialists who evaluatethe abnormalities in the person's gait

and employ such treatments as strengthening and balance training toimprove stability and body perception as these pertain to the patient'senvironment.

Gait training often incorporates the use of such assistive devices asparallel bars, walkers or canes to promote safe and proficientambulation. In order to walk again without assistance,

the patient will need mental attentiveness and adequate sensation,coordinated with adequate musculoskeletal functioning and motorcontrol.

Purpose of gait training:

A person's gait is a pattern of stepping or walking that is specific to thatindividual.
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GAIT 14

Types of walking:Human gait is the waylocomotionis achieved using humanlimbs.

For this article different gaits do not require changes in the geometry of motion, but rather, changes in the contact with thesurface (ground, floor,etc).

Walks:

In common with other gaits,walkinginvolves progression by alternatingperiods of loading and unloading. In walking, as distinct from running, atleast one limb is always in contact with the ground.

In bipedal locomotion, this results in periods of double support, in whichboth limbs make contact for some time in the gait cycle. In running, thisdouble support phase is lost and replaced by a flight phase, in which nolimb is in contact with the ground.

Walking is the most common human gait. It is characterized byalternating steps of left and right lower limbs. It generally provides usefulspeeds of progression for daily activities with near-optimal energyefficiency.

Backpedal:

Backpedaling is a walk in the opposite direction without changing facing.

Moonwalk

Similar to backpedaling, the moonwalk is a walk in an opposite direction,

but the subject seems to be stepping forward instead. The term
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GAIT 14Similar to the ghost walk, but instead of landingon the heel and rolling to the outer ridge of thefoot, the walker lands first on the outer edge of the ball of the foot,

then places his weight fully on the ball, thensets the edge and heel down.

This form of walking is very deliberate and quiet but also slower thanmost gaits.

Often weight is kept on the standing leg until the walker is ready to placehis forward foot rather than than pitching his weight forward inanticipation of the next step.

The forward leg is bent at the knee, not locked, allowing the foot to movestraight up and down vis-a-vis the ground. It is a useful gait for peoplewho are walking barefoot,

particularly on rough or dangerous surfaces because the walker canquickly pull away from a dangerous step before committing to it.

Also they can avoid stepping on an object that would make noise. Thisgait can be performed bent over or in a squat as in the stalk or prowl,described below.

Hand walking:


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GAIT 13

An acro dancer handwalks across the stage.

Hand walkingis when the walker moves primarily using their hands.Knee walk:

Also known as shikk inJapanese martial arts (especiallyaikido),

a 2-beat gait that starts with one foot and the other knee on the ground.

The kneeling foot is brought forward and the standing foot rotates downto a kneel.

This is used to keep the centre-of-mass as close to the ground as possible(by force orvolition),

while still being able to move and fight.

March:

Marching is typically only used in the military or marching bands.

It is a sub-gait because it is in essence walking.The main differences are that side-to-side motion is virtually removedand the weight is placed on the leading foot, rather than equidistantbetween the two, as in walk.

This produces a highly efficient, high speed walk which is far moreenergy efficient than running and can produce 2x to 4x a typical walk's

speed.[citation needed]Speed walking:

Speed (or race) walkingis a modified walk where the leg must be straightas it passes below thehip, which is not a requirement for marching. Thisis mainly because a march will often cause a person to overstep, and thatmarching is but slightly off of running and would be extremely difficult

to tell the difference in a race.
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GAIT 13Shuffle:

A sub-gait of walking where, if the feet arebrought off the ground,

it is done only so much as necessary.

Useful for when one is in weakened state or lazy,

especially for soft ground such as snow and sand.

More energy-wasteful than walking on hard ground.

Stalk or prowl:A stalk or prowl is essentially a walk while in a fullsquat.

This is designed to be a walk that maintains a low profile.

A goodsoldiercan keep the profile as low as a regular crawl.

Runs:

A runner at a track

Run:

Running is nearly identical to walking or marching except that theperson is actuallyairborne once each beat. This is the chief high-speedgait of humans.

The beats happen faster and the distance traveled per-beat is also muchhigher.

Running requires much more energy than walking
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GAIT 14. A well-trained human can run continuously for hours at a time (seemarathon).

Jog:

Joggingis a sub-gait of run where the pace is much less and the legsnearly never go out of the body's centreline.

Sprint:

Sprinting is to running what marching is to walking.

It requires running as fast as one can for a defined length, resulting in thespeed being much greater than the conventional "run" or "jog". Theweight is put on top of or even beyond the front foot.

This will quickly cause the person to becomewinded.

Airborne shuffle:

Essentially half-way between marching and jogging, where the feet are

pulled just off the ground.This is to provide a middle ground between marching and jogging.

Crawls:

Babies usually learn to crawl before they develop walking skills.

Crawls can refer to the specific gait or to any gait involving the arms andlegs. Crawling is used mainly:

When he/she cannot walk because of being aninfant or due todisability or being wounded or sick.

In very low places (caves, under a table, in amine, etc.). Sometimesunderground miners need to crawl long distances during theirwork.

When searching for something on the ground.
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GAIT 13 To get down to the ground ingardening, for maintenance or other

work-related purposes which require a good reach on the ground

For stealth (camouflage and quietness)

To lower the field of vision

For fun or comical purposes.

Crawl:

Crawlingis a specific 4-beat gait involving thehands and knees.

A typical crawl is left-hand, right-knee, right-hand, left-knee, or a hand,the diagonal knee, the other hand then its diagonal knee.

This is the first gait most humans learn, and is really only practicalduring early childhood, or when looking for something on the floor orunder lowrelief . It can be used to move with a lowersilhouette, but thereare better crawls for that purpose.

This is the most natural of the crawls and is the one that requires theleast effort.

Bear crawl:

The bear crawl is almost identical to the regular crawl, but thefeetareused instead of the knees, which creates an arched or squattedbodyposture. This works as a faster crawl but requires more effort tomaintain.

Crab crawl:
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GAIT 14The crab crawl is an upside down bear crawl.

This is the most unnatural of the crawls, requiring the most effort, and isused incrab soccer.

The crab crawl starts by sitting down with the feet and hands flat on theground, the hips are then raised off the ground and the chest faces thesky.

Due to its inefficiency, it is more commonly used as a form of exercise than actual transportation.

Crabwalking buildstriceps endurance [1]and arm and leg strength, andis a recommended exercise of various school athletic departments andsoccerorganizations (such asUSA Football. Because of its unusualappearance, crabwalking has been used in severalhorror films to suggestthe demonic possession of a character. These have includedThe Exorcist and The Unborn.

Leopard crawl/Low crawl:

The leopard crawl is amilitary-specific crawl. There are two versions, theleopard crawl proper and a modified version for when carryingweapons in the hands.

This is a two-beat gait like atrot: an arm/elbowis advanced with thediagonal knee.

This is designed for the smallest silhouette possible, and the body is oftennearly or actually touching the ground, and although the elbow and kneeare the main focus, most of the respective limbs touch the ground.

Tiger crawl:

The tiger crawl is essentially a highly accelerated combination betweencrawl and leopard crawl.
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GAIT 14It uses the hands and the knees/feet depending upon the situation,

while maintaining a silhouette almost as small as that of the leopardcrawl.

This is relatively fast gait but can take large amounts of energy.

Other:Hop:

Hoppingis a 1-beat gait on either one or two feet. 1-foot hops are

practical when a limb is no longer usable.Skip:

A 3-beat, 4-beat, or 6-beat gait where a foot is repeated (i.e. LLR, RRL,etc. but there are many variations thereof: L,L,R,R, etc.)

It is typically considered an expression of giddiness, but it can be used inthe place of run when one limb is injured but can still be used (mild

sprain).

Skun:

Half-way between a run and a skip.

A three-beat gait (i.e. R,R,L or L,L,R) in which between the second andthe third beats there is basically a run. There are three types "The fastskun", "The slow skun", and "The fancy skun."

Hobble:

A two-beat gait similar to walk except that one of the paces issignificantly shorter than the other. This is done to protect an injuredlimb. Often called a "limp."
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GAIT 13Side-step:

A two-beat gait where one foot is moved to the side and the other isbrought to meet (rather than pass) it. This is used for moving sideways.

Strafe:

Computer gaming jargon for a two-beat gait where one foot is moved tothe side and the other is brought past it. This term is popularly used todescribe sideways movement by the player in first-person shooters.

Scoot:

A movement from a seated position, where the person moves forward bypulling the feet in towards the body. This is typically performed byinfants who are not yet able to crawl.

Gender differences:

There are manygender differencesin human gait, females walk withlesser step width and more pelvic movement.[1] Gait analysisgenerallytakes gender into consideration.[2]Females walking with hip sway, andmales walking with swagger in shoulder generally have morephysicalattractiveness.[3]A study by Stuart Brody of theUniversity of the Westof Scotlandsays female gait reflectsorgasmicability.[4]

Military paces:

In the military there are various standard paces:

Quick March:The basic mobility. 120-beats/min, 75 cm (30") pace.

Double March:The basic run. 240-beats/min.

Highland March:Regiment specific pace, 80-beats/min. Used whenwearingkilts.

Rifle March:Regiment specific pace, 180-beats/min.

Slow March:Ceremonial pace, 40-60 beats/min.
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GAIT 13 Parade March: Usually seen combined with music, ~108 beats/min.

in the UK, ~120 beats/min. in the USA

Paso legionario:Specific march used by theSpanish Legion, 144beats/min, embodiment of their "espiritu de marcha".

There are various other requirements for marching (excluding 2x-time.)The British and her Commonwealth bring their arms chest-pocket high.Countries of theEastern Blocoften have the leg kept straight on theforward pace. These actually aid in maintaining speed and increase

efficiency for long range travel.

Anatomy:
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GAIT 14I. FUNCTIONS OF THE LOWER EXTREMITY

Bipedalism is the process by which we are able to stand upright and tomove about on 2 limbs.

Bipedalism imparts three unique functions on the lower limbs. The limbsmust

bear weight

provide a means for locomotion

maintain equilibrium.The lower limbs are adapted for stability rather than range of motionand that stability is achieved at most of the major joints of the lower limbthrough the use of strong ligaments and tight fitting bony surfaces ratherthan the expenditure of energy in the form of muscle contraction.

A. Weight Bearing Properties

1. Support weight of head and torso with minimal expenditureof energy

2. Bony Features

a. Relatively large areas of articulation

b. Close pack fit of articular surfaces of bones involved inthe formation of joints

i. Hip joint b. Wide surface areas

i. Knee joint

b. Weight supporting arches

i. Arches of the foot

2. Ligaments


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GAIT 13a. Strong

b. Maintain stable configuration

B. Center of Gravity

1. Center of mass of body generally falls halfway between iliaccrests and in front of second sacral vertebra

2. Position

a. Posterior to hip joint

b. Anterior to knee jointc. Anterior to ankle joint

B. Stability

1. Position of joints during normal upright standing

a. Due to center of mass of body

2. Can be maintained while bearing weight with minimalexpenditure of energy (muscle contraction)

3. Stable position maintained through use of :

a. ligaments

b. close packing of joints

2. Position

a. Hip joint = extension b. Knee joint = extension

c. Ankle joint = dorsiflexion

d. no ligamentous support

e. Foot = supinated position

II. Locomotion


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GAIT 13A. Position of the Lower Extremity

1. Weight bearing / Fixed

a. Motion occurs with foot fixed to ground

b. Limb is in good position to support weight

2. Non weight bearing / Free

a. Foot is not in contact with the ground

b. Limb is not in a position to support weight

2. Same relative motion occurs in both position

a. Different bones will move

B. B. Movements of the Lower Extremity

1. 1. Hip Joint

a. Weight bearing - pelvis moves on femur

b. Non weight bearing - femur moves on pelvisc. Types

i. Flexion - Extension

ii. Abduction - Adduction

iii. Medial rotation - Lateral rotation

2. Knee Joint

a. Weight bearing - femur moves on tibia

b. Non weight bearing - tibia moves on femur

c. Types

i. Flexion - Extension

ii. Medial rotation - Lateral rotation

2. 3. Ankle Joint


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GAIT 13a. Weight bearing - tibia and fibula moves on foot

b. Non weight bearing - foot moves on tibia and fibula

c. Types

d. Dorsiflexion - Plantar flexion

2. Foot (Tarsal Joints)

a. Pronation - Supination

IV. MUSCLE ACTIVITY(Chart I)The major muscle groups that are active at each of the various phases of the gait cycle and the joint (s) upon which they act are listed below. Thisinformation is also presented in the tape "The Anatomical Gait Cycle".As you proceed to study of each major joint of the Lower Extremity , youshould be able to do the following:

A. Know the position of each of the joints of the lower limb at each intervalof the gait cycle and the factors responsible for this position.

B. Determine the major muscle groups acting on the particular joint andknow the function(s) / actions(s) of each muscle

C. Determine if the muscle has an restraining effect ( eccentric contraction)

or a propulsive effect ( concentric contraction).D. Know the innervation of each muscle or group of muscles.

E. Understand how to determine how a nerve lesion would affect themovement and position of the particular joint during the gait cycle.

MUSCLE ACTIVITY DURING GAIT

INTERVAL JOINT POSITION MUSCLE

ACTIVITY


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GAIT 14Acceleration toHeel Strike

Hip Flexed Gluteus Maximus

Hamstrings

Gluteus medius &minimus

Knee Flexed Quadriceps femorisAnkle Neutral Anterior crural

musclesHeel Strike to

Midstance

Hip Neutral Gluteus medius &

minimusKnee Extended Quadriceps femorisAnkle Dorsiflexed Gastrocnemius;

soleusTarsal Inverted Tibialis anterior

Tibialis posterior

Midstance toToe Off

Hip Extended -

Knee Flexed GastrocnemiusAnkle Plantar

flexedGastrocnemius;soleus

Tarsal Everted Fibularis longus

Fibularis brevis

Toe Off toAcceleration

Hip Flexed IliopsoasAdductors longus,brevis, magnus

Knee Flexed GastrocnemiusAnkle Neutral Anterior crural

musclesTarsal Neutral -


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GAIT 15

PHYSIOLO

GY :

Physiology of gait In humans, inability to stand and walk is the most

limiting of motor disabilities. In humans, upright stance and gait is the


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GAIT 16most sensitive indicator of cerebellar disease. From animal and human

studies, much has been learned about how the cerebellum coordinates

normal movement, and how it may play roles in normal motor

adaptation and learning. Much of this work suggests that different parts

of the cerebellum control stance and gait in different ways, and

differently located lesions cause different deficits. What is not known is

whether the cerebellum can compensate for stance and gait disorderscaused by lesions in other parts of the nervous system, or whether one

part of the cerebellum can compensate for deficits caused by lesion of

another part. These issues have become increasingly important in

rehabilitation research and practice.

Role of basal ganglia in in gait: Here we review a role of a basal ganglia brainstem (BGBS) system throughout the mesopontine tegmentum inthe control of various types of behavioral expression. First the basalgangliabrainstem system may contribute to an automatic control of movements, such as rhythmic limb movements and adjustment of postural muscle tone during locomotion, which occurs in conjunction

with voluntary control processes. Second, the basal gangliabrainstemsystem can be involved in the regulation of awakesleep states. Wefurther propose the possibility that the basal gangliabrainstem system isresponsible for the integration of volitionally-guided and emotionally-triggered expression of motor behaviors. It can be proposed thatdysfunction of the basal gangliabrainstem system together with that of


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GAIT 17cortico-basal ganglia loop underlies the pathogenesis of behavioraldisturbances expressed in basal ganglia dysfunction.

The central nervous systems (CNS) control of motorics and locomotionis excep- tionally complex. A significant contribution to this field camefrom Charles Scott Sherrington (1857-1952) in Great Britain. Heintroduced the terms proprioception and synapse and pointed to a

mechanism by which complex motor acts may be produced byconnecting a large number of simple reflexes. Today, due to Bernsteinsresearch and research that followed, this field has branched into a richmulti- and interdisciplinary field which includes neurophysiology,neuroscience, several clinical medical areas, cybernetics, computerscience, etc. For now, it suffices to state the components in thehierarchical system of motor control: motor cortex, basal ganglia,

thalamus and hypothalamus, midbrain, cerebellum, brainstem, andspinal cord.

A fact that needs to be stressed is that sensory and motor functionsare connected at all levels which is a feature of CNS. In other words,there are very few sensory pro- grams that do not finish with theinitiation or modification of movement. The sensory functions includenot only proprioceptive organs in the neuromuscular system (mus- clespindles and Golgi tendon organs, Chapter 2.3), but also visual,auditory, and vestibular system functions. Figure 2.5 is a scheme of thesensomotor mechanism of the neuromuscular locomotor system.55

As far as motor learning is concerned, an important term is themotor engram. Gage7 cites Kottkes (1980) definition of the motorengram as a pathway of


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GAIT 18

FIGURE 2.5 Scheme of some neuro-musculo-skeletal sensomotormechanisms; example of the upper arm. (From Vodovnik, L. 1985.Nevrokibernetika, Ljubljana, Slovenija: Fakulteta za Elektrotehniko.With permission.)

Definition of Proprioceptive Activities


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GAIT 14n, proprioceptionadj, proprioceptive

the ability to sense the position and location and orientation andmovement of the body and its parts.

Proprioception is the information we get regarding the position of ourbody and the relationship of body parts to each other. Fromproprioception we know the position an arm or a leg ?without having tolook. We get this information from sensors in the body. We have joint

position sensors, and muscle stretch detectors. We have load sensors inthe tendons that connect muscles to bone, and sensors in the skin thatdetect pressure. Activities that emphasize proprioceptive sensoryexperience emphasize bending, stretching, twisting, pushing and pullingagainst resistance.

Ding, Ding, Ding, went the Trolleys/Big Foot

Body Statues

Body Sox

Restaurant Rush

Wax Paper Slide

Materials:

- Big Foot Strider- Trolley

Procedure:1. Place your feet in the appropriate places on the Big Foot Strider orTrolley.2. Lift the ropes in your hands with a tight grip, making sure that there is

no slack.
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GAIT 143. Keep the Big Foot Strider/Trolley pressed up against the bottom of thefeet and proceed in walking.

To Decrease the Complexity:Have the child stand on a Big Foot Strider with a parent behind them.Hold the childs hands in the adults hands while they grip the rope andwalk with the Strider pressed against their feet.

To Increase the Complexity:Have the student and parents or siblings get on the Trolley and walk as a

team. This is more difficult than using a Big Foot Strider (requiring onlyone person to use) because the participants must constantly adjust to theothers movements. Try to walk backwards as a team or s Body Statueskip!

Materials:- A piece of paper

- A pen/pencil- A partner

Procedure:1. Draw a stick figure on a sheet of paper (this can also be done byplacing a favorite doll in a certainly form).2. Have the child take a look at the position of the stick figure and ask them to imitate the position drawn.3. Draw different stick figures in various positions (both simple andcomplex) and have the child assume the positions.

To Decrease the Complexity:Have the position be very simple such as extending an arm out.


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GAIT 15To Increase the Complexity:Have the position involve various parts of the body. Ask the student tohold the designated position for as long as they can.

Definition of Tactile Activities

adj, tactileOf, relating to, mediated by, or affecting the sense of touch .

The word tactile refers to the sense of touch. Tactile sensations lead tothe detection of temperature, vibration, texture. It is tactile experience

that also helps us determine shapes and size. Detection of edges andcurves are tactile sensations. Remember, all parts of the body arereceptive to sensations through contact.

Definition of Vestibular Activities

adj, vestibularn, vestibular system,

Organs mediating the labyrinthine sense; concerned with equilibrium; of,or relating to the sense of equilibrium.

Vestibular sensations create our sense of balance, or equilibrium. Thevestibular system is a series of non-auditory anatomic structures in theear responsible for detecting our orientation to gravity and ouracceleration through space. It is information from the vestibular systemthat helps us know that we are standing upright, even in the dark. It is


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GAIT 16information from the vestibular system that helps us detect changes inspeed, even with our eyes closed. The vestibular system helps us maintainour equilibrium while we spin, rock, sway, bend.

Definition of Vestibular Activities

adj, vestibularn, vestibular system,

Organs mediating the labyrinthine sense; concerned with equilibrium; of,or relating to the sense of equilibrium.

Vestibular sensations create our sense of balance, or equilibrium. Thevestibular system is a series of non-auditory anatomic structures in theear responsible for detecting our orientation to gravity and ouracceleration through space. It is information from the vestibular systemthat helps us know that we are standing upright, even in the dark. It isinformation from the vestibular system that helps us detect changes in

speed, even with our eyes closed. The vestibular system helps us maintainour equilibrium while we spin, rock, sway, bend.


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GAIT 14movement, leading to interception (catching) of objects, or the avoidanceof collisions (e.g., riding a bicycle).

Bubble Mania

Ribbon Dance

Flash Light Tag

What's Different?

Biomechanics of gait:

In understanding normal gait, it is important to recognise six importantcriteria for normalcy.

The bisection of the lower 1/3 of the leg is parallel to the

bisection of the calcaneus.

The horizontal plane of the forefoot is perpendicular to the

bisection of the calcaneus.

There is a minimum 10 degree ankle dorsiflexion.

Leg must be vertical to the ground in frontal plane.

Leg must be vertical to the ground in saggital plane.

There is no horizontal plane rotation in limb above.

Normal Biomechanics in the Gait Cycle
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GAIT 13Human gait is a very complicated, coordinated series of movements.Walking is divided into two main phases. The stance phase is the weightbearing portion of each gait cycle. It is initiated by heel contact and endswith toe off of the same foot. Swing phase is initiated with toe off andends with heel strike.

Figure 2.6 in heel pain presentation

The two periods when both feet are on the floor, are called initial doublesupport and terminal double support. Initial double support occurs from

heel contact of one limb to toe-off of the opposite limb. Terminal doublesupport occurs from opposite limb heel strike to support limb toe-off.

Single limb support is identical to the period of swing of the oppositelimb.

GAIT

Gait may be described as a translatory progression of thebody as a whole, produced by coordinated, rotatorymovements of body segments.

Stages of gait:

I. stance phase: the stance phase begins at the instant thatone extremity contacts the ground and continuous only as

long as some portion of the foot is in contact with the


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GAIT 14ground.

Heel strike: the beginning of the stance phase when the heelcontacts the ground. Foot flat: It occurs immediatelyfollowing heel strike, when sole of the foot contacts thefloor.Mid stance: the point at which the body passes directlyover the reference extremity.

Heel off: the point following midstance at which time theheel of the reference extremity leaves the ground.Toe off: the point following heel off when only the toe of thereference extremity is in contact with the ground.


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GAIT 13

II. Swing phase: the swing phase begins as soon as the toeof one extremity leaves the ground and ceases just beforeheel strike or contact of the same extremity.

Acceleration: the portion of beginning swing from the

moment the toe of the reference extremity leaves the groundto the point when the reference extremity is directly underthe body.

Midswing: portion of the swing phase when the referenceextremity passes directly below the body. Midswing extendsfrom the end of acceleration to the beginning of deceleration.Deceleration: the swing portion of the swing phase whenthe reference extremity is decelerating in preparation forheel strike


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GAIT 15

Acceleration Midswing Deceleration


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Variables:Stance time: It is the amount of time that elapses during

stance phase of one extremity in a gait cycle.

Single-support time: It is the amount of time that elapsesduring the period when only one extremity is on supportingsurface in the gait cycle.

Double-support time: It is the amount of time that a personspends with both the feet on the ground during one gaitcycle.

Stride length: It is the linear distance from the point of heelstrike of one lower extremity to the next heel strike of thesame extremity.

Step length: It is the linear distance from the point of heelstrike of one lower extremity to the next heel strike of theopposite extremity.

Stride duration: It refers to amount of time it takes toaccomplish one stride. Step duration: It refers to theamount of time spent during a single step. Cadence: It is

the number of steps taken by a person per unit of time.


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Pathological gaits:1. Antalgic or painful hip gait: this is the gait of a personwith a painful condi- tion in the hip joint. To minimize the

pain the person shortens the time duration of the stancephase on the painful side and quickly transfers the weight tothe pain- less leg.

2. Stiff hip gait: when one hip is ankylosed, it is not possibleto flex at the hip joint during walking to clear the ground inthe swing phase.

3. Unstable hipgait:The stability of the hip in walking is provided by the bony

components of the joint being kept in stable position by themuscles and ligaments around the joint. Any problem inthese structures causes instability of hip.


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Stance phase

The following is a simplified description of the foot anatomy and motions involvedcomplete normal single stance phase of gait. This period is from heel strike to toe

The stance phase consists of 60% of normal gait cycle.

The stance phase is divided into three suphases: Contact, Midstance and Propulsion. The end of one sub-phase denotes beginning of the next sub-phase.

Figure 2.8

Contact phase - (heel strike until the first sign of forefoot loading)

The heel hits the ground slightly lateral of center. The calcaneus is inverted aboudegrees. At this point the foot aids in shock absorption and accepts leg rotation frabove. The calcaneus begins to pronate at heel strike and continues until about 22%

the stance phase when a position of almost 4 degrees of pronation is reached (tpronation =almost 6 degrees). Forefoot loading terminates contact phase.

Midstance phase - (first sign of forefoot loading until heel lift)

Midstance begins with forefoot loading. Motion at the subtalar joint is continusupination from 22% to 100% of the stance phase. The end of midstance is heel-lithe support limb. This occurs at about 50% of the stance. Stability of the limb


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required at this point and to achieve this the foot must be in a position to lock midtarsal joint. Near the end of mid-stance, at about 55 per cent of stance phase subtalar joint should be in neutral position (which means the midtarsal joint is locke

Propulsive phase - (heel lift until toe off)This is the final 50% of the stance phase. The foot continues to supinate (for a ftotal of 6 degrees) and attains about a 2 degree supinated position. The midtarsal jois locked and maximum forefoot loading takes place at about 75-80% of the staphase. Toe-off is at a 2 degree supinated position. The leg moves into swing phase.

Swing phase

The swing phase consists of 40% of normal gait cycle and occurs from toe-off to strike. During this phase the foot pronates first and then supinates.

Pronation shortens the foot, which helps it to clear the ground. Pronation aminimizes the energy expenditure necessary for ground clearance as the non-webearing limb passes the weightbearing limb. Supination stabilizes the barchitecture of the foot thus preparing it for heel strike, when the foot must absorb

shock of striking the ground.Abnormalities in the latter part of swing phase which lead to the foot striking ground in a pronated position inevitably lead to significant damage to the joints ofankle, knee, and hip as the "rigid lever" capability imparted by supination to the fare lost.

Transmission of the forces through the Kinetic Foot

During the stance phase of gait, weight passes through the ankle and ththrough the stable bones of the foot to the ground. Prior to any bosupporting weight, it must first be stable against a more proximal bone, asecond, it must be stabilized against a more distal bone or against the grouAn

unstable bone will not support weight, and will be placed in motion byforces acting upon it. The transmission of forces through the foot, at any given insta


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during the stance phase of gait, only occurs through bones which form a continustable v link to the ground. The average direction of forces passing through the foothe ground can be plotted at each instant of time during stance phase. A l

connecting each point in time is called a force curve (gait line). The force curepresents the direction in which weight is transmitted through the foot during tstance phase.

Normal Force Curve

Figure 2.7

In the normal functioning foot, the force curve has three components. They are pronatory curve (from A-E above), the supinatory curve (from E-F above), and straight propulsive line (from G-H above). From point F-G above, heel lift evertsforefoot to bring force from the fifth met head to the first. So the motion for F to G

the rearfoot supinating and the forefoot pronating.

Weight is first received by the lateral side of the heel because the foot is sligsupinated as it contacts the ground. The foot immediately begins to pronate andnormal gait, pronates until about 22% of the stance phase. Weight is then receivedthe medial side of the heel, then the 5th metatarsal head, and then the forefoot lofrom a lateral to medial direction. As the foot unloads, the heel unloads first, then


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metatarsals and toes begin to unload from lateral to medial, and the hallux is the lasunload at toe-off.

Pronation shifts weight to the medial side of the foot, and supination shifts we

toward the lateral side. Line A-B represents the lateral thrust of weight caused by supinated position of the foot at heel strike. Pronation then shifts weight medially curve (curved line B-E). Supination of the foot during propulsion then reversesweight thrust (curve E-G), and weight is finally directed down the long axis ofhallux at toe-off.

The Kinetic Foot During Normal Gait Cycle - Stance Phase

In normal gait the foot strikes the ground at the beginning of the contact phase isupinated position of approximately 2 degrees. The foot moves through 5 - 6 degof pronation (passing through neutral position) to a position of approximately 3 1/2degrees pronated (allowing the foot to function as a mobile adaptor, adjustingvariances in terrain). At 3 1/2 - 4 degrees pronation, the beginning of the midstaphase occurs. The foot begins to resupinate and passes through neutral position, whthe foot begins the propulsive phase continuing in supination through toe-off.

As a result of the foot supinating during the midstance propulsive periods, the fooconverted from a "mobile adaptor" (which it is during the contact period) to a "riglever" because the Midtarsal Joint locks in supination. By having the foot function "rigid lever' (as a result of a locked Metatarsal joint) during the time immediatepreceding toe-off, the weight of the body is propelled more efficiently.

If the foot overpronates during midstance and propulsion and is in a pronated posit

at toe-off, the foot is more of a "mobile adaptor" (i.e. a relatively "loose bag of bonerather than a "rigid lever" in these latter stages. It would, therefore, take more muscenergy to propel the weight of the body off of such a platform and the foot woulmore mobile (a "loose bag") than it should be in propulsion.

Certain types of foot pathology cause abnormal pronation during propulsion andpronated position at the end of propulsion. As a result, there is significant foot and

fatigue secondary to overuse of muscles. In addition to this, abnormal pronat


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during the propulsive period causes hypermobiity (an unstable state of joints), thaturn produces joint subluxations. These distortions of the joints lead to trauma adamage of the joints and soft tissue. For example, abnormal shearing forces betw

the bones and skin of the forefoot produce skin calluses and corns.The Role of the Tibia and Femur in the Gait Cycle

The tibia and femur bones of the leg also work in conjunction with the foot as pronating and supinating through normal gait. This is due to the fact that the tibia"locked in" to the talus in the talus's abduction (causing external rotation of the tiband the talus's adduction (causing internal rotation of the tibia). It has bedemonstrated that a foot that is 3 degrees pronated causes the tibia to be 5 degrinternally rotated. This is illustrated best by working with the skeletal model in thdimensions and in Figure 2.9. It has also been shown that a foot which is 2 degsupinated causes the tibia to be 10 degrees externally rotated. Therefore, as the foogoing through its normal pronation and supination in the stance phase of gait, the tirotates a full 15 degrees from an initial position of 10 degrees externally rotated atbeginning of the contact phase (when the foot is 2 degrees supinated) to 5 deg

internally rotated at the end of contact phase (when the foot is 3 degrees pronateFigure 2.9 shows these various movements.

In normal gait, the tibia and femur rotate simultaneously and in the same direction.other words, the femur is internally rotating while the tibia rotates internally (duripronation) and the femur is externally rotating while the tibia externally rotat(during supination).

In the case of abnormal pronation, the femur and tibia can counter-rotate causing tpatella (knee cap) to track improperly. See Pathology section under ChondromalaPatella. The femur rotates more than tibia Figure 2.9


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Many attempts have been made to clarify the three-dimensional motion that occurs the foot upon contact with the ground. Despite this, there is still a tremendous amouof confusion about how the foot and leg function together and how their movementaffects our running.

The term biomechanics refers to the way our muscles, bones, and joints work togeth

as we move. When applied to the lower limb, we focus on the biomechanics of impabsorbtion and propulsion.

The two terms used to describe the movements associated with these are pronation asupination, respectively.

Pronation


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Just after the heel strikes the ground the foot begins to pronate.Pronation is a movement that occurs as the weight of the runner move

from the lateral aspect (or outside) of the heel to the medial aspect (orinside) of the forefoot. This movement allows the foot and leg to adap

the terrain and absorb the impact of the footstrike. A certain amount of pronation isnecessary to walk and run normally but too much or too little can contribute toinjuries. Runners with low arches tend to "over-pronate".

When the foot is in an over-pronated position the alignment of three major joints in foot are less than optimal. This misalignment of the joints causes the foot to becomestructurally unstable, and, in turn, the muscles, tendons and ligaments of the lower lare forced to work harder in an attempt to stabilize the foot. This is why over-

pronaters are vulnerable to plantar fasciitis (heel pain), shin splints,achilles tendonitis, iliotibial band syndrome, knee pain and otheroveruse injuries. If you are a runner with a visibly low arch or haveexperienced recurrent or chronic overuse injuries, chances are you are

pronating excessively.

Supination

Just after the foot has absorbed impact, the forefoot contacts the ground andsupination begins. A supinated foot is sometimes referred to as a "rigid lever" becau

it provides the firm base that pushes us forward after our heel leaves the ground andour weight shifts to the forefoot in the toe off phase of gait. A certain amount of supination is necessary to generate the force needed to run, but too much can decreathe foot's ability to absorb impact and, therefore, can lead to impact-related injuries.Runners with high arches tend to "over-supinate" or "under-pronate." Runners witha supinated foot type may experience back, hip, and knee pain. The most severe ovesupinators tend to have a history of recurrent ankle sprains and/or stress fractures.


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Runners who supinate excessively require the highest level of cushioning in theirrunning shoes and should avoid shoes with stability features. See our running shoeguide on the the things to look out for when purchasing a new pair of trainers

How do I know if I'm an "over-pronator" or an "over-supinator"?

The most common method to determineyour foot type is to stand on a paper towelwith a wet foot. If your foot leaves an

imprint of your entire foot, from heel to toe,you probably have a flat foot. If the imprintconsists of the heel, the ball and a thin lineconnecting the two, you probably have ahigh-arched or supinated foot. This method is accurate if you have an extremely flatfoot or an extremely high arch, but is not very accurate for those of us who fallsomewhere in between.

For most of you, it is more accurate to evaluate your history of running or athleticinjuries, and to combine that information with the paper towel test to determine whatype of orthotics you need. If you have had a long history of knee pain, iliotibial bansyndrome, plantar fasciitis, achilles tendonitis, or shin splints, you may over-pronatyou suffer from continued shock absorbancy problems then you may supinate (rare)you're still just not sure what type of foot you have use our virtual practitioner servi

or make an appointment with our practice.Please remember that with some forms of biomechanical inefficiency, the feet mayhave a normal arch when standing or walking, but then over-pronate when the forceof running are encountered. This is due to the fact that runners plant their feet on thmidline of their body when at speed, this will istelf cause an otherwise biomechanicnormal individual to over pronate when running. So if your foot type looks normal b


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you are still gettting repeated over pronation injuries then we advise undertaking aninitial consultation.

THE GAIT CYCLE, THE BASIC UNIT OF GAIT

Gait is a cyclical movement that, once begun, possesses very repeatable events that continue repetitively until the individual begins to stop the motion. The steady-state movement of normal locomotion is composed of a basic repeating cycle, the gaicycle (Fig. 48.1). The cycle is traditionally defined as

Double support Single support Double support Single support

Right step Left stepStance Swing

Stride

Figure 48.1: The gait cycle of a single lower extremity consists of a stance and swing period and lasts from ground contact of onefoot to the subsequent ground contact of the same foot. It includes two steps that are defined as the period from ground conta ct of one foot to the ground contact of the opposite foot. A single gait cycle includes two periods of double limb support and two periodsof single limb support.


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GC FF HO CGC TO


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0% 15% 40% 50% 60%

Figure 48.2: The stance phase is divided into smaller phases that are demarcated by specificevents. GC, ground contact; FF, foot flat; HO, heel off; CGC, contralateral ground contact, TO,toe o ff .


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gait project

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