Gait

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gait biomechanics

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Gait

  1. 1. GAITGAIT BY Dr. AMRIT KAUR (PT) Lecturer, N.D.M.V.P college of physiotherapy nashik
  2. 2. GAITGAIT  Normal GaitNormal Gait Series of rhythmical , alternating movements ofSeries of rhythmical , alternating movements of the trunk & limbs which result in the forwardthe trunk & limbs which result in the forward progression of the center of gravityprogression of the center of gravity  One gait cycleOne gait cycle period of time from one heel strike to the nextperiod of time from one heel strike to the next heel strike of the same limbheel strike of the same limb
  3. 3. GAIT CYCLEGAIT CYCLE ► The gait cycle consist of 2 phases for each footThe gait cycle consist of 2 phases for each foot Stance (60 percent of the cycle )  Begins when the heel of one leg strikes the ground and ends when the toe of the same leg lifts off. Swing (40 percent)  Swing phase represents the period between a toe off on one foot ad heel contact on the same foot.
  4. 4. ► Time FrameTime Frame:: A. Stance vs. Swing:A. Stance vs. Swing: ►Stance phaseStance phase == 60% of gait cycle60% of gait cycle ►Swing phaseSwing phase == 40%40% B. Single vs. Double support:B. Single vs. Double support: ►Single support=Single support= 40% of gait cycle40% of gait cycle ►Double support=Double support= 20%20%
  5. 5. Gait Cycle - SubdivisionsGait Cycle - Subdivisions ► A.A. Stance phase:Stance phase: 1.1. Heel contact: ‘Initial contact’.Heel contact: ‘Initial contact’. 2.2. Foot-flat: ‘Loading response’, initial contact ofFoot-flat: ‘Loading response’, initial contact of forefoot on ground.forefoot on ground. 3.3. Midstance: greater trochanter in alignment w.Midstance: greater trochanter in alignment w. vertical bisector of footvertical bisector of foot 4.4. Heel-off: ‘Terminal stance’Heel-off: ‘Terminal stance’ 5.5. Toe-off: ‘Pre-swing’Toe-off: ‘Pre-swing’
  6. 6. Gait Cycle - SubdivisionsGait Cycle - Subdivisions ► B.B. Swing phase:Swing phase: 1.1. AccelerationAcceleration: ‘Initial swing’: ‘Initial swing’ 2.2. MidswingMidswing: swinging limb overtakes the limb in: swinging limb overtakes the limb in stancestance 3.3. DecelerationDeceleration: ‘Terminal swing’: ‘Terminal swing’
  7. 7. DISTANCE AND TIME VARIABLES ► Temporal variables 1. Stance time 2. Single limb support time 3. Double limb support time 4. Swing time 5. Stride and step time 6. Cadence 7. speed ► Distance variables 1. Stride length 2. Step length 3. Width of walking
  8. 8. ► Step length Distance between corresponding successive points ofDistance between corresponding successive points of heel contact of the opposite feetheel contact of the opposite feet ► Stride length Stride length is determined by measuring the linear distance from point of heel strike of one lower extremity to next heel strike of same extremity. ► Width of base of support Side-to-side distance between the line of the two feetSide-to-side distance between the line of the two feet ► Degree of toe outDegree of toe out It is the angle formed by each foot’s line of progression and a line intersecting the centre of the heel and second toe.
  9. 9. KINEMATICS AND KINETICS OF GAIT ►Path of Center ofPath of Center of GravityGravity  midway between themidway between the hipships  Few cm in front of S2Few cm in front of S2  Least energyLeast energy consumption if CGconsumption if CG travels in straight linetravels in straight line
  10. 10. Path of Center of GravityPath of Center of Gravity
  11. 11. Path of Center of GravityPath of Center of Gravity
  12. 12. HEEL STRIKE TO FOOT FLAT ► Heel strike to forefoot loading ► Foot pronates at subtalar joint ► Only time (stance phase) normal pronation occurs ► This absorbs shock & adapts foot to uneven surfaces ► Ground reaction forces peak ► Leg is internally rotating ► Ends with metatarsal heads contacting ground
  13. 13. Sagittal plane analysis Joint Motion GRF Mome- nt Muscle Contraction Hip Flexion 30-25 Anterior flexion G.Maximus Hamstring Add.magnus, Isometric to ecentric knee Flexion 0-15 Anterior To Posterior Extensi- on to flexion quadriceps Concentric to ecentric ankle Plantar- Flexion 0-15 Posterior PF Tibialis anterior Ex. digitorum longus Ex.hallucis longus ecentric
  14. 14. Frontal plane analysis JOINT MOTION Pelvis Forwardly rotated position Hip Medial rotation of femur on pelvis knee Valgus thrust with increasing valgus Medial rotation of tibia Ankle Increase pronation Thorax posterior position at leading ipsilateral side Shoulder Shoulder is slightly behind the hip at ipsilateral extremity side
  15. 15. FOOT FLAT TO MIDSTANCE
  16. 16. FOOT FLAT TO MIDSTANCE (SAGITTAL PLANE) Joint Motion GRF Moment Muscle Contractio n Hip Extension 25-0 Flexion-0 Anterior to posterior Flexion to extensi- on G.maximus Concentric to no activity Knee Extension 15-5 15-5 flexion Posterior to anterior Flexion to extensi- on Quadriceps Concentric to no activity Ankle 15 of PF to 5-10 of DF Posterior to anterior PF to DF Soleus, gastronem- ius, PF Eccentric
  17. 17. Frontal plane analysis Joint Motion Pelvis Ipsilateral side rotating backward to reach neutral at midstance ,lateral tilting towards the swinging extremity. Hip Medial rotation of femur on the pelvis continue to neutral position at midstance. adduction moment continue throughout single support. Knee There is reduction in valgus thrust and the tibia begins to rotate laterally. Ankle The foot begins to move in the direction of supination from its pronated position at the end of loading response. The foot reaches a neutral position at midstance.
  18. 18. Frontal plane analysis Ankle The foot begins to move in the direction of supination from its pronated position at the end of loading response. The foot reaches a neutral position at midstance. Thorax Ipsilateral side moving forward to neutral. shoulder Moving forward
  19. 19. MIDSTANCE TO HEEL OFF
  20. 20. MIDSTANCE TO HEEL OFF (sagittal plane analysis) Joint Motion GRF Moment Muscl e Contract- ion Hip Extension 0 to hyperexten sion of 10- 20 Posterior Extension Hip flexors Eccentric Knee Extension 5 degree of flexion to 0 degree Posterior to anterior Flexion to extension No activity
  21. 21. Ankle PF:5 degree of DF to 0 degree. Anterior DF Soleus PF Eccentric to concentric. Toes Extension: o-30 degree of hyperextens -ion. Flexor hallicus longus and brevis Abductor digiti quinti, interossei, lumbricals
  22. 22. MIDSTANCE TO HEEL OFF (frontal plane analysis) Joint Motion Pelvis Pelvis moving posteriorly form neutral position Hip Lateral rotation of femur and adduction Knee Lateral rotation of tibia Ankle – foot Supination of subtalar joint increases Thorax Ipsilateral side moving forward Shoulder Ipsilateral shoulder moving forward.
  23. 23. HEEL OFF TO TOE OFF
  24. 24. HEEL OFF TO TOE OFF (sagittal plane analysis) Joint Motion GRF Moment Muscle Contraction Hip Flexion :20 degree of hyperextensi- on to 0 degree. Posterior Extension to neutral iliopsoas Adductor magnus Adductor longues concentric Knee Flexion :o- 30degree of flexion Posterior Flexion Quadrice ps Ecentric to no activity
  25. 25. Ankle PF :0-20 degree of PF Anterior DF Gastronemius. soleus, peroneus brevis, peronius longus. Concentri c to no activity Toes (MTP) Extension: 50- 60 of hyperextension. Flexor hallucis longus Adductor hallicus Abductor digiti minimi Flexion digitorum brevis and hallicus brevis, inrossei, lumbricals Close chain resonse to increasing PF at the ankle.
  26. 26. HEEL OFF TO TOE OFF (frontal plane analysis) Joint Motion pelvis Contralateral side moving forward unless contralateral heel touches the ground. Hip Abduction occur, lateral rotation of femur Knee Inconsistent lateral rotation tibia Foot / ankle Weight is shifted to toes and at toe off only the first toe is in contact., supination of subtalar joint. Thorax Translation on the ipsilaterior side. Shoulder Moving forward.
  27. 27. DETERMINANTS OF GAITDETERMINANTS OF GAIT ►Six optimizations used to minimizeSix optimizations used to minimize excursion of CG in vertical & horizontalexcursion of CG in vertical & horizontal planesplanes ►Reduce significantly energy consumption ofReduce significantly energy consumption of ambulationambulation ►The six determinants areThe six determinants are  Lateral pelvis tiltLateral pelvis tilt  Knee flexionKnee flexion  Knee, ankle and foot interactionsKnee, ankle and foot interactions  Forward and backward rotation of pelvisForward and backward rotation of pelvis  Physiological valgus of kneePhysiological valgus of knee
  28. 28. DETERMINANTS OF GAITDETERMINANTS OF GAIT 1)1) Pelvic rotationPelvic rotation::  Forward rotation of the pelvis in the horizontalForward rotation of the pelvis in the horizontal plane approx. 8o on the swing-phase sideplane approx. 8o on the swing-phase side  Reduces the angle of hip flexion & extensionReduces the angle of hip flexion & extension  Enables a slightly longer step-length w/o furtherEnables a slightly longer step-length w/o further lowering oflowering of CGCG
  29. 29. (2)(2) Pelvic tiltPelvic tilt::  5 degree dip of the swinging side (i.e. hip5 degree dip of the swinging side (i.e. hip adduction)adduction)  In standing, this dip is a positive Trendelenberg signIn standing, this dip is a positive Trendelenberg sign  Reduces the height of the apex of the curve of CGReduces the height of the apex of the curve of CG
  30. 30. ((3)3) Knee flexion in stance phaseKnee flexion in stance phase::  Approx. 20o dipApprox. 20o dip  Shortens the leg in the middle of stance phaseShortens the leg in the middle of stance phase  Reduces the height of the apex of the curve ofReduces the height of the apex of the curve of CGCG
  31. 31. (4)(4) Ankle mechanismAnkle mechanism::  Lengthens the leg at heel contactLengthens the leg at heel contact  Smoothens the curve of CGSmoothens the curve of CG  Reduces the lowering of CGReduces the lowering of CG
  32. 32. (5)(5) Foot mechanismFoot mechanism::  Lengthens the leg at toe-off as ankle movesLengthens the leg at toe-off as ankle moves from dorsiflexion to plantarflexionfrom dorsiflexion to plantarflexion  Smoothens the curve of CGSmoothens the curve of CG  Reduces the lowering of CGReduces the lowering of CG
  33. 33. ►Physiological valgus of knee Reduces the base of support, so only little lateral motion of pelvis is necessary.
  34. 34. FACTORS AFFECTING GAIT ►Age ►Gender ►Assistive devices ►Disease states ►Muscle weakness or paralysis ►Asymmetries of the lower extremities ►Injuries and malalignments
  35. 35. GAIT EXAMINATION ►Take a history ►Couch examination ►Static examination ►Allow patient time to relax ►Reasonable length walkway - gait pattern changes before & after turn ►Various systematic ways ►Look for the obvious!
  36. 36. COUCH EXAMINATION ►Observe deformities & lesions ►Check ROM’s ►Check muscle tightness/strength ►Neurological & vascular assessment
  37. 37. STATIC EXAMINATION ►Feet non-weight bearing (hanging) with weight bearing ►Standing from front  Shoulders, hips, knees, feet  From behind  Shoulders, hips, calcaneus
  38. 38. GENERAL POINTS ►Is the gait fast or slow? ►Is it smooth? ►Does the patient appear relaxed & comfortable or pained? ►Is it noisy?
  39. 39. FEET
  40. 40. ►Is the 1st MPJ functioning properly? ►Are the toes bearing weight? ►When is the heel lifting? ►Is toe off through the hallux? ►Does the swing phase appear normal? ►Are the feet too close or is the base of gait wide? FEET
  41. 41. LEGS ►Are the knees pointing forwards? ►Is there genu valgum or varum? ►Is there tibial varum present? ►Do they appear internally or externally rotated? ►Knees from the side – are they fully extending?
  42. 42. HIPS & BODY
  43. 43. HEAD & SHOULDERS ►Are the shoulders level? ►Do the arms swing equally? ►Does the head & neck appear normal?
  44. 44. Gait: Major points of observation.  1.Cadence a. Symmetrical b. Rhythmic 2.Pain a. Where b. When 3.Stride a. Even/uneven 4.Shoulders Dipping. Elevated, depressed, protracted, retracted 5.Trunk a. Fixed deviation b. Lurch 6.Pelvic  a. Anterior or posterior tilt b. Hike c. Level 7.Knee  a. Flexion, extension b. Stability 8.Ankle  a. Dorsiflexion b. Eversion, inversion 9.Foot  a. Heelstrike 10.Base  a. Stable/variable b. Wide/narrow
  45. 45. COMMON GAITCOMMON GAIT ABNORMALITIESABNORMALITIES ► Antalgic GaitAntalgic Gait • Gait pattern in which stance phase onGait pattern in which stance phase on affected side is shortenedaffected side is shortened • Corresponding increase in stance onCorresponding increase in stance on unaffected sideunaffected side • Common causes: OA, Fx, tendinitisCommon causes: OA, Fx, tendinitis
  46. 46. Lateral Trunk bending/Lateral Trunk bending/ TrendelenbergTrendelenberg gaitgait ►Usually unilateralUsually unilateral ►Bilateral = waddling gaitBilateral = waddling gait ►Common causes:Common causes: A. Painful hipA. Painful hip B. Hip abductor weaknessB. Hip abductor weakness C. Leg-length discrepancyC. Leg-length discrepancy D. Abnormal hip jointD. Abnormal hip joint
  47. 47. Functional Leg-LengthFunctional Leg-Length DiscrepancyDiscrepancy ►Swing leg: longer than stance legSwing leg: longer than stance leg ►4 common compensations:4 common compensations: A. CircumductionA. Circumduction B. Hip hikingB. Hip hiking C. SteppageC. Steppage D. VaultingD. Vaulting
  48. 48. Increased Walking BaseIncreased Walking Base ►Normal walking base: 5-10 cmNormal walking base: 5-10 cm Common causes:Common causes: ►DeformitiesDeformities ►Abducted hipAbducted hip ►Valgus kneeValgus knee InstabilityInstability ►Cerebellar ataxiaCerebellar ataxia ►Proprioception deficitsProprioception deficits
  49. 49. Inadequate DorsiflexionInadequate Dorsiflexion Control/foot drop gaitControl/foot drop gait ►In stance phase (Heel contact – Foot flat):In stance phase (Heel contact – Foot flat): Foot slapFoot slap ►In swing phase (mid-swing):In swing phase (mid-swing): Toe dragToe drag  Causes:Causes:  Weak Tibialis Ant.Weak Tibialis Ant.  Spastic plantarflexorsSpastic plantarflexors
  50. 50. Excessive knee extensionExcessive knee extension ►Loss of normal knee flexion during stanceLoss of normal knee flexion during stance phasephase ►Knee may go into hyperextensionKnee may go into hyperextension ►Genu recurvatumGenu recurvatum: hyperextension deformity: hyperextension deformity of kneeof knee Common causes:Common causes:  Quadriceps weakness (mid-stance)Quadriceps weakness (mid-stance)  Quadriceps spasticity (mid-stance)Quadriceps spasticity (mid-stance)  Knee flexor weakness (end-stance)Knee flexor weakness (end-stance)
  51. 51. Others pathological gaits ►Arthrogenic gait ( stiff hip or knee) ►Contracture gait ►Gluteus maximus gait ►Planter flexor gait ►Scissors gait
  52. 52. Neurological gait ►Ataxic gait ►Parkinsons gait ►Hemiplegic gait ►Spectic diplegic ►Myopatic gait ►Hyperkinetic gait
  53. 53. RUNNING GAIT ► Require greater balance, muscle strength, ROM than normal walking. ► Difference b/w running and walking ► Reduced BOS ► Absence of double support ► More coordination and strength needed ► Muscle must generate higher energy bout to raise HAT higher than in normal walking. ► Divided into flight and support phase.
  54. 54. STAIR GAIT ► Ascending and descending stairs is a basic body movement required for ADL ► Stair gait involved stance and swing phase
  55. 55. kinematics ► SWING PHASE(36%) • Foot clearance • Foot placement ► STANCE PHASE(64%) • Weight acceptance • Pull up • Forward continuance
  56. 56. SIMILARITIES & DIFFERNCES BETWEEN LEVEL GROUND GAIT AND STAIR GATE ►Similarities to Walking Double support periods Ground reaction forces have double peak Cadence similar Support moment is similar (always positive with two peaks)
  57. 57. Differences with Walking ► More hip and knee flexion ► Greater Rom needed ► Peak forces slightly higher ► Centre of pressure is concentrated under metatarsals, rarely near heel ► Step height and tread vary from stairway to stairway ► Railings may be present
  58. 58. ……….. THANK YOU ….

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