Gait analysis


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Gait analysis

  3. 3. Diagnosis of gait DeviationsDiagnosis of gait Deviations Awareness of the functionalAwareness of the functionallimitationslimitations Familiarity with normal functionFamiliarity with normal function Trained eye or gait analysisTrained eye or gait analysissystemsystem Use the information forUse the information forappropriate treatment regimenappropriate treatment regimen
  4. 4. GAIT-DEFINITIONGAIT-DEFINITION Word meaning is manner ofWord meaning is manner ofwalkingwalking Highly controlled,coordinatedHighly controlled,coordinatedand repetitive series of limband repetitive series of limbmovements whose function ismovements whose function isto advance the body fromto advance the body fromplace to place with minimumplace to place with minimumexpenditure of energyexpenditure of energy
  5. 5. GAIT CYCLEGAIT CYCLEOne gait cycle is the movementOne gait cycle is the movementof a single limb from heel strikeof a single limb from heel strike(initial contact ) to next heel(initial contact ) to next heelstrikestrike
  6. 6. SUBDIVISIONS OF GAIT CYCLESUBDIVISIONS OF GAIT CYCLE Stance phase and swing phaseStance phase and swing phase Stance phase begins with initialStance phase begins with initialcontact of heel and ends with toecontact of heel and ends with toeoffoff
  7. 7. SUBDIVISIONS OF GAIT CYCLESUBDIVISIONS OF GAIT CYCLE Initial contact occurs atInitial contact occurs at 0%0% andand 100%100% of gaitof gaitcycle and toe off occurs atcycle and toe off occurs at 60%60% So stance phase is aboutSo stance phase is about 60%60% and swing phaseand swing phase40%40% of gait cycleof gait cycle
  8. 8. STANCE PHASESTANCE PHASE Period when foot is on the groundPeriod when foot is on the ground Sub divisionsSub divisions1) initial contact1) initial contact2) loading response2) loading response3) mid stance3) mid stance4) terminal stance and4) terminal stance and5) pre swing5) pre swing
  9. 9. INITIAL CONTACTINITIAL CONTACT Occur atOccur at 0%0% of gait cycleof gait cycle Principal objective of bodyPrincipal objective of bodyis to position the footis to position the footcorrectly as it comes incorrectly as it comes incontact with the floorcontact with the floor Body is about to beginBody is about to begindecelerationdeceleration
  10. 10. LOADING RESPONSELOADING RESPONSE OccupiesOccupies 0 to 10%0 to 10% of gait cycleof gait cycle Maintain smooth progressionMaintain smooth progressionwhile decelerating the body masswhile decelerating the body massas it travels from its zenith atas it travels from its zenith atmid stance of opposite limbmid stance of opposite limb Opposite limb toe off occurs atOpposite limb toe off occurs atend of loading response . So thisend of loading response . So thisis a period of double limb supportis a period of double limb support
  11. 11. MID STANCEMID STANCE Utilize momentum to maintainUtilize momentum to maintainstability of the hip and kneestability of the hip and kneewhile advancing the body overwhile advancing the body overa stationary foota stationary foot The centre of gravity hasThe centre of gravity hasreached its zenith and forwardreached its zenith and forwardvelocity is minimumvelocity is minimum Initial swing has begun onInitial swing has begun onopposite sideopposite side
  12. 12. TERMINAL STANCETERMINAL STANCE OccupiesOccupies 30 to 50% range30 to 50% range ofofgait cyclegait cycle Provide acceleration & toProvide acceleration & toensure an adequate stepensure an adequate steplengthlength Acceleration is provided byAcceleration is provided by1)forward fall of centre of1)forward fall of centre ofmass of bodymass of body2) concentric contraction of2) concentric contraction oftriceps suraetriceps suraeConstitutesConstitutes 80 -85%80 -85% of totalof totalenergy generatedenergy generated
  13. 13. PRE SWINGPRE SWING OccupiesOccupies 50-60% range50-60% rangeof gait cycleof gait cycle Period of double limbPeriod of double limbsupportsupport Goal is to prepare theGoal is to prepare thelimb for swinglimb for swing Initial contact ofInitial contact ofopposite limb marksopposite limb marksbeginning of pre swingbeginning of pre swing
  14. 14. SWING PHASESWING PHASE Limb is off the groundLimb is off the ground Divided intoDivided into1) initial swing1) initial swing2) mid swing2) mid swing3) terminal swing3) terminal swing
  15. 15. INITIAL SWINGINITIAL SWING OccupiesOccupies 60-70% range60-70% rangeof gait cycleof gait cycle Critical function is toCritical function is toallow foot clearance &allow foot clearance &variable cadencevariable cadence Varying cadenceVarying cadencerequires CNS control &requires CNS control &precise timing of twoprecise timing of twojoint musclesjoint muscles
  16. 16. MID SWINGMID SWING OccupiesOccupies 70 to 85% range70 to 85% range of gaitof gaitcyclecycle Critical function is to maintainCritical function is to maintainfoot clearancefoot clearance
  17. 17. MID SWING (contd)MID SWING (contd) Foot clearance dependsFoot clearance dependson maintaining aon maintaining arelatively level pelvis,relatively level pelvis,sufficient hip flexion &sufficient hip flexion &adequate ankleadequate ankledorsiflexiondorsiflexion In normal gait footIn normal gait footclearance is only 0.87cmclearance is only 0.87cm
  18. 18. TERMINAL SWINGTERMINAL SWING OccupiesOccupies 85-100%85-100%rangerange of gait cycleof gait cycle Function is decelerationFunction is decelerationof shank & correct pre-of shank & correct pre-positioning of foot forpositioning of foot forcontactcontact Complete kneeComplete kneeextension & neutralextension & neutralposition of foot areposition of foot arecritical for heel strikecritical for heel strike
  19. 19. Linear measurements- ( cadenceLinear measurements- ( cadenceor temporal parameters )or temporal parameters ) Step lengthStep length Stride lengthStride length Step timeStep time CadenceCadence Walking velocityWalking velocity
  20. 20. KINEMATICSKINEMATICS It denotes movements observedIt denotes movements observedand measured at the pelvis, hip,and measured at the pelvis, hip,knee, and ankle during stanceknee, and ankle during stanceand swing phasesand swing phases It can be observed in 3 planesIt can be observed in 3 planessagittalsagittalcoronalcoronaltransversetransverse
  21. 21. SAGITTAL PLANESAGITTAL PLANEThe pelvis tilts approximatelyThe pelvis tilts approximately 1515 degreedegree
  22. 22. SAGITTAL PLANESAGITTAL PLANEHIPHIP• StanceStance –flexed at–flexed atinitial contactinitial contactthen extends fullythen extends fully• SwingSwing – hip flexes– hip flexesrapidly to pull therapidly to pull thestance limb offstance limb offthe groundthe ground
  23. 23. SAGITTAL PLANESAGITTAL PLANEKNEEKNEE• StanceStance- At initial contact- At initial contactknee flexesknee flexes 1515 deg. It thendeg. It thenextendsextends• SwingSwing – At heel rise knee– At heel rise kneebegins to flex againbegins to flex againreaching maximum flexionreaching maximum flexionin early swing .Inin early swing .Inremainder of swing kneeremainder of swing kneeextends passivelyextends passively
  24. 24. SAGITTAL PLANESAGITTAL PLANEANKLEANKLE• StanceStance – neutral at initial– neutral at initialcontact,then plantar flexescontact,then plantar flexes5-10 deg as forefoot comes5-10 deg as forefoot comesto rest on the ground.-to rest on the ground.-FIRST ROCKERFIRST ROCKER• Ankle dorsiflexes throughoutAnkle dorsiflexes throughoutmid stance as tibia movesmid stance as tibia movesforward over plantigradeforward over plantigradefoot –foot – SECOND ROCKERSECOND ROCKER
  25. 25. SAGITTAL PLANESAGITTAL PLANEANKLEANKLE(CONTD)(CONTD)--during terminalduring terminalstance and pre swingstance and pre swingankle plantar flexes andankle plantar flexes andheel rises to prepare forheel rises to prepare forpush off-push off- THIRD ROCKERTHIRD ROCKER• SwingSwing – dorsiflexion to– dorsiflexion toneutral position seenneutral position seen
  26. 26. CORONAL PLANECORONAL PLANE PELVIS-each hemipelvisPELVIS-each hemipelvisrises slightly during swingrises slightly during swingphasephase - stance phase hemipelvis- stance phase hemipelvisdrops slightlydrops slightly - accentuated pelvic drop in- accentuated pelvic drop inswing seen inswing seen intrendelenburg gaittrendelenburg gait
  27. 27. CORONAL PLANECORONAL PLANE (CONTD)(CONTD) HIP-HIP- StanceStance phasephase– slight adduction– slight adductionoccursoccurs -- SwingSwing – abduction– abductionseenseen
  28. 28. TRANSVERSE PLANETRANSVERSE PLANE Measure rotationMeasure rotation Pelvis and hips rotate minimallyPelvis and hips rotate minimally Tibia has a fixed external rotationTibia has a fixed external rotation
  29. 29. NEUROLOGICAL CONTROL OFNEUROLOGICAL CONTROL OFGAITGAIT Muscle actions programmed asMuscle actions programmed asinvoluntary reflex arcs in EPSinvoluntary reflex arcs in EPS Golgi tendon ,muscle spindle &Golgi tendon ,muscle spindle &joint receptors producejoint receptors produceneurologic feedbackneurologic feedback Voluntary modulation of gaitVoluntary modulation of gaitmade by interaction with motormade by interaction with motorcortexcortex Cerebellum - balanceCerebellum - balance
  30. 30. 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)Concentric1)Concentric• 2)Eccentric2)Eccentric• 3)Isometric3)Isometric
  31. 31. MUSCLE ACTIVITYMUSCLE ACTIVITYCONCENTRIC CONTRACTIONCONCENTRIC CONTRACTION Muscle shortensMuscle shortensgenerating power andgenerating power andaccelerationacceleration Gastrocsoleus andGastrocsoleus andiliopsoas are the primaryiliopsoas are the primaryaccelerators of gaitaccelerators of gait Concentric contraction ofConcentric contraction ofthese occur at terminalthese occur at terminalstancestance
  32. 32. MUSCLE ACTIVITYMUSCLE ACTIVITYECCENTRIC CONTRACTIONECCENTRIC CONTRACTION Muscle lengthens despiteMuscle lengthens despiteelectrical contractionelectrical contraction These slow down & stabilize jointThese slow down & stabilize jointmotions during gaitmotions during gait Eccentric contractionsEccentric contractionsoutnumber concentricoutnumber concentriccontractions during gaitcontractions during gait
  33. 33. ECCENTRIC CONTRACTIONECCENTRIC CONTRACTION Eg:- tibialis anterior muscleEg:- tibialis anterior musclecontracts eccentrically atcontracts eccentrically atinitial contact to slow downinitial contact to slow downplantar flexion of ankleplantar flexion of ankle -gastrosoleus contracts-gastrosoleus contractseccentrically during 2eccentrically during 2ndndrocker to slow downrocker to slow downdorsiflexiondorsiflexion
  34. 34. MUSCLE ACTIVITYMUSCLE ACTIVITYISOMETRIC CONTRACTIONISOMETRIC CONTRACTION No change in length of muscleNo change in length of muscleoccursoccurs Postural stabilisers like gluteusPostural stabilisers like gluteusmedius work in this modemedius work in this mode More muscle activity occurs inMore muscle activity occurs instance phasestance phase In swing momentum carries theIn swing momentum carries theleg forwardleg forward
  35. 35. GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCYPrerequisites ofPrerequisites ofnormalnormalambulation areambulation are Stability atStability atstancestance Means ofMeans ofprogressionprogression Conservation ofConservation ofenergyenergy
  36. 36. GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY Bipedal gait is inherentlyBipedal gait is inherentlyunstableunstableand inefficientand inefficient Quadrupeds run faster thanQuadrupeds run faster thanhumans because vertebral andhumans because vertebral andtrunk muscles act to augmenttrunk muscles act to augmentstridestride
  37. 37. GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCYPROGREESSIONPROGREESSION• Forward fall of theForward fall of thecentre of gravity ofcentre of gravity ofbody from its highbody from its highpoint at mid stancepoint at mid stanceto its low point atto its low point atdouble supportdouble support• Now potentialNow potentialenergy is convertedenergy is convertedto kinetic energyto kinetic energy
  38. 38. GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCYPROGRESSION (contd)PROGRESSION (contd) To raise the CG back to zenithTo raise the CG back to zenithkinetic energy must be suppliedkinetic energy must be supplied This is supplied by inertia ofThis is supplied by inertia ofswinging limb which in turnswinging limb which in turnderives energy from plantarderives energy from plantarflexors and hip flexors of thatflexors and hip flexors of thatlimblimb
  39. 39. GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCYPROGRESSION (contd)PROGRESSION (contd) In normal walkingIn normal walking 85%85% ofofenergy comes from plantarenergy comes from plantarflexorsflexors Energy expended in normalEnergy expended in normalwalking iswalking is 2.5 Kcal/min2.5 Kcal/min This is less than twice the energyThis is less than twice the energyspent while standing stillspent while standing still--1.5Kcal/min1.5Kcal/min
  40. 40. GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCYENERGY CONSERVATIONENERGY CONSERVATIONEnergy 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 energyActive or passive transfer of energybetween segmentsbetween segments
  41. 41. GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCYENERGY CONSERVATIONENERGY CONSERVATION Movement of a wheel is highlyMovement of a wheel is highlyefficient 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 combinedrotation, tilt ,& obliquity combinedwith coordinated knee and anklewith coordinated knee and anklemotion the vertical and horizontalmotion the vertical and horizontalexcursion are reduced toexcursion are reduced to 4.4cm4.4cm
  42. 42. GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCYENERGY CONSERVATIONENERGY CONSERVATIONCONTROLLING MOMENTUMCONTROLLING MOMENTUM*This conserves energy*This conserves energyeg:-by maintaining theeg:-by maintaining theground reaction force in frontground reaction force in frontof the knee during the lastof the knee during the lasthalf of stance , an extensionhalf of stance , an extensionmovement occurs whichmovement occurs whichallows it to remain stableallows it to remain stable
  43. 43. GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCYENERGY CONSERVATIONENERGY CONSERVATIONACTIVE OR PASSIVE TRANSFER OF ENERGYACTIVE OR PASSIVE TRANSFER OF ENERGY• Passive flow of energy across jointsPassive flow of energy across jointsaccounts for most of the energyaccounts for most of the energychanges occuring at the distalchanges occuring at the distalsegments during initiation andsegments during initiation andtermination of swingtermination of swing• In active transfer two joint musclesIn active transfer two joint musclesplay a major roleplay a major role
  44. 44. GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY Interference with these mechanismsInterference with these mechanismsincrease energy consumptionincrease energy consumption Eg:-fast walking –Eg:-fast walking – 60% inc60% incBK 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%
  45. 45. DEVELOPMENT OF GAIT INDEVELOPMENT OF GAIT INCHILDRENCHILDREN Toddlers walk with a wide basedToddlers walk with a wide basedgait, increased flexion of hip andgait, increased flexion of hip andknees & arms held out to theknees & arms held out to thesidessides At 5 yrs child has developed aAt 5 yrs child has developed astable velocity patternstable velocity pattern Adult gait pattern is attained byAdult gait pattern is attained by7 yrs7 yrs
  46. 46. GAIT ANALYSISGAIT ANALYSIS Systematic descriptionSystematic descriptionand assessment of qualities thatand assessment of qualities thatcharacterize human locomotioncharacterize human locomotion Mainly used in pre operativeMainly used in pre operativeplanning and documentation ofplanning and documentation ofpost operative outcome inpost operative outcome inpatients with cerebral palsypatients with cerebral palsy
  47. 47. GAIT DEVIATIONSGAIT DEVIATIONS Due to painDue to pain weak muscleweak muscle abnormal muscle activityabnormal muscle activity joint abnormalitiesjoint abnormalities Contractures around jointsContractures around joints limb length discrepancieslimb length discrepancies
  48. 48. GAIT DEVIATIONSGAIT DEVIATIONS1)antalgic gait1)antalgic gait - dec stance phase- dec stance phaseavoiding wt. Bearing on involved limbavoiding wt. Bearing on involved limb2)Short limb gait2)Short limb gait – dipping of shoulder– dipping of shoulderand pelvis on affected side & incand pelvis on affected side & incflexion of hip , knee and ankle offlexion of hip , knee and ankle ofopposite limb.opposite limb.3)Trendelenburg gait3)Trendelenburg gait –patient lurches–patient lurcheson affected side & pelvis drops on oppon affected side & pelvis drops on oppsideside
  49. 49. Goddess trying to avoidShort lomb gait
  50. 50. GAIT DEVIATIONSGAIT DEVIATIONS4)Waddling gait4)Waddling gait – patient lurches– patient lurcheson both sides during walkingon both sides during walking5)High stepping gait5)High stepping gait – patient– patientflexes foot and knee excessivelyflexes foot and knee excessivelyto clear the groundto clear the ground
  51. 51. GAIT DEVIATIONSGAIT DEVIATIONS6)Scissoring gait6)Scissoring gait –– one legone legcrosses directly over the othercrosses directly over the otherwith each stepwith each step7)Calcaneus gait7)Calcaneus gait –walks on–walks onbroadened heel with tendency tobroadened heel with tendency toexternal rotation and genuexternal rotation and genurecurvatum. No calcaneal pick uprecurvatum. No calcaneal pick upand push offand push off
  52. 52. GAIT DEVIATIONSGAIT DEVIATIONS8)Stiff hip gait8)Stiff hip gait – no movements– no movementsat affected hip , excessat affected hip , excessmovements in spine & unaffectedmovements in spine & unaffectedhiphip9)Stiff knee gait9)Stiff knee gait – no flexion at– no flexion atknee, so pelvis raised duringknee, so pelvis raised duringswingswing
  53. 53. GAIT DEVIATIONSGAIT DEVIATIONS10)Gluteus maximus gait10)Gluteus maximus gait ––patient lurches backwards due topatient lurches backwards due toweak gluteus maximusweak gluteus maximus11)Gluteus medius gait11)Gluteus medius gait – like– liketrendelenburg gaittrendelenburg gait
  54. 54. GAIT DEVIATIONSGAIT DEVIATIONS12)Quadriceps gait /12)Quadriceps gait / hand to kneehand to kneegaitgait –– patient stabilizes hips &patient stabilizes hips &knee for weight bearing byknee for weight bearing byleaning on affected side &leaning on affected side &pressing over lower thigh by hispressing over lower thigh by hishandhand
  55. 55. CONCLUSIONCONCLUSION Normal gait is designed by GodNormal gait is designed by GodAlmighty to be efficient & all theAlmighty to be efficient & all thepriorities are met . In abnormalpriorities are met . In abnormalgait these are lostgait these are lost Studying the human gait hasStudying the human gait hasenabled us to define , documentenabled us to define , document& analyze normal and abnormal& analyze normal and abnormalhuman gait more accuratelyhuman gait more accurately