I:\Kinemetics Of Gait2 Dh 2

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  • Contralateral toe off Contralateral foot strike Foot off Maximum knee flexion Tibia is vertical Initial contact
  • Terminal swing Max knee flex
  • Physical Rehabilitation,3 rd edition/Susan B sullivan
  • I:\Kinemetics Of Gait2 Dh 2

    1. 1. Kinematics Of Human Gait
    2. 2. OBJECTIVE OF THIS PRESENTATION <ul><li>To describe the normal joint kinematics of human gait </li></ul><ul><ul><li>Gait cycle/gait terminology </li></ul></ul><ul><ul><li>Average ROM in sagital/frontal & transverse plan </li></ul></ul><ul><ul><li>Normal joint motion in sagital/frontal & transverse plan </li></ul></ul><ul><ul><li>Average peak ROM comparison between running and walking </li></ul></ul><ul><ul><li>Stair ascent gait </li></ul></ul>
    3. 3. What is gait? <ul><li>A translatory progression of the body as whole, produced by coordinated, rotatory movement of different body segments. </li></ul><ul><ul><li>Which Includes :— </li></ul></ul><ul><ul><ul><li>— Head </li></ul></ul></ul><ul><ul><ul><li>— Upper Extremity </li></ul></ul></ul><ul><ul><ul><li>— Trunk </li></ul></ul></ul><ul><ul><ul><li>— Pelvis </li></ul></ul></ul><ul><ul><ul><li>— Lower Extremity </li></ul></ul></ul>
    4. 4. What is Kinematic ? <ul><li>Kinematic is science of motion, in human movement sciences. </li></ul><ul><ul><li>Kinematics includes the set of concepts that allow us to describe the motion or displacement of a body segment without regard to the forces that causes that movement. </li></ul></ul>
    5. 5. What is kinematics ? <ul><li>What we assess is kinematics i.e. what the terminology and what involves kinematics. </li></ul><ul><ul><li>One of the major purposes of any rehabilitative process is to help patients achieve the highest level of functional independence as possible within the limit of their disability. </li></ul></ul><ul><ul><li>The human locomotion or gait is one of the basic components of independent functioning. </li></ul></ul>
    6. 6. Gait analysis <ul><li>In order to set realistic treatment goals and to develops treatment plan. </li></ul><ul><ul><li>1) An accurate description of gait pattern and gait variables. </li></ul></ul><ul><ul><li>2) Identification and description of common gait deviations. </li></ul></ul><ul><ul><li>3) Analyses of deviatons and identification of possible cause. </li></ul></ul><ul><ul><li>4) Assessement of energy expenditure and endurance. </li></ul></ul><ul><ul><li>5) Determination of the functional ambulation capability of the patients </li></ul></ul>
    7. 7. Gait Terminology. <ul><li>To assess gait we should be well familiar with terminology used to describe gait. </li></ul><ul><li>Gait cycle— </li></ul><ul><ul><li>Gait cycle commences when the heel of one leg come in contact with supporting surface and ends when heel of same leg come in contact with supporting surface again. </li></ul></ul><ul><ul><li>A gait cycle consists of two major phases called </li></ul></ul><ul><ul><ul><li>— stance phase </li></ul></ul></ul><ul><ul><ul><li>— swing phase and a periods of two double support. </li></ul></ul></ul>
    8. 8. Gait Terminology. <ul><li>Time and distance are two basic parameters of motion we measures these variables to the description of gait. </li></ul><ul><ul><li>— Temporal variables. </li></ul></ul><ul><ul><li>— Distance variables. </li></ul></ul><ul><li>Temporal variable includes :— </li></ul><ul><li>Stance time </li></ul><ul><ul><li>i.e. time elapsed during stance phase of one extremity in a gait cycle. </li></ul></ul><ul><li>Single limb support time— </li></ul><ul><ul><li>Amount of time elapsed during the period when only one limb is an supporting surface. </li></ul></ul>
    9. 9. Gait Terminology. <ul><li>Double-support time : —Amount to time spent with both feet on ground. </li></ul><ul><ul><li>This is increased in elderly and patients with balance disorders. </li></ul></ul><ul><ul><li>This decreased when walking speed increase. </li></ul></ul><ul><li>Stride length—It is linear displacement or distance between two successive events that is accomplished by the same extremity during gait cycles. </li></ul><ul><ul><li>i.e. linear distance between point of one feet strike to next feet strike of same extremity. </li></ul></ul><ul><ul><li>A stride includes two steps whereas the stride length is not always twice the length of one step. </li></ul></ul>
    10. 10. Gait Terminology.
    11. 11. Gait Terminology. <ul><li>Step length— </li></ul><ul><ul><li>linear distance between two successive points of contact of opposite extremity. </li></ul></ul><ul><li>Step duration— </li></ul><ul><ul><li>Amount of time spent during single step. </li></ul></ul><ul><li>Cadence—it is number of steps taken by a person per unit of time. </li></ul><ul><ul><li>Cadence=No of steps/time. </li></ul></ul><ul><ul><li>110 steps/min is typical for adult men. </li></ul></ul><ul><ul><li>116 steps/min is typical for adult female. </li></ul></ul>
    12. 12. Gait Terminology. <ul><li>Walking velocity :— </li></ul><ul><ul><li>It is ratio of linear forward motion of body usually measured in meter/second. </li></ul></ul><ul><ul><li>Walking speed = distance walked/time (sec.) </li></ul></ul><ul><ul><li>Women tends to walk with shorter and faster steps than do men at the same velocity. </li></ul></ul><ul><li>Power generation— </li></ul><ul><ul><li>It is accomplished when muscles shortens i.e. concentric contraction and the positive work added to the energy of body. </li></ul></ul><ul><li>Power absorption— </li></ul><ul><ul><li>It is accomplished when muscle lengthens i.e eccentric contraction they do negative work and reduce the energy. </li></ul></ul>
    13. 13. Normal Kinematic of gait includes <ul><li>The events occuring during different phases of gait cycle. </li></ul><ul><li>Joint motion i.e. </li></ul><ul><ul><li>Joint angle in sagital plane. </li></ul></ul><ul><ul><li>Joint angle in frontal plane. </li></ul></ul><ul><ul><li>Joint angle in transverse plane. </li></ul></ul><ul><li>Gait cycle phases :—events </li></ul><ul><li>There are two types of terminology used i.e. </li></ul><ul><ul><li>— Traditional </li></ul></ul><ul><ul><li>— Rancho los Amigos. </li></ul></ul><ul><li>A gait cycle has </li></ul><ul><ul><li>— A stance phase it makes about 60% of total gait. </li></ul></ul><ul><ul><li>— Swing phase it makes about 40% of gait cycle. </li></ul></ul>
    14. 14. Gait cycle phases <ul><li>Events of stance phase :— </li></ul><ul><li>1) Heel contact or Heel strike. </li></ul><ul><ul><li>— When leading limb heel strike the ground. </li></ul></ul><ul><li>2) Foot flat — </li></ul><ul><ul><li>when whole foot makes contact with ground, it occurs after heel strike at about 7% of gait cycle. </li></ul></ul><ul><li>3) Midstance — </li></ul><ul><ul><li>Occurs when total body weight is on supporting limb at about 30% of gait cycle. </li></ul></ul><ul><li>4) Heel off— </li></ul><ul><ul><li>Point at which heel of the reference limb leaves the ground at about 40% gait cycle. </li></ul></ul><ul><li>5) Toe off— </li></ul><ul><ul><li>When the toe of foot leaves the ground at about 60% of the gait cycle. </li></ul></ul>
    15. 15. Gait cycle phases <ul><li>Subphases of stance phase :— </li></ul><ul><ul><li>1) Heel strike phase—Occurs from heel strike to foot flat. </li></ul></ul><ul><ul><li>2) Mid stance phase—From foot flat to heel off at 40% of Gait cycle. </li></ul></ul><ul><ul><li>3) Push off phase—Begins at heel off 40% to toe off i.e. 60%. </li></ul></ul>
    16. 16. Gait cycle phases <ul><li>Event of swing phase : — </li></ul><ul><li>1) Acceleration or early swing— </li></ul><ul><ul><li>Occurs when toe leaves the ground and continues until mid swing. </li></ul></ul><ul><li>2) Mid swing — </li></ul><ul><ul><li>Occurs approximately when extremity passes beneath the body it begins at end of acceleration and ends at starts of decceleration. </li></ul></ul><ul><li>3) Decceleration or late swing phase — </li></ul><ul><ul><li>it occurs after mid swing when limb is deccelerating to prepare heel strike </li></ul></ul>
    17. 17. Jim Patton
    18. 18. Determinants of Gait 1) Pelvic rotation 2) Pelvic list (lateral tilt) (pelvic dips) 3) Stance knee flexion 4&5) knee, ankle & foot interactions
    19. 19. Determinant 1 Pelvic Rotation <ul><li>Pelvis moves forward with swing limb- increasing limb length forward </li></ul>
    20. 20. Determinant 2 <ul><li>Pelvis dips down on swing side </li></ul><ul><li>Lowers CM </li></ul>Pelvic Tilt
    21. 21. Determinant 3 <ul><li>Shortens the leg length during stance </li></ul><ul><li>Flexion at beginning and end smoothes the abrupt change in CM </li></ul>Stance Knee Flexion
    22. 22. Determinant 4/5 <ul><li>Heel strike </li></ul><ul><ul><li>Knee is extended & ankle is dorsiflexed to lengthen the leg </li></ul></ul>Knee ankle foot interaction
    23. 23. Determinant 4/5 <ul><li>Heel strike to foot flat </li></ul><ul><li>Knee flexes, ankle planterflex, foot pronates. </li></ul>Knee ankle foot interaction
    24. 24. Determinant 4/5 <ul><li>Foot flat to heel off </li></ul><ul><li>Knee extends, Ankle dorsiflexes </li></ul>Knee ankle foot interaction
    25. 25. Determinant 4/5 <ul><li>Heel off to toe off </li></ul><ul><li>Ankle planterflexes to lengthen the leg </li></ul>Knee ankle foot interaction
    26. 26. Joint Motion — <ul><li>It could be discussed under following headings. </li></ul><ul><ul><li>Joint angle in sagital plane. </li></ul></ul><ul><ul><li>Joint angle in frontal plane. </li></ul></ul><ul><ul><li>Joint angle in transverse plane. </li></ul></ul>
    27. 27. Sagital plane kinematics. Heel strike to foot Flat <ul><li>Hip: </li></ul><ul><ul><li>30 Degree Flexion </li></ul></ul><ul><li>Knee: </li></ul><ul><ul><li>0 – 15 degree flexion </li></ul></ul><ul><li>Ankle: </li></ul><ul><ul><li>0-15 degree planter flexion </li></ul></ul>Physical Rehabilitation,3rd edition/Susan B sullivan
    28. 28. Sagital plane kinematics. Foot Flat to midstance <ul><li>HIP : </li></ul><ul><ul><li>30 degree to 5 degree flexion (neutral) </li></ul></ul><ul><li>KNEE : </li></ul><ul><ul><li>15 to 5 degree flexion </li></ul></ul><ul><li>ANKLE : </li></ul><ul><ul><li>15 degree planter flexion to 10 degree dorsiflexion </li></ul></ul>Physical Rehabilitation,3rd edition/Susan B sullivan
    29. 29. Sagital plane kinematics. M idstance to heel off <ul><li>HIP : </li></ul><ul><ul><li>5 degree flexion to 10 degree extension </li></ul></ul><ul><li>KNEE : </li></ul><ul><ul><li>Extends from 5 degree flexion to 0 degree </li></ul></ul><ul><li>ANKLE : </li></ul><ul><ul><li>10 degree dorsiflexion to 15 degree dorsiflexion </li></ul></ul>Physical Rehabilitation,3rd edition/Susan B sullivan
    30. 30. Sagital plane kinematics H eel off to Toe off <ul><li>HIP : </li></ul><ul><ul><li>10 degree extension to 5 degree flexion </li></ul></ul><ul><li>KNEE : </li></ul><ul><ul><li>0 degree to 40 degree flexion </li></ul></ul><ul><li>ANKLE : </li></ul><ul><ul><li>15 degree dorsiflexion to 20 degree planter flexion </li></ul></ul>Physical Rehabilitation,3rd edition/Susan B sullivan
    31. 31. Sagital plane kinematics Swing Phase Toe off to Heel strike <ul><li>HIP : </li></ul><ul><ul><li>5 degree to 30 degree flexion </li></ul></ul><ul><li>KNEE : </li></ul><ul><ul><li>40 degree to 60 degree flexion </li></ul></ul><ul><li>ANKLE : </li></ul><ul><ul><li>20 degree planter flexion to 0 </li></ul></ul>Physical Rehabilitation,3rd edition/Susan B sullivan
    32. 32. Sagittal plane Motion Curve
    33. 33. Swing phase Stance phase Extension Flexion 10 90 50 70 30 Loading Response Mid stance Terminal stance Pre swing Initial swing Mid swing Terminal swing Single support Double support Double support Acceleration Deceleration Traditional Terninology RLA Terninology Phases Evemts Traditional RLA Initial contact Heel strike Contra foot off Foot flat Contra foot strike Contra foot strike Foot off Toe off Midstance Max knee flex Tibia is vertical Initial contact Mid swing Heel strike Heel off Gait cycle One stride(100 %) (60-62%) (38-40 %)
    34. 34. Loading Response Mid stance Terminal stance Pre swing Initial swing Mid swing Terminal swing Single support Double support Double support Acceleration Deceleration Traditional Terninology RLA Terninology Phases Evemts Traditional RLA Initial contact Heel strike Contra foot off Foot flat Contra foot strike Contra foot strike Foot off Toe off Midstance Max knee flex Tibia is vertical Initial contact Mid swing Heel strike Heel off Gait cycle One stride(100 %) Swing phase Stance phase Extension Flexion 10 90 50 70 30 (60-62%) (38-40 %)
    35. 35. Loading Response Mid stance Terminal stance Pre swing Initial swing Mid swing Terminal swing Single support Double support Double support Acceleration Deceleration Traditional Terninology RLA Terninology Phases Evemts Traditional RLA Initial contact Heel strike Contra foot off Foot flat Contra foot strike Contra foot strike Foot off Toe off Midstance Max knee flex Tibia is vertical Initial contact Mid swing Heel strike Heel off Gait cycle One stride(100 %) Swing phase Stance phase Planterflesion Dorsilexion 10 90 50 70 30 (60-62%) (38-40 %)
    36. 36. Sagital plane kinematics Other motion <ul><li>ARMS: </li></ul><ul><ul><li>Swings opposite to the legs </li></ul></ul><ul><li>MTP : </li></ul><ul><ul><li>0 to 60 degree dorsiflexion (variable) </li></ul></ul>
    37. 37. Frontal plane kinematics Hip& Pelvis motion <ul><li>Pelvic Obliquity(List) </li></ul><ul><ul><li>Near midstance the CM is high the swing side of the pelvis list down to lower the CM </li></ul></ul><ul><li>Hip Abd-Add </li></ul><ul><ul><li>Adducts in early stance about 5°,Abducts in late stance about 5°,returns to neutral in swing </li></ul></ul>
    38. 38. Frontal plane kinematics Subtalar motion <ul><li>In early stance,eversion allowing shock absorption. </li></ul><ul><li>In late stance, inversion locks the midtarsal joint,allowing a rigid fore foot for heel off. </li></ul>Heel off Midstance Heel strike
    39. 39. Transverse plane kinematics Hip,Trunk & Lower limb <ul><li>Pelvic rotation </li></ul><ul><ul><li>The swing leg side of the pelvis rotates 10°. </li></ul></ul><ul><li>Trunk rotation </li></ul><ul><ul><li>Lower trunk rotates with the pelvis upper trunk rotates opposite. </li></ul></ul><ul><li>Femoral/tibial rotation </li></ul><ul><ul><li>Internal rotation until foot flat </li></ul></ul><ul><ul><li>External rotation until toe off </li></ul></ul><ul><ul><li>Then internal rotation during swing. </li></ul></ul>
    40. 40. Stair gait Kinematics <ul><li>Phases of stair gait </li></ul><ul><li>Stance phase – 64% </li></ul><ul><ul><li>Weight acceptance – 15% </li></ul></ul><ul><ul><li>Pull up – 15%-30% </li></ul></ul><ul><ul><li>Forward continuance 30%-64% </li></ul></ul><ul><li>Swing phase – 36% </li></ul><ul><ul><li>Foot clearance – 64%-80% </li></ul></ul><ul><ul><li>Foot placement – 80%-100% </li></ul></ul>
    41. 41. Sagittal analysis of stair ascent. Weight acceptance to pull up <ul><li>JOINT </li></ul><ul><ul><li>Hip joint </li></ul></ul><ul><li>MOTION </li></ul><ul><ul><li>Extends from 60° flexion to 30° flexion </li></ul></ul><ul><li>MUSCLE </li></ul><ul><ul><li>G-MAX (Power generation) </li></ul></ul><ul><ul><li>G-MED (Power generation) </li></ul></ul><ul><ul><li>Hams (Power generation) </li></ul></ul>Source – Joint structure & function,a comprehensive analysis /Levangie,C norkins,4th edition /chapter-14/page 552-558
    42. 42. Sagittal analysis of stair ascent. Weight accepatence to pull up <ul><li>JOINT </li></ul><ul><ul><li>Knee joint </li></ul></ul><ul><li>MOTION </li></ul><ul><ul><li>Extends 80° flexion – 35° flexion </li></ul></ul><ul><li>MUSCLE </li></ul><ul><ul><li>VL (Power generation) </li></ul></ul><ul><ul><li>RF (Power generation) </li></ul></ul>Source – Joint structure & function,a comprehensive analysis /Levangie,C norkins,4th edition /chapter-14/page 552-558
    43. 43. Sagittal analysis of stair ascent. Weight acceptance to pull up <ul><li>JOINT </li></ul><ul><ul><li>Ankle joint </li></ul></ul><ul><li>MOTION </li></ul><ul><ul><li>Dorsiflexion:- 20° to 25° dorsiflexion </li></ul></ul><ul><ul><li>Planterflexion:- 25° dorsi to 15° dorsiflexion </li></ul></ul><ul><li>MUSCLE </li></ul><ul><ul><li>Tibialis anterior (Power generation) </li></ul></ul><ul><ul><li>Solius (Power generation) </li></ul></ul><ul><ul><li>Gastrocnemius (Power generation) </li></ul></ul>
    44. 44. Sagittal analysis of stair ascent. End of pull up forward continuation <ul><li>JOINT </li></ul><ul><ul><li>Hip joint </li></ul></ul><ul><li>MOTION </li></ul><ul><ul><li>Extends from 30° flexion to 5° flexion </li></ul></ul><ul><ul><li>Flex from 5° flexion to 20° flexion </li></ul></ul><ul><ul><ul><ul><li>(Power Absorption) </li></ul></ul></ul></ul><ul><li>MUSCLE </li></ul><ul><ul><li>G-MAX (Power generation) </li></ul></ul><ul><ul><li>G-MED (Power generation) </li></ul></ul><ul><ul><li>Hams (Power generation) </li></ul></ul>
    45. 45. Sagittal analysis of stairascent. End of pull up forward continuation <ul><li>JOINT </li></ul><ul><ul><li>Knee joint </li></ul></ul><ul><li>MOTION </li></ul><ul><ul><li>Extends 35° flexion – 10° flexion (PG </li></ul></ul><ul><ul><li>Flexion 10° flexion – 35° flexion (PA) </li></ul></ul><ul><li>MUSCLE </li></ul><ul><ul><li>VL (Power generation) </li></ul></ul><ul><ul><li>RF (Power generation) </li></ul></ul>See – Joint structure & function,a comprehensive analysis /Levangie,C norkins,4th edition /chapter-14/page 552-558
    46. 46. Sagital analysis of stair ascent. End of pull up forward continuation <ul><li>JOINT </li></ul><ul><ul><li>Ankle joint </li></ul></ul><ul><li>MOTION </li></ul><ul><ul><li>Planterflexion:- 15° dorsi to 10° planterflexion </li></ul></ul><ul><li>MUSCLE </li></ul><ul><ul><li>Tibialis anterior (Power absorption) </li></ul></ul><ul><ul><li>Solius (Power generation) </li></ul></ul><ul><ul><li>Gastrocnemius (Power generation) </li></ul></ul>See – Joint structure & function,a comprehensive analysis /Levangie,C norkins,4th edition /chapter-14/page 552-558
    47. 47. Stair ascent.(Sagital) Swing phase Foot clearance to foot placement <ul><li>JOINT </li></ul><ul><ul><li>Hip joint </li></ul></ul><ul><li>MOTION </li></ul><ul><ul><li>Flexion 20° to 60° flexion then </li></ul></ul><ul><ul><li>Extend 60° Flexion to 50° flexion </li></ul></ul><ul><li>MUSCLE </li></ul><ul><ul><li>G medius (Power generation) </li></ul></ul>Source– Joint structure & function,a comprehensive analysis /Levangie,C norkins,4th edition /chapter-14/page 552-558
    48. 48. Stair ascent.(Sagital) Swing phase Foot clearance to foot placement <ul><li>JOINT </li></ul><ul><ul><li>Knee joint </li></ul></ul><ul><li>MOTION </li></ul><ul><ul><li>Flexion 10° flexion to 100° flexion (PG </li></ul></ul><ul><ul><li>Extends 100° flexion – 85° flexion (PG) </li></ul></ul><ul><li>MUSCLE </li></ul><ul><ul><li>VL (Power generation) </li></ul></ul><ul><ul><li>Hams (Power generation </li></ul></ul>Source – Joint structure & function,a comprehensive analysis /Levangie,C norkins,4th edition /chapter-14/page 552-558
    49. 49. Stair ascent.(Sagital) Swing phase Foot clearance to foot placement <ul><li>JOINT </li></ul><ul><ul><li>Ankle joint </li></ul></ul><ul><li>MOTION </li></ul><ul><ul><li>Dorsiflexion 10° planterflexion to 20° dorsi </li></ul></ul><ul><li>MUSCLE </li></ul><ul><ul><li>Tibialis anterior (Power absorption) </li></ul></ul>Source – Joint structure & function,a comprehensive analysis /Levangie,C norkins,4th edition /chapter-14/page 552-558
    50. 50. Running gait Kinematics Gait cycle phase Toe off Heel strike Stance phase Swing phase Heel strike
    51. 51. Running gait Kinematics Average peak ROM comparision running and walking <ul><ul><ul><li>Running walking </li></ul></ul></ul><ul><li>Hip joint </li></ul><ul><li>Flexion- 55-65 30 </li></ul><ul><li>Extension- 10-20 0-20 </li></ul><ul><li>Knee </li></ul><ul><li>Flexion 80-130 40-50 </li></ul><ul><li>Extension 0-5 0 </li></ul><ul><li>Ankle </li></ul><ul><li>Dorsi flexion 10-30 10 </li></ul><ul><li>Planter flexion 20-30 20 </li></ul>Source – Joint structure & function,a comprehensive analysis /Levangie,C norkins,4th edition /chapter-14/page 552-558
    52. 52. Where to get more…… Web/Internet www.curtin,edu.au/curtin/depat/physi www.kinesiology.ne www.apta.org www.arialdynamics.com www.medicalstudent.com www.oandp.org/jpo/library Books 1- Physical Rehabilitation,3rd edition/SusanB sullivan 2- Joint StructureFunction,4thedition/Levangie,C. Norkins 3- Dynamics of human Gait,2nd edition , Christopher & Brian Juornals Physical Therapy Clinical Anatomy Juornal of orthopaedic surgery Juornal of physical therapy science
    53. 53. …… .. ?
    54. 54. Thank you !

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