Analysis of Typical Gait - Part 1

Analysis of Typical Gait – Part I

• The end goal is to describe typical gait sequence using observational gait analysis terms from Rancho Los Amigos (RLA) and JAKC Observational Gait Analysis.

Review of Terms: Gait Parameters

• Spatial descriptors include step and stride length, step width, and foot angle.
• Temporal descriptors include cadence, stride time, and step time.
• Walking speed is a spatial-temporal descriptor.

Typical Gait Descriptors for Adults

• Step width is 8 – 10 cm between the midline of heels.
• Toe out (foot angle) is 5-7°.
• Walking speed/velocity for females is 79.3 m/min and for males is 82.1 m/min.
• Cadence/Step rate is 121.0 steps/min for females and 111.0 steps/min for males.
• Step length is 66 cm.
• Stride length is 1.32 m (132 cm).

Observational Gait Analysis Process

• You can organize observation by swing phase - stance phase, head-to-feet or feet-to-head methods, by body segment, or by joint like hip, knee, ankle/foot.
• Determine the reference limb.
• Look for any deviations during swing/stance at each key joint or segment.
• AP and lateral views are used for movements in a plane 90 degrees to view.
• AP view: movements in the frontal plane.
• Both sides and multiple planes are preferred for a full picture initially,
• Video the patient with your/patient's phone to analyze.

A-P View: Position and Movements in Frontal Plane

• Head alignment to vertical and upright.
• Shoulders symmetry is level.
• Trunks rotations separate the upper and lower trunk
• Pelvis symmetrical level
• Hips alignment is neutral AB/ABduction, neutral IR/ER
• Knee alignment shows no change from static to dynamic in valgus or varus alignment.
• Ankle / Foot alignment is neutral, with hindfoot inversion/eversion, and forefoot pronation/supine.

Lateral View: Position and Movements in Sagittal Plane

• Head orientation to vertical, neutral flexion/extension.
• Shoulders alignment to head (external auditory meatus), neutral protraction/retraction.
• Trunk upright, neutral flexion/ extension (lean).
• Pelvis neutral protraction/retraction; slight anterior tilt.
• Knees Appropriate flexion or extension for gait phase; no excessive knee flexion (buckling) or hyperextension.
• Ankle / Foot Appropriate dorsiflexion or plantarflexion for gait phase; with no foot drop or foot slap.

Center of Mass Displacement During Gait

• The vertical displacement of the center of mass is 5 cm.

Phases of Gait

• Initial Contact, Loading Response, Mid Stance, Terminal Stance, Pre Swing, Initial Swing, Mid Swing, and Terminal Swing are all phases of gait.

Stance Phase: Initial Contact to Loading Response

• The reference limb is either right or left.
• The pelvis is in 10° of anterior tilt.
• The hip is flexed up to 20°.
• There is a slight (5°) flexion in the knee that goes to 20° in LR, and then the ankle transitions from neutral DF at IC to 5° PF to Neutral in LR.
• The foot slightly everts at LR.

Stance Phase: Midstance to Terminal Stance

• Neutral rotation and Anterior tilt in MS Posterior rotation in TS.
• Extension changes from 0° to 15 – 20° of extension.
• The knee remains at 5º flexion.
• Ankle Dorsiflexion increases from 5 to 10°.
• Decreasing eversion with MTP joint extension to 30°.

Swing Phase: Pre-Swing to Initial Swing

• There is a slight Ipsilateral drop 5° as the Pelvis remains anteriorly tilted at 10°.
• The Hip & Thigh moves from 10° hip extension to 15° of flexion.
• The Knee has increased flexion from 40° to 60°.
• The Ankle decreases PF from 15° to 5°.
• Foot & Toes MTP has extension that goes to 50° at PSw

Swing Phase: Mid-Swing to Terminal Swing

• Shoulders experience contralateral protraction and/or arm swing.
• The trunk is upright in sagittal and frontal planes as the rotation of shoulders occurs in opposite direction of hips.
• There is Ipsilateral hip drop of 5° Neutral → Ant rotation Anterior tilt.
• As TS goes to 20° Hip flexion, the hip & thigh the decreasesfrom 25°.
• The knees flexion decreases from 25° in MSw to 5º in TSW.
• The Ankle is in a neutral DF to provide toe clearance in swing.
• No Inversion or Eversion.

Summary

• Analyzing gait, even when typical or normal, is complex, requiring a systematic approach, and repeated viewings.
• Having a solid knowledge of typical gait is important before analyzing atypical gait.
• Gait analysis takes practice to become skilled; it is beneficial search the community to observe walking.

Analysis of 'Typical' Gait

• Subject(s) - PhysioU (Home) → Gait → Analyze → Normal Gait at https://app.clinicalpattern.com/gait/2409/p7010/
• Open Assessment tool is the JAKC Analysis tool
• Organization of assessment requires a focus toes upward to head/trunk - View: Side - Rear - Front.
• Swing v Stance

Tools to use in Observational Gait Analysis

Rancho Los Amigos (RLA) Gait analysis; Full body JAKC Gait Analysis

Look at Each Joint/Segment: Ankle/Foot

Looking at ankle/foot in 12, 31, 50, 62, 75, 87, 100 positions to address stance & swing w/ weight acceptance and is it full or not, including single limb support & swing limb advancement

What's Happening at the Knee

The knee's roles and what constitutes as normal from the same positions.

Moving on Up to the Pelvis and Hip

Addresses the thigh and pelvis to cover stance- swing positioning

What's Happening at the Trunk

Addresses the trunk addressing the positioning given weight and lean

Do the Numbers

• Velocity (m/min or m/sec) = Distance (m) / time (s) = m/sec (x 60 sec/min) = m/min
• Cadence (steps/minute) = #steps / time(sec) x (60 sec/min) = steps/min Stride Length (meters) = Velocity (m/min) /½ #steps/min = meters/stride Note: 2 steps =1 stride, so therefore divide by ½ #steps per minute

Summary

Effective gait analysis requires a systematic approach from multiple views as using a standardized terminology is essential for consistent identification and description of gait as knowledge of what is typical or normal is critical to identifying gait deviations