Gait Analysis PDF

BIOMECHANICS OF GAIT AND GAIT ABNORMALITIES GAIT  GAIT THE NORMAL PROGRESSION OF THE BODY  GAIT WALKING GAIT RUNNING GAIT STAIR GAIT  GAIT TERMINOLOGIES GAIT CYCLE- time interval from HEEL STRIKE to HEEL STRIKE of the SAME foot STANC...

BIOMECHANICS OF GAIT AND GAIT ABNORMALITIES GAIT  GAIT THE NORMAL PROGRESSION OF THE BODY  GAIT WALKING GAIT RUNNING GAIT STAIR GAIT  GAIT TERMINOLOGIES GAIT CYCLE- time interval from HEEL STRIKE to HEEL STRIKE of the SAME foot STANCE PHASES SWING  PHASES OF GAIT STANCE reference limb is in contact with the ground (CKC) 60% SWING reference limb is off the ground (OKC) 40%  PERIODS OF GAIT SINGLE LIMB SUPPORT LESS STABLE 80% DOUBLE LIMB SUPPORT MORE STABLE 20% **Evident gait changes in the elderly?  CRITERIA FOR STABILITY LARGE BOS COG WITHIN BOS LOWER COG  GAIT ANALYSIS Describing and measuring human movements by focusing on the type of motion, the KINEMATIC direction, and the quantity of the motion without regard for the forces that may produce that movement The science that deals with forces that produce, KINETIC stop, or modify motion of bodies as a whole or of individual body segments; The study of forces acting on the body KINEMATIC GAIT ANALYSIS  KINEMATIC GAIT ANALYSIS SPATIAL DISTANCE TEMPORAL TIME SPATIAL PARAMETERS STEP WIDTH measurement between the medial sides of the feet (N) 2-4 inches/ 5-10cm  STEP WIDTH 1.Cerebellar pathology 1.Spastic hip adductors (ataxic gait) 2.Increasing speed 2.Diabetic (running: 0 inch: polyneuropathy (late crossover) stage) 3.Tight hip abductors SPATIAL PARAMETERS STEP LENGTH measurement from H S to HS of OPPOSITE foot (N) 14-16 inches/ 28inches PROBLEM Patient S/P (R) THR: a. decreased step length on the left b. decreased step length on the right SPATIAL PARAMETERS STRIDE LENGTH measurement from H S to HS of SAME FOOT foot (N) 56 inches SPATIAL PARAMETERS FICK ANGLE Angle of toe out Angle of foot placement with respect to the line of progression Landmark: 2nd MTT (N) 7 degrees PROBLEM INCREASING SPEED WILL: a. increase fick angle b. decrease fick angle **RUNNING: SPATIAL PARAMETERS L A T E RA L PELVIC SHIFT side to side pelvic movement to STANCE limb (N) 2.5-5 cm SPATIAL PARAMETERS VERTICAL PELVIC SHIFT vertical displacement of the pelvis (N) >5 cm HIGHEST- SLS/ MS COG < LOWEST- DLS SPATIAL PARAMETERS PELVIC ROTATION lessens the angle of the femur lengthens the femur 4 deg forward- swing (N) 8 deg < 4 deg backward- stance TEMPORAL PARAMETERS CADENCE # of steps per minute (N) 90-120 steps/ min (N) Male: 111 steps/ min (N) Female: 117 steps/ min TEMPORAL PARAMETERS WALKING SPEED rate of displacement Scalar: without direction (N) 3 mph TEMPORAL PARAMETERS WALKING VELOCITY rate of displacement Scalar: with direction (N) 3 mph (N, S, E, W) TEMPORAL PARAMETERS ACCELERATION rate of change of speed TEMPORAL PARAMETERS STEP TIME STRIDE TIME GAIT PATTERN  GAIT TERMINOLOGIES TRADITIONAL RLA 1.HEEL STRIKE 1. INITIAL CONTACT 2. FOOT FLAT 2. LOADING RESPONSE 3.MIDSTANCE 3. MIDSTANCE 4.HEEL-OFF 4. TERMINAL STANCE 5. TOE-OFF 5. PRE-SWING 6. ACCELERATION 6. INITIAL SWING 7. MIDSWING 7. MID SWING 8. DECCELERATION 8. TERMINAL SWING  GAIT TERMINOLOGIES RLA 1. INITIAL CONTACT- heel/ other parts contacts the ground 2. LOADING RESPONSE- weight transfer/ shock absorption 3. MIDSTANCE- 1st half of single limb support 4. TERMINAL STANCE- 2nd half of single limb support 5. PRE-SWING- push-off; raping unloading 6. INITIAL SWING- toe off to reference limb below trunk 7. MID SWING- reference limb directly under the body 8. TERMINAL SWING- reference limb under the body to initial contact  NORMAL VALUES ** R O M required on MTP jt for gait?  DETERMINANTS OF GAIT 1. Pelvic rotation on horizontal plane 2. Pelvic list on the frontal plane 3. Early knee flexion during the early stance 4. Weight transfer from HS to FF 5. Late knee flexion during the late stance 6. Lateral pelvic shift towards stance limb 7. Knee, ankle, foot interactions 8. Physiologic valgus of the knee  PEDIATRIC GAIT MILESTONES 18 months- HS emerges; reciprocal arm swing 2 y/o- knee flexion emerges 3 y/o- starts maturing 7 y/o- mature gait pattern KINETIC GAIT ANALYSIS  KINETIC GAIT ANALYSIS GROUND REACTION FORCE CENTER OF GRAVITY CENTER OF PRESSURE TORQUE  KINETIC GAIT ANALYSIS GROUND REACTION FORCE A P the force=magnitude but opposite the direction of the force the body applies to the ground Newton's 3rd law of motion  NEWTONS’S 3RD L A W OF MOTION “For every action, there is an equal and opposite reaction.”  KINETIC GAIT ANALYSIS GROUND REACTION FORCE A P HEEL STRIKE- posterior to ankle; through the knee; anterior to hip FOOT FLAT- posterior to knee MIDSTANCE- anterior to ankle  KINETIC GAIT ANALYSIS CENTER OF GRAVITY point of concentration of weight A P slightly anterior to S2; 2 inches/ 5 cm anterior to S2 (N) Displacement: >5cm Horizontal Figure of 8 < Vertical KINETIC GAIT ANALYSIS CENTER OF PRESSURE point of concentration of resultant force HS- @ lateral midpoint of heel PF to MS- @ lateral midfoot HO to TO- @ medial forefoot under 1st and 2nd MTT head KINETIC GAIT ANALYSIS TORQUE turning/ rotational effect @ joints EXTERNAL- GRF, gravity INTERNAL- muscles  TORQUE EXTERNAL INTERNAL Posterior to ankle- PF Posterior to ankle- Anterior to hip- Hip flexion dorsiflexors Posterior to knee- Knee Anterior to hip- Hip flexion extension Posterior to knee- Knee extension  PEAK MUSCLE ACTIVITY 1.DORSIFLEXORS- H S to FF 2.PLANTARFLEXORS- concentric: Push-off; eccentric FF to MSt 3.KNEE EXTENSORS- H S to FF 4.KNEE FLEXORS- MSw to FF 5. HIP FLEXORS- IS to MSw 6.HIP EXTENSORS- LS to H S to FF (decceleration phase) 7.HIP ABDUCTORS- MSt ** Quads to Hams ratio?  RUNNING GAIT (-) Double limb support (-) Step width (-) Fick angle PHASES: 1.STANCE- 40% 2.SWING- 30% 3.FLOATING- 30%  STAIR GAIT PHASES: 1.WEIGHT ACCEPTANCE 2.PULL-UP AND FORWARD CONTINUANCE 3.FOOT CLEARANCE 4.FOOT PLACEMENT GAIT DEVIATIONS  ABNORMAL GAIT 1 2 3 Pathology or Compensation Compensation injury in a for injury or for injury or specific joint pathology in pathology in other joints on other joints on the I/L side the C/L side  ANTALGIC GAIT PAINFUL GAIT Self-protective Pain may occur on any part of the LE from ankle to pelvis Painful limb- shortened phase (N) limb- shortened phase STEP LENGTH? WALKING SPEED? CADENCE? PROBLEM Pt has (L) hip OA and presents with antalgic gait. Where does the hip shifts the body weight? a. on the I/L side b. on the C/L side PROBLEM Pt has left hip ankylosis, an excessive plantaflexion can be seen as a compensation to arthrogenic gait. What limb will compensate: a. I/L limb b. C/L limb  ATAXIC GAIT Caused by poor sensation or lack of muscle coordination that leads to poor balance and broad base of support The feet slaps on the ground, may lurch or stagger, all movements are exaggerated, tends to watch the feet while walking; results to an irregular, jerky, and weaving pattern of walking  ARTHROGENIC GAIT STIFF HIP OR KNEE GAIT structure involved: JOINTS HIP ARTHRITIS- (R) hip arthritis will lead to I/L trunk lean HIP ANKYLOSIS- exaggerated movement of the OPPOSITE limb (such as ankle PF) can be compensated by? Gait length?  CONTRACTURE GAIT HIP FLEXION CONTRACTURE will result to? KNEE FLEXION CONTRACTURE will result to? PLANTARFLEXION CONTRACTURE will result to?  SHORT LEG GAIT aka PAINLESS OSTEIGENIC GAIT (+) LLD SHORTER LIMB: lengthen vian ankle PF/ supination LONGER LIMB: shorten via knee and/or hip flexion/ hip hiking PROBLEM Pt presents with "toe first gait", what could be the possible cause/s? a. spastic PF b. flaccid DF c. painful heel d. (+) LLD e.AOTA  GLUTEUS MAXIMUS GAIT IGN injury (+) Backward lurch/ Hyperextension of the spine Seen during HS/ IC  GLUTEUS MEDIUS GAIT SGN injury (+) Trendelenburg gait will lead to I/L G. Med weakness COMPENSATED: I/L trunk lean towards weak side; I/L BC. C/L cane UNCOMPENSATED: (+) pelvic drop series of compensated trendelenburg; B/L affectation?  QUADRICEPS GAIT Femoral Nerve Injury (+) Forward lurch gait  DORSIFLEXORS GAIT DPN injury FOOT SLAP FOOR DRAG with toe drag FOOT DROP STEPPAGE GAIT  PLANTARFLEXOR GAIT Tibial nerve injury (-) CONCENTRIC: lack of push-off will lead to decreased step length C/L (-) ECCENTRIC: uncontrolled tibial advance and excessive DF (CKC) DEFINITION OF TERMS FOR ANKLE AND FOOT TALIPES EQUINUS CALCANEOUS VALGUS VARUS CAVUS  EQUINUS GAIT TOE WALKING childhood gait seen with talipes equinovarus (clubfoot) W B occurs primarily on the dorsolateral or lateral edge of the foot W B phase of the affected limb is decreased, and a limp is present pelvis and femur rotated to partially compensate for tibial and foot  SCISSORS GAIT secondary to spastic paralysis of the hip adductor muscles often referred to as NEUROGENIC OR SPASTIC GAIT  HEMIPLEGIC GAIT 1.CIRCUMDUCTION GAIT 2. VAULTING GAIT 3. STEPPAGE GAIT sometimes call as NEUROGENIC OR FLACCID GAIT  PARKINSONIAN GAIT Seen during LATE stage PD Neck, trunk, and knees are SHUFFLING GAIT- shorter steps FESTINATING GAIT- progressive increase in speed and unable to stop SHOE MODIFICATION: TOE WEDGE En Bloc Movement- head, arms, and trunk acts as a unit  PSOATIC LIMP GAIT Usually seen in patients with LCPD presents with difficulty in swing-through, and an accompanying limp is noted together with exaggerated trunk and pelvic movement the classic manifestation of the limps?  POSTERIOR COLUMN DEFICIT (+) Rhomberg sign (+) Double tapping sign FUNCTIONAL TASK OF WALKING 1.Weight acceptance 2. Single limb support 3.Limb advancement Thank you!