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EVALUATIONEVALUATION
OF GAITOF GAIT
EVALUATION IN ATHENS
Diagnosis of gait DeviationsDiagnosis of gait Deviations
 Awareness of the functionalAwareness of the functional
limitationslimitations
 Familiarity with normal functionFamiliarity with normal function
 Trained eye or gait analysisTrained eye or gait analysis
systemsystem
 Use the information forUse the information for
appropriate treatment regimenappropriate treatment regimen
GAIT-DEFINITIONGAIT-DEFINITION
 Word meaning is manner ofWord meaning is manner of
walkingwalking
 Highly controlled,coordinatedHighly controlled,coordinated
and repetitive series of limband repetitive series of limb
movements whose function ismovements whose function is
to advance the body fromto advance the body from
place to place with minimumplace to place with minimum
expenditure of energyexpenditure of energy
GAIT CYCLEGAIT CYCLE
One gait cycle is the movementOne gait cycle is the movement
of a single limb from heel strikeof a single limb from heel strike
(initial contact ) to next heel(initial contact ) to next heel
strikestrike
SUBDIVISIONS OF GAIT CYCLESUBDIVISIONS OF GAIT CYCLE
 Stance phase and swing phaseStance phase and swing phase
 Stance phase begins with initialStance phase begins with initial
contact of heel and ends with toecontact of heel and ends with toe
offoff
SUBDIVISIONS OF GAIT CYCLESUBDIVISIONS OF GAIT CYCLE
 Initial contact occurs atInitial contact occurs at 0%0% andand 100%100% of gaitof gait
cycle 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 phase
40%40% of gait cycleof gait cycle
STANCE PHASESTANCE PHASE
 Period when foot is on the groundPeriod when foot is on the ground
 Sub divisionsSub divisions
1) initial contact1) initial contact
2) loading response2) loading response
3) mid stance3) mid stance
4) terminal stance and4) terminal stance and
5) pre swing5) pre swing
INITIAL CONTACTINITIAL CONTACT
 Occur atOccur at 0%0% of gait cycleof gait cycle
 Principal objective of bodyPrincipal objective of body
is to position the footis to position the foot
correctly as it comes incorrectly as it comes in
contact with the floorcontact with the floor
 Body is about to beginBody is about to begin
decelerationdeceleration
LOADING RESPONSELOADING RESPONSE
 OccupiesOccupies 0 to 10%0 to 10% of gait cycleof gait cycle
 Maintain smooth progressionMaintain smooth progression
while decelerating the body masswhile decelerating the body mass
as it travels from its zenith atas it travels from its zenith at
mid stance of opposite limbmid stance of opposite limb
 Opposite limb toe off occurs atOpposite limb toe off occurs at
end of loading response . So thisend of loading response . So this
is a period of double limb supportis a period of double limb support
MID STANCEMID STANCE
 Utilize momentum to maintainUtilize momentum to maintain
stability of the hip and kneestability of the hip and knee
while advancing the body overwhile advancing the body over
a stationary foota stationary foot
 The centre of gravity hasThe centre of gravity has
reached its zenith and forwardreached its zenith and forward
velocity is minimumvelocity is minimum
 Initial swing has begun onInitial swing has begun on
opposite sideopposite side
TERMINAL STANCETERMINAL STANCE
 OccupiesOccupies 30 to 50% range30 to 50% range ofof
gait cyclegait cycle
 Provide acceleration & toProvide acceleration & to
ensure an adequate stepensure an adequate step
lengthlength
 Acceleration is provided byAcceleration is provided by
1)forward fall of centre of1)forward fall of centre of
mass of bodymass of body
2) concentric contraction of2) concentric contraction of
triceps suraetriceps surae
ConstitutesConstitutes 80 -85%80 -85% of totalof total
energy generatedenergy generated
PRE SWINGPRE SWING
 OccupiesOccupies 50-60% range50-60% range
of gait cycleof gait cycle
 Period of double limbPeriod of double limb
supportsupport
 Goal is to prepare theGoal is to prepare the
limb for swinglimb for swing
 Initial contact ofInitial contact of
opposite limb marksopposite limb marks
beginning of pre swingbeginning of pre swing
SWING PHASESWING PHASE
 Limb is off the groundLimb is off the ground
 Divided intoDivided into
1) initial swing1) initial swing
2) mid swing2) mid swing
3) terminal swing3) terminal swing
INITIAL SWINGINITIAL SWING
 OccupiesOccupies 60-70% range60-70% range
of gait cycleof gait cycle
 Critical function is toCritical function is to
allow foot clearance &allow foot clearance &
variable cadencevariable cadence
 Varying cadenceVarying cadence
requires CNS control &requires CNS control &
precise timing of twoprecise timing of two
joint musclesjoint muscles
MID SWINGMID SWING
 OccupiesOccupies 70 to 85% range70 to 85% range of gaitof gait
cyclecycle
 Critical function is to maintainCritical function is to maintain
foot clearancefoot clearance
MID SWING (contd)MID SWING (contd)
 Foot clearance dependsFoot clearance depends
on maintaining aon maintaining a
relatively level pelvis,relatively level pelvis,
sufficient hip flexion &sufficient hip flexion &
adequate ankleadequate ankle
dorsiflexiondorsiflexion
 In normal gait footIn normal gait foot
clearance is only 0.87cmclearance is only 0.87cm
TERMINAL SWINGTERMINAL SWING
 OccupiesOccupies 85-100%85-100%
rangerange of gait cycleof gait cycle
 Function is decelerationFunction is deceleration
of shank & correct pre-of shank & correct pre-
positioning of foot forpositioning of foot for
contactcontact
 Complete kneeComplete knee
extension & neutralextension & neutral
position of foot areposition of foot are
critical for heel strikecritical for heel strike
Linear measurements- ( cadenceLinear measurements- ( cadence
or temporal parameters )or temporal parameters )
 Step lengthStep length
 Stride lengthStride length
 Step timeStep time
 CadenceCadence
 Walking velocityWalking velocity
KINEMATICSKINEMATICS
 It denotes movements observedIt denotes movements observed
and measured at the pelvis, hip,and measured at the pelvis, hip,
knee, and ankle during stanceknee, and ankle during stance
and swing phasesand swing phases
 It can be observed in 3 planesIt can be observed in 3 planes
sagittalsagittal
coronalcoronal
transversetransverse
SAGITTAL PLANESAGITTAL PLANE
The pelvis tilts approximatelyThe pelvis tilts approximately 1515 degreedegree
SAGITTAL PLANESAGITTAL PLANE
HIPHIP
• StanceStance –flexed at–flexed at
initial contactinitial contact
then extends fullythen extends fully
• SwingSwing – hip flexes– hip flexes
rapidly to pull therapidly to pull the
stance limb offstance limb off
the groundthe ground
SAGITTAL PLANESAGITTAL PLANE
KNEEKNEE
• StanceStance- At initial contact- At initial contact
knee flexesknee flexes 1515 deg. It thendeg. It then
extendsextends
• SwingSwing – At heel rise knee– At heel rise knee
begins to flex againbegins to flex again
reaching maximum flexionreaching maximum flexion
in early swing .Inin early swing .In
remainder of swing kneeremainder of swing knee
extends passivelyextends passively
SAGITTAL PLANESAGITTAL PLANE
ANKLEANKLE
• StanceStance – neutral at initial– neutral at initial
contact,then plantar flexescontact,then plantar flexes
5-10 deg as forefoot comes5-10 deg as forefoot comes
to rest on the ground.-to rest on the ground.-
FIRST ROCKERFIRST ROCKER
• Ankle dorsiflexes throughoutAnkle dorsiflexes throughout
mid stance as tibia movesmid stance as tibia moves
forward over plantigradeforward over plantigrade
foot –foot – SECOND ROCKERSECOND ROCKER
SAGITTAL PLANESAGITTAL PLANE

ANKLEANKLE(CONTD)(CONTD)--during terminalduring terminal
stance and pre swingstance and pre swing
ankle plantar flexes andankle plantar flexes and
heel rises to prepare forheel rises to prepare for
push off-push off- THIRD ROCKERTHIRD ROCKER
• SwingSwing – dorsiflexion to– dorsiflexion to
neutral position seenneutral position seen
CORONAL PLANECORONAL PLANE
 PELVIS-each hemipelvisPELVIS-each hemipelvis
rises slightly during swingrises slightly during swing
phasephase
 - stance phase hemipelvis- stance phase hemipelvis
drops slightlydrops slightly
 - accentuated pelvic drop in- accentuated pelvic drop in
swing seen inswing seen in
trendelenburg gaittrendelenburg gait
CORONAL PLANECORONAL PLANE (CONTD)(CONTD)
 HIP-HIP- StanceStance phasephase
– slight adduction– slight adduction
occursoccurs
 -- SwingSwing – abduction– abduction
seenseen
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
NEUROLOGICAL CONTROL OFNEUROLOGICAL CONTROL OF
GAITGAIT
 Muscle actions programmed asMuscle actions programmed as
involuntary reflex arcs in EPSinvoluntary reflex arcs in EPS
 Golgi tendon ,muscle spindle &Golgi tendon ,muscle spindle &
joint receptors producejoint receptors produce
neurologic feedbackneurologic feedback
 Voluntary modulation of gaitVoluntary modulation of gait
made by interaction with motormade by interaction with motor
cortexcortex
 Cerebellum - balanceCerebellum - balance
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
MUSCLE ACTIVITYMUSCLE ACTIVITY
CONCENTRIC CONTRACTIONCONCENTRIC CONTRACTION
 Muscle shortensMuscle shortens
generating power andgenerating power and
accelerationacceleration
 Gastrocsoleus andGastrocsoleus and
iliopsoas are the primaryiliopsoas are the primary
accelerators of gaitaccelerators of gait
 Concentric contraction ofConcentric contraction of
these occur at terminalthese occur at terminal
stancestance
MUSCLE ACTIVITYMUSCLE ACTIVITY
ECCENTRIC CONTRACTIONECCENTRIC CONTRACTION
 Muscle lengthens despiteMuscle lengthens despite
electrical contractionelectrical contraction
 These slow down & stabilize jointThese slow down & stabilize joint
motions during gaitmotions during gait
 Eccentric contractionsEccentric contractions
outnumber concentricoutnumber concentric
contractions during gaitcontractions during gait
ECCENTRIC CONTRACTIONECCENTRIC CONTRACTION
 Eg:- tibialis anterior muscleEg:- tibialis anterior muscle
contracts eccentrically atcontracts eccentrically at
initial contact to slow downinitial contact to slow down
plantar flexion of ankleplantar flexion of ankle
 -gastrosoleus contracts-gastrosoleus contracts
eccentrically during 2eccentrically during 2ndnd
rocker to slow downrocker to slow down
dorsiflexiondorsiflexion
MUSCLE ACTIVITYMUSCLE ACTIVITY
ISOMETRIC CONTRACTIONISOMETRIC CONTRACTION
 No change in length of muscleNo change in length of muscle
occursoccurs
 Postural stabilisers like gluteusPostural stabilisers like gluteus
medius work in this modemedius work in this mode
 More muscle activity occurs inMore muscle activity occurs in
stance phasestance phase
 In swing momentum carries theIn swing momentum carries the
leg forwardleg forward
GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY
Prerequisites ofPrerequisites of
normalnormal
ambulation areambulation are
 Stability atStability at
stancestance
 Means ofMeans of
progressionprogression
 Conservation ofConservation of
energyenergy
GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY
 Bipedal gait is inherentlyBipedal gait is inherently
unstableunstable
and inefficientand inefficient
 Quadrupeds run faster thanQuadrupeds run faster than
humans because vertebral andhumans because vertebral and
trunk muscles act to augmenttrunk muscles act to augment
stridestride
GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY
PROGREESSIONPROGREESSION
• Forward fall of theForward fall of the
centre of gravity ofcentre of gravity of
body from its highbody from its high
point at mid stancepoint at mid stance
to its low point atto its low point at
double supportdouble support
• Now potentialNow potential
energy is convertedenergy is converted
to kinetic energyto kinetic energy
GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY
PROGRESSION (contd)PROGRESSION (contd)
 To raise the CG back to zenithTo raise the CG back to zenith
kinetic energy must be suppliedkinetic energy must be supplied
 This is supplied by inertia ofThis is supplied by inertia of
swinging limb which in turnswinging limb which in turn
derives energy from plantarderives energy from plantar
flexors and hip flexors of thatflexors and hip flexors of that
limblimb
GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY
PROGRESSION (contd)PROGRESSION (contd)
 In normal walkingIn normal walking 85%85% ofof
energy comes from plantarenergy comes from plantar
flexorsflexors
 Energy expended in normalEnergy expended in normal
walking iswalking is 2.5 Kcal/min2.5 Kcal/min
 This is less than twice the energyThis is less than twice the energy
spent while standing stillspent while standing still
--1.5Kcal/min1.5Kcal/min
GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY
ENERGY CONSERVATIONENERGY CONSERVATION
Energy 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 energy
between segmentsbetween segments
GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY
ENERGY CONSERVATIONENERGY CONSERVATION
 Movement of a wheel is highlyMovement of a wheel is highly
efficient 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 combined
with coordinated knee and anklewith coordinated knee and ankle
motion the vertical and horizontalmotion the vertical and horizontal
excursion are reduced toexcursion are reduced to 4.4cm4.4cm
GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY
ENERGY CONSERVATIONENERGY CONSERVATION
CONTROLLING MOMENTUMCONTROLLING MOMENTUM
*This conserves energy*This conserves energy
eg:-by maintaining theeg:-by maintaining the
ground reaction force in frontground reaction force in front
of the knee during the lastof the knee during the last
half of stance , an extensionhalf of stance , an extension
movement occurs whichmovement occurs which
allows it to remain stableallows it to remain stable
GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY
ENERGY CONSERVATIONENERGY CONSERVATION
ACTIVE OR PASSIVE TRANSFER OF ENERGYACTIVE OR PASSIVE TRANSFER OF ENERGY
• Passive flow of energy across jointsPassive flow of energy across joints
accounts for most of the energyaccounts for most of the energy
changes occuring at the distalchanges occuring at the distal
segments during initiation andsegments during initiation and
termination of swingtermination of swing
• In active transfer two joint musclesIn active transfer two joint muscles
play a major roleplay a major role
GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY
 Interference with these mechanismsInterference with these mechanisms
increase energy consumptionincrease energy consumption
 Eg:-fast walking –Eg:-fast walking – 60% inc60% inc
BK 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%
DEVELOPMENT OF GAIT INDEVELOPMENT OF GAIT IN
CHILDRENCHILDREN
 Toddlers walk with a wide basedToddlers walk with a wide based
gait, increased flexion of hip andgait, increased flexion of hip and
knees & arms held out to theknees & arms held out to the
sidessides
 At 5 yrs child has developed aAt 5 yrs child has developed a
stable velocity patternstable velocity pattern
 Adult gait pattern is attained byAdult gait pattern is attained by
7 yrs7 yrs
GAIT ANALYSISGAIT ANALYSIS
 Systematic descriptionSystematic description
and assessment of qualities thatand assessment of qualities that
characterize human locomotioncharacterize human locomotion
 Mainly used in pre operativeMainly used in pre operative
planning and documentation ofplanning and documentation of
post operative outcome inpost operative outcome in
patients with cerebral palsypatients with cerebral palsy
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
GAIT DEVIATIONSGAIT DEVIATIONS
1)antalgic gait1)antalgic gait - dec stance phase- dec stance phase
avoiding wt. Bearing on involved limbavoiding wt. Bearing on involved limb
2)Short limb gait2)Short limb gait – dipping of shoulder– dipping of shoulder
and pelvis on affected side & incand pelvis on affected side & inc
flexion of hip , knee and ankle offlexion of hip , knee and ankle of
opposite limb.opposite limb.
3)Trendelenburg gait3)Trendelenburg gait –patient lurches–patient lurches
on affected side & pelvis drops on oppon affected side & pelvis drops on opp
sideside
Goddess trying to avoid
Short lomb gait
GAIT DEVIATIONSGAIT DEVIATIONS
4)Waddling gait4)Waddling gait – patient lurches– patient lurches
on both sides during walkingon both sides during walking
5)High stepping gait5)High stepping gait – patient– patient
flexes foot and knee excessivelyflexes foot and knee excessively
to clear the groundto clear the ground
GAIT DEVIATIONSGAIT DEVIATIONS
6)Scissoring gait6)Scissoring gait –– one legone leg
crosses directly over the othercrosses directly over the other
with each stepwith each step
7)Calcaneus gait7)Calcaneus gait –walks on–walks on
broadened heel with tendency tobroadened heel with tendency to
external rotation and genuexternal rotation and genu
recurvatum. No calcaneal pick uprecurvatum. No calcaneal pick up
and push offand push off
GAIT DEVIATIONSGAIT DEVIATIONS
8)Stiff hip gait8)Stiff hip gait – no movements– no movements
at affected hip , excessat affected hip , excess
movements in spine & unaffectedmovements in spine & unaffected
hiphip
9)Stiff knee gait9)Stiff knee gait – no flexion at– no flexion at
knee, so pelvis raised duringknee, so pelvis raised during
swingswing
GAIT DEVIATIONSGAIT DEVIATIONS
10)Gluteus maximus gait10)Gluteus maximus gait ––
patient lurches backwards due topatient lurches backwards due to
weak gluteus maximusweak gluteus maximus
11)Gluteus medius gait11)Gluteus medius gait – like– like
trendelenburg gaittrendelenburg gait
GAIT DEVIATIONSGAIT DEVIATIONS
12)Quadriceps gait /12)Quadriceps gait / hand to kneehand to knee
gaitgait –– patient stabilizes hips &patient stabilizes hips &
knee for weight bearing byknee for weight bearing by
leaning on affected side &leaning on affected side &
pressing over lower thigh by hispressing over lower thigh by his
handhand
CONCLUSIONCONCLUSION
 Normal gait is designed by GodNormal gait is designed by God
Almighty to be efficient & all theAlmighty to be efficient & all the
priorities are met . In abnormalpriorities are met . In abnormal
gait these are lostgait these are lost
 Studying the human gait hasStudying the human gait has
enabled us to define , documentenabled us to define , document
& analyze normal and abnormal& analyze normal and abnormal
human gait more accuratelyhuman gait more accurately
THANK YOUTHANK YOU

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Gait analysis

  • 3. Diagnosis of gait DeviationsDiagnosis of gait Deviations  Awareness of the functionalAwareness of the functional limitationslimitations  Familiarity with normal functionFamiliarity with normal function  Trained eye or gait analysisTrained eye or gait analysis systemsystem  Use the information forUse the information for appropriate treatment regimenappropriate treatment regimen
  • 4. GAIT-DEFINITIONGAIT-DEFINITION  Word meaning is manner ofWord meaning is manner of walkingwalking  Highly controlled,coordinatedHighly controlled,coordinated and repetitive series of limband repetitive series of limb movements whose function ismovements whose function is to advance the body fromto advance the body from place to place with minimumplace to place with minimum expenditure of energyexpenditure of energy
  • 5. GAIT CYCLEGAIT CYCLE One gait cycle is the movementOne gait cycle is the movement of a single limb from heel strikeof a single limb from heel strike (initial contact ) to next heel(initial contact ) to next heel strikestrike
  • 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 initial contact of heel and ends with toecontact of heel and ends with toe offoff
  • 7. SUBDIVISIONS OF GAIT CYCLESUBDIVISIONS OF GAIT CYCLE  Initial contact occurs atInitial contact occurs at 0%0% andand 100%100% of gaitof gait cycle 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 phase 40%40% of gait cycleof gait cycle
  • 8. STANCE PHASESTANCE PHASE  Period when foot is on the groundPeriod when foot is on the ground  Sub divisionsSub divisions 1) initial contact1) initial contact 2) loading response2) loading response 3) mid stance3) mid stance 4) terminal stance and4) terminal stance and 5) pre swing5) pre swing
  • 9. INITIAL CONTACTINITIAL CONTACT  Occur atOccur at 0%0% of gait cycleof gait cycle  Principal objective of bodyPrincipal objective of body is to position the footis to position the foot correctly as it comes incorrectly as it comes in contact with the floorcontact with the floor  Body is about to beginBody is about to begin decelerationdeceleration
  • 10. LOADING RESPONSELOADING RESPONSE  OccupiesOccupies 0 to 10%0 to 10% of gait cycleof gait cycle  Maintain smooth progressionMaintain smooth progression while decelerating the body masswhile decelerating the body mass as it travels from its zenith atas it travels from its zenith at mid stance of opposite limbmid stance of opposite limb  Opposite limb toe off occurs atOpposite limb toe off occurs at end of loading response . So thisend of loading response . So this is a period of double limb supportis a period of double limb support
  • 11. MID STANCEMID STANCE  Utilize momentum to maintainUtilize momentum to maintain stability of the hip and kneestability of the hip and knee while advancing the body overwhile advancing the body over a stationary foota stationary foot  The centre of gravity hasThe centre of gravity has reached its zenith and forwardreached its zenith and forward velocity is minimumvelocity is minimum  Initial swing has begun onInitial swing has begun on opposite sideopposite side
  • 12. TERMINAL STANCETERMINAL STANCE  OccupiesOccupies 30 to 50% range30 to 50% range ofof gait cyclegait cycle  Provide acceleration & toProvide acceleration & to ensure an adequate stepensure an adequate step lengthlength  Acceleration is provided byAcceleration is provided by 1)forward fall of centre of1)forward fall of centre of mass of bodymass of body 2) concentric contraction of2) concentric contraction of triceps suraetriceps surae ConstitutesConstitutes 80 -85%80 -85% of totalof total energy generatedenergy generated
  • 13. PRE SWINGPRE SWING  OccupiesOccupies 50-60% range50-60% range of gait cycleof gait cycle  Period of double limbPeriod of double limb supportsupport  Goal is to prepare theGoal is to prepare the limb for swinglimb for swing  Initial contact ofInitial contact of opposite limb marksopposite limb marks beginning of pre swingbeginning of pre swing
  • 14. SWING PHASESWING PHASE  Limb is off the groundLimb is off the ground  Divided intoDivided into 1) initial swing1) initial swing 2) mid swing2) mid swing 3) terminal swing3) terminal swing
  • 15. INITIAL SWINGINITIAL SWING  OccupiesOccupies 60-70% range60-70% range of gait cycleof gait cycle  Critical function is toCritical function is to allow foot clearance &allow foot clearance & variable cadencevariable cadence  Varying cadenceVarying cadence requires CNS control &requires CNS control & precise timing of twoprecise timing of two joint musclesjoint muscles
  • 16. MID SWINGMID SWING  OccupiesOccupies 70 to 85% range70 to 85% range of gaitof gait cyclecycle  Critical function is to maintainCritical function is to maintain foot clearancefoot clearance
  • 17. MID SWING (contd)MID SWING (contd)  Foot clearance dependsFoot clearance depends on maintaining aon maintaining a relatively level pelvis,relatively level pelvis, sufficient hip flexion &sufficient hip flexion & adequate ankleadequate ankle dorsiflexiondorsiflexion  In normal gait footIn normal gait foot clearance is only 0.87cmclearance is only 0.87cm
  • 18. TERMINAL SWINGTERMINAL SWING  OccupiesOccupies 85-100%85-100% rangerange of gait cycleof gait cycle  Function is decelerationFunction is deceleration of shank & correct pre-of shank & correct pre- positioning of foot forpositioning of foot for contactcontact  Complete kneeComplete knee extension & neutralextension & neutral position of foot areposition of foot are critical for heel strikecritical for heel strike
  • 19. Linear measurements- ( cadenceLinear measurements- ( cadence or temporal parameters )or temporal parameters )  Step lengthStep length  Stride lengthStride length  Step timeStep time  CadenceCadence  Walking velocityWalking velocity
  • 20. KINEMATICSKINEMATICS  It denotes movements observedIt denotes movements observed and measured at the pelvis, hip,and measured at the pelvis, hip, knee, and ankle during stanceknee, and ankle during stance and swing phasesand swing phases  It can be observed in 3 planesIt can be observed in 3 planes sagittalsagittal coronalcoronal transversetransverse
  • 21. SAGITTAL PLANESAGITTAL PLANE The pelvis tilts approximatelyThe pelvis tilts approximately 1515 degreedegree
  • 22. SAGITTAL PLANESAGITTAL PLANE HIPHIP • StanceStance –flexed at–flexed at initial contactinitial contact then extends fullythen extends fully • SwingSwing – hip flexes– hip flexes rapidly to pull therapidly to pull the stance limb offstance limb off the groundthe ground
  • 23. SAGITTAL PLANESAGITTAL PLANE KNEEKNEE • StanceStance- At initial contact- At initial contact knee flexesknee flexes 1515 deg. It thendeg. It then extendsextends • SwingSwing – At heel rise knee– At heel rise knee begins to flex againbegins to flex again reaching maximum flexionreaching maximum flexion in early swing .Inin early swing .In remainder of swing kneeremainder of swing knee extends passivelyextends passively
  • 24. SAGITTAL PLANESAGITTAL PLANE ANKLEANKLE • StanceStance – neutral at initial– neutral at initial contact,then plantar flexescontact,then plantar flexes 5-10 deg as forefoot comes5-10 deg as forefoot comes to rest on the ground.-to rest on the ground.- FIRST ROCKERFIRST ROCKER • Ankle dorsiflexes throughoutAnkle dorsiflexes throughout mid stance as tibia movesmid stance as tibia moves forward over plantigradeforward over plantigrade foot –foot – SECOND ROCKERSECOND ROCKER
  • 25. SAGITTAL PLANESAGITTAL PLANE  ANKLEANKLE(CONTD)(CONTD)--during terminalduring terminal stance and pre swingstance and pre swing ankle plantar flexes andankle plantar flexes and heel rises to prepare forheel rises to prepare for push off-push off- THIRD ROCKERTHIRD ROCKER • SwingSwing – dorsiflexion to– dorsiflexion to neutral position seenneutral position seen
  • 26. CORONAL PLANECORONAL PLANE  PELVIS-each hemipelvisPELVIS-each hemipelvis rises slightly during swingrises slightly during swing phasephase  - stance phase hemipelvis- stance phase hemipelvis drops slightlydrops slightly  - accentuated pelvic drop in- accentuated pelvic drop in swing seen inswing seen in trendelenburg gaittrendelenburg gait
  • 27. CORONAL PLANECORONAL PLANE (CONTD)(CONTD)  HIP-HIP- StanceStance phasephase – slight adduction– slight adduction occursoccurs  -- SwingSwing – abduction– abduction seenseen
  • 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. NEUROLOGICAL CONTROL OFNEUROLOGICAL CONTROL OF GAITGAIT  Muscle actions programmed asMuscle actions programmed as involuntary reflex arcs in EPSinvoluntary reflex arcs in EPS  Golgi tendon ,muscle spindle &Golgi tendon ,muscle spindle & joint receptors producejoint receptors produce neurologic feedbackneurologic feedback  Voluntary modulation of gaitVoluntary modulation of gait made by interaction with motormade by interaction with motor cortexcortex  Cerebellum - balanceCerebellum - balance
  • 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. MUSCLE ACTIVITYMUSCLE ACTIVITY CONCENTRIC CONTRACTIONCONCENTRIC CONTRACTION  Muscle shortensMuscle shortens generating power andgenerating power and accelerationacceleration  Gastrocsoleus andGastrocsoleus and iliopsoas are the primaryiliopsoas are the primary accelerators of gaitaccelerators of gait  Concentric contraction ofConcentric contraction of these occur at terminalthese occur at terminal stancestance
  • 32. MUSCLE ACTIVITYMUSCLE ACTIVITY ECCENTRIC CONTRACTIONECCENTRIC CONTRACTION  Muscle lengthens despiteMuscle lengthens despite electrical contractionelectrical contraction  These slow down & stabilize jointThese slow down & stabilize joint motions during gaitmotions during gait  Eccentric contractionsEccentric contractions outnumber concentricoutnumber concentric contractions during gaitcontractions during gait
  • 33. ECCENTRIC CONTRACTIONECCENTRIC CONTRACTION  Eg:- tibialis anterior muscleEg:- tibialis anterior muscle contracts eccentrically atcontracts eccentrically at initial contact to slow downinitial contact to slow down plantar flexion of ankleplantar flexion of ankle  -gastrosoleus contracts-gastrosoleus contracts eccentrically during 2eccentrically during 2ndnd rocker to slow downrocker to slow down dorsiflexiondorsiflexion
  • 34. MUSCLE ACTIVITYMUSCLE ACTIVITY ISOMETRIC CONTRACTIONISOMETRIC CONTRACTION  No change in length of muscleNo change in length of muscle occursoccurs  Postural stabilisers like gluteusPostural stabilisers like gluteus medius work in this modemedius work in this mode  More muscle activity occurs inMore muscle activity occurs in stance phasestance phase  In swing momentum carries theIn swing momentum carries the leg forwardleg forward
  • 35. GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY Prerequisites ofPrerequisites of normalnormal ambulation areambulation are  Stability atStability at stancestance  Means ofMeans of progressionprogression  Conservation ofConservation of energyenergy
  • 36. GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY  Bipedal gait is inherentlyBipedal gait is inherently unstableunstable and inefficientand inefficient  Quadrupeds run faster thanQuadrupeds run faster than humans because vertebral andhumans because vertebral and trunk muscles act to augmenttrunk muscles act to augment stridestride
  • 37. GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY PROGREESSIONPROGREESSION • Forward fall of theForward fall of the centre of gravity ofcentre of gravity of body from its highbody from its high point at mid stancepoint at mid stance to its low point atto its low point at double supportdouble support • Now potentialNow potential energy is convertedenergy is converted to kinetic energyto kinetic energy
  • 38. GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY PROGRESSION (contd)PROGRESSION (contd)  To raise the CG back to zenithTo raise the CG back to zenith kinetic energy must be suppliedkinetic energy must be supplied  This is supplied by inertia ofThis is supplied by inertia of swinging limb which in turnswinging limb which in turn derives energy from plantarderives energy from plantar flexors and hip flexors of thatflexors and hip flexors of that limblimb
  • 39. GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY PROGRESSION (contd)PROGRESSION (contd)  In normal walkingIn normal walking 85%85% ofof energy comes from plantarenergy comes from plantar flexorsflexors  Energy expended in normalEnergy expended in normal walking iswalking is 2.5 Kcal/min2.5 Kcal/min  This is less than twice the energyThis is less than twice the energy spent while standing stillspent while standing still --1.5Kcal/min1.5Kcal/min
  • 40. GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY ENERGY CONSERVATIONENERGY CONSERVATION Energy 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 energy between segmentsbetween segments
  • 41. GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY ENERGY CONSERVATIONENERGY CONSERVATION  Movement of a wheel is highlyMovement of a wheel is highly efficient 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 combined with coordinated knee and anklewith coordinated knee and ankle motion the vertical and horizontalmotion the vertical and horizontal excursion are reduced toexcursion are reduced to 4.4cm4.4cm
  • 42. GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY ENERGY CONSERVATIONENERGY CONSERVATION CONTROLLING MOMENTUMCONTROLLING MOMENTUM *This conserves energy*This conserves energy eg:-by maintaining theeg:-by maintaining the ground reaction force in frontground reaction force in front of the knee during the lastof the knee during the last half of stance , an extensionhalf of stance , an extension movement occurs whichmovement occurs which allows it to remain stableallows it to remain stable
  • 43. GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY ENERGY CONSERVATIONENERGY CONSERVATION ACTIVE OR PASSIVE TRANSFER OF ENERGYACTIVE OR PASSIVE TRANSFER OF ENERGY • Passive flow of energy across jointsPassive flow of energy across joints accounts for most of the energyaccounts for most of the energy changes occuring at the distalchanges occuring at the distal segments during initiation andsegments during initiation and termination of swingtermination of swing • In active transfer two joint musclesIn active transfer two joint muscles play a major roleplay a major role
  • 44. GAIT ENERGY AND EFFICIENCYGAIT ENERGY AND EFFICIENCY  Interference with these mechanismsInterference with these mechanisms increase energy consumptionincrease energy consumption  Eg:-fast walking –Eg:-fast walking – 60% inc60% inc BK 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. DEVELOPMENT OF GAIT INDEVELOPMENT OF GAIT IN CHILDRENCHILDREN  Toddlers walk with a wide basedToddlers walk with a wide based gait, increased flexion of hip andgait, increased flexion of hip and knees & arms held out to theknees & arms held out to the sidessides  At 5 yrs child has developed aAt 5 yrs child has developed a stable velocity patternstable velocity pattern  Adult gait pattern is attained byAdult gait pattern is attained by 7 yrs7 yrs
  • 46. GAIT ANALYSISGAIT ANALYSIS  Systematic descriptionSystematic description and assessment of qualities thatand assessment of qualities that characterize human locomotioncharacterize human locomotion  Mainly used in pre operativeMainly used in pre operative planning and documentation ofplanning and documentation of post operative outcome inpost operative outcome in patients with cerebral palsypatients with cerebral palsy
  • 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. GAIT DEVIATIONSGAIT DEVIATIONS 1)antalgic gait1)antalgic gait - dec stance phase- dec stance phase avoiding wt. Bearing on involved limbavoiding wt. Bearing on involved limb 2)Short limb gait2)Short limb gait – dipping of shoulder– dipping of shoulder and pelvis on affected side & incand pelvis on affected side & inc flexion of hip , knee and ankle offlexion of hip , knee and ankle of opposite limb.opposite limb. 3)Trendelenburg gait3)Trendelenburg gait –patient lurches–patient lurches on affected side & pelvis drops on oppon affected side & pelvis drops on opp sideside
  • 49. Goddess trying to avoid Short lomb gait
  • 50. GAIT DEVIATIONSGAIT DEVIATIONS 4)Waddling gait4)Waddling gait – patient lurches– patient lurches on both sides during walkingon both sides during walking 5)High stepping gait5)High stepping gait – patient– patient flexes foot and knee excessivelyflexes foot and knee excessively to clear the groundto clear the ground
  • 51. GAIT DEVIATIONSGAIT DEVIATIONS 6)Scissoring gait6)Scissoring gait –– one legone leg crosses directly over the othercrosses directly over the other with each stepwith each step 7)Calcaneus gait7)Calcaneus gait –walks on–walks on broadened heel with tendency tobroadened heel with tendency to external rotation and genuexternal rotation and genu recurvatum. No calcaneal pick uprecurvatum. No calcaneal pick up and push offand push off
  • 52. GAIT DEVIATIONSGAIT DEVIATIONS 8)Stiff hip gait8)Stiff hip gait – no movements– no movements at affected hip , excessat affected hip , excess movements in spine & unaffectedmovements in spine & unaffected hiphip 9)Stiff knee gait9)Stiff knee gait – no flexion at– no flexion at knee, so pelvis raised duringknee, so pelvis raised during swingswing
  • 53. GAIT DEVIATIONSGAIT DEVIATIONS 10)Gluteus maximus gait10)Gluteus maximus gait –– patient lurches backwards due topatient lurches backwards due to weak gluteus maximusweak gluteus maximus 11)Gluteus medius gait11)Gluteus medius gait – like– like trendelenburg gaittrendelenburg gait
  • 54. GAIT DEVIATIONSGAIT DEVIATIONS 12)Quadriceps gait /12)Quadriceps gait / hand to kneehand to knee gaitgait –– patient stabilizes hips &patient stabilizes hips & knee for weight bearing byknee for weight bearing by leaning on affected side &leaning on affected side & pressing over lower thigh by hispressing over lower thigh by his handhand
  • 55. CONCLUSIONCONCLUSION  Normal gait is designed by GodNormal gait is designed by God Almighty to be efficient & all theAlmighty to be efficient & all the priorities are met . In abnormalpriorities are met . In abnormal gait these are lostgait these are lost  Studying the human gait hasStudying the human gait has enabled us to define , documentenabled us to define , document & analyze normal and abnormal& analyze normal and abnormal human gait more accuratelyhuman gait more accurately