15- Normal and Abnormal Gait

Normal GaitNormal GaitHeikki Uustal, MDHeikki Uustal, MD

Medical Director, Prosthetic/Orthotic TeamMedical Director, Prosthetic/Orthotic TeamJFKJFK--Johnson Rehab InstituteJohnson Rehab Institute

Edison, NJEdison, NJ

Critical Gait ParametersCritical Gait Parameters

Average walking speed = 2Average walking speed = 2--3 mph (603 mph (60--80m/min)80m/min)Average cadence = 80Average cadence = 80--110 steps/min110 steps/minAverage step length = 60 cmAverage step length = 60 cmStance/swing = 60/40Stance/swing = 60/40Single/double limb support = 80/20Single/double limb support = 80/20Running has no double limb supportRunning has no double limb support

Step or Stride?Step or Stride?

Phases of the Gait CyclePhases of the Gait CycleStance Phase Stance Phase –– 60%60%Swing Phase Swing Phase –– 40%40%

Single Limb Support Single Limb Support –– 80% 80% Double Limb Support Double Limb Support –– 20%20%

Phases of the Gait CyclePhases of the Gait Cycle

Comparison of Right Leg to Left Comparison of Right Leg to Left Leg PhasesLeg Phases

Subdivisions of the Gait CycleSubdivisions of the Gait Cycle

Rockers or Pivot Points in Rockers or Pivot Points in StanceStance

Joint Positions and MovementsJoint Positions and MovementsToo Complex?Too Complex?

Methods of Analyzing GaitMethods of Analyzing Gait

KinematicsKinematics is the method of is the method of observing or measuring the position observing or measuring the position of joints and segments through each of joints and segments through each phase of gait (visual gait analysis)phase of gait (visual gait analysis)KineticsKinetics is the method of measuring is the method of measuring the Ground Reaction Force at each the Ground Reaction Force at each joint and then calculating the muscle joint and then calculating the muscle activity or soft tissue resistance activity or soft tissue resistance present to stabilize the jointpresent to stabilize the joint

Planes of Planes of ReferenceReference

Kinetics of Stance PhaseKinetics of Stance Phase

Gait Analysis Basic TrainingGait Analysis Basic Training

Assess only one joint at a timeAssess only one joint at a timeLook at early stance, late stance, Look at early stance, late stance, then swingthen swingSeparate kinetics from kinematicsSeparate kinetics from kinematicsKEEP IT SIMPLE!KEEP IT SIMPLE!

KinematicsKinematics of the Ankle from of the Ankle from Initial Contact to MidstanceInitial Contact to Midstance

KineticsKinetics of the Ankle from of the Ankle from Initial Contact to MidstanceInitial Contact to Midstance

Muscle Activity of the Muscle Activity of the Dorsiflexors and PlantarflexorsDorsiflexors and Plantarflexors

KinematicsKinematics of the Knee from of the Knee from Initial Contact to MidstanceInitial Contact to Midstance

KineticsKinetics of the Knee from of the Knee from Initial Contact to MidstanceInitial Contact to Midstance

Activity of the Quads in Early Activity of the Quads in Early StanceStance

KinematicsKinematics of the Hip from of the Hip from Initial Contact to MidstanceInitial Contact to Midstance

KineticsKinetics of the Hip from Initial of the Hip from Initial Contact to MidstanceContact to Midstance

Muscle Activity of the Hip Muscle Activity of the Hip ExtensorsExtensors

KinematicsKinematics of the Ankle from of the Ankle from Midstance to PreMidstance to Pre--swingswing

KineticsKinetics of the Ankle from of the Ankle from Midstance to PreMidstance to Pre--swingswing

Muscle Activity of the Muscle Activity of the Plantarflexors in Late StancePlantarflexors in Late Stance

KinematicKinematics of the Knee from s of the Knee from Midstance to PreMidstance to Pre--swingswing

KineticsKinetics of the Knee from of the Knee from Midstance to PreMidstance to Pre--swingswing

KinematicsKinematics of the Hip from of the Hip from Midstance to PreMidstance to Pre--swingswing

KineticsKinetics of the Hip from of the Hip from Midstance to PreMidstance to Pre--swingswing

KinematicsKinematics of the Hip, Knee, of the Hip, Knee, and Ankle in Swing Phaseand Ankle in Swing Phase

KineticsKinetics of the of the Hip in Hip in

Midstance Midstance Frontal PlaneFrontal Plane

Muscle Activity of the Hip Muscle Activity of the Hip Abductors in StanceAbductors in Stance

Hip Abductor ActivityHip Abductor Activity

Activity of All Major MusclesActivity of All Major Muscles

Activity of All Major MusclesActivity of All Major Muscles

Determinants of GaitDeterminants of GaitStick Figure Model Stick Figure Model

1.Pelvic Rotation1.Pelvic RotationLengthens Limb at IC and PSLengthens Limb at IC and PS

2.Pelvic Tilt2.Pelvic TiltShortens Limb at MSShortens Limb at MS

3.Knee Flexion in Stance3.Knee Flexion in StanceShortens Limb at MSShortens Limb at MS

4&5.Foot and Ankle Motion4&5.Foot and Ankle MotionLengthens and Shortens LimbLengthens and Shortens Limb

Effect of Ankle Motion on the Effect of Ankle Motion on the KneeKnee

Smoothing the COG MotionSmoothing the COG Motion

Muscles Muscles of the of the AnkleAnkle

Vertical Displacement of the Hip Vertical Displacement of the Hip JointsJoints

Sinusoidal Motion of the COGSinusoidal Motion of the COG

6.Narrow Base of Support6.Narrow Base of Supportto Minimize Horizontal Motionto Minimize Horizontal Motion

3D Displacement of COG3D Displacement of COG

Effect of Increased Speed on Effect of Increased Speed on Gait ParametersGait Parameters

Effect of Incline on EnergyEffect of Incline on Energy

Effect of Ankle Effect of Ankle Immobilization Immobilization

on Gaiton Gait

Effect of Knee ImmobilizationEffect of Knee Immobilization

Up and Down StairsUp and Down Stairs

Center of Center of Gravity Gravity

LineLine

Base of SupportBase of Support

Base of SupportBase of Support

Thank YouThank You