GAIT ANALYSIS

L.S.Angliadi
Department of Physical Medicine and
Rehabilitation Faculty of Medicine
University of Sam Ratulangi Manado
OBJECTIVES
After readIng this lecture you should have an understanding of the
following :
1. The gait cycle , and the features of an efficient gait ;
2, Gait measurement techniques, including observational analysis,
footfall measurements, kinematics,kinetic and electromyography
3. The effect of gait on energy consumption, and ways of calculating
energy expenditure.
4. Maturational changes in gait ;
5. The impact of musculoskeletal impairments on gait, and how to
distinguish between the primary impairment and secondary
copying mechanisms ;
6. The different walking aids and gait patterns used with walking aids;
7. Gait re-education.

BACKGROUND
During the last twenty years that the science of gait analysis has been
more widely applied in the clinical setting.
Gait analysis is reported to have begun in 1872 when Muybridge
developed the technique using a series of stationary cameras to study
the Governor of Californias horse running at full speed.
Since then there have been many developments in gait analysis
technology, not least due to the exploision in the capabilities of
computer hardware and user-friendly software.
Pioneering work by Vern Inman,David Sutherland, Jacquelin Perry and
James Gage in the USA has stimulated interest in clinical gait
in the UK .
Three-dimensional (3D) gait analysis has radically changed the
treatment for some neuromuscular diseases, yet gait analysis assesment
are still not commonly carried out on patient with walking difficulties.
Understanding of normal gait provides the back ground for assesing
pathological gait and the succesful planning of treatment goals.
THE SUBDIVISIONS OF THE GAIT
CYCLE

THE BASIC PARAMETER S OF NORMAL
GAIT
The walking pattern is studied with reference to gait cycle , which
begins when one foot makes contact with the floor and ends when
the same foot contacts the floor again.
The Gait Cycle is devided into a period of stance (ground contact)
and a period of swing (no ground contact).
The Stance phase consists of two periods of double support when
both feet make ground contact, plus a period of single support when
only one foot is on the ground.
In each gait cycle there are two periods of double support and two
periods of single support.
The complete stance phase usually lasts about 60% of the gait
cycle(40% single support phase plus two periods of 10% double
support), and the swing phase 40% of gait cycle.
The use of the functional phases of the gait cycle helps identify the
integration of movements occuring at individual joints and gives a
totallity of function of the limb.
THE BASIC PARAMETER S OF NORMAL
GAIT
The gait cycle is now described in periods of stance and swing.
The stance period is further broken down into tasks of weight
acceptance and single limb support, with the swing period task
comprising limb advencement.



Periods

Taks


Phases
Stride
(gait cycle)
Stride
(gait cycle)
Stance
Swing
Weight
acceptence
Single limb support Limb advancement
Initial contact
Loading
Response
Mid-stance
Terminal
stance
Pre-swing Initial swing Mid-swing
Terminal
swing
STANCE PHASE
WEIGHT ACCEPTANCE INITIAL CONTACT AND LOADING
RESPONSE
Initial contact commences the moment the foot touches the floor
(0-2% of gait cycle) and the loading response corresponds to the
first period of double support ( 2-10% )
Loading response finishes as the contralateral limb is lifted for for the
swing phase.
At initial contact the ankle is in minimal dorsiflexion. The heel is used
as the first rocker to lower the foot to the floor, the ankle moves into
plantarflexion and forward momentum of the body is maintained.
The hip is in approximately 30
o
flexion . The knee have 7 flexion at
initial contact, the knee flexes further to 20 during weight acceptance.
In the frontal plane about 5 of adduction occurs and in the transverse
plane the knee internally rotates at heel strike.
At the hip in the frontal plane transfer of the body weight to the single
limb requires lateral stabilizing of the pelvis, the abductors contracting
stabilize the pelvis and trunk.
STANCE PHASE
SINGLE LIMB SUPPORT : MID-STANCE ,TERMINAL STANCE AND PRE
SWING
Mid Stance (10-30%) : commences as the contralateral foot is liftted.
The body starts to advance over the stationary foot and therefore the ankle
dorsiflexes to maintain momentum ( the second rocker).
Soleus acts eccentrically to control the rate of dorsiflexion. The knee extends
to 3 flexion through the mid-stance phase and hip motion is towards extension.
The bodys centre of mass now reaches its maximum vertical height. The
lateral displacement of the pelvis is also st its maximum , about 25 mm from its
central position. Trunk rotation is neutral over the pelvis. As the stance phase
progresses, the tibia externally rotate , and the subtalar joint causes the
midfoot to pronate.

Terminal stance phase (30-50%): commences with heel rise(third rockeraction)
and continues until the contralateral limb makes ground contact. The need for
abductor power now disminishes,as the lateral displacement over the single
support limb reduces. The bodys centre of mass now passes ahead of the
forefoot and the foot progresses with the body causing further heel rise. As the
heel rises it invert s and the foot then supinates. Maximum hip extensions
occurs and the knee joint commences rapid flexion.

SWING PHASE
Pre Swing (50-60%) corresponds to the second period of double support and
final phase of the stance phase. It is a phase when the limb prepares for the
rest of the swing phase. It commences with ground contact by the
contralateral limb and ends with toe - off of the ipsilateral limb
Initial Swing (60-75%) commences at toe-off and finishes as the advancing
limb is level with the stance limb. The swing limb is unloaded and lifted from
the ground,acting as compound pendulum. The ankle moves into
dorsiflexion to facilitate foot clearance and the knee joint continues to flex
rapidly,reaching a maximum of 60
o
flexion. Continuation of hip flexion
assists the limb in progressing forwards
Mid-Swing(73-87%) starts when the swing limb is opposite the stance limb
and finishes when the swing limb is forward of the stance limb and the tibia
vertical. The ankle remain dorsiflexred and the hip in flexion to ensure foot
clearance ; the knee flexion reduces to 30
o .

Terminal Swing (87-100%) completes the gait cycle. The thigh advancement
is curtailed,while the knee continues to extend,reaching maximal extension of
0-5
o.
The ankle reduces the amount of dorsiflexion and may even go into then
poised for initial ground contact again.

Spatial and Temporal Gait
Parameters
Spatial parameters are a spatial measure (meter) of foot contact during the
gait cycle.
Spatial and Temporal Gait
Parameters
Stride length is the distance between two successive foot
placements. Footwear and a persons height have a direct
influence on stride length.
Step length is the distance by which one foot moves in front of
the other foot.
Stride width is the perpendicular distance between the
midpoints of the heel for consecutive steps.
Angle of foot progression is the angle between a reference
line along the midline of the foot and the direction of
progression.
Spatial and Temporal Gait
Parameters
CADENCE is the number of steps in a given time, i.e. steps per
minute.
VELOCITY is step length x cadence , or Stride length / 2 x
Cadence, measured in distance travelled per unit time, usually
meters per minute.
Key Points
- A gait cycle consists of a period of stance (60%) and swing
(40%)
- Stance phase is a further subdivided into two periods of double
support ( 2 x10%) and one period of single support (40%)
- Proportion of time spent in each phase varies with velocity.
- Velocity alters joint range.
- Foot wear influences stride length.
- Gait does not require full joint range or full muscle power.



Gait in The Elderly People
Murray et al ( 1969): Kinematic gait patterns in
elderly men.
Finley et al ( 1969) : in Elderly women.
Most study agree that the elderly have :
A shorter step and stride length.
A broader walking base.
Reduced swing phase &
A slower cadence.