Movement Analysis of ADL:

From Rolling to Sitting to Standing to Walking

Movement Analysis:
An Introduction
Movement Analysis of ADL: Movement Analysis 1:
From Rolling to Sitting to Standing to Walking Rolling over in bed

Movement Analysis 2:
Sitting up from bed
Dr. Goh Ah-Cheng, PhD
Associate Professor, School of Health Sciences, Shinshu University, JAPAN
Adjunct Associate Professor, School of Physiotherapy, Curtin University, AUSTRALIA Movement Analysis 3:
Founding President, International Society for Electrophysical Agents in Physical Therapy Standing up from chair

Movement Analysis 4:
Walking

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Movement Analysis: Movement Analysis:

An Introduction An Introduction

In order to fully appreciate and understand motion

analysis of patients with movement dysfunction, it is
first necessary to understand the normal movement
1. Observational Motion Analysis
pattern in various activities of daily living, such as:
2. Instrumented Motion Analysis

Rolling over 3. Clinical Motion Analysis

Sitting up
Standing up
Walking

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 Movement Analysis: Movement Analysis:
An Introduction An Introduction

1. Observational Motion Analysis 1. Observational Motion Analysis

D. Identify the “essential components” and compare it with

the patient’s movement
A. Direct observation of subject’s movement by therapist
“Essential components” are
B. Observation is carried out in a systematic manner,
either from head down to the foot, or from foot up to
the parts of the movement
the head. which are absolutely
necessary for the execution
C. Do not interfere with the subject’s movement. and completion of the
D. Identify the “essential components” and compare it with
movement.
the patient’s movement

E. Identify the difference between the movement Without these essential

performed by a normal subject and the patient components, the execution of
the movement is not possible.

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Movement Analysis: Movement Analysis:

An Introduction An Introduction

2. Instrumented Motion Analysis 2. Instrumented Motion Analysis

5.4m
6.5m

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 Movement Analysis: Movement Analysis:
An Introduction An Introduction

3. Clinical Motion Analysis 3. Clinical Motion Analysis

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Movement Analysis 1: Movement Analysis 1:

Rolling over in bed Rolling over in bed

What are the “essential components”?

Essential components (Top Down) for rolling over to left side:

1. Rotation of the head to the LEFT side

2. Flexion and protraction of RIGHT shoulder
3. Flexion and protraction of RIGHT hip and pelvis
4. Flexion of RIGHT knee
5. Plantarflexion of RIGHT foot (slight push off)
What are the “essential components”?

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 Movement Analysis 2: Movement Analysis 2:
Sitting up from bed Sitting up from bed

What are the “essential components”?

Essential components for sitting from left side lying:

1. RIGHT lateral flexion of head

2. RIGHT side flexion of the trunk
3. Flexion of hips
4. Dropping of both lower legs over the edge of the
What are the “essential components”? bed (to provide a swinging momentum)
5. Push off with left arm.

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Movement Analysis 3: Movement Analysis 3:

Standing up from chair Standing up from chair

What are the “essential components”?

Essential components for standing up from chair:

1. Placement of foot backwards (not shown in video)

2. Flexion of trunk to bring CoG forwards over base of support
3. Lifting of buttocks from chair and simultaneous
forward movement of knees (dorsiflexion of ankles)
What are the “essential components”? 4. Simultaneous extension of knees, hips and trunk

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 Movement Analysis: Movement Analysis 4:
Reaching for glass of water Walking

Stride

Stance Swing

Weight Single Limb Limb

Acceptance Support Advancemen

What are the “essential components”? Initial

Contact
Loading
Respons
Mid
Stance
Terminal
Stance Pre Swing Initial
Swing
Mid
Swing
Terminal
Swing

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Movement Analysis 4: Movement Analysis 4:

Walking Walking

Weight Single Limb

Acceptance Support

Initial Loading Mid Terminal

Contact Respons Stance Stance Pre Swing

Weight acceptance is the most demanding task in the gait cycle.
It involves the following:
1. the transfer of body weight onto a limb that has just
finished swinging forward and has an unstable alignment.
2. shock absorption, and
3. the maintenance of a forward progression
The next task of the gait cycle is single limb support.
This involves:
1. one limb supporting the entire body weight
2. ability to provide trunk stability while progression
of the body forward is continued

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 Movement Analysis 4: Movement Analysis 4:
Walking Walking
Limb
Advancemen

Initial Mid Terminal

Swing Swing Swing

The final task of the gait cycle is limb advancement.

This involves:
1. foot clearance from the floor
2. the limb swings through 3 positions as it moves in
front of the body.
What are the “essential components”?

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Movement Analysis 4: Movement Analysis 4:

Walking Walking
Speed
What are the “essential components”? changes
Pathological Normal Muscle EMG
Gait Gait Action
Adaptation
Joint Forces Joint Amplification
Moment

Body Segment Free Body Kinetics Action

Parameters Diagrams Potential

Position Kinematics Ground

Reaction Force

Angle Stride Weight Center of

measures Mass

Angular Force Mass

velocity

Inertia
Acceleration (Newton’s Law)

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 Movement Analysis 4: Movement Analysis 4:
Walking Walking

Position Kinematics Stride Position Kinematics Angular

measures velocity
Angle Angle Stride
measures

Angular Step Length

velocity Velocity = Distance / Time
Velocity is about 1.5 m/s or 5 km/hr in normal adults.
Acceleration Acceleration

Cadence = number of steps / minute

Stride Length Cadence is about 11- steps/min in normal adults

Velocity = Stride length X cadence / 120

Therefore, stride length = 120 X velocity / cadence

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Movement Analysis 4: Movement Analysis 4:

Walking Walking

Position Kinematics Angle Position Kinematics Angle

Stride Stride
measures measures

Angular Angular
velocity velocity

Acceleration Acceleration

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 Movement Analysis 4: Movement Analysis 4:
Walking Walking

Ground Reaction Force Ground Reaction Force

Kinetics Kinetics

Center of Center of Force Plate

Weight Mass Weight Mass

Force Mass Force Mass

Inertia Inertia
(Newton’s Law) (Newton’s Law)
Inverse
Dynamics

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Movement Analysis 4: Movement Analysis 4:

Walking Walking

Ground Reaction Force Ground Reaction Force

Kinetics Kinetics

Weight Center of Weight Center of

Mass Mass

Force Mass Force Mass

Inertia Inertia
(Newton’s Law) (Newton’s Law)

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 Movement Analysis 4: Movement Analysis 4:
Walking Walking

Joint Moment
Kinetics

Normal
Gait
Angle

Weight Center of Joint Forces

Mass Joint
Moment
Free Body
Force Mass Diagrams

Inertia
(Newton’s Law)
Ground
Reaction Force

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Movement Analysis 4: Movement Analysis 4:

Walking Walking

Muscle Action Muscle Action

The two basic muscle functions to be performed

during gait are:
EMG EMG
Stance - body is maintained upright by anti-

Amplification Amplification
gravity muscles
Swing - leg swings forward, in front of the rest
Action Action
Potential Potential of the body

Simulation of muscle action during normal gait.

RED represents eccentric contraction;
and GREEN represents concentric contraction

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 Movement Analysis 4: Movement Analysis 4:
Walking Walking

Muscle Action Muscle Action

Stride
Stride

Stance
Stance Swing
EMG

Weight Single Limb

Weight Single Limb Limb Acceptance Support
Amplification Acceptance Support Advancement
Closed Kinetic
Action Closed Kinetic Open Kinetic
Potential Chain
Chain Chain

Stance: Anti-gravity muscles are

Hip extensors (gluteus maximus, hamstrings)
Knee extensors (quadriceps femoris)
Ankle plantarfelxors (gastrocnemius, soleus)

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Movement Analysis 4: Movement Analysis 4:

Walking Walking

Muscle Action Speed Pathological Gait

changes
Stride
Adaptation In humans, there is more than one group of
Swing muscles responsible for propulsion.
As a result, it is possible to compensate for
Limb a defect.
Advancement
For example, when walking across slippery
Open Kinetic ice, there is a transfer from pushing against
Chain
the ground to lifting the leg up.
Swing: Limb advancement
The leg is made to swing forward at the end of
stance by two mechanisms: push-off and pull-off
The ankle plantar flexors push the leg forwards,
while the hip flexors (iliopsoas) pull it forward.

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 Movement Analysis 4: Movement Analysis 4:
Walking Walking

Pathological
Speed changes Speed Adaptation
Gait changes
Adaptation Pathological
Velocity = Stride length X cadence / 120 Gait In most gait pathologies, the patient
will attempt to compensate.
Although locomotion is still possible using Deciding what is a primary
alternative muscle groups, stride length and abnormality and what is secondary
velocity are often reduced as a result. compensation can be quite difficult.
Gait velocity is very sensitive to pathology and
should be measured frequently during
rehabilitation to chart progress.
Patients tend to compensate for a short stride
length by increasing cadence, so calculating the
stride length is even more useful.

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Movement Analysis 4: Movement Analysis 4:

Walking Walking
Speed
changes
Pathological Adaptation Speed
Gait changes
Pathological Gait
Adaptation
Problem Causes Compensations
Inadequate Leg length discrepancy Circumduction
foot clearance Inadequate knee flexion during swing Vaulting
from floor phase Hip-hiking
Plantarflexion deformity 1 Rachos Los Amigos OGA
Secondary to pelvis tilt (Trendelenburg)
Decreased Weak push off / pull off Excess hip
step length Excess hamstring activity during flexion during 2 10 points to observe in OGA
terminal swing initial contact
Pain (antalgic gait) Forward trunk
inclination
3 10 points to observe in
Short stance Hemiplegia
phase
Balance Cerebellar ataxia Wide based
problems Vestibular problems gait

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 Movement Analysis 4: Movement Analysis 4:
Walking Walking

Pathological Gait 1 Rachos Los Amigos OGA Pathological Gait 1 Rachos Los Amigos OGA

STEP 1 Problem Identification

STEP 2 Cause Identification

STEP 3 Treatment

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Movement Analysis 4: Movement Analysis 4:

Walking Walking

Pathological Gait 1 Rachos Los Amigos OGA Pathological Gait 1 Rachos Los Amigos OGA

STEP 1 Problem Identification STEP 2 Cause Identification

Identify deviation
Determine significant
Possible causes such as:
deviations (i.e. interferes with Motor control problems
critical events from occurring) ROM limitations
Sensory (proprioceptive) deficits
Pain
Leg length discrepancy
Balance deficits

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 Movement Analysis 4: Movement Analysis 4:
Walking Walking

Pathological Gait 1 Rachos Los Amigos OGA Pathological Gait 2 10 points to observe in OGA

STEP 3 Treatment

Direct the treatment to the cause

Assess the effectiveness of the treatment STEP 1 Problem Identification

STEP 2 Cause Identification

STEP 3 Treatment

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STEP 1 Problem Identification STEP 2 Cause Identification STEP 3 Treatment Movement Analysis 4:
Walking
Point 1 Step / Stride length Inadequate push-off / pull-off, pain
10 points to observe in
Pathological Gait 3 Hemiplegia
Point 2 Ankle angle at contact 1. Equinus deformity, 2. Drop foot

Plantarflexion contracture, or
Point 3 Ankle angle at toe-off
gastrocnemius tightness due to a muscle

Knee flexion contracture, or hamstrings

Point 4 Knee angle at contact
tightness due to a muscle sprain

Amount of stance phase knee STEP 1 Problem Identification

Point 5 Quadriceps weakness
flexion

Amount of swing phase knee 1. Hypermobile knee, 2. Knee STEP 2 Cause Identification
Point 6
flexion contracture

Hip extension in terminal STEP 3 Treatment

Point 7 Hip flexion contracture
stance

Point 8 Trunk angle (forward flexed ?) Compensation for short stride length

Point 9 Trendelenberg Sign Hip abductor muscle weakness

Angle of patella, feet, arm

Point 10 Problems with joint alignment
posture

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STEP 1 Problem Identification STEP 1 Observed Deviation

Point 1 Step / Stride length Decreased step length

Point 2 Ankle angle at contact Decreased dorsiflexion in swing

Decreased ankle plantarflexion at toe

Point 3 Ankle angle at toe-off
off

Decreased knee extension prior to

Point 4 Knee angle at contact
heel strike

Amount of stance phase knee Decreased knee flexion (or knee Increased knee flexion in
Point 5
flexion hyperextension) in stance stance

Amount of swing phase knee Decreased peak knee flexion in early

Point 6
flexion swing

Hip extension in terminal Decreased peak hip extension in late

Point 7
stance stance

Decreased peak hip flexion in swing

Point 8 Trunk angle (forward flexed ?)
phase

Decreased peak lateral pelvic Increased lateral pelvic

Point 9 Trendelenberg Sign displacement in stance
displacement in stance

Angle of patella, feet, arm

Point 10 Nil
posture

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