Gait: Development & Analysis

Dr.Zakir UK
DPT, MSPT MSK , KMU
 Gait: Development & Analysis
 Development of Gait
• First and last question from family members
• Important element of growth and development
• Ultimate goal of therapeutic intervention
 Important factors affecting gait development
1. Neurological factors
2. Biomechanical factors
3. Determinants of walking
4. Refinement of gait by age
 1-Neurological Factors
 Intact Neurological system
• Adequate motor control and central system
maturation
• Prenatal: Neural foundation is present
• Postnatal: 3-10 months neural maturation
and myelination ( important for locomotion)
• Information processing capabilities of CNS
also play an important role for locomotion
 2-Biomechanical Factors
 Application of mechanical factors to
biological systems
 ROM
 Strength
 Appropriate bone structure and composition
 Optimal body growth is pre-requisite for
locomotion( Can constraint early locomotion
and stepping reflex (fatter child)
 Determinants of walking
Mature (3 year) Vs. Immature Walk (2.5)
5 important determinants of mature gait
a. Duration of single-limb stance (Shows stability and control)
b. Waking velocity( 1 year-64cm/s, 3 year-86, 7 year 144)
c. Cadence ( 1 year-176, 3-year-154, 7-year-144)
d. Step length (1 year-22cm, 3 year-33cm, 7 year-48)
e. The ratio of pelvic span to ankle spread (rises
rapidly until the age of 2.5 then least increase)
 Refinement of Gait by Age
A. Birth to age 9 months
 Body growth ( more fat contents than muscle mass)
Bigger & fatter Vs. smaller peers
 HIP: flexion contracture, external rotation, abduction,
femoral anteversion, femoral antetorsion.
 Knee: Genu varum
 Ankle: heel everted (medial inclination of talotibial jt.)
 Muscle strength: increases in hip extensors, hip
flexors, abductors
 Coordination of visual, proprioceptive/vestibular syst.
Genu varum, femoral
anteversion/torsion
 Refinement of Gait by Age Cont..
Age 9 to 15 months
o Center of mass closer to head and trunk
o body fat to muscle mass still large- weakness
o Abdominals, hip flexors, knee extensors, ankle dorsiflexors
work aganist gravity
o Base of support is wide ( side to side stability is better than
anteroposterior stability)
o Pattern of walk ( adult walker on a slippery floor)
o Frequent falls because hip strength is inadequate to control
the gravitational forces
o More intra limb kicking practice, more refined walk
o Significant Co-contraction across antagonist muscle group
 Refinement of Gait by Age Cont..
o Age 18 to 24 months
o Varus angulation is resolved and limb is straight
o Hip abduction is normal ( base of support decreases)
o Antero-posterior stability and movement increases
o Center of mass descends(efficiency of walk improves)
o Heel strike develops at the age of 24 months
o More refined motor control and muscle strength ( head
and trunk oscillation decreases)
o Single leg stance is more stable
o Co-contraction across antagonist decreases
o Role of walking experience??? 9000steps/day
 Refinement of Gait by Age Cont..
Age 3 to 3.5 years
o Maximum physiologic
valgus alignment
o Center of mass closer to
extremities but still high
o Decrease in heel eversion
o Heel strike with knee
flexion is still present
o Balance mechanism is more
refined but still immature
pattern ( Experienced
walker)
 Refinement of Gait by Age Cont..

 Age 6 to 7 years
 Child has a fully mature walk
 balance and posture mechanism are more advanced
after perturbation/disequilibrium
 Center of mass still high at the level of 3rd Lumber
vertebrae
 Femoral antetorsion partially resolved
 tibiofemoral alignment is neutral
 Heel position is neutral
 Components of Typical Gait
(Mature walking)
 Gait cycle: single stride
o Stance Phase: 60% of gait cycle
o Swing phase: 40 % of gait cycle
 Stance Phase: consists of 5 sub-phases
 Initial Contact: 0-2% of the cycle
 Loading response: 0-10% of the cycle
 Mid-stance: 10-30% of the cycle
 Terminal Stance: 30-50% of the cycle
 Pre-swing :( 50-60% of the cycle)
 Two periods of double support ( loading response,
pre-swing)
Components of Typical Gait Cont…

 Swing Phase: 3 sub-phases

 Initial Swing: 60-73% of
the cycle
 Mid swing: 73-87% of
the cycle
 Terminal swing: 87% to
100% of the cycle
Some common terms used to measure
the Typical Gait Patterns
o Cadence: steps/minute
o Step length vs. stride length
o Concentric Vs. eccentric muscle contraction
o External Load: Ground reaction forces, inertial
forces, gravitational forces that affect motion
o Joint movement: External vs. internal load
o Kinematics: parameters used to describe motion
( velocities, acceleration)
o Kinetics: parameters that describe causes of
movements ( external vs. internal forces)
Step length and cadence
Description of Gait Activity in sagittal plane

 Initial Contact: 0-2% of the cycle

o Aim: Appropriate prepositioning of foot to begin the
gait cycle
 Ankle: neutral dorsiflexion
 Knee: minimal flexion
 Hip: approximatly 35 degree of flexion
 Ground Reaction force: passing through heel and
anterior to both the knee and the hip
 Muscle activities: Hip extensor and knee flexors
Orientation and path of ground
reaction force
 Sagittal Plane Cont..
 Loading response: 0-10% of the cycle
 First period of double support
 Aim: Cushion or absorb the impact of the body’s
moment of inertia
 Ankle: Ankle planter flex due to eccentric work of
anterior tibialis muscle
 Knee: initial flexion to 15 degrees ( Quads work
eccentrically to decelerate knee flexion)
 HIP: Hip extension due to hip extensors and knee
flexors (work to counteract the ground reaction force)
 Sagittal Plane Cont..
 Mid-stance: 10-30% of the cycle
 Goal is to maintain trunk and limb stability
 Ankle: Increased dorsiflesion controlled by
eccentric contraction of soleus muscle
 Knee: extension first due to ground reaction
force then due to Quads concentric work
 HIP: extension continues first due to concentric
work of hip extensors later due to shifting of
ground reaction force posterior to HIP joint
 Sagittal Plane Cont….
 Terminal stance: 30-50% of the cycle
 Ground reaction force passes anterior to knee
and posterior to hip
 Ankle: decreasing dorsiflexion due to concentric
work of Gastrocnemius and soleus
 Knee: goes from extension to flesion due to
ground reaction force and gastrocnemius activity
 HIP: Continues to extend because of the ground
reaction force and resisted by internal flexor
movement
 Sagittal Plane Cont..
 Pre swing: 50-60% of the cycle
 Second period of double support
 Ankle: true planter flexion
 Knee: flexing and reaches 45 degrees of
flexion at toe off due to activity of rectus
femoris muscle
 HIP: Begin to flex due concentric work of hip
flexors and augmented by rectus femoris
 Sagittal plane cont…
Initial Swing: 60-73% of gait cycle
 Goal is foot clearance and limb advancement
 Maximum planter-flexion, knee flexion, hip
flexion
 Mid Swing: 73-87% of the cycle
 Ankle: dorsi flexion due to concentric work of
Anterior tibialis muscle
 Knee: extending due to inertial force without any
muscle activity
 HIP: flexion
 Sagittal plane cont…
 Terminal Swing: 87-100% of the gait cycle
 Goal is pre-positioning of limb for weight acceptance
 Ankle: begin to planter flex due to eccentric work of
Tibialis anterior
 Knee: flexor movement is dominant( hamstrings and
quadriceps work together to decelerate the forward
swing of the thigh
 HIP: minimal movement is noted at the hip
 Description of Gait Activity in coronal
plane
 Stance Phase: Hip and pelvis motion optimize vertical
excursion of center of mass
o Pelvis:
a) at level during initial contact
b) Stance side rises 5 degrees at loading response due to
ground reaction force
c) Clears foot on swing side
o HIP:
a) neutral abduction & adduction at initial contact
b) hip abductors works concentrically at midstance
c)Hip remains abducted during preswing for toe-off
 Energy Conservation
 One of the 5 attributes of
normal gait
 Hoe do we conserve
energy
o by optimizing the excursion
of center of mass
 Pelvic rotations ( rotations,
tilts, obliquity) along with
coordinated knee and ankle
movements ( normal-4.5 cm
vs. abnormal-9.5)
o Control of momentum:
natural selection of speed
that consume less energy
( D/D)
 Use of Gait Analysis
o Useful tool to assess
walking impairments
o Always co-relate gait-
analysis data with history,
X-rays/lab tests, and
physician’s findings, family
members objectives
o Children under 3 years are
not suitable for gait analysis
because ????