Module 4 Normal Gait 2 F Objective Gait

Module 4 Normal Gait 2 F: Objective Gait Analysis of Total Limb Function

References § Perry, J and Burnfield, J. (2010). Gait Analysis: Normal and Pathological Function 2 nd edition. Chs 9 and 24, pgs 483 to 494. § Winter, DA. (1995). Human balance and posture control during standing and walking. Gait & Posture, December, No 3, 193 to 214. (pdf available on ANGEL) § Lusardi, MM and Nielsen, CC. (2007) Orthotics and Prosthetics in Rehabilitation, 2 nd edition. Ch 3, pgs 35 to 41. § Hsu, JD; Michael, JW and Fisk, JR. (2008) Atlas of Orthoses and Assistive Devices, 4 th edition. Ch 5, pgs 61 to 67. § Smith, DG; Michael, JW and Bowker, JH. (2004) Atlas of Amputations and Limb Deficiencies, 3 rd edition. Ch 29.

Agenda • A. Total Limb Function • B. Stance Phase • C. Swing Phase

A. Total Limb Function

A. Total Limb Function, continued • Weight Acceptance – Initial Contact = limb stabilization to support the fall of the body weight – Loading Response = Shock absorption • Single Limb Support – Midstance = progression – Terminal Stance = weight-bearing stability • Swing Limb Advancement – – Pre-Swing = unloading of trailing leg Initial swing = forward swing of the limb Mid-swing = foot clearance of the floor Terminal swing = preparation of the limb for stance

B. Stance Phase • Total Limb - Weight Acceptance • • Joint Positions: – ST = Neutral – Ankle = Neutral – Knee = 5° flexion…or “near full extension” – Hip = 20° flexion – Pelvis = 10° anterior tilt, 5° forward rotation, neutral frontal plane GRF: – ST = lateral – Ankle = posterior – Knee = anterior – Hip = anterior Active Muscles: – ST = evertors – Ankle = pretibials – Knee = quads and hams – Hip = gluteus maximus

Stance Phase Total Limb - Weight Acceptance • Critical Events: – Heel first contact – Heel rocker initiated – Impact deceleration • Goal: – – Begin Stance Double limb support Lowest point of gait 0 to 2% of gait cycle Initial Contact

B. Stance Phase Total Limb – Weight Acceptance • • • Joint Position: – ST = 5° eversion – Ankle = 5°PF then neutral – Knee = 20° flexion – Hip =20° flexion – Pelvis = 10°anterior tilt, 5° forward rotation, 5°contralateral drop GRF: – ST = lateral – Ankle = posterior – Knee = posterior – Hip = anterior Active Muscles: – ST = Ant & Post Tibialis – Ankle = pretibials – Knee = quads – Hip = gluteus max

Stance Phase Total Limb – Weight Acceptance • Critical Events: – Heel rocker progression…key mechanism forward progression – Restrained ankle plantarflexion – Restrained knee flexion…a primary source of shock absorption – Sustained hip flexion • Goal: – Weight acceptance, shock absorption and advancing the body over the heel rocker – Double limb support – 2 to 12% of gait cycle

B. Stance Phase Total Limb – Single Limb Support • • • Joint Position: – ST = decreasing eversion – Ankle = neutral to 5° dorsiflexion – Knee =5° flexion (observationally appears extended) to extension – Hip = flexed to extension/neutral (0°) – Pelvis = 10°anterior tilt, neutral 0° rotation, neutral frontal plane GRF: – ST = lateral – ankle = just to way anterior – knee = from posterior to anterior – hip = from posterior to just at Active Muscles: – ST = All 7 – Ankle = – Knee = – Hip = Gluteus Medius

Stance Phase Total Limb – Single Limb Support • Critical Events: – Restrained ankle dorsiflexion • Ankle rocker – Knee extension – Coronal plane hip stabilization • Goal: – Advance the body over the stationary foot – Single limb support – Highest point of gait cycle – 12 to 32% of gait cycle

B. Stance Phase Single Limb Support • • • Joint Position: – ST = Eversion decreases to 2° by end of phase – Ankle = 10° DF with heel-off – Knee = 5° flexion (observationally appears extended) – Hip = Extension to 20° apparent hyperextension – Pelvis = 10°anterior tilt, 5° backward rotation, neutral frontal plane GRF: – ST = lateral – Ankle = anterior – Knee = anterior – Hip = posterior Active Muscles: – ST = – Ankle = all 7 PFs – Knee = – Hip =

Stance Phase Single Limb Support • Critical Events: – Controlled ankle dorsiflexion with heel rise • Forefoot rocker – Trailing limb posture – Free forward fall of body • Goals: – Advance body over forefoot rocker – Start double limb support – 31 to 50% of gait cycle

B. Stance Phase Swing Limb Advancement • Joint Position: – – – MTPs = dorsiflexed ST = neutral Ankle = plantarflexed Knee = flexed Hip =less hyperextended Pelvis = • GRF: – – – MTPs = at MTP joint ST = neutral Ankle = anterior Knee = posterior Hip = posterior • Active Muscles: – – ST = Ankle = elastic recoil of PFs Knee = Hip = accessory flexors

Stance Phase Swing Limb Advancement • Critical Events: – Toe rocker – Knee flexion to 40° for foot clearance • Goals: – Prepare for swing – Double limb support – 50 to 62% of the gait cycle

C. Swing Phase Swing Limb Advancement • Gravity and Momentum • Joint Position: – Pelvis = 10° anterior tilt, 5° backward rotation, neutral frontal plane – Hip = 15° flexion – Knee = 60° flexion – Ankle = 5° PF – ST = neutral • Active Muscles: – Hip = flexors – Knee = flexors – Ankle = pretibials

Swing Phase, 2 Swing Limb Advancement • Critical Events: – Knee flexion – Hip flexion • Goals: – Achieve optimal knee flexion (up to 60°) for foot/toe clearance – Clear foot and advance limb – Single limb support – 62 to 75% of the gait cycle

Swing Phase, 3 Single Limb Advancement • Initial Swing provides momentum generation through muscular action for increased efficiency • Passive muscular activity during Mid Swing (knee & hip) but dorsiflexors continue activity

Swing Phase, 4 Swing Limb Advancement • Critical Events: – Ankle dorsiflexion – Hip flexion • Goals: – Advance the limb and clear the foot – Single limb support – 75 to 87% of the gait cycle

C. Swing Phase, 5 Single Limb Advancement • Approach 30° hip flexion • Momentum and knee extensor action required to lift weight of tibia and foot for full extension • Knee flexors decelerate the hip

Swing Phase, 6 Single Limb Advancement • Critical Events: – Hip deceleration – Further hip flexion (i. e. thigh advancement is inhibited) – Knee deceleration – Knee extension – Ankle dorsiflexion • Goals: – Advance limb – Prepare for Initial Contact – 87 to 100% of the gait cycle

Major Muscle Activity During the Gait Cycle

The End

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