7th International Conference

Research and Development in Mechanical Industry

RaDMI 2007
16 - 20. September 2007, Belgrade, Serbia

EVALUATION METHODS OF THE GAIT PARAMETERS

Dan Ioan Stoia, Mirela Toth-Taşcău, Mircea Dreucean
Politehnica University of Timisoara, ROMANIA,

Summary: The paper proposes an analysis based on two different gait evaluation methods in order to establish the common and
the specific parameters. One of the methods analyzes the gait from the kinematical point of view and the second one from the
plantar reactions point of view. In order to obtain comparable results, a number of 20 subjects having the same small deficiency
were recorded using both systems in the same conditions. In order to conclude, the gait parameters indicated by the two systems
were grouped in a table, in a comparative way.
Keywords: human gait, gait parameters, swing-stance phases, plantar pressure distribution.

1. INTRODUCTION

The human skeleton it’s a complex system composed by rigid bodies (bones), joints (articulations) and actuators
(muscles). According to the complexity of the lower limbs construction, the movement capacities at this level are
great. The human gait represents a succession of stance and swing phases of the both limbs in a specific order. Due
to the variety of the human beings, the gait presents typical features for each person. Up to now, several types of
normal gait and hundreds of abnormalities were recorded.
The results of gait analysis represent a useful tool for discovering and evaluating abnormal movements, which are
connected with different deficiencies in joints, muscles, and nerves. By gait analysis it’s possible to establish the best
treatment for patients, and develop therapeutic strategies to compensate the existing deficiencies. Thus, based on a
protocol for gait analysis, in correlation with a consultation, the doctors are able to diagnose different disorders or
monitor the patients in their rehabilitation.
The human gait has traditionally been studied subjectively through visual observations. By combining advanced
measurement technology and biomechanical modeling, human gait can now be objectively done. Today,
physiotherapists, orthopedists and neurologists all use gait analysis to evaluate a patient’s status, treatment and
rehabilitation [6].
It’s important to know that any deviation from the normal gait reduces the efficiency and leads to an increase in
energy consumption. The "step cycle" starts with touching the floor with the foot and ends with touching it again
with the same foot. The step cycle subdivides into two main phases, the "standing and swing phases". In normal gait,
the stance phase begins with the touch-down of the heel and ends with the lifting of the toes. Afterwards, the swing
phase begins. The swing phase is defined as the time period between the lifting of the toes from the floor and
touching it again with the foot.
The events during a step cycle happen regularly at moments that can be fixed in terms of percentage. With normal
walking, the lifting of the toes from the floor occurs approximately at 60 % of the step cycle. The stance phase,
therefore, consists of 60 % of the complete step and the swing phase of 40 % of the complete step. The lifting of the
opposite foot occurs at 10 % and its touch-down at 50 %. While walking, there are two periods during which both
feet touch the floor. These constitute 10 % of the step cycle each and happen immediately after the touch-down of
the foot and shortly before the lifting of the toes. During the normal gait, for the left and right limbs, the
corresponding phases are symmetrical [1], [2], [3].
Further gait analysis can be carried out by determining the step length, the step speed, and the cadence. A step is
defined as the distance that is covered by a complete step cycle. This corresponds to the total of the lengths of the left
and right half step. Cadence stands for the half steps and steps made during a certain period of time.

2. INVESTIGATION METHODS

In order to investigate and analyze the human gait, a large number of equipments are available on the market. The
kinematics of the gait means a description of angles, spatial positions, velocities and accelerations of the human
lower limbs. There are several possibilities and methods to evaluate the human gait from the kinematical point of
view [1]:
 Electrogoniometers;
 Ultrasound and electromagnetic tracking systems;
 Optical (video based) systems;
 Inertial systems.
With 3-dimensional kinematical analysis, the gait is evaluated from three viewing positions. The side view, for
example, allows for the measuring of the flexion and extension of hip, knee, and ankle joints. It is better to measure
abduction and adduction of the hip joints and extremities, respectively, as well as the pelvic obliquity. The
transversal view is the view from above or below and represents for example the rotations of the feet.
The second method described in the paper is based on the ground reaction forces measurement, during gait cycle.
The method provides important data about the plantar pressure distribution, gait line length, position of the gravity
center. There are basically five main techniques available for these investigations:
 Optical systems (pedobarography) which relies on the ability of pressure to cause interference patterns on light
reflected from plastic film;
 Capacitive systems (which relies on the change of electrical capacitance when two plates are pressed together);
 Piezo-resistive systems in which the resistance of a special conductive ink is changed on application of pressure;
 Piezo-electric in which pressure on a ceramic crystal generates an electrical voltage;
 Laser system.

3. EXPERIMENTS

In the present paper, two of the most used systems in gait investigations were used. For kinematical records, the
Zebris CMS-HS ultrasound equipment successfully was used. For the plantar pressure distribution we used a
capacitive system called Zebris FDM. All of these systems are dedicated or can be adapted to the study purpose.
In order to draw a conclusion about the gait parameters recorded with these two equipments, a number of 20 subjects
were recorded and analyzed. The paper presents the results of one single subject, which was considered to be
representative.

3.1. Kinematical gait analysis using Zebris CMS-HS measuring system

The Zebris measuring system for gait analysis enables simple and fast analysis of all important parameters of the
human gait. The measuring system allows an objective kinematical analysis of the human gait by means of analyzing
the tracks of body surface markers [4].
The measuring method is based on the determination of spatial coordinates of miniature ultrasound transmitters
(markers) by measuring the delay between the emission of sonic pulses by the transmitters and their reception at the
microphones of the measuring sensor. The exact spatial position of the markers is determined by triangulation
method (figure 1).
 Figure 1: Zebris CMS-HS measuring system

The measurement starts with the attachment of the two markers on the body in two key points. The first marker
triplet it’s attached on the thigh and the second one on the upper part of the foot. In the next step, the anatomic
landmarks are marked with the pointer, and the dedicated software creates the geometrical model (figure 2). After
this point, the recording can start. In order to reveal the gait problems, the investigations must be correlated with the
patients diagnostic.

Triple Markers

Limb’s models

Figure 2: Geometrical model

Using this technique, several parameters were recorded. We can divide those parameters in two groups: general
evaluation parameters and specific parameters. The general gait parameters are described in the table 1.

Table 1: Recorded parameters

Parameter/limbs Left Right
Number of steps 3 2
Double support time [sec] 0.22 0.40
Cadence [st/sec] 0.82
Velocity [cm/sec] 25

The number of the steps was isolated from the large data recorded and used to calculate the velocity, cadence and
double support time. In a normal gait, the step time it’s about 1.3 seconds, but in our case the subject made small and
short steps (figure 3). We can say that this parameter it’s characteristic for our subject. Another important parameter
it’s the balance between the gait phases. For a normal gait, the swing phase must be around 40% of the gait cycle
time and the stance phase 60%. This case relives an abnormality of the gait, with around 25% of swing and 75% of
stance (figure 4). The difference between the left and right limb in gait phases it’s still insignificant.
 Figure 3: Step diagram during gait cycles Figure 4: Swing –Stance phases

The joint angles recorded during the gait cycle are presented in the figure 5. The diagram shows the angular variation
for each individual joint in all the possible movements: flexion-extension, abduction-adduction and rotations. The
flexion-extension movements of the thigh, knee and ankle present the highest amplitudes, with the values included in
the normal range for a gait cycle. In the upper part of the figure 5 are highlighted the diagrams for the left limb joint
variations, and at the bottom the same parameters for the right limb. The angular variations of the left and right limbs
prove also, the similitude between the limbs. So, the angular parameters indicate a gait movement close to the normal
one.

Figure 5: Angular variation in lower limb joints during a gait cycle

3.2. Force distribution measuring using Zebris FDM system

The Zebris FDM measuring system functions using high-quality capacitive force sensors that are arranged in matrix
form. The measuring plate enables both the static and dynamic plantar force distribution to be analyzed during the
patient standing and walking [5]. The FDM equipment it’s presented in the figure 6.

Figure 6: Zebris FDM system

In order to compare the resulting gait parameters with the parameters from the first recording method the same
subject was investigated.
The recording method it’s very facile consisting in a calibration followed by the simple walking on the platform. The
results are provided as a report that includes two types of gait parameters: general and specific. The general gait
parameters are sown in the table 2.

Table 2: General gait parameters

Parameter/limbs Left Right
Step time [sec] 0.81 0.77
Swing time [%] 21.48 24.17
Stance time [%] 78.52 75.83
Load response [%] 24.64 30.75
Pre-swing [%] 30.75 24.64
Single support [%] 23.12 20.43
Cadence [steps/min] 38
Velocity [cm/sec] 26
Variability of velocity [%] 14.31
Stride time [sec] 1.58

The general parameters indicate a particular type of gait (like in the first case), with large stance periods up to 78%
on the right limb, and large stride time of 1.58 sec (a normal gait has a stride time of 1.3 sec).
The specific parameter of the system it’s the plantar pressure distribution. The pressure distribution looks like a
colored footprint (tracking). The values of the pressures are provided in N/cm² units and can be identified in
comparison with a reference color bare (figure 7).
 Figure 7: Long platform picture

Another specific parameter recorded with FDM system it’s the reaction force. The reaction forces at the plantar level
vary like in the figure 8. The capacitive sensors of the system measure the instantaneous pressure and calculate the
force F=P*S (S represents stance for the contact area between foot and platform). The graphic below reveal three
major points for the force distribution: peaks, flat middle lines and valleys.
The peaks on the graphic correspond to the double support of the limbs at the moment when the first initial heal
contact happens. At this moment, the force it’s greater then the force of gravity because of the small contact area and
the inertial forces caused by the movement.
The valleys correspond to the double support of the limbs, with a large contact, when one foot it’s completely on the
ground and the other one it’s in toe-off position. This large contact area explains the low values of the forces.
The flat lines between peaks and valleys indicate a single support. Because the movement it’s fully generated by the
other limb, the forces correspond to a static loading. In this case, the force represents the gravity force of the subject.

Figure 8: Variation of the reaction forces during the gait

Another parameters provided by this method are presented in the figure 9. The first one, the GLL (gait line length)
parameter is the length of the line that describes the course of the pressure center, when only the individual ground
contacts of the side of the body are taken into consideration. This parameter comprises the course of the pressure
center for all the steps recorded of one by one sides of the body.

Figure 9: GGL - Gait line length diagram Figure 10: Steps cyclogram

In the steps cyclogram (figure 10), another two parameters are drawn. The SSL-single support line is equivalent to
the average length of the lines that describes the course of the pressure center, when all the ground contacts are taken
into consideration. The A/PP (anterior/posterior position) parameter describes the shift forwards/backwards of the
intersection point of the CoP trajectory in the cyclogram, taking all the steps into consideration.

4. CONCLUSIONS

After recording and analyzing the gait parameters, we can say that we are handling with two kinds of parameters
which fully characterize the human gait. These parameters are generically called: general evaluation parameters and
specific evaluation parameters. The general evaluation parameters can be recorded with both measuring systems,
with very similar results. The specific parameters relive the characteristic of each system. For a synthetically
approach of all the parameters, table 3 was created.

Table 3: Evaluation parameters

System/parameter general evaluation parameters specific evaluation parameters
1. Number of steps 1. Joints angles
Zebris CMS-HS
2. Double support time [sec]
3. Cadence [st/sec]
1. Plantar pressure [N/cm²]
4. Velocity [cm/sec]
2. Pressure center’s trajectory
5. Step length [m]
Zebris FDM 3. Gait line length [m]
6. Stride length [m]
4. Single support line [m]
7. Swing time [%]
5. Anterior/Posterior position [m]
8. Stance time [%]

The results of the experimental measurements objectively underline that the deficiency of investigated patients is a
little one. The quantitative results will contribute to establish the medical diagnostic.

REFERENCES

[1] KIRTLEY C.: Clinical Gait Analysis, theory and practice. Churchill Livingstone Elsevier 2006.
[2] FISH D J.; NIELSEN J-P.: Clinical assessment of the human gait. Journal of Prosthetic and Orthotics 1993
[3] KISS J.; POPESCU S.; CINTEZA D.; GALBEAZA G.; DIACONESCU S.; MARCU V.: Institutul National de
Recuperare, Medicina Fizica si Balneologie, Bucuresti. http://www.presspro-medic.ro/article--x-Clinic-
Evaluarea_mersului_in_medicina_de_reabilitare--3387.html
[4] *Zebris CMS-HS: Operating Instructions.
[5] *Zebris FDM: Operating Instructions.
[6] * http://www.qualisys.se/archive/application_notes_pdf/AN_Gait.pdf.