AMBULATION VS GAIT DETERMINANTS OF GAIT

Ambulation – is defined as the movement from one place to another (1) Pelvic Rotation
 Forward rotation of the pelvis in the horizontal plane
- E.g: Wheelchair ambulation, walking ambulation approx. 8o on the swing-phase side
Gait – is defined as walking or running  Reduces the angle of hip flexion & extension
 The pelvis rotates medially (anteriorly) on the swinging-leg
STANCE PHASE side, lengthening the limb as it prepares it to accept weight.
 With 4° pelvic rotation in either direction during double
EVENTS DESCRIPTION TRADITIONAL support, the limbs are essentially lengthened in the would-
(RLA)
be lowest point of the gait cycle (preventing a sudden
Initial Heel Strike
_DROP_ of the COG).
Contact (0-
2%)
Loading Just after initial Opposite foot Foot Flat (2) Pelvic tilt:
Response contact when leaves the  5degrees dip of the swinging side (i.e. hip adduction)
(0-10%) body wt. is ground  In standing, this dip is a positive Trendelenberg sign
being  _REDUCES_ the height of the apex of the curve of CG
transferred onto  The pelvis on the side of the swinging leg (opposite to the
leg and entire weight-bearing leg) is lowered 4°–5°, which _LOWERS_
foot makes COG at midstance
contact with
ground (3) Knee flexion in stance phase:
Midstance Opposite foot Body is directly Midstance  Approx. 20degrees dip
(10-30%) leaves the over the WB  Shortens the leg in the middle of stance phase
ground limb
 _REDUCES the height of the apex of the curve of CG
Terminal As the heel of Initial contact of Heel-off
 Early knee flexion knee flexion at foot strike (15°).
Stance WB leg rises the opposite
 The bending of the knee _REDUCES_ the vertical
(30-50%) foot. The body
has moved in elevation of the body at midstance (would-be highest point
front of the WB in the gait cycle) by shortening the hip-to-ankle distance.
leg This _LOWERS_ the COG (by minimizing its vertical
Pre-Swing Initial contact Just before toes Toe-off displacement) decreasing the energy expenditure. It also
(50-60%) and weight of WB leg leave tends to absorb the shock of impact at heel strike by
shifted onto the the ground lengthening the contraction of the quadriceps.
opposite leg
(4) Ankle mechanism:

SWING PHASE  Lengthens the leg at heel contact

 Smoothens the curve of CG
EVENTS DESCRIPTION TRADITIONAL  Reduces the _LOWERING_ of CG
(RLA)  At heel strike, ankle plantar flexion smoothens the curve of
Initial The toes leave The swing foot Acceleration the falling pelvis.
Swing the ground is opposite the  It is associated with controlled plantar flexion during the
WB foot and the first part of stance.
knee is in
maximum (5) Foot mechanism:
flexion
Midswing The swing foot The swing leg Midswing  Lengthens the leg at toe-off as ankle moves from
is opposite the has moved in dorsiflexion to plantarflexion
WB foot front of the body  Smoothens the curve of CG
and the tibia in a  Reduces the _LOWERING_ of CG
vertical position  After midstance, the knee extends as the ankle plantar
Terminal The tibia is in a Just prior to Deceleration flexes and the foot supinates to restore the length to the leg
Swing vertical position initial contact and diminish the fall of the pelvis at opposite heel strike.
SUMMARY: DETERMINANTS OF GAIT GROUND REACTION FORCES

DIRECTION OF NAME OF ACTION VERTICAL

ACTION STRATEGY
Vertical Horizontal plane Reduces the  PEAK twice in the gait cycle, at _FOOTFLAT_and _HEEL
pelvis rotation downward OFF_
displacement of  The fluctuation in force is a result of vertical acceleration of
the CoM the body’s CoM.
Vertical Sagittal plane Reduces
ankle rotation downward
displacement of  Loading response
the CoM body’s CoM moves
Vertical Stance phase Reduces downward. A vertical
knee flexion upward ground reaction force
displacement of greater than one’s
CoM body weight is needed
Vertical Frontal Plane Reduces to decelerate the
pelvic rotation upward movement
displacement of  Midstance- the vertical
CoM ground reaction force is
Medial-Lateral Frontal plane Reduces side- less than the body
hip rotation to-side weight
(step width) excursion of  Terminal stance-higher
CoM GRF

KINEMATICS OF GAIT
ANTEROPOSTERIOR FORCES
PELVIS HIP KNEE ANKLE ANKLE/
FOOT  Shear forces are applied parallel to the supporting surface
SA Pelvic Flexion- Flexion- Plantarflexio 1st MTP  Heel contact – the GFR is in the _POSTERIOR_ direction,
GIT Tilting - ↑ extension Extensio n- extension this will prevent the foot from slipping forward
TAL speed of n dorsiflexion
ambulatio
 Terminal stance and preswing the GFR is _ANTERIORLY_
n directed to propel the body forward
FR Pelvic Abduction- Stance: DorsiFlex- Initial Contact:  Peak antero-posterior GFR is 20% of the body weight
ON drop- Adduction 5deg Eversion & inverted
TAL pelvic varus abduction MEDIO-LATERAL
hike Loading
Swing: Plantarflex- Response-  Initial 5% or so of the gait cycle, a small, _LATERALLY_
5deg inversion & Midstancet: directed GFR is produced to stop the small lateral to medial
valgus adduction everted velocity
Midstancet-  During the rest of the stance phase the CoM of the body is
Terminal _MEDIAL_ to the foot, causing a laterally directed force
stance-Pre- applied to the ground by the foot à _MEDIALLY directed
Swing: GRF
inverted

HO Ant./Post Initial Highly n/a Same with

PATH OF THE CENTER OF PRESSURE
RIZ Rot. Contact: variable frontal
ON Slight ER
 Heel contact CoP- lateral to the mid point of the heel
TAL  Mid stance- mid foot region
Loading
Response-  The location of CoP helps to explain the tendency of the
MidStance: ankle and foot to plantarflex and evert, respectively
IR

Pre-Swing
Midswing:
ER

Midswing-
Iinitial
Contact:
Slight IR
KINETICS OF GAIT EVENTS OF GAIT: MIDSWING THROUGH TERMINAL SWING

JOINTS MOTION MUSCLE/INTERN CONTRACTION

AL MOMENT
INITIAL CONTACT TO END OF LOADING RESPONSE HIP Flexion Hip Extensors Eccentric
JOINTS MOTION MUSCLE/INTERN CONTRACTION
AL MOMENT
KNEE Extension Knee Flexors and Knee Extensors:
HIP Flexion Hip Extensors Eccentric
Extensors concentric
KNEE Flexion Knee Extensors Eccentric
Knee flexors:
ANKLE Plantarflexion Ankle Dorsiflexors Eccentric eccentric
ANKLE Neutral Dorsiflexors Isometric

END OF LOADING RESPONSE TO END OF MIDSTANCE

JOINTS MOTION MUSCLE/INTERN CONTRACTION

AL MOMENT
HIP Extension Hip Extensors Concentric
KNEE Extension Knee Extensors Concentric
ANKLE Dorsiflexion Plantarflexors Eccentric

MIDDLE OF MIDSTANCE TO PRIOR TO END OF TERMINAL

STANCE

JOINTS MOTION MUSCLE/INTERN CONTRACTION

AL MOMENT
HIP Extension Hip Flexors Eccentric

KNEE Extension Knee Flexors Eccentric

ANKLE Plantarflexion Plantarflexors Concentric

END OF TERMINAL STANCE TO END OF PRE-SWING

JOINTS MOTION MUSCLE/INTERN CONTRACTION

AL MOMENT
HIP Flexion Hip Flexors Concentric
KNEE Flexion Knee Extensors Eccentric
ANKLE Plantarflexion Plantarflexors Concentric

EVENTS OF GAIT: INITIAL SWING THROUGH MIDSWING

JOINTS MOTION MUSCLE/INTERN CONTRACTION

AL MOMENT
HIP Flexion Hip Flexors Concentric

KNEE Flexion Knee Flexors and Knee Flexors

Extensors and extensors:
concentric
ANKLE Dorsiflexion Dorsiflexors Concentric