Introduction Gait Analysis Major Tasks of Gait Phases of the Gait Cycle Events in Stance Phase Subphases of Stance Phase Swing Phase Gait Terminology ‘Time and Distance Terms Kinematic Terms Kinetic Terms Electromyography Characteristics of Normal Gai Time and Distance Characteristics Sagittal Plane Joint Angles Frontal Plane Joint Angles Ground Reaction Force and Center of Pressure Sagittal Plane Moments Frontal Plane Moments Sagittal Plane Powers Frontal Plane Powers Mechanical Energy of Walking Muscle Activity Gait initiation and Termination 324 Gait Sandra J. Olney, PT, OT, PhD, and Janice Eng, PT, OT, PhD ‘Trunk and Upper Extremities Trunk Upper Extremities ‘Treadmill, Stair, and Running Gaits Treadmill Gait Stair Gait Running Gait Joint Motion and Muscle Activity ‘Moments, Powers, and Energies Summary Effects of Age, Gender, Assistive Devices, and Orthoses Age Abnormal Gait Structural impairment Functional Impairment Pain Adaptation/Compensation Scanned with CamScannerG it Analysis ; ion ven the opportune’ (ub and muscles functioy ¢° ion in maintain upri an body as 0 hate postire an ies of normal 7 foundation for analygic” P®Ovides the abnormalitie Y7N8, identifying.” al ei Bair, ying, Walking is proba of all human movene he Most coupled with the divent® 4 d produced a compley sn} Ot ‘The biomechanical pont, £™ not permitted to cloud eo chapter is to provide th serve as the foundation of gait deviations In early gait analysi film and until about 20, quired frame-by- been placed on body lana with knowledge of the e : floor forces derived from fr an rte fon! i Spl, kinetic information. This is referred toe the inverse dynamic approach with link segment mechanics Fletrogoniometers fastened to joints wee ocean sed to describe joint motion and still have applications? Similarly, electromyography (EMG) has been used for many decades, although the expectation that it would be possible to convert those signals to force values in simple, useful ways has not been fulfilled. However, the past two decades have witnessed an explosion of technical advancements in motion analysis that offer the ability to collect and process large amounts of data. As with the development of any science, the knowledge available far exceeds its current applications. ‘A modern gait of motion analysis syste tions that are subsequen body with joint centers inte id to ‘Brated Manne ‘ lgeof f Produce motion of the and kinet- reader with a and correcting sively studied of technologies, Perspectives, has launting literature. '€ movements that Stood if the detail is The purpose ofthis ion of gait that will normal walking and the variety isciplinary p times ents of th asily unders prehension, is comprehensi for analysis of investigators used ci years ago, inematographie frame hand-digit Sophisticated analysis re- izing of markers that had ‘These data were coupled ‘laboratory (Fig. 14-1) includes some kind that employ reie marr lc tly used to model a several-segment and centers of mas, lg included jatforms that provide simultaneous are one or mors eC aystems provide simultaneous infor from surface electrod welling les, or, sometimes, indwel mation from surface elect baal : G flene and engaging report ofthe € tk ct ea ot analysis, including motion analysis and tion of inf found in Sutherland articles?) imam locomotion, oF ey Lancet duced Jon of the body as a whole, wasn eo area a bay ee! by coordinasee TGvements of the lover extremities ese ‘heater movement ye pen ar ab eo The send as and trunk cont poset about ‘The head, arms: Ont head and arms contributing 20° body weight ae aes a ehe trunk contsibuting 25% of t0 AGait has been divided into 4m Gait 525 CHAPTER 1 Figure 14-1 A modem gat laboratory remaining 50%. To make full use of this chapter you should review the relevant biomechanics and anatomy. You must understand the basic hlcmnpchatdot, ont wresented in Chapter 1, the joint motion of major joints of the lower limbs, and have a thorough knowledge of the major muscle groups of the lower limbs and their actions. Major Tasks of Gait ‘To understand gait, let us first identify the fundamental pur- poses. Winter? proposed the following five main tasks for walking gai 1. Maintenance of support of the head, arms, and trunk, that is, preventing collapse of the lower limb Maintenance of upright posture and balance of the body Control of the foot trajectory to achieve safe ground clearance and a gentle heel or toe landing Generation of mechanical energy to maintain the present forward velocity or to inerease the forward velocity Absorption of mechanical energy for shock absorption and stability or to decrease the forward velocity of the body ‘Maintaining balance and stability is clearly important during ambulation, and there is an inereasing body of literature on what might be called sub-tasks of gait that are potentially destabilizing. These include gait initiation and termination, stair-climbing,® turning,” obstacle cross- ing?! and negotiating a raised surface.!2 Gait initiation and termination and stair-climbing will be introduced in this chapter, . Phdses ofthe Gait Cyete | 1// a number of segments that make _ understand, and analyze the events ig: A gait cycle spans two successive events of ‘sually initial contact of the lower extremity it possible to describe, unc ‘that are occurrin, the same limb, Scanned with CamScanner526 SECTION Sm Integrated Function with the supporting surface. During one gait cycle, each e tremity passes through two major phases: a stance phase, when some part of the foot isin contact with the floor, w makes up about 60% of the gat eycl,!? and a swing phase, when the foot is notin contact with the floor, which makes up the remaining 40%" (Fig. 14-2), There are two periods of double support occurring between the time one limb makes, initial contact and the other one leaves the floor at toe-off. Ata normal walking speed, each period of double support cecupies about 11% of the gait eyele, which makes a total of approximately 22% for a full eyele.8 The body is thus sup- ported by only one limb for nearly 80% of the cycle. The approximate value of 10% for each double-support phase is usually assigned to each of the two double-support periods. Stance phase is divided into subphases by a number cf events that mark the start and end of the subphases. Figure 14-3 identifies the events delimiting the stance phase as initial contact, sometimes referred to as heel contact or heel strike and toe-off. The gait cycle is divided into percentiles that will be used to clarify Right eight fetta 7% Fe Lettoe ot "0% 10% 20% 90% 40% 50% 60% es ee eee ay ight Let Fight heelott ints! to off 0% contact “60% 30% 0% J phases. Values for normal walking appear in events and phases. Values the figures. = now Events in Stance Phase - Initial contact refers to the instant the foot of the leading Frit ona kes the ground.!® In normal gait, the hee] ety he ron rr aoe er hee strike. ‘The word sirike is actually a mis- santa Oe ae ach as the horizontal velocity reduces To about 0.4 m/see and only 0.05 m/sec verticaly.!” In thnormal gait itis possible for the whole foot or the foes rather than the heel, to make initial contact with 2, eran normal gait occurs after initial contact at ” approximately 7% of the gi Its the first instant doing stance when the foot is fat on the ground, 3. Midatmnee is the point at which the body weight is directly over the supporting lower extremity, usually about 30% of the gait cycle. Figure 14-2 A gait cycle spans the period between initial contact of the reference extremity (right) and the successive contact of the same extremity. ‘This figure shows the gait eycle with major Fight mdsning 70% 80% 90% ot 100% GAT CYCLE events: stance and swing phases for each limb and periods of FRIGHT STANCE single and double support. The oe stance phase constitutes 60% of. Fight pi LeFT swing LEFT STANCE the gait cycle, and the swing phase constitutes 40% of the cycle at normal walking speeds, Double support Right single limb support Double support Increases or decreases in walking Let single speeds alter the percentages of limb support In y wel jeyen 10% time spent in each phase. Figure 14-3. ‘The stance phase ofa gait eyele ofthe right lower limb. The events Foot at 7% Intl contact 0% Event that delimit subphases are shown and expressed as percentages of full gat cycle: inital contac, foot fat, Heel strike Phase hree-off, midstance, and toe-off Subphases are heel Push of strike phase, midstance Phase, and push-off phase. Scanned with CamScannersara s. Toes the is the ground, usw t whic the heel of the reference, ® Usually about 40% of the ean Which the lly abour 60% of he a i Subphases of Stance Ph, a se 4. Heel strike phase begin extremity lifts off the support phase and ocean the end of the double ee about 11% ofthe git cyte : off at abou 2 3. Pash-off phase hegine wah ont 10% of the gait eycle irene ‘th heel-off at about eit vee and ends with toe-off ot a labost ofc Eycle (eee Fig, 14-3), bout 60% of the gait jometimes authors refer to a presvi terminology originating in Raho Low Ages National bee crus ; 7 enter. Pres ‘ing refers to the last 10% of Phase, beginning with initial contact of the contralat- eral foot (at 50% of the gait i er fo the gait eyele) and ending with toc-off Swing Phase Ad { 1. Early sting pape begins once the toe leaves the ground and continues until midswing, or the point at the swinging extremity is directly under the body (Fig. 14-4), This phase is also referred to as initial swing, ‘or the acceleration phase. 2, Midswing occurs approximately when the extremity passes directly beneath the body, or from the end of {eceleration to the beginning of deceleration. 3, Late swing occurs after midswing when the limb is decel- crating in preparation for heel strike, It s also known as terminal swing, or the deeleraton phase. yan who sustained a Marlene Brown is a 63,ear-old wor Marne prays ago and shows weakness, 0 emipars of re and leg She has been na ehabliaon on a a and is aking good progress walking athogh for V0 dare ating at ony 0.20 men. A value of 220% | shes aed be pial or an able bod pean of et Jer She ha weaknessn several muse oP ert sre rably the ankle plantarlexor, { Bel nae vad hip Hexrs, with distal muscles more knee ese proximal ones, Parlay roubles afeaed at pr foot during the ng ae I bility oh age base (2 furpoine Om a i aby asyouread the Gai TeminoOny a leas cifereness fom normal oH Late suing 25-100% Heme “Aieauin an ae —e igo known as terminal swing or deceleration. GAIT TERMINOLOGY Time and Distance Terms ~ ewo basic parameters of motion, and vane grants of these variables provide a basic descripsor® a eTeenporal variables include stance time, single-Lin> x¥Fme, zwing time, stride and step times ease and ved. ‘The distance variables include stride Fanarh step length and width, anc degree of toc-out. ‘These Nice Nerived in classic research of over 30 years ag0, Jrovide essential quantitative information about a persons Pije and should be included in any gait description.1618°1 ‘th variable may be affected by such factors as age, se%, height, size and shape of bony components, distribution of mass in body’ segments, joint mobility, muscle strength, type of clothing and footgear, habit, and psychological status. However, a discussion of all the factors affecting gait is be~ yond the scope of this text. ‘Stance time is the amount of time that elapses during thé stance phase of one extremity in a gait eyele. ‘Single-support time is the amount of time that lapses a fing the period when period when only one extremity is on the sup- porting surface in a gait cycle. wo agablesuppor ime isthe amount of ime spent with Ton the ground duting one gait cycle. The percent- Yesy penal and in those with balance dries, ‘The Dercalage of tine spent in double sepportdeerese ar the speed of walking increases. Ppsrt decrees 206 de length is the spent the linear distance between two succes- eee re accomplished by the same lower extrem- ity during gait. In general, stride length is determined by measuring the linear distance from the point of one hel lower extremity to the point of the next heel strike of the same extret Sede ancl al oF ae, Figs 14-5). The length of one fengih thio’ ie events of one gait cycle. Stride tog thoi ay be measured by using other events of the Seas heal zag #8 t0e-off, but in normal gait, two suc~ steps, a right ste ar usually used. A stride includes two morale eh and a left step, However, stride lenguh is leftstepe rao bent length of a single step, because rightand 'y be unequal. Stride length varies greatly among. Time and distance ——————_—— Scanned with CamScannerS28 SECTION $m Integrated Function = Y Rightioot ange Side length individuals, because itis affected by leg length, height, age, sex, and other variables. Stride length ean be normalized by dividing stride length by leg length or by total body height, so people of different sizes can be compared. Stride length usually decreases in elderly persons":!522 and in- creases as the speed of gait increases.2} Stride duration refers to the amount of time it takes to accomplish one stride, Stride duration and gait cycle dura- tion are synonymous, One stride, for a normal adult, lasts approximately 1 second.!* Step length isthe linear distance between two successive points of contact of opposite extremities. It is usually meas- ured from the heel strike of one extremity to the heel strike of the opposite extremity (see Fig. 14-5). A comparison of right and left step lengths will provide an indication of gait symmetry. The more equal the step lengths, the more sym- metrical isthe gait. Step duration refers to the amount of time spent during a single step. Measurement usually is expressed as seconds per step. When there is weakness or pain in an ex- ttemity, step duration may be decreased on the affected side and increased on the unaffected (stronger) or less painful side. Cadence is the number of steps taken by a person per unit of time. Cadence may be measured as the number of steps per second or per minute, but the later is more com- mon. A shorter step length will result in an increased cadence at any given velocity: Lamoreaux found that when a person walks with a cadence between 80 and 120 steps per minute, cadence and stride length had a linear relation- ship. As a person walks with increased cadence, the dura- tion of the double-support period decreases, When the cadence of walking approaches 180 steps per minute, the period of double support disappears, and running com- ences. A step frequency or cadence of about 110 steps per minute can be considered as “typical” for adult men; a typi- cal cadence for women is about 116 steps per minute.* Sometimes authors report values that refer to stride cadence, which is exactly hal the step cadence. Walking velocity is the rate of linear forward motion of the body, which can be measured in meters or centime- ters per second, meters per minute, or miles per hour Scientific literature favors meters per second. The term velocity inaplies that direction is specified, although this is frequently not incladed, and the more correct term walk- ing speed should be used if direction is not reported. Tnincerumented gait analyses, walking velocity is used, Right step length Let step length Paar igure 14-5. Stride length, step length, a ri shown ‘with foot angle place- iments. The midpoint of the heel is used ta point of reference for meas stop width. — snych as the velocities of the segments involve specif- cation of direction: i a Faking velocity (meters/second) = distance wal Walking veo crers)time (seconds) Yomen tend to W Jhorter and faster steps than Women rend to walk with a sy ts ich eal do men at the same velocity Bata e length differences. Increases in velocity up to 120 steps per minute are brought about by increases in both cadence and stride length, but above 120 steps per minute, step length levels off; and speed increases are achieved with only ca- econ normal comfortable speed of gait may be referred to as preferred, natural, self-selected, or free. Slow and fast speeds of gait refer to speeds slower or faster than the person’ normal comfortable walking speed, designated in a variety of ways. There is a certain amount of variability in the way an individual elects to increase walking speed. Some individuals increase stride length to achieve a fast walking speed. Others increase cadence. Step width, or width of the walking base, may be found by measuring the linear distance between the midpoint of the heel of one foot and the same point on the other foot (Gee Fig. 14-5). Step width has been found to increase when there is an increased demand for side-to-side stability, such as occurs in elderly persons and in small children. In tod- dlers and young children, the center of gravity is higher than in adults, and a wide base of support is necessary for stability. In the normal population, the mean width of the base of support is about 3.5 inches and varies within a range of I to 5 inches. Desmes-oftoeout represents the angle of foot place- ‘ment and may Be Totnd by measuring the angle formed by each foots line of progression and a line intersecting the Center of the heel and the second toe, The angle for men normally is about 7° froni the line of progression of each foot at free speed walking (see Fig. 14-5). The degree of toe-out decreases as the speed of walking increases in no- mal men.'4 Kinematic Terms _ Kinematics is the term consid pe used to describe movements without the internal or external forces that caused the movements. These measures include positions, velocities, and accelerations of body markers or body segments, Sophis. Seated equipment—at firs, stroboscopic photography, then EEE ee Scanned with CamScannerSS a cinematography ang sy es fc ma End provided comprenect2ed mori" and, more ry ind their mogone eS i tation ates Systems Observational gg) 74 and ayn 22 limb po less ohne! gait anal 4 tbnornal gate an objective method 8 employs a j judgment as to wyirethod in yy les sophisticated ind © whether ich an observer ai es fr makes a sales fom a norm joint angle or m8 used to hypothesize tional we OF to ional gait analysis i rent objectives ions and 4 method of analysis yt @¥anage of th ee cael at it requis '¢ observational and practice ‘quires a great d and pecs 7 ARIE 0 identify che fret el of riing articular joint 2 ee Pattcular segment 0 Cving crane Vas Ss fo na cer daivanage of geek npn a EN observatio Set eaeis that they frequently have ie Sid analysis methods is ports have iden ys although recent re~ which reliabj tified some variab} isfacton itbles and conditions under : Y is satisfactory.8 nly, 4 Particulay + Usually a Causes of ts space or, more ve angles of join adj Segments such a5 the hip or the knees hen icant ip or the knee. In mo: st literature the led the “zero” posit anatomical position is ca ion of the joint. Kinetic Terms ane erms the forces acting on the body that are the eause of the movement. kinetic smalsisis per formed to understand the forces acting on the foot by the supporting surface, the forces acting on the joints, the forces procuced by muscles, the moments produced by those mus. cles crossing the joins, the mechanical power generated oF absorbed by those muscles, and energy patterns ofthe body during walking. ‘A linkesegment model is most often used with an in- verse dynamic approach. This means that we look at the d (c.g. foot, lower leg, thigh, etc.) body asa series of segments efx vere thigh ete) with links a the joints. We begin the analysis starting yhing the supporting surface (foot) and use the sgmentouching the sppeting sre (bo an ws Nevtonian mechani (ig. 14618 do his. ems know the postions of body markers trou i itm the modion ana echoloy, We abo need 0 know the forces acting on the body ee, derived from a for these are the ground ete ody pars (ravi), and iner- Jlatform,3 the weight of the body pat Mi) sae Sa of the body pars.” ee don te Iris of an objects resis Ta eer ingrn the rotational Moving parts of the body during the gait in analyzing fast-moving pat orl te komen mode, we con deine wit Dein omnes hve been nga cach join ie forces an eee nel i ankle) in order that, the Tov" gith those particular linear and moment of inertia move ply progres up the and angular aceeleration®- ic 529 ait cuapTer 14 = © 12 Head, arms, and irk segments Momento inertia location of conte of mass “Thigh segment mass moment of inertia locaton of center of mass Lower lag segment: mass ‘moment of inertia location of contr of mass Foot segment: mass moment of inertia. tocaton of center of mass ent model of half a re 14-6 Simple four-segment link segment mode! of nn dy ein a ses Forsch segment denied, ‘the mass, moment of inertia, and location of the center of mass should be known for applications. body segment by segment and solve for the more proximal joie Larger ait of segments and three-dimensional ‘analyses are more complex than this, but the principles are the same. . Ground reaction forces (GRFs) are the forces being ap- plied to the foot by the ground when a person takes a step. ‘These forces are equal in size (magnitude) but opposite in direction to the forces applied to the ground by the foot. GRFs are expressed using vertical, anteroposterior, and ‘mediolateral axes.4°1 If we combine the force components in two or thee planes, the vector sum is a single expression of the ground reaction force and is termed the ground reaction force vector (GRFV). When we refer toa single component, such as the vertical GRF, the abbreviation GRF will be used, If components are combined into a single vector (Force(s} with a direction), GRFV willbe used. In gait we frequently use the sagittal GRFV. The center of pressure of the foo on the supporting surface is the point where the resultant of all the floor-foot forces act. It and produces a characteristic pattern, GREs, GRFVs and Cobs that are characteristic of normal walking appear later in the chapter as Figures 14-10, 14-11, and 14-10, Amoment of force, usually referred to simply as moment, is the same as torque, which was introduced in Chapter 1. Itis defined as the product of the force (asually muscle) and the Perpendicular distance from its action line to the joint center, Tecan be thought of as the tendency to turn, ———__ Scanned with CamScanner| S30 SECTION $m Integrated Function inva eae Understanding How the Are Studied The three equations on which the solutions are based for a two-dimensional analysis are simple: for each segment, the following three are applied: LF, =a, (1) YF, =ma,@) I Mp=IaQ) etics of Gait where ¥ means “the sum ofall of the” forces in the designated x direction, in this case horizontal, in newtons (N) ass of the segment, derived from anthropometric in kilograms (kg) For sim- were derived from three es li aa ean value shown in the figures will be referred acest text, taken 0 the nearest 5°, and, to remind the to ip hat these are not fixed values, the “approximately” eel te used. In the anatomical position, the hip, Lae, and ankle are at approximately 0°, Flexion for the hip and knee and dorsiflexion for the ankle are given positive aves and extension and plantarflexion are given negative Th Figure 14-8, itenn be seen that the hip achieves max- imum flexion (~+20°) around initial contact at 0% of the tat cycle and reaches its most extended position (~~20*) at ‘bout 50% of the gait cycle, between heel-off and toe-off. ‘The knee is straight (0°) at initial contact and nearly straight again just before heel-off at 40% of the gait cycle. During the swing phase, the knee reaches its maximum flexion of ~+60 at ~70% of the gait cycle, Note also that a sinall knee flexion phase occurs at 10% of the gait cycle and peaks at ~+15°, The ankle reaches maximum dorsiflex- ion of ~+7° at approximately heel-off at about 40% of the gait cycle and reaches maximum plantarflexion (-25°) at toc-off (60%). _Table 14-1__ Normative Values for Time and Distance Variables (CHARACTERISTIC MALE: MEAN (5D) FEMALE: MEAN (SD) SOURCE Speed of walking (m/sec) 137(0.22) 1.23 (0.22 Finley and Cody's ‘39 (01m ites) mao 122-132" 1.10-1.29" Oberg etal” 134 (0.22) 127 (0.16) Kadaba et al"é Length of one stride (m) 1.48 (0.18) 1.27 (0:19) Finley and Cody's 1.48 (015) 132(0:13) Rut 1.23-130 107-1.19 Oberg etal” ws 141 (0:14) 130(0.10) Kadaba er al!é ep cadence step/min) 110(10) 116 (12) Finley and Cody'* 1176) 121(85) RUS u7-iat+ 422-130" Oberg ec al” 12.0) 115(9) Kadaba et all6 Range of means. LA. Ranchos tos Aries. Scanned with CamScannerSa wait 533 cHapTer 14 8 GA - + JOINT ANGLES / | SAGITTAL PLANE / oo _— 20" Prantar flexion, id Decel HIP KNEE ANKLE 470 F 50 8 40 8 2 ° 20 g10 vo 2 40 6 80 100 2 49 60 80 100 % Galt Cycle % Gait Cycle grees atthe hip, knee, and ankle inthe sagival plane, The dotte toe agian Figure 14-8 Joint angles in dbgrrt’ and the slid lines represen the mean values. Goon on Pra the tana evion a ces ence at an digrams erro from lines in the angle diagrams i Ista far RL, Otis CA feds): Gait Analysis. Te At 0D er Bak, D4 prt fo ee an ET A Scanned with CamScanner534 SECTION 5 a Incegrated Function Concept Comertone =a] Hip) Renee, and Anide Range of Motion! Needed for Normal Walking For normal walking, we need a hip ROM from approxi mately 20° of extension to 20° of flexion, a knee range from straight (0°) to 60° flexion, and an ankle range from 25° of plantarflexion to 7° dorsiflexion. If these joint ranges are not available, a gait pattern would be expected to show considerable deviation from the norm. Frontal Plane Joint Angles During the first 20% of stance, the pelvis or the contralat~ eral side drops about 5°, which results in adduction of the hip (Fig. 14-9). The hip abducts smoothly to about 5° of abduction, peaking about toe-off, then returns to neutral at initial contact. ‘The knee remains more or less neutral, except for a brief abduction peaking at about 7° in midswing, and then returns to neutral? From the figure, it can be seen that the ankle complex everts from about 5° of inversion to 5° of eversion in early stance and inverts about 15° during push-off. ‘CASE APPLICATION Effects on Joint Angle Patterns Cf. ‘An examination of videotaped joint angles reveals that Ms. Brown has no knee flexion phase in early stance, and she tends to fully extend her knee in midstance. She has ‘minimal abily to dorsiflx her ankle and has difficulty clear- ing the floor with her affected limb asa result of poor dorsi- flexion and because she doesnot bend her knee more than a few degrees during swing phase. Instead, she tends to lft her pehis (“hike”) to clear her foot during swing on the affected side. Her affected hip does not extend beyond neutral. How 07s abductor > oss 035 ANGLE (6) (wimg) ‘Normaszed EMG (%) € abduction © sovctor 100 Fu tstud i Losi 150 100 F 50 inversion > (wang) ANGLE (deg) 00 Lust oa 40 60 80 100 € invertor € eversion 50 2040 ‘% Gait Oyte ‘Gat cyee %Gaitoyele iments in the frontal plane, and EMG profiles ofr i Fi ine angles and net joint moment p representatives of major contributors sees ments chip, knee and ale during adult galt ge nd moment prof rsrmon fom Wintr DA, Eng 7 Isbac MGs A rieo of kinetic parameters in buman walking. It Sat ae Otis oe sis pies hae fa ee fp 263-265. St. Louis, MO, Mosby- Year: 4, with permission from Elsevier. Musee acriity from Winter Da Tee Biomechanics and Motor Control of Hamat Har Boa 19, ere el 2 Wen, Ot Web Bom, 191, witb prison fom Ded Wee —_—_—_——_——— Scanned with CamScannerS42 SECTION 5m Integrated Function ‘CASE APPLICATION Effects of an Ankle-Foot i onters case 14-4. Recall that Ms. Brown hiked up her affected side (lifted hip and pelvis) in order to clear her foot during swing phase. This has been shown to have a serious energy cost’? as the full \weight of the upper body israised and lowered, and there are ‘10 opportunities for savings by kinetic-potential exchange. Because the inability to adequately dorsifex her foot ap- peared to be part of he problem, alight ankle-foot orthosis was prescribed, which held her ankle in a neutral position during swing phase. The orthosis also assisted with her ability to provide sufficient support during stance. The some- what stiff erthosis material accomplished this by resisting, dorsiflevion of her ankle during stance, as her body pro~ _gressed forward over her foot. She gained the ability to bend her knee in later stance, thus avoiding excessive hip hiking Watch for possible drambacks while you read the section on power and work. If the orthosis does not permit any ankle plantarflesion during push-off, she will lose the energy that would otherwise be provided by plantarflexor generation. Ceviin lode jai: tee ee Understanding Power and Work in Gi Examination of power plots helps us identify and under- stand the contribution of lower extremity muscles to gait, and its phases. When slow or inefficient gait is a problem, knowledge of the sources of power enables a health practi tioner to assist the client to compensate for deficiencies. Note thatthe sales used for power in the figures vary, and this must be taken into account when assessing the work (che area under the power curve). In Figure 14-19, identify the joint around which the largest amount of positive work (above zero line) is performed in the sagital plane. Ii ap- parent that the burst denoted A2-S (S denoting burst in the sagital plane) isthe largest, and this occurs at the ankle. We now that this positive work may be caused by either ankle plantarflexor activity with plantarflexion, or else active ankle dorsiflerors with dorsiflexion. We know this because positive work is occurring. A quick examination of the joint angle profile shows us that ankle plantarflexion is occurring at this time so we know the burst of positive work is caused by the plantarflexors. The second largest burst of postive power, denoted HI-S, isa hip extensor moment with hip extension occurring in early stance. The third burst, H3-S, ‘occurs near A2-S. It is caused by a hip flexor moment and hip flexion that occur at the end of stance and the begin- ning of swing, Itis frequently called pul-of. “The knee is not of major importance in energy gener- ation. However, there is a small phase, denoted K2-S, in which the knee’extensors extend the knee after the knee flexion phase of early stance. K2-S can be important in pathologies such as cerebral palsy when other sources of energy are not available. rait velocity is increasing, energy has to be sys- Unk et ae accom hia KI tematically rere a knee extensor moment) and K3-§ «flew aor moment in late tance occuring while Gamal ence ote quickly). The later may represent the knee is fev a8 (knee flexor absorption with inefficiency eccurs before initial contac. Note tha, as scowteion) 0ccS i sp ps ht when eceriric mule ati “raninaing, he dominating moment is opposite to the iy dai ing In this cae, a flexor moment is Fee nating (tis the net moment) while knee extension is serine The knee flexors are acting ecentially, and one jeing pulled into extension. A simpler example ieee when you squat. In this case, a knee extensor mo- 2 Nominating while knee flexion is occurring. Energy ing removed from the body, whichis very eviden as youen op ina lowe poston tan you wes Your poten. et y is therefore lower. ae tl ener tine te periods during which simulta neous positive and negative work normally occur, which, if anne nae wrk ral ih ‘occurs in late stance: Negative work done by the flexing nee (K3-S) occurs concurrently with both positive work by the hip flexors (13-S—pull-of) and ankle plantarlexors (A2-S—push-off}. Values of K3-S that are above normal represent excessive inefficiency and usually result in slower walking speeds Frontal Plane Powers In the frontal plane (Fig. 14-20), an initial period of absorption by the hip abductors (H1-F) is followed by two ‘small bursts of positive work in the remainder of stance (H2-F, H3-F). These bursts provide fine control of the mediolateral position of the center of mass of the body. At the knee, there is a very small generation pattern during the first half of stance (K1-F), followed by a stall absorp- tion (K2-F) both caused by’ abductor structures. Ankle power patterns are not shown as they are small and some- what inconsistent. Mechanical Energy of Walking Walking ata constant speed is accomplished by the bursts of positive (concentric) and negative (eccentric) muscle work described above that result in small stride-to-stride fluctuations in body height and variations in the velocities of the body parts. One way the body saves energy is by making use of passive exchange of potential and kinetic energy’ through the stride, a process that is much like a ball rolling down one hill and up another. Figure 14-21 isa diagram of kinetic energy of the head, arms, and trunk (bottom line), their potential energy (middle), and the two added together (top). At initial contact of each foot, that is at 0% and 50% of the gait cycle, the body has’ the lowest potential energy but is moving the fastest, and as it moves into midstance, the potential energy rises and is exchanged for kinetic energy. Evidence of the energy exchange can be seen as the potential energy curve slopes downward following Scanned with CamScanner543 Gs cHapTER 14 * Muscle Activity GLUTEUS MAXIMUS t 30 § HP 8 a % i § 3 i i + 2 ? § 60 gs gee 5 g 2 oO. o t < : ANKLE @ & za we 6 2 2 g a ey E 5 = 3 Bas + 0 20 40 60 80 100 % Gait Cycle ‘ Jowers in the sagittal plane, and EMG profiles of representatives of majc ib Figure 14:19 Join angles and join agit plang and EMG profiles of ep jor contributors to joint antes daring adult gait. Angle profs tr Da, Eng 7, Ishac MG: A review of liners pos Eres oi ke a MRL Ons C4 fe i hs yon en 3.2055 Ls Mo, Baap Yer Bast eae fr lenen melon ay ser profiles redo 7, Winter Da: Kinetic analysis ofthe lcer lbs daring wate: io ith permisin from Ekevier. Ose” wn A Bie ISS, 1995 ehh po ng walking: What jd from a three dimensional ion from Ekevier. Muscle activity redSeun oman ane ie fm 8 ef Hoa Gat Nol ly on Peg eb on Ga from Winter DA: The se ram Dav A. Winter. ipo mule ati redrawn from Bac! CO: Normal Hliman Gare. Biomechanics, 1991, sith perm eof Oro P1St Los, MO, CV sy 1974 ib pertain lo Een Ameri eademy of rtbopacdie Saree” a — Scanned with CamScanner