Video based observational

Gait analysis

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What is Gait???

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 Gait is a scientific term used for
walking/locomotion.

 It is the pattern of the movement

of the body and limbs during
locomotion.

 Although performed without

much thought, walking is a
complex task that integrates
multiple signals.

Hamill J and Knutzen K 2013

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When do you say it as a Normal Gait?

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 Normal Gait
 A normal gait appears to be co-ordinated , efficient and
effortless.

 It is a series of rhythmical alternating movements of the trunk

and the limbs which results in forward progression of centre of
gravity.
Perry,2nd edition

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 Four objectives must be accomplished for normal gait to occur.

 Leg should support body weight without

collapsing.

 Balance should be maintained (statically &

dynamically) during single support phase.

 Swing leg advances to take over supporting role.

 Sufficient power for necessary limb movements

and trunk advancement.

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Is it Important????

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YES!!!
 Bipedal walking is an important
characteristic of humans.

 It is a very economical means of

locomotion.

 In clinical and research settings, gait

performance is widely accepted as a
general measure of functional ability
among individuals.

 In addition, gait is associated with

health, well-being and quality of life.
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 Annegarn et. al. has revealed that walking is the primary
activity reported as problematic by patients with Chronic
Obstructive Pulmonary Disease(COPD) .

 Janice J has reported that patients with stroke spend more of

their rehabilitation time practicing walking compared to all
other activities . Improved walking ability is one of the most
often stated goals by people with stroke undergoing
rehabilitation and with those individuals living with stroke in
the community.

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 Raluka D ,has stated the clinical importance of gait analysis in
cerebral palsy as we can observe specific deviations in a
patient, allowing us to be more accurate in motor diagnoses
and treatment solutions: surgery intervention, botulinum toxin
injection, use of orthosis, physical kinetic therapy, oral
medications, baclofen pump.

 All this attests to the clinical relevance of human gait analysis

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Why is it important for
Physiotherapist ???????

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 Physical therapists are well trained in the area of gait and
movement analysis and are also addressed as, movement
scientists .
Edelle,2017

Gait analysis aids us in effective clinical decision making for

rehabilitation, surgery, adaptive devices, ergonomics, and
sports .

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Research shows that gait is correlated with QOL,
physical functioning.

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 Diagnosis

Prognosis

Prediction

Assessment

Including the
possibility of not
intervening.
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 wealth of
data can be
gathered
qualitative
Field of
and
interest can
quantitative
be identified
evaluation

Gait
analysis

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Gait Cycle
 A sequence of gait involves a series of interactions between 2
multi segmented lower limbs and body mass.

 In order to identify numerous events it is necessary to view gait

from various aspects.

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In order to identify numerous events it is necessary to view gait
from various aspects.

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Glimpse through some basic terms

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Step length

Distance between the corresponding successive points of the

heel contact of the opposite feet

Rt step length =lt step length

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 Stride length

 Distance between the corresponding successive points of the

heel contact of the same foot

 Double the step length=stride length

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 Step
Stepwidth
width

Side to side distance between the

line of two feet

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 Cadence
 Number of steps per unit time
 Normal: 100 – 115 steps/min
 Cultural/social variations

 Velocity
  Distance covered by the body in unit time
 Usually measured in m/s
 Instantaneous velocity varies during the gait cycle
  Average velocity (m/min) = step length (m) x cadence
(steps/min)

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Comfortable Walking Speed (CWS) = Least energy consumption
per unit distance

  Average= 80 m/min (~ 5 km/h)

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Phases of gait cycle

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Initial Contact
 This is the instantaneous
moment when the right/left
foot first makes contact
with the ground.

 In normal walking this

initial contact is a heel
strike.

 This also marks the

beginning of double
support
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 Loading Response
 The loading response is a transitional
period from double support to single
support.

 As the right foot rocks from heel to

midfoot it begins to accept the full
weight of the body.

 This phase continues all the way up until

toe-off of the left foot.

 The loading response accounts for about

10% of the gait cycle
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 Midstance
 Midstance is the first half of single
support.

 The entire weight of the body is on the

right leg and the left foot swings from its
toe-off point towards its next heel strike.

 At the end of midstance the centre of mass

of the body is aligned over the left
forefoot.

 Midstance accounts for about 25% of the

gait cycle
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Terminal Stance
 The remainder of single support is the
terminal stance phase.

 This phase is from the moment the

heel of the supporting foot rises of the
ground until the foot strike of the
swinging ipsilateral leg.

 The terminal stance phase is about

20% of the gait cycle.

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Pre-swing
 Again we are in double
support, however, this time
weight is shifting from the
right leg to the left leg and the
right foot continues to rock
from midfoot to toeoff

 This phase positions the limb

for swing. This pre-swing
phase is about 10%
of the gait cycle.
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 The swing phase functions to advance the limb forward and
position the limb in preparation for the next stance phase.

 The swing phase has subdivisions: initial swing, mid-swing,

and terminal swing.

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Initial Swing
 The initial swing commences
the moment the foot leaves the
ground continues until the
swing foot is next to the stance
foot.

 This contributes to
approximately one-third of
swing and about 13% of the
gait cycle
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Midswing
 Midswing is from when the feet
are adjacent until the tibia of
the swing leg is vertical.

 This phase is about 14% of the

gait cycle.


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Terminal Swing
 The final phase of gait cycle is
the terminal swing.

 It begins when the tibia of the

swing leg is vertical and ends
when the foot strikes the floor.

 This phase is about 13% of the

gait cycle.

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 Centre of gravity enter of Gravity
(CG)

Midway between the hips

Few cm in front of S2
Least energy consumption if
CG travels in straight line.

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Parameters of gait analysis

Spatio temporal variables

Kinematic variables

Kinetic variables

Energetics
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 Temporal and spatial
 Characteristics are obtained by measuring the distances and
velocities between the feet at different phases of the gait
cycle.

These measurements include

 step time,
 step length
 stride time
 stride length
 step width
 cadence
 swing and stance phase durations.

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 Kinematics

 An analysis of this type is concerned with the position,

orientation, and velocity of the limbs at all times during gait,
typically in the form of joint angles, joint angular velocity,
and joint angular acceleration .

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Kinetics
 It is a term for the forces and torques that compel bodies to
move.

 A kinetic analysis wants to know the reaction forces between

the feet and ground and also, ideally, the muscle forces
generated by the body to maintain posture and cause
movement.

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Energetics
 Deals with oxygen consumption during gait

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 a detailed history and physical examination. 40
It is the clinician’s preference to evaluate the individual's gait after
The observation and
evaluation of gait Detailed
can occur either musculoskeletal and Detailed history and
before or after the neurologic physical
physical examination examination. examination.
and is included as a
part of the physical
examination.
How will you perform gait analysis ??
 History of gait analyses

Inman and Perry and Observationa Scales Instrumented

Eberhart in the Sutherland l
1950s 1990s 41
 In its earliest form gait analyses were semi-subjective
procedures carried out by trained specialists who directly
observe a patient's gait by making her walk.

 This is perhaps accompanied a survey to the patient

asking for a self-evaluation of her gait quality.

 This analysis can only give a subjective and qualitative

measure of gait with questionable accuracy and
precision, resulting in negative effects on the diagnosis,
follow-up, and treatment of the pathologies.
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 Methods of gait assessments
Observation Instrumente
Scales
al d
The Knee Society
Score

Tinetti scale Picture video

Naked eye

A modified version of the

Physician Rating Scale,
the Hugh Williamson
Gait Laboratory Scale
(HWGLS),

The Physician Rating force plates and 3D

Banesh Movement
Scale optical motion
Notation
Rivermead Visual capture
Gait Assessment
(RVGA)

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 Footswitches
Temporal and
spatial
Instrumented gait
analysis

kinematics
Gait mats
Kinetics

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 Electromyograms

Temporal
and spatial
Video Motion

Instrumented gait Kinematics

analysis
Electrogoniometers
Kinetics

Magnetometers

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 Temporal and
spatial Foot pressure
Kinematics
Instrumented
gait analysis
Kinetics Pressure Insoles

Pressure Mats

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 Video Motion

 Video systems utilize one or more video cameras to track bright

markers placed at various locations on the person being tested.

 The markers are either infrared (IR) light-emitting diodes (LEDs)

for active marker systems or solid shapes covered with retro
reflective tape for passive marker systems.

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 The systems keep track of the horizontal and vertical
coordinates of each marker from each camera.

 In three-dimensional (3D) systems, the computer software

computes 3D coordinates for each marker based upon the 2D
data from two or more

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 Generally, measurement
systems for physiotherapy
require expensive devices.

 An ideal measuring
system is one that can
be easy to use without the
need to utilize sensors
attached to the body and
cheap.

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KINOVEA
 Kinovea is an open-access video analysis software and
available online (https://www.kinovea.org), which could be
explored for motion analysis.

 It free 2D motion analysis software under GPLv2 license,

created in 2009 via the non-profit collaboration of several
researchers, athletes, coaches and programmers from all over
the world.

 It is widely available for download on the web ; the current

official version is 0.8.15, 55 although 0.8.24 has been used
experimentally and the most recent update is 0.8.25 .
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The main advantage of Kinovea is the easy of use and the
analysis without use high tech physical sensors.

In addition, it is free and can be used for measurements in a

rehabilitation process.

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2D motion
analysis
software

low-cost
technology

Analysis,
comparison
and
evaluation of
movement.

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 It is increasingly popular to be used for video analysis
Hisham et al, 2017

 Kinovea software is a valid and reliable tool that is able to

measure accurately at distances up to 5 m from the object and
at an angle range of 90°–45° Puig-Divi A,et al 2017

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 Kinovea allows the user to control temporal parameters and
measure angles and distances frame by frame.

 These measurements can also be made from different

perspectives, since the software carries out calibrations in
non-perpendicular planes to the camera-object line analyzed.

 As it is not a 3D program, Kinovea enables users to choose

the plane on which to perform the dimensional analysis in 2D

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 2 web
2 stands or
cameras/m
stable
obile
surfaces
cameras
Minimal
10 metres
clothing or
walking
black
track
outfit

(VBOGA)
Markers using 2 laptops
KINOVEA

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 Pathway for analysis

3 mtrs

3 mtrs

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Errors

 Parallax error

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 Perspective error

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 Soft tissue artifacts
 Landmark error

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Technical aspects and
procedure of gait evaluation

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Energy Expenditure Index (EEI)
 The Energy Expenditure Index (EEI), also called
Physiological Cost Index (PCI), is a method of indirect
evaluation of energy consumption.

 EEI has traditionally been calculated using the amount of

oxygen production, requiring expensive and cumbersome
equipment. In simple standard settings, EEI can be calculated
using heart rate and walking speed.

Mathew J, 2018

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 EEI was estimated using the formula

EEI = Working HR-baseline HR/speed

Speed = Distance/Time

MacGregor's Equation.

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Pathway of evaluation

Identification of the client

Explanation to the client

Informed consent form

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 Platform preparation

Exposure of bony landmarks

Retro reflective spherical markers

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 Safety measure

Platform familiarization

Simultaneous recording of both the

camera

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Recording of various planes of gait

Import the video to kinovea /motion

analysing software

Data table

Result generation
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Informed consent form

Subject
information
form Consent form

Inform consent.pdf

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 Platform preparation

3M

3M

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Exposure of bony landmarks

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 Safety measure assurance

 Geriatric clients and participants at potential for risk of fall

SHOULD necessarily wear a gait belt/transfer belt and be
accompanied by a therapist.

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Import the video to kinovea /motion analysing software

Spatial
(Distance)
Spatiotemporal
Temporal
Parameters of (Time)
gait

Kinematics Angles

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 Data table
Kinematic parameters

Ankle Joint Kinematics (Rt Female)

No IC LR
IC1 IC2 IC3 ICM ICSD LR1 LR2 LR3 LRM LRSD

Knee Joint Kinematics (Rt Female)

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 Data table
Spatiotemporal parameters

 Same as kinematic parameters

Velocity: Stride length × 0.5 cadence

V=SL ×0.5 C

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 Result generation

No ICM± SD LRM± S MSM± SD TSM± SD PSM± SD

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 Ankle and subtalar joint ROM of typical adults

Ankle and subtalar joint ROM of stroke survivors

Ankle joint ROM Subtalar joint ROM

Events On pebbles(degree) On sand(degree) Events On pebbles(degree) On sand(degree)
IC 5p -13p 3p – 14p IC 16e – 20.3e 20e – 24e
LR 6d – 9.3p 11d – 9p LR 8e – 21e 22e – 23e
MS 12.3d – 7p 13.3d – 10p MS 21e – 22.7e 18e – 23.7e
TS 4d – 7p 17.6d – 5p TS 10e – 22e 13e – 15.6e
PS 3.3p – 11p 13d – 11p PS 10e – 11e 9.3e – 12e

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