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KINESIOLOGY OF WALKING

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Title: KINESIOLOGY OF WALKING


1
KINESIOLOGY OF WALKING
  • Dr. Michael P. Gillespie

2
WALKING (AMBULATION)
  • Ideally, walking is performed efficiently to
    minimize fatigue and safely to prevent falls and
    associated injuries.
  • Healthy people can ambulate wile carrying on a
    conversation, looking in various directions, and
    even handling obstacles and other destabilizing
    forces with minimal effort.
  • Individuals at both ends of the lifespan
    experience challenges with ambulation.

3
WALKING AT VARIOUS STAGES IN LIFE
4
WALKING AT VARIOUS STAGES IN LIFE
  • Early in life, the young child needs 11 to 15
    months to learn how to stand and walk.
  • By 4-5 years of age they refine the pattern of
    gait so that it looks like that of an adult.
  • Decreased strength, decreased balance, and
    disease in the elderly become a gait challenge.
  • The elderly may require a cane or walker to
    ambulate safely.

5
WALKING INDEPENDENCE
  • Nothing epitomizes a level of independence and
    our perception of a good quality of life more
    than the ability to travel independently under
    our own power from one place to another. We
    celebrate the development of this ability in
    children and try to nurture and sustain it
    throughout the lifespan. A. Palta

6
MAREYS INSTRUMENTED SHOES FOR THE MEASUREMENT OF
GAIT
7
MURRAY USED REFLECTIVE TARGETS AND A CAMERA WITH
THE SHUTTER OPEN TO ANALYZE GAIT
8
ANALYSIS OF HUMAN MOTION
9
INSTRUMENTATION IN A TYPICAL GAIT LABORATORY TO
STUDY WALKING
10
SPATIAL AND TEMPORAL DESCRIPTORS
  • Gait Cycle
  • Stance and Swing Phases

11
GAIT CYCLE
  • Walking is the result of a cyclic series of
    movements.
  • It can be characterized by a detailed description
    of the gait cycle (the fundamental unit of
    walking).
  • Foot contact typically begins with the heel.
  • The beginning of the gait cycle is typically
    referred to as heel contact or heel strike.
  • The 100 point or completion of the gait cycle
    occurs as soon as the same foot once again makes
    contact with the ground.
  • Initial contact is often used in place of heel
    contact.

12
GAIT CYCLE
  • A stride (synonymous with a gait cycle) is the
    sequence of events taking place between
    successive heel contacts of the same foot.
  • A step is the sequence of events that occurs
    within successive heel contacts of opposite feet
    (i.e. between left and right heel contacts).
  • A gait cycle has two steps- a left step and a
    right step.

13
GAIT CYCLE 15-6
14
SPATIAL DESCRIPTORS OF GAIT
  • Stride Length the distance between two
    successive heel contacts of the same foot.
  • Step Length the distance between successive
    heel contacts of the two different feet.
  • Comparing right and left step length can be
    useful in evaluating symmetry of gait in the
    lower extremities.
  • Step Width step width is the lateral distance
    between the heel centers of two consecutive foot
    centers (average 8 to 10 cm).
  • Foot Angle the amount of toe-out. The angle
    between the line of progression of the body and
    the long axis of the foot (average 5 to 7
    degrees).

15
SPATIAL DESCRIPTORS OF GAIT 15-7
16
COMPONENTS OF GAIT CYCLE
  • Heel contact (heel strike)
  • Stride
  • Step
  • Stride length
  • Step length
  • Step width
  • Foot angle

17
TEMPORAL DESCRIPTORS OF GAIT
  • Cadence the number of steps per minute (also
    called step rate).
  • Stride Time the time for a full gait cycle.
  • Step Time the time for completion of a right or
    left step.
  • With symmetric gait, step time can be derived
    from cadence.

18
SPATIAL-TEMPORAL DESCRIPTOR
  • Walking Speed

19
WALKING SPEED
  • Walking Speed combines both spatial and temporal
    measurements by providing information on the
    distance covered in a given amount of time.
  • The units of measure are typically meters per
    second (m/sec) or miles per hour (mph).
  • Calculating speed
  • Measure the time it takes to cover a given
    distance.
  • Measure the distance covered in a given amount of
    time.
  • Multiply the step rate by the step length.
  • Speed may be the best and most functional
    measurement of an individuals walking ability.

20
WALKING SPEED
  • For healthy adults, a gait cycle (2 consecutive
    steps) takes slightly more than 1 second and
    covers approximately 1.44 m (4.5 feet).
  • This results in a walking speed of 1.37 m/sec.
  • At a freely chosen walking speed, women exhibit a
    slower walking speed, shorter step length, and
    faster cadence than men.
  • These differences are likely in part due to
    anthropometric disparities between genders
    however, even when anthropometrically matched
    with men, women still demonstrate a higher
    cadence and shorter step length than men when
    walking at the same speed.

21
NORMAL VALUES FOR WALKING
  • Walking speed 1.37 m/sec (3 mph)
  • Step rate 1.87 steps/sec (110 steps/min)
  • Step length 72 cm (28 inches)

22
METHODS TO INCREASE WALKING SPEED
  • Longer step length.
  • Shorter gait cycle (faster walking cadence).

23
METHODS TO INCREASE WALKING SPEED
24
INFLUENCE OF IMPAIRMENT ON STEP LENGTH 15-8
25
INFLUENCE OF IMPAIRMENT ON STEP LENGTH 15-8
26
ABNORMAL GATE EXAM PARKINSONS DISEASE
  • Parkinsonian Gait Demonstration?This type of gait
    is seen with rigidity and hypokinesia from basal
    ganglia disease. The patient's posture is stooped
    forward. Gait initiation is slow and steps are
    small and shuffling turning is en bloc like a
    statue.
  • https//www.youtube.com/watch?v7SyTpEdhBLw
  • https//www.youtube.com/watch?vylHZWO17W70

27
STANCE AND SWING PHASES
  • To describe the events taking place during the
    gait cycle, it is customary to subdivide the gait
    cycle from 0 to 100.
  • Heel or foot contact with the ground is
    considered the start of the gait cycle (0).
  • The next ground contact made from the same foot
    is considered the end of the gait cycle (100).
  • A full gait cycle can be divided into two major
    phases.
  • Stance phase (from right heel contact to right
    toe off).
  • The right foot is one the ground supporting the
    bodys weight.
  • Swing phase (from right toe off to the next right
    heel contact).
  • The right foot is in the air, being advanced
    forward for the next contact with the ground.

28
SIMPLE CLINICAL MEASUREMENTS OF WALKING
  • Sophisticated instrumentation such as walkways
    and foot switches exist to make spatial and
    temporal measurements however, these are not
    necessary.
  • Average walking speed can be measured using a
    stopwatch and a known distance.
  • Step length and step width can be measured using
    ink marks made by shoes or feet on a roll of
    paper covering the floor.
  • Documents abnormal gait patterns including
    asymmetry in step length.

29
MINIMUM STANDARDS BASED ON COMMUNITY-LIVING
ACTIVITIES
  • Compare your results with normal values or with
    minimum standards required to perform a specific
    task (i.e. crossing the street within the time
    allowed by the stoplights.
  • Minimum standards based upon community-living
    activities
  • The ability to walk 300 m (1000 feet) in less
    than 11.5 minutes (walking speed of 0.45 m/sec or
    1 mph).
  • The ability to walk at a speed of 1.3 m/sec (3
    mph) for 13 to 27 m (42 to 85 feet) to cross a
    street safely.

30
HESITANCY CROSSING THE STREET
  • https//www.youtube.com/watch?vlc32tnYCe1E

31
GAIT CYCLE
  • Stance Phase 60 of gait cycle
  • Swing Phase 40 of gait cycle

32
SUBDIVISION OF THE GAIT CYCLE 15-10
33
GAIT CYCLE BREAKDOWN OF COMPONENTS
  • https//www.youtube.com/watch?v5j4YRHf6Iyo

34
SUBDIVISION OF STANCE AND SWING PHASES
  • Five specific events are typically described
    during stance phase
  • Heel contact
  • Foot flat
  • Mid stance
  • Heel off (heel rise)
  • Toe off
  • Three specific events are typically described
    during the swing phase
  • Early swing
  • Mid swing
  • Late swing

35
STANCE PHASE
  • Heel contact the instant the heel comes in
    contact with the ground (occurs at 0 of the gait
    cycle).
  • Foot flat the instant the entire plantar
    surface of the foot comes in contact with the
    ground (occurs at approximately 8 of the gait
    cycle).
  • Mid stance the point at which the bodys weight
    passes directly over the supporting lower
    extremity. The point when the foot of the lower
    extremity in the swing phase passes the lower
    extremity in the stance phase (feet are side by
    side). (occurs at 30 of the gait cycle or 50 of
    the stance phase)
  • Heel off (heel rise) the instant the heel comes
    off the ground (occurs between 30 and 40 of the
    gait cycle).
  • Toe off the instant the toes come off the
    ground (occurs at 60 of the gait cycle).

36
PUSH OFF
  • A period referred to as push off is also often
    used.
  • This period roughly corresponds to the movement
    of ankle plantar flexion at 40 to 60 of the
    gait cycle.

37
SWING PHASE
  • Early swing the period of time from the time of
    toe off to mid swing (60 to 75 of the gait
    cycle).
  • Mid swing the time from slightly before to
    slightly after the mid stance event of the
    opposite lower extremity, when the foot of the
    swing limb passes next to the foot of the stance
    limb (75 to 85 of the gait cycle).
  • Late swing the period from the end of mid swing
    to foot contact with the ground (85 to 100 of
    the gait cycle).

38
TERMINOLOGY DEFINING SUBDIVISIONS OF GAIT CYCLE
Phases Events Percentage of Cycle Events of Opposite Limb
Stance Heel Contact Foot Flate Mid Stance Heel Off Toe Off 0 8 10 30 30-40 50 60 Toe Off Mid swing (25-35) Heel Contact
Swing Early Swing Mid Swing Late Swing Heel Contact 60-75 75-85 85-100 90 100 Mid-stance (80) Heel off (80-90)
39
GAIT CYCLE - PERRY
  • 8 events
  • 7 Periods

40
EVENTS OF GAIT CYCLE - PERRY
  • Initial contact
  • Opposite toe off
  • Heel rise
  • Opposite initial contact
  • Toe off
  • Feet adjacent
  • Tibia vertical
  • Initial contact

41
PERIODS OF GAIT CYCLE - PERRY
  • Stance phase
  • Loading response
  • mid stance
  • Terminal stance
  • Pre swing
  • Swing phase
  • Initial swing
  • Mid swing
  • Terminal swing

42
EVENTS OF GAIT CYCLE 15-12
43
NORMAL GAIT
  • https//www.youtube.com/watch?vVYVyoFdJHdU

44
ABNORMAL GAIT
  • https//www.youtube.com/watch?vpnMpHwBClw8index
    3listPLt9rbdWnb3kjThf6oUGhdrd6TcNpYFgU2

45
DISPLACEMENT AND CONTROL OF THE BODYS CENTER OF
MASS
  • Walking can be described as a series of losses
    and recoveries of balance.
  • Ambulation is initiated by allowing the body to
    lean forward.
  • For a fall to be prevented, momentary recovery of
    balance is achieved by moving either foot forward
    to a new location.
  • Once gait is initiated, the bodys forward
    momentum carries the center of mass (CoM) of the
    body beyond the foots new location,
    necessitating a step forward with the other foot.
  • Ambulation stops when foot placement stops the
    forward momentum of the body.

46
DISPLACEMENT OF THE CENTER OF MASS
  • The bodys center of mass (CoM) is located just
    anterior to the second sacral vertebra, but the
    best visualization of the movement of the CoM is
    by tracking the displacement of the head or
    torso.
  • The most notable displacement of the body during
    gait is in the forward direction however,
    displacement also occurs in the vertical and
    side-to-side directions.

47
DISPLACEMENT OF CENTER OF MASS
  • Total Vertical Displacement 5 cm
  • Total side-to-side displacement 4 cm

48
CENTER OF MASS DISPLACEMENT 15-13
49
TRANSFER BETWEEN KINETIC AND POTENTIAL ENERGY
DURING GAIT 15-14
50
EXCESSIVE DROP OF ILIAC CREST FROM WEAK GLUTEUS
MEDIUS 15-18
51
INCREASED ENERGY COST OF WALKING WITH SPECIFIC
CONDITIONS 15-4
Conditions Increased Energy Cost ()
Immobilization of one ankle 3-6
Immobilization of one knee in full extension 23-33
Immobilization of one knee at 45 degrees of flexion 37
Immobilization of one hip, arthrodesis 32
Unilateral transtibial amputation, walking with prosthesis 20-38
Unilateral transfemoral amputation, walking with prosthesis 20-60
Postcerebrovascular accident 55
52
PATH OF THE CENTER OF PRESSURE 15-32
53
GAIT DYSFUNCTIONS
54
CAUSES OF PATHOLOGIC GAIT PATTERNS
  • Pain
  • Central Nervous System Disorders
  • Musculoskeletal System Impairments

55
ANKLE PLANTAR FLEXION CONTRACTURE
56
WEAK ANKLE DORSIFLEXORS
57
EXCESSIVE ANKLE PLANTAR FLEXION
58
WEAK QUADRICEPS LEADING TO ANTERIOR TRUNK LEAN
59
KNEE FLEXION CONTRACTURE RESULTING IN CROUCHED
GAIT OF THE STANCE LIMB
60
HIP CIRCUMDUCTION DURING SWING
61
ATAXIC GAIT DEMONSTRATION
  • The patient's gait is wide-based with truncal
    instability and irregular lurching steps which
    results in lateral veering and if severe,
    falling. This type of gait is seen in midline
    cerebellar disease. It can also be seen with
    severe lose of proprioception (sensory ataxia)
  • https//www.youtube.com/watch?vFpiEprzObIUlistP
    LCB588B387FB08409

62
NORMAL AND ABNORMAL GAIT SERIES
  • https//www.youtube.com/playlist?listPLt9rbdWnb3k
    jThf6oUGhdrd6TcNpYFgU2
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