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  1. 1. SHRI GURU RAM RAI University, Dehradun
  4. 4. INTRODUCTION SAGITTAL PLANE  SAGITTAL plane analysis of gait or kinematic gait analysis in the Sagittal plane is used for clinical and laboratory identification of deviations of normal gait  The Sagittal plane divides the body into left and right  Extension and flexion happen along the sagittal plane
  5. 5. SAGITTAL PLANE ANALYSIS OF GAIT  When we move along this plane, we are using the strength of our muscles to move parts of the body forward or backward  Flexion and extension occur in this plane  Example:- Running, walking, jumping , squatting, kicking a football ,chest pass in netball, lifting movements make use of this plane
  6. 6. IN order to conduct a “SAGITTAL PLANE ANALYSIS OF GAIT” we should firstly learn about the normal gait cycle NORMAL GAIT CYCLE (STANCE phase occupies 60% and SWING phase occupies 40%)
  8. 8. GAIT ANALYSIS  GAIT :- Manner, pattern or style of walking or way of walking  GAIT ANALYSIS :-is the study of human motion  :- Using the eye and the brain of observer  :- Augmented by instrumentation  For Measuring  - Body movements  - Body mechanics  - Activity of muscles
  9. 9. The analysis of the Gait cycle is important in the Biomechanical mobility For analysis of gait cycle we can used Subjective and Objective Methods FUNCTION DIVISIONS OF THE GAIT CYCLE (GAIT ANALYSIS)
  10. 10. Gait initiation (GI) involves the shifting of body weight from double limb support during quiet standing (QS) to a single limb, moving the body forward while controlling frontal and sagittal plane forces as the body transitions to steady-state gait whereby the center of mass (COM) velocity is relatively constant.  With the feet side-by-side prior to GI, the initial intended swing limb is unable to develop ‘push-off’ energy normally seen in steady-state gait.  Thus, energy for the first step must come from other sources, including passive gravitational forward lean and active hip flexor contraction to pull the swing leg forward  As opposed to the predominately sagittal motion of steady-state gait, GI begins with the lateral shifting of the COM, which cannot be too lateral or too fast as this may result in a loss of balance, possibly leading to a fall
  11. 11. From a neuromuscular perspective, when a subject commits to begin walking, soleus activity is inhibited followed immediately by activation of the tibialis anterior of both legs, which allows the center of pressure (COP) to move backward Concurrently, hip abductors are inhibited on the initial stance limb and activated on the ipsilateral limb, such that the COP shifts briefly towards the stance limb Paradoxically, this pattern results in the initial swing limb being loaded momentarily while the contralateral limb is unloaded, the intention of which is to allow the COP to accelerate the COM toward the contralateral limb. This results in unloading the initial swing limb so that the first step of GI may take place  Subsequently, the COP is driven medially during stance limb loading, and forward along the stance foot as the swing limb is lifted upward and forward  During the first step of GI, hip abductors of the stance limb act to prevent the pelvis from dropping on the side of the intended swing limb
  12. 12.  The principle of the overall support moment, i.e., the algebraic summation of sagittal plane lower extremity joint extensor moments of force during gait (Winter, 1980).  The principle was based on the concept that the central nervous system (CNS) does not simply control individual joint moments of force; rather, the entire lower extremity acts as a single unit with respect to support against gravity, particularly during the single support phase of gait where the collapse of the limb would be disastrous. The support moment allows the CNS considerable flexibility in adapting joint motion patterns of the lower extremity hip and knee moments, depending upon such circumstances as pain avoidance, changes in terrain, speed, aging, and so forth.
  13. 13. Joint Power and Mechanical Energy in Gait Initiation From the perspective mechanical energy, GI has been described as the the changing of the body’s energy state from primarily potential energy during QS to the states of both kinetic and potential energy during the first three steps (Miller and Verstraete, 1999). Previous energy analyses of GI have considered segmental components and total body energy throughout each step calculated from anthropometric and kinematic data However, for individuals with neurological conditions such as multiple sclerosis or Parkinson’s disease, movement transition states such as GI present unique neuromuscular control challenges.
  14. 14.  Hypotheses The sagittal plane support moment would be like that previously reported and would be evident following the first step. There would be a differentiation in the roles of the sagittal and frontal planes support moment, respectively. Sagittal powers would have little contribution during the initial transfer of weight in the stance phase of the first step. The energies in the sagittal plane would be significantly larger than those of the frontal plane particularly for the hip in the first step forward. By the third step of GI, all kinetic variables would be like those seen in steady-state gait.
  15. 15. : Schematic of the gait initiation protocol - FPn = force platform n. +Y = AP direction, +X = ML direction B: Time-normalization schema - DS = double support, SwL = swing leg, StL = stance leg
  16. 16. SAGITTAL PLANE DATA To facilitate understanding the natural sequence of GI, STEP1 and STEP3 are plotted continuously (left leg) with STEP2 (right leg) plotted underneath for each joint in each plane. Vertical dotted lines show the
  17. 17.  Sagittal plane The typical support moment pattern, i.e., predominately extensors during stance and zero during swing, seen in steady-state gait was not evident in STEP1.  During STEP2, there was a gradual increase in magnitude during the stance phase of the support moment as the COM began to move away from the starting point. By STEP3, there was positive (extensor) activity during stance and slightly negative or zero support moment during swing, which was more or less typical (Winter, 1980).  At the lower extremity joints, the magnitudes of the moments in STEP1 were relatively small, with most of the activity occurring in STEP2 and STEP3 at the ankle. Typical support moment patterns at the hip and knee were not evident until STEP3.
  18. 18.  Sagittal Plane Energy  There were no sagittal plane energy data for the knee joint during STEP1. Ankle energy absorption (A1) was present in all three steps and modified as a function of the step number (F(2,42) = 36.27, p < 0.0001): A1 progressively increased in magnitude with each step. Ankle push-off (A2) was also present in all three steps, and modified as a function of the step number (F(2,42) = 68.27, p < 0.0001): A2 was lowest in STEP1, highest in STEP2, and all steps were different from each other.  At the knee, no knee energy bursts were apparent in STEP1, K2 and K4 appeared in STEP2, while STEP3 contained K2, K3 and K4. Therefore, at the knee, steady state gait patterns were achieved progressively with each step. Comparisons across the latter two steps demonstrated that only K4 was different (F(1,28) = 5.50, p = 0.026), with STEP3 larger than STEP2.  At the hip, only hip pull-off (H3) was apparent at the toe-off in STEP1. Additional energy bursts became apparent as steps progressed: H1 was added at STEP2, and H2 was added at STEP3. H1 was significantly greater in STEP3 compared to STEP2 (F(1,26) = 10.44, p = 0.0033). Hip pull-off (H3) was not different across the different steps (F(2,42) = 2.32, p = 0.11
  19. 19. PROCESS AND EQUIPMENT  Subjective and Objective Methods can be used to assess the Gait cycle  SUBJECTIVE:-  :1- Different Gait patterns-  -Ask the patient to Walk normally  -On inside and outside of the feet in a straight line  -Running call the time looking to compare side and understanding of normal  2- Ask/observe:-  -the type of footwear the patient uses  -Shoes affect Velocity, Step time and Step length in younger children’s gait
  20. 20. Objective  1- QUANTITATIVE & PARAMETERS LIKE  time, distance & muscle activity will be measured  Other objective methods to assess the gait cycle that  USE Equipment include-   :-Video Analysis & treadmill  :-Electronic & Computerized apparatus  :- Electronics pedometers  :- Satellite positioning system
  21. 21. 2- QUALITATIVE METHODS :- Rancho Los Amigos Hospital rating list  :- ten meter walking test  :-6 minute walk test  :- 2 minute walk test  :- Dynamic gait index  :- Emory Functional profile  :- Timed and go test ( falling in men but not in women)  :- Functional Ambulation categories  :- Tinetti test
  22. 22. Video Gait Analysis & Treadmill
  23. 23. Rancho Los Amigos Gait Cycle
  24. 24. FACTORS EXTRINSIC Such as terrain, footwear , clothing, cargo  INTINSIC :- Sex, weight, height, age etc  PHYSICAL :- Such as weight, height , physique  PSYCHOLOGICAL :- Personality type, emotions PHYSIOLOGICAL :- psychiatric disorders Anthropometric characterstic smeasurements & proportions of body PATHOLOGICAL :- For example- Trauma, neurological diseases, musuculoskeletal Anomalies
  25. 25. Factors Affecting joint momemts
  27. 27. TECHNIQUES Gait Analysis involves measurement Where measurable parameters are  - Introduced  - Analyzed  - Interpretation Where Conclusions about the subject are drawn  - Health  - Age  - Size  - Weight  - Speed 
  28. 28. TEMPORAL/ SPATIAL Spatio-Temporal-Gait -parameters
  29. 29. TEMPORAL/SPATIAL  It consists of :-The calculation of speed :-The length of rhythm :- Pitch Measurements are carried out through :- Stopwatch & marks on the ground :-Walking on a pressure mat :-Range laser sensors scanning a plane a few centimeters above the floors :- Inertial sensors and software to interpret 3D gyroscope & 3D accelerometric data
  30. 30. KINEMATICS & KINETICS KINEMATICS  IT is defined as study of angular rotations of each joint during movement  It can be observed & measured at foot, ankle, knee & hip during gait cycle  Observed in three planes Sagittal: hip flexion, extension Coronal: hip abduction, adduction Transverse: hip rotation, tibial,foot  KINETICS:- is the study of the forces involved in the production of movements
  31. 31. SAGITTAL PLANE ANALYSIS OF GAIT  The pelvis is tilted anteriorly approx-15 degrees  Minimal motion of anterior tilt  When Hamstrings are tight, pelvis assumes posterior tilt  The hip is flexed at initial contact & extends during stance phase  The hip continues to flex during walking
  32. 32. SAGITTAL PLANE ANALYSIS  INITIAL CONTACT Hip 30 degree of flexion Knee is extended Ankle is neutral GRF  - Anterior to Hip, drives the hip into flexion  - Anterior to Knee, drives the knee into extension  - Ankle into planter flexion
  33. 33. HIP:- hamstrings, gluteus maximus, and adductor magnus (i to e)  KNEE:- quadriceps (c to e) TIBIOTALAR joint: tibialis anterior (e) SUBTALAR joint:- anterior and lateral compartment muscles (e)
  34. 34. SAGITTAL PLANE ANALYSIS LOADING RESPONSE  Hip extension 25°  Knee flexion 20°  Ankle planter flexion to 10°  Contra-lateral pelvis rotates anterior  GRF  > Anterior to hip  > Posterior to knee  > Posterior to ankle
  35. 35.  HIP:- Extensors (e), Abductors (e) limit contra-lateral drop 5 degree  KNEE:- Quadriceps fire (c)  ANKLE:- Tibialis anterior (e)
  36. 36. SAGITTAL PLANE ANALYSIS MID STANCE GRF through hip, Knee, and ankle Muscular activity terminaters Hip and knee stability provided by ligamentous restraints
  37. 37. GRF  Posterior to hip  Anterior to knee and ankle  Gastroc-soleus complex fires to initiate knee flexion  Pelvis continues to rotate, abductors continue to resist pelvic drop
  38. 38. SAGITTAL PLANE ANALYSIS TERMINAL STANCE  Single stance : falling forward  Forward fall of the body moves the vector further anterior to the ankle, creating a large dorsi-flexion moment  Strong activation of gastroc- soleus complex  Begins as COG passes over foot & ends when opposite foot touches ground
  39. 39.  The body moves past the foot  Hip is in 20 degrees extension (apparent motion; some of these comes from pelvic rotation)  Knee is in 5 degrees of flexion  Ankle is in 10 degreed of dorsiflexion
  40. 40. SAGITTAL PLANE ANALYSIS PRE-SWING  Hip 20° of hyper-extension  Knee 30° of flexion  Ankle 20° of plantar-flexion  Toes 50° of hyper extension
  41. 41. GRF  Posterior to hip, knee anterior to ankle  Rapid flexion of knee from rapid heel rise and unweighting of limb  Rectus femoris initiates hip flexion  Adductor longus  Hip: iliopsoas, adductor magnus, adductor longus  Knee: Quadriceps  Ankle: Gastrocsoleus complex  Toes: Ab.hal. FDB, FHB, Introssei, lumb.
  42. 42. SAGITTAL PLANE ANALYSIS INITIAL SWING  Hip 0- 30° of flexion  Knee from 30- 60° of flexion and extension from 60-30°  Ankle 20° of plantar-flexion to neutral  Foot clearance is passive due to rapid hip flexion, unless gait is very slow  In slow gait, tibialis anterior and hamstring fire to help  Gait cadence (speed) governed by accelerations of hip flexion during this phase
  43. 43.  Hip flexion  - Rectus femoris  - Hiacus  - Adductor longus  - Gracilis  - Sartorius  Rest of limb is passive pendulum
  44. 44. SAGITTAL PLANE ANALYSIS MID SWING  Tibialis anterior fires to maintain foot position  Knee extension and hip flexion continue by inertia
  45. 45.  Leg has advanced past the stance limb  Hip is in 25 degrees of flexion  Knee is in 25 degrees of flexion (perpendicular to the ground)  Ankle is in 0 degree dorsiflexion
  46. 46. SAGITTAL PLANE ANALYSIS TERMINAL SWING  Decelerate Knee extension and hip flexion  - Hamstrings  - Gluteus maximus  Quads Co-contract  Tibialis anterior maintains ankle position
  47. 47.  The leg extends to provide length to the step  The hip is in 20 degrees of flexion  The knee is in 5 degrees of flexion  The ankle is in 0 degrees of flexion
  49. 49. BODY WEIGHT & GRF
  50. 50. MUSCLE FORCE
  51. 51. DYNAMIC ELECTROMYOGRAPHY EMG Activity during Gait
  52. 52. APPLICATIONS MEDICAL DIAGNOSTICS 1. Pathological Gait  Cerebral palsy  Stroke • Gait Analysis techniques allow for the assessment of gait disorders & effects of corrective orthopedic surgery
  53. 53. CEREBRAL PALSYEx:- options for treatment of cerebral palsy  Botox or the lengthening  Re-attachment or detachment of particular tendons  Osteotomy Gait Analysis is used in professional sports training to optimize and improve athletic performance
  54. 54.  2. Chiropractic & Osteopathic uses • Gait assessment may be indicative of a mis-aligned pelvis or sacrum • Both doctors use Gait to discern the listing of a pelvis & can employ various techniques to restore a full range of motion to areas involved in ambulatory movement  3. Comparative Biomechanics By studying the gait of non-human animals  4. Gait as biometrics • Gait has been established as biometrics to recognize people by the way they walk • For forensics use since each person can have a gait define by unique measurements such as the locations of ankle, knee,hip
  55. 55. PURPOSE FOR GAIT ANALYSIS For a particular disorder to gain an understanding of the gait Characterstics of a particular disorder For a diagnosis to assist movement diagnosis For a selective treatment to inform treatment selective To Evalute the effectiveness of treatment
  56. 56.  Paediatric physiotherapist Can use gait analysis to help identify the issues with developmental delay along with more general injury
  57. 57. SPORTS PHYSIOTHERAPIST For athletes and knee runners Sports Physiotherapist can use gait analysis to improve the efficiancy of their running style