This presentation provides an overview of the analysis of joint movements during gait

1. Suruchi.V. Rao, PT
Neurological and Psychosomatic disorders

2. To have an over view on
1. Regarding the terminologies and variables of the gait
2. What are the phases of the gait and joint position
during each phase
3. What are the types of gait analyses and the procedure
followed for each analysis

3.  Gait is defined as the ability to walk, it is a
co-ordinated movement between joints . It
requires integration of numerous
physiological systems to sequence events
necessary to accomplish efficient walking.
Susan’O Sullivan; 6th edition

4.  In absence of pathology, gait appears
coordinated, efficient and effortless.
 Disease or trauma, however, can disrupt the
precision, coordination, speed and versatility
that characterize normal walking.

5.  It consists of 2 phases-
1. Stance phase
2. swing phase
 Gait analysis is done to obtain an accurate
description of gait pattern and variable
 Kinetic and kinematic analysis of gait include
the joint movement and forces acting on the
body while walking

6.  To obtain an accurate description of gait
pattern and identify gait deviation
 Determine balance, endurance, energy
expenditure index, during walking
 Determining functional ambulation
capabilities of patient in relation to
ambulation status at home, work, community
 To predict the prognosis, QOL
 Helps therapist to plan the treatment
accordingly and select a particular
intervention and aids
 Evaluate the effectiveness of treatment

7.  A time interval between two successive
occurrence of one event during walking.
 One gait cycle consist of one stance phase &
one swing phase of reference extremity.
 Consists of 60% of stance and 40% of swing
phase

8. A. Stance phase:
1. Initial contact
2. Loading response
3. Mid stance
4. Terminal stance
5. Preswing
B. Swing phase:
1. Initial swing
2. Mid swing
3. Terminal swing

9. 1. Stance time: is the amount of that elapses
during stance phase of each extremity in gait
cycle.
2. Initial double stance- begins in gait cycle, it
is the time where both the feet are in
contact with the floor
3. Single limb support: begins when opposite
limb is lifted for swing. The entire body is
resting on single extremity
4. Terminal Double stance: begins with floor
contact by the other foot and continues
until the original limb is lifted for swing

10. 5. Stride length- it is equivalent of gait cycle
and is time interval between 2 sequential
initial contact by same limb; Stride time: is
amount of time it takes to accomplish one
stride.
6. Step length- timing between 2 limbs; Step
time: refers to amount of time spent during
a single step.
7. Cadence: is number of steps taken by a
person per unit time.
8. Speed- it is the distance covered by time
taken

13.  Truncal rotation – it rotates in the opposite
and counter clock wise direction, there is
simultaneous horizontal rotation of trunk and
pelvis in opposite direction
 Arm swing- as a person steps forward with
left leg, the right shoulder and elbow flex
slightly and correct arm swing will generate
correct trunk rotation

14. Initial contact ANKLE KNEE HIP
posture Ankle at 90 degree to
initiate heel rocker, ankle
is positioned at 90 degree
and support of the foot is
provided by dorsiflexor
pull by pre tibial muscles
Extended knee posture
Function: Stabile weight-bearing
Hip will be in flexion
Joint position
Dorsiflexion Extension
20-30 degree of flexion
Internal joint
moment
Pre tibial muscles
maintain the DF and
achieves peak
Two extensor mechanisms are
active. First is the alignment of the floor
impact vector. The immediate
floor reaction force creates a vertical vector
anterior to the knee axis. Second is active
muscular control. Vastii. IT band are active
hip is in an unstable position.
And the body vector is anterior of the hip joint
at the moment of fIoor contact
Pathology And
gait deviation
Less control on
dorsiflexion will cause 5-
10 degree of plantar
flexion
Less control or difficulty in stabilization of
pelvis leads to anterior tilt and increased hip
flexion and can be due to contractures,
spasticity

15. LOADING
RESPONSE
ANKLE KNEE HIP
Posture Ankle at 90 degree to
initiate heel rocker,
ankle is positioned at
90 degree and support
of the foot is provided
by dorsiflexor pull by
pre tibial muscles
Extended knee posture
Function: Stabile weight-bearing
Hip will be in flexion
Joint
position Dorsiflexion Extension
20-30 degree of flexion
Internal joint
moment
Pre tibial muscles
maintain the DF and
achieves peak
Two extensor mechanisms are
active. First is the alignment of the floor impact
vector. The immediate
floor reaction force creates a vertical vector
anterior to the knee axis. Second is active
muscular control. Vastii. IT band are active
hip is in an unstable position.
And the body vector is anterior
of the hip joint at the moment of
fIoor contact
Pathology
And gait
deviation
Less control on
dorsiflexion will
cause 5-10 degree of
plantar flexion
Less control or difficulty in
stabilization of pelvis leads to
anterior tilt and increased hip
flexion and can be due to
contractures, spasticity

16. Midstance Ankle Knee Hip
Posture Ankle serves as an ankle rocker,
the body advances across the
foot and creates DF
Knee extension and total body
weight is transferred onto the flexed
knee at the onset of singIe
limb support, there is an additional
5° of knee flexion
Progressive hip extension
.
Joint position 5 degree of dorsiflexion Extensor moment transits to flexor
moment
neutral
Internal joint
moment
Soleus activity is the dominant
decelerating force between the
tibia and is the largest plantar
flexor muscle.
There is assymmetry of forces
acting by the quadriceps, vastii and
IT band, as the vector keeps shifting
Extensor moment
As the limb rolls forward
over the supporting foot
during mid stance, the
hip moves from its 30°
flexed posture toward
Pathology And
gait deviation
Excess dorsiflexion can cause
delayed or absent heel off.
Excess plantar flexion-
contracture of PF (Overactivity)
Early heel rise
Pathogy can be structural
abnormality, spasticity, contracture of
hip flexors, In stance phase- either
hyperextension or wobbling of knee
can be present
Contralateral pelvic drop, if
abductors are weak

17. Terminal
stance
Ankle Knee Hip
Posture Dorsiflexio
n- 10
degree of
DF
Knee is in extension
Joint
position
Plantar
flexors
reaches
momentum
and allows
controlled
progression
of tibia
Three mechanisms contribute to knee extension
which is ankle plantar flexion provides a stable
tibia over which the femur continues to advance.
Swing limb momentum. The forefoot rocker
facilitates forward fall of the body vector over the
leg. tensor fascia lata also tenses the iliotibial
band to provide indirect knee extension and the
popliteus and gastrocnemius provide a flexor
action posteriorly.
20 degree apparent hyperextension- because
of the anatomical hip joint configuration,
hip appears to be extended combined with
pelvic tilt and rotation
Internal
joint
moment
Uncontrolle
d
dorsiflexion
can cause
delayed
heel off-
Flexor moment
Pathology
and gait
deviation
Early heel
rise or no
heel off
Contralateral pelvic drop

18. Pre
swing
Ankle Knee Hip
Posture Plantar flexion Passive knee flexion
to Prepare for swing
Hyper extension of the knee
Joint
position
15 degree of plantar
flexion
40 degree of flexion
10 degree of HE
Internal
joint
moment
Plantar flexors reaches
momentum and allows
controlled progression
of tibia. Stored energy
in TA contributes for
rapid plantar flexion
three mechanisms are used to gain
adequate knee flexion; 1.vector
moves anteriorly to MTP joints
2. Tibia rolls forwards and active
plantar flexor muscles combined
with their continuing low level
of action accelerate heel rise and
tibial advancement.
3. There is direct knee flexor
muscle action by the
gastrocnemius and by
popliteus action and the rectus
femoris
Rectus femoris restraint of the knee
motion
would provide direct hip flexion, there
is flexor moment
Pathology
and gait
deviation
Lack of rapid PF will
lead to low heel off
Circumduction

19. Initial swing Ankle Knee Hip
Posture Plantar flexion Knee flexion
And the function is Foot clearance for limb
advancement
Flexion
Joint position 5 degree of plantar
flexion
60 degree of flexion 15 degree of flexion
Internal joint
moment
Low dorsiflexor
moment. Pretibial
muscles elevate foot to
maintain neutral
Three mechanisms are used
Appropriate pre-swing knee flexion (40°)is
the first component. Second
is momentum initiated by rapid hip flexion.
Which advances the femur,
while tibial inertia leads to knee flexion.
The third is active knee flexion
by the short head of the biceps femoris. and
assistance from the sartorius and gracilis
muscles, which simultaneously flex
the hip and knee.
Flexor moment. The gracilis
provides adduction, internal
rotation and flexion. Simultaneous
sartorius activity provides
counterforces of abduction and
external rotation as it assists in
flexion.
Pathology
and gait
deviation
Excess PF and foot drag
particular in midswing.
Foot drag, excess
eversion or inversion
Limited knee flexion for foot clearance During foot clearance there may be
limited flexion

20. Midswing Ankle Knee Hip
Posture Plantar flexion Passive knee extension
And the function is limb advancement
flexion
Joint position Neutral 25 degree of flexion Passive flexion of 20-
25degree
Internal joint
moment
Low dorsiflexor moment.
Pretibial muscles elevate foot to
maintain neutral
Once the foot has moved forward of the
hip joint, knee position does not
Contribute further, As no muscle action
is needed as
gravity makes the flexor muscles
relaxed
The limb advances an
additional 10 by a
continuation of the action
occurring
in initial swing.- extensor
moment
Pathology and
gait deviation
Excess PF and foot drag
particular in midswing. Foot
drag, excess eversion or
inversion
_ _

21. Terminal
swing
Ankle Knee Hip
Posture Neutral Appears fully extended Flexion
Joint position Neutral 20 degree of flexion
Internal joint
moment
Low dorsiflexor moment.
Pretibial muscles elevate
foot to maintain neutral
Knee extension at this time can
be considered completion of
swing or
preparation for stance. Hams
activity become active
Terminal swing is the transitional
phase between swing and stance.
Hip
muscle action at this time prepares
the limb for stance by stopping
further
flexion. Strong action by the
hamstring musc1es is the controlling
force
Pathology and
gait deviation
Excess PF and foot drag
particular in midswing.
Foot drag, excess
eversion or inversion
Failure to achieve optimum limb
position can lead to decrease in gait
speed

22. There are 2 types of analysis
1. Kinematic analysis- Deals with the
description of movement of the body/body
segments in relation to each other during
gait. It can be either qualitative or
quantitative
2. Kinetic gait analysis – It is used to determine
the forces involved in gait

23. 1. QUALITATIVE: deals with the gross quality of
movement, pattern of movements,
deviations and joint angles
2. QUANTITATIVE : Is used to obtain
information on spatial and temporal
parameters which are quantifiable. Assessing
of spatial and temporal parameters is vital as
this will determine the patient’s functional
status.

24.  Observational gait analysis- commonly used
scale is ranchos los amigos(RLA)
 GHORT analysis- commonly used by
podiatrists

25.  The Rancho Los Amigos Observational Gait Analysis
system (Rancho OGA) is a standardized approach utilized
to assess gait impairment for various diagnoses.
 Moderate to substantial intra-rater reliability, and fair to
moderate inter-rater reliability and concurrent validity
of Rancho OGA at the ankle, knee, and hip in the sagittal
plane.
 Rancho OGA is a moderately reliable and valid clinical
tool that can be utilized to monitor treatment progress
and to assess treatment outcomes.
(Groth, Heather and Novak, Sarah, "Examination of the Reliability and Validity of Rancho Los
Amigos Observational Gait Analysis" (1999). Masters Theses. 479.)

27. 2. GHORT analysis
 It is an acronym for gait, homunculus,
observed, relational and tabulator. It is used
by podiatrists, the therapist or examiner also
checks for hallux valgus or hammer toes.

31. 3. Digital video recording
Digital records of the patient performance
can be replayed in slow motion and allows
therapist the time needed to analyze gait
events. Some of the common software are
 Dart fish
 Kinovea analysis
 Templo

32. 1. Select the area in which patients can walk and the
joint body or position
2. Therapist position is vital and cameras to be positioned
in a way where the entire body can be examined
3. Select the body segment and plane of observation
4. Perform on the both the sides and the two planes
5. Hypothesize the gait deviations and develop a
treatment plan to address gait deviations
6. Periodically use OGA to reassess the patient’s gait and
determine response to the treatment

33. 2. Kinematic quantitative gait analysis
Is used to obtain information on spatial and
temporal parameters which are quantifiable.
Assessing of spatial and temporal parameters
is vital as this will determine the patient’s
functional status.

34. Methods to analyze are
1. Simple methods are
 Recording the foot prints and also includes
the application of chalk, ink or paint for
calculation of stride and step length
 Speed can be calculated by distance covered
with time taken
 Another way of obtaining step and stride
length is by grid measurement , grid pattern
can be placed on the floor and tape is
marked off in 3cm each and no of heel
strikes are counted

35.  Variables like stride length, step length and
cadence can be measured by the total
number of steps, number of right steps and
number of left steps with distance covered
 The standardized methods used are 6MWT
and timed walk tests based on the endurance

36. Instrumentation for quantifying spatial and
temporal variables
 Accelerometers- during walking, the body
generates force and measured by
accelerometer and these can be used to
calculate step symmetry, stride width etc
 Gyroscopes – it can be attached to the to the
skin surface and will determine the speed,
cadence

37. Systems for determining spatial and temporal
parameters
 Walkway system- consists of foot switches
and cameras. GaitMat II is commercially
available
 Foot switches and footswitch system- There
are pressure sensitive switches placed either
on patient’s feet or on the shoes. They
consists of transducers and semiconductor
and will determine the amount of heel
strikes

38.  The stride analyzer is a footswitch placed
under heels, metatarsals (1st and 5th ). The
parameters measured are stride length,
velocity, cadence, single and double time,
they are recorded automatically and is
transmitted to computer that analyzes data
 Advantages are its portable , measurements
of both the feet are available so that it can
be compared with normative data

39. 1. Electrogoniometers- it consists of a flexible
shaft and 2 blocks which is proximal and
distal segments of the joint. It provides an
affordable means of measuring joint motion
during walking

40. 2. Video based motion analysis
 2D and 3D video base motion analysis are
available to identify the joint angles and
markers can be fixed on the skin surface or
anatomical landmarks

41. 3. optical motion analysis system :They are
3D, image based systems and uses active or
passive markers
4. electromagnetic analysis: It employs
electromagnetic tracking capabilities to
determine 3D coordinate location and
angulation of each sensor

42.  functional ambulation profile and
modification
 Iowa assistance scale
 FIM and FAM
 Community balance and mobility scale
 GARS(Gait abnormality Rating scale and
modification)
 dynamic gait index
 figure of 8