KINESIOLOGY OF WALKING

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KINESIOLOGY OF WALKING

• Dr. Michael P. Gillespie

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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.

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WALKING AT VARIOUS STAGES IN LIFE
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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.

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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

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MAREYS INSTRUMENTED SHOES FOR THE MEASUREMENT OF
GAIT
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MURRAY USED REFLECTIVE TARGETS AND A CAMERA WITH
THE SHUTTER OPEN TO ANALYZE GAIT
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ANALYSIS OF HUMAN MOTION
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INSTRUMENTATION IN A TYPICAL GAIT LABORATORY TO
STUDY WALKING
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SPATIAL AND TEMPORAL DESCRIPTORS

• Gait Cycle
• Stance and Swing Phases

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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.

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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.

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GAIT CYCLE 15-6
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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).

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SPATIAL DESCRIPTORS OF GAIT 15-7
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COMPONENTS OF GAIT CYCLE

• Heel contact (heel strike)
• Stride
• Step
• Stride length
• Step length
• Step width
• Foot angle

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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.

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SPATIAL-TEMPORAL DESCRIPTOR

• Walking Speed

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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.

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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.

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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)

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METHODS TO INCREASE WALKING SPEED

• Longer step length.
• Shorter gait cycle (faster walking cadence).

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METHODS TO INCREASE WALKING SPEED
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INFLUENCE OF IMPAIRMENT ON STEP LENGTH 15-8
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INFLUENCE OF IMPAIRMENT ON STEP LENGTH 15-8
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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

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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.

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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.

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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.

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HESITANCY CROSSING THE STREET

• https//www.youtube.com/watch?vlc32tnYCe1E

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GAIT CYCLE

• Stance Phase 60 of gait cycle
• Swing Phase 40 of gait cycle

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SUBDIVISION OF THE GAIT CYCLE 15-10
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GAIT CYCLE BREAKDOWN OF COMPONENTS

• https//www.youtube.com/watch?v5j4YRHf6Iyo

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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

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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).

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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.

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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).

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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)
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GAIT CYCLE - PERRY

• 8 events
• 7 Periods

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EVENTS OF GAIT CYCLE - PERRY

• Initial contact
• Opposite toe off
• Heel rise
• Opposite initial contact
• Toe off
• Feet adjacent
• Tibia vertical
• Initial contact

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PERIODS OF GAIT CYCLE - PERRY

• Stance phase
• Loading response
• mid stance
• Terminal stance
• Pre swing
• Swing phase
• Initial swing
• Mid swing
• Terminal swing

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EVENTS OF GAIT CYCLE 15-12
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NORMAL GAIT

• https//www.youtube.com/watch?vVYVyoFdJHdU

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ABNORMAL GAIT

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

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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.

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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.

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DISPLACEMENT OF CENTER OF MASS

• Total Vertical Displacement 5 cm
• Total side-to-side displacement 4 cm

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CENTER OF MASS DISPLACEMENT 15-13
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TRANSFER BETWEEN KINETIC AND POTENTIAL ENERGY
DURING GAIT 15-14
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EXCESSIVE DROP OF ILIAC CREST FROM WEAK GLUTEUS
MEDIUS 15-18
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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
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PATH OF THE CENTER OF PRESSURE 15-32
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GAIT DYSFUNCTIONS
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CAUSES OF PATHOLOGIC GAIT PATTERNS

• Pain
• Central Nervous System Disorders
• Musculoskeletal System Impairments

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ANKLE PLANTAR FLEXION CONTRACTURE
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WEAK ANKLE DORSIFLEXORS
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EXCESSIVE ANKLE PLANTAR FLEXION
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WEAK QUADRICEPS LEADING TO ANTERIOR TRUNK LEAN
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KNEE FLEXION CONTRACTURE RESULTING IN CROUCHED
GAIT OF THE STANCE LIMB
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HIP CIRCUMDUCTION DURING SWING
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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

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NORMAL AND ABNORMAL GAIT SERIES

• https//www.youtube.com/playlist?listPLt9rbdWnb3k
  jThf6oUGhdrd6TcNpYFgU2