INTRODUCTION TO GAIT ANALYSIS DATA 1. Phases of gait a. Stance (% gc) i. Loading response (10%) ii. Mid- and terminal stance (%) iii. Pre-swing (10%) b. Swing (% gc) i. Initial swing ii. Mid-swing iii. Terminal-swing 2. Data collected a. Kinematics 3-D joint motion of pelvis, hips, knees and ankles i. Allows assessment of motion in 3 planes: 1. Sagittal flexion/extension 2. Coronal ab/adduction 3. Transverse rotation Knee Flexion/ension D e g re e s 10 0 % gc Normal Left Right b. Kinetics ernal joint net moments and powers i. Information about factors producing or controlling motion 1. Describes joints response to external moments a. Power absorption eccentric contraction b. power generation concentric contraction ii. Provides additional information to use with kinematics and electromyography in explaining gait deviations iii. Helpful for evaluating effectiveness of treatment interventions, bracing and assistive devices, for example: DF PF eration PF DF orption Motion Moment Power
c. Electromyography (EMG) i. Muscle timing during gait cycle 1. Surface EMG for large, superficial muscles or muscle groups 2. Fine wire EMG for specific muscles or deep muscles such as posterior tibialis ii. Needed to determine appropriateness of muscle for transfer Raw EMG Processed EMG INTERPRETATION PROCESS: 1. ress patient s/family s concerns, each of MDs proposed interventions 2. Observe child walking, note stability in stance, clearance in swing, etc. 3. List of impairments on static exam a. ROM limitations, bony deformities, b. Strength and control limitations, c. Tone abnormalities 4. Examine kinematics and kinetics a. Note primary deviations b. Compare barefoot to braced or other conditions, note differences 5. Examine EMG a. Note areas of abnormal timing especially helpful for stiff knee (rectus femoris) and foot deformities (AT, PT) 6. Summary list of each gait problem/functional problem, probable cause(s) and recommended interventions Problem Cause ervention 1. a. b. c. a. b. c. 2. a. b. c. a. b. c.
NAME: Case #1 AGE: 6.5 yrs. DIAGNOSIS: Cerebral palsy, diplegia PREVIOUS SURGERIES: None GAIT HISTORY: wears hinged AFOs bilaterally. does not use any assistive devices. falls 5 times per day. The primary concerns of the patient and family are: Toe walking, in-toeing and crouch bilaterally. functions at a GMFCS level of 1. FMS at 6 at 5 meters, 6 at meters, 6 at 0 meters. RANGE OF MOTION: Left Right Hip flexion wnl wnl Hip extension 0 0 Hip abduction, knee extended 25 Hip abduction, knee flexed 65 Hip internal rotation (prone) 80 80 Hip external rotation (prone) Popliteal angle (with opposite hip extended) 45 Knee extension 15, hyperextension 10, hyperextension iflexion, knee flexed inverted; 25 neutral 10 inverted; 15 neutral iflexion, knee extended 0 inverted; 10 neutral 0 inverted; 0 neutral Forefoot inversion 45 Forefoot eversion Hindfoot inversion 25 25 Hindfoot eversion Femoral anteversion Transmalleolar angle 10, ernal 10, ernal Transmalleolar angle, sitting 15, ernal 15, ernal Hindfoot-thigh angle 10, ernal 10, ernal Thigh-foot angle 0 0 Forefoot adductus flexibility Corrects past neutral Corrects past neutral SELECTIVITY/STRENGTH ** selectivity graded 0 = no selective control, 1 = partial selective control, 2 = full selective control. Strength rated on traditional 5 grade scale, in mass pattern when unable to isolate movement. NT = not tested. Left Right Selectivity Strength Selectivity Strength Hip flexor NT 4 / 5 NT 4 / 5 Hip extensor 0 / 2 3 / 5 0 / 2 3+ / 5 Hip abductor NT 2+ / 5 NT 2+ / 5 Knee flexor 1 / 2 4 / 5 1 / 2 4- / 5 Knee extensor 0 / 2 4+ / 5 0 / 2 4+ / 5 iflexor 1 / 2 3 / 5 0 / 2 3 / 5 tarflexor 1 / 2 1+ / 5 0 / 2 1 / 5 NEUROLOGICAL SIGNS. Rated according to the modified Ashworth scale (please see key below). Spasticity: Left Right Hip adductors 1 0 Hamstrings 0 1 Quadriceps 0 0 Duncan-Ely (rectus test) Negative Negative tarflexors 1+ knee flexed; 2 knee extended 1 knee flexed; 2 knee extended erior tibialis 0 0
Barefoot with no assistive device Braced with no assistive device Pelvis T ilt Pelvis T ilt D own % Gait C ycle - - Hip Flexion/ension Hip Ab /uction Hip Flexion/ension Hip Ab/uction - % Gait C ycle - - - - - Knee Flexion/ension Knee / Knee Flexion/ension Knee / % Gait C ycle Ankle i/tar Ankle i/tar D ors - - % Gait C ycle Right Left Normal Right Left Normal Left side Right side
NAME: Case #2 AGE: 9 yrs DIAGNOSIS: Myelomeningocele REASON FOR REFERRAL: Gait analysis to determine the need for bilateral TDRO, left FDRO, bilateral psoas recessions and bilateral hamstring lengthenings, and to evaluate gait in KAFOs locked vs. unlocked. GAIT HISTORY: wears KAFOs bilaterally. walks independently. falls 2-3x daily at school, when running and playing. has FMS ratings of 6 for 5 meters, 5 for meters, and 5 for 0 meters. PHYSICAL THERAPY EVALUATION Leg lengths: left = 62.5 cm, right = 62.5 cm, measured ASIS to medial malleolus. RANGE OF MOTION: Left Right Hip extension Hip abduction, knee extended Hip internal rotation (prone) Hip external rotation (prone) 55 45 Popliteal angle (with opposite hip extended) Knee extension u varum (In supine) 10 10 iflexion, knee flexed 0 inverted; 10 neutral 25 inverted; neutral iflexion, knee extended -5 inverted; 0 neutral inverted; neutral Transmalleolar angle 10, ernal 15, ernal Hindfoot-thigh angle 5, ernal 10, ernal Thigh-foot angle 5, ernal 5, ernal SELECTIVITY/STRENGTH ** Strength rated on traditional 5 grade scale. Left Right 8/23/13 8/23/13 Hip flexor 4+ / 5 4+ / 5 Hip extensor Gluteals 3- /5, hamstrings 4/5 Gluteals 4-/5, hamstrings 4/5 Hip abductor 4- / 5 4- / 5 Hip adductors 5/5 5/5 Knee flexor Medial 4+/5, lateral 4/5 Medial 4/5, lateral 3+/5 Knee extensor 3+ / 5 at end range 5 / 5 at end range iflexor 5 / 5 5 / 5 tarflexor 2+ / 5 2+ / 5 Ankle inversion 2- / 5 2- / 5 Ankle eversion 4+ / 5 4+ / 5
Pelvis Tilt Pelvis Tilt 0 - - 100 Hip Flexion/ension Hip Ad/uction 90 Hip Flexion/ension Hip Ad/uction - - - - 100 Knee Flexion/ension Knee us/gus 80 Knee Flexion/ension Knee us/gus Ankle i/tarflexion Ankle i/tarflexion - - Barefoot KAFOs unlocked Pelvis Tilt Pelvis Tilt 90 Hip Flexion/ension Hip Ad/uction 90 Hip Flexion/ension Hip Ad/uction - - - - 80 Knee Flexion/ension Knee us/gus 80 Knee Flexion/ension Knee us/gus Ankle i/tarflexion Ankle i/tarflexion - - KAFOs, left locked KAFOs, both locked
Average Sagittal e Kinetics Hip Flexion/ension Knee Flexion/ension Ankle i/tarf lexion Average Sagittal e Kinetics Hip Flexion/ension Knee Flexion/ension Ankle i/tarf lexion - - Hip Flex/ Moment Knee Flex/ Moment Ankle i/ Moment Hip Flex/ Moment Knee Flex/ Moment Ankle i/ Moment % Gait Cylce % Gait Cylce Hip Power Knee Power Ankle Power Hip Power Knee Power Ankle Power Barefoot KAFOs unlocked Average Sagittal e Kinetics Average Sagittal e Kinetics Hip Flexion/ension Knee Flexion/ension Ankle i/tarf lexion Hip Flexion/ension Knee Flexion/ension Ankle i/tarf lexion - - Hip Flex/ Moment Knee Flex/ Moment Ankle i/ Moment Hip Flex/ Moment Knee Flex/ Moment Ankle i/ Moment % Gait Cylce % Gait Cylce Hip Power Knee Power Ankle Power Hip Power Knee Power Ankle Power KAFOs, left locked KAFOs, both locked
KAFOs with both knees unlocked Velocity (m/min) 66.0 (91.0%N) Cadence (steps/min) 111.5 (92.1%N) Stride length (m) 1.2 (99.2%N) Step length (m) Left Right 0.6 0.6 Gait cycle time (s) 1.1 (108.0%N) Double limb stance (%gc) 19.2 (95.8%N) (initial + terminal) Single limb stance (%gc) Left Right.0 (100.0%N) 41.3 (103.3%N) KAFOs with left locked, right unlocked Velocity (m/min) 62.4 (86.1%N) Cadence (steps/min) 11 (93.4%N) Stride length (m) 1.1 (92.1%N) Step length (m) Left Right 0.6 0.5 Gait cycle time (s) 1.1 (106.0%N) Double limb stance (%gc).8 (103.8%N) (initial + terminal) Single limb stance (%gc) Left Right 36.6 (91.5%N) 42.3 (105.8%N) KAFOs with both knees locked Velocity (m/min) 36.6 (.5%N) Cadence (steps/min) 92.8 (76.7%N) Stride length (m) 0.8 (66.3%N) Step length (m) Left Right 0.4 0.4 Gait cycle time (s) 1.3 (1.0%N) Double limb stance (%gc) 26.2 (1.8%N) (initial + terminal) Single limb stance (%gc) Left Right 35.2 (88.0%N) 38.3 (95.8%N) * gc = gait cycle %N = % normal for age