400906 Introduction to Physiotherapy Practice
Clinical Gait Analysis
Professor Roy Cheung PT PhD
Professor of Physiotherapy, School of Health Sciences
Gait kinematics
Joint motion during walking
How do we measure gait kinematics?
Eyeball
Video analysis
Markerless
system
Wearable
sensors
Traditional
mocap
Traditional motion capturing
Research grade equipment – costly and difficult
Skin artefacts
Wearable sensors
It breaks the wall of laboratories
Data Drifting
Frequent re-calibration required
Markerless system
No subject preparation is needed
Video-based analysis
Beware of projection error
2D Joint range measurement
Perpendicular to axis
Projection error
Visual illusion
Eyeball
Shortcomings are obvious
“Simplified” version
Sagittal plane Frontal plane
Gait cycle 0%: heelstrike; Gait cycle ~60%: toe-off
Hip: Flexion-extension
• Hip flexion accompanies with body progression • Max hip flexion at ipsilateral heel strike
• It governs step length • Max hip extension at contralateral heel
• Hip extension allows the ‘hind limb’ to support strike
the body
Knee: Flexion-extension
• Two knee flexion waves • Full knee extension at mid stance can be
• Small flexion wave missed in patients with weak quadriceps
– Occurs at early stance
– Shock absorption by eccentric contraction of • Large flexion wave
quadriceps
– Foot clearance in the swing phase
Ankle: Dorsiflexion-plantarflexion
(Dorsiflexion)
• Heel strike to early stance • Early to mid stance
– Slight dorsiflexion or in neutral – Ankle passively pushed to dorsiflexion
– Eccentric control of dorsiflexors
Ankle: Dorsiflexion-plantarflexion
• Propulsion • Rapid ankle dorsiflexion
– Rapid contraction of plantarflexion – Foot clearance
– Plantarflexors turn silent after contralateral heelstrike
– Plantarflexion movement continues due to inertia
Hip: Abduction-adduction
Hip Adduction
• Pelvis in neutral at heel strike
• Hip abductor of stance leg fires to work against pelvic drop
• Max abduction at ipsilateral toe off
• Max adduction at contralateral toe off
• No abduction in swing i.e. no circumduction gait
Knee & ankle frontal plane movements
Limited by strong ligament and joint morphology
Gait kinetics
Force related to walking
How do we measure gait kinetics?
Footprint
Pressure
map
Force
plate
Footprint
Integrity of foot arch
Arch indices
Details will be covered in future MSK units
Pressure map device
More information than footprint
Dynamic measurement
Not only confine to gait analysis
Force plate
3-dimensional force vector(s)
Gait kinetics
Force (ground reaction force) during walking
Vertical ground reaction force
Key:
IC=initial contact;
OT=opposite toe off;
HR= heel rise;
OI=opposite initial contact;
TO=toe off;
FA=feet adjacent;
TV=tibia vertical
• A double hump and overlapped curve
• F1: results from the loading of the body
• F2: a reduction in downward force with the upward acceleration of the
center of mass (COM)
• F3: a second peak due to a downward acceleration of the COM and
the force generated during push off
COM trajectory during walking
Antero-posterior ground reaction force
• F4: braking force
• F5: propulsive force
Medio-lateral ground reaction force
• ML force should be very small (look at • Weight shift to medial border
the scale!) • A hump due to contralateral toe-off
• We land on lateral border of foot and weight shifting
• A second peak of medial force due to
• Induce a lateral ‘braking’ force propulsion
Learning Summary
1. Understand ‘norm’ kinematics and
kinetics data
2. Appreciate the equipment required
for different gait measurements
3. Understand the strength and
limitations of the methods