2) Knee
3) Hip
4) Head, Trunk and Pelvis
5) Arm
6) Total Limb Function ① Initial contact 0-2% GC Critical event : Floor contact by the heel. To initiate an optimum heel rocker, the ankle is at neutral, knee extended and hip flexed. ② Loading Response 0-10% GC Critical event : Restrained knee flexion. Restrained ankle plantar flexion. Hip stabilization. ③ Mid stance 10-30% GC Critical event : Restrained ankle dorsiflexion. Knee extension. Hip stabilization. ④ Terminal Stance 30-50% GC Critical event : Heel rise. Free forward fall of the body. ⑤ Pre-Swing 50-60% GC Critical event : Knee flexion.
6) Total Limb Function ⑥ Initial Swing 60-73% GC Critical event : Knee flexion. Hip flexion. ⑦ Mid Swing 70-85% GC Critical event : Ankle dorsiflexion. Hip flexion. ⑧ Terminal Swing 85-100% GC Critical event : Hip deceleration. Knee deceleration. Knee extension. Ankle dorsiflexion.
Total Limb Function Summary Walking is a pattern of motion under muscular control. The relative significance of the events occurring during each stride is best summarized by the sequence of muscular action. Phasing within the stride displays the gross control requirement. The timing of peak muscle activity accentuates their unique responsibility for the limb’s function. Such information groups the muscles according to three basic functions ; stance, swing and foot control.
Stance Muscle Control Pattern
Swing Muscle control Pattern
Intrinsic Foot Muscle Control
5. Pathological Gait 1) Pathological Mechanism ① Deformity(Contracture)
1) Pathological Mechanism ② Muscle Weakness Insufficient muscle strength Disuse muscular atrophy Neurological impairment ③ Sensory Loss Proprioceptive impairment ④ Pain Trauma or Arthritis Deformity Muscular weakness
1) Pathological Mechanism ⑤ Impaired Motor Control(Spasticity) Overreaction to stretch(i.e., spasticity) Selective control is impaired Primitive locomotor patterns emerge Muscle change their phasing Proprioception may be altered
2) Ankle and Foot Gait Deviation ① Causes of Excessive Plantar Flexion Pretibial Muscle Weakness Plantar Flexion Contracture 30◦ plantar flexion contracture Rigid 15◦ contracture Elastic 15◦ contracture Soleus and Gastrocnemius Spasticity Voluntary Excessive Ankle Plantar Flexion ② Causes of Excessive Dorsiflexion Soleus Weakness Ankle Locked at Neutral Stance Knee Flexion
2) Ankle and Foot Gait Deviation
Stance Knee Flexion Persistent knee flexion during the foot flat support period(mid stance) requires ankle dorsiflexion beyond neutral in order to align the body vector over the foot for standing balance. The amount of dorsiflexion required is proportional to the flexed knee posture. As the body progresses over the supporting foot, the normal sequence of floor contact by the heel, foot flat and forefoot may be altered.
① Causes of Inadequate Knee Flexion and Excessive Extension 3) Knee Abnormal Gait ① Causes of Inadequate Knee Flexion and Excessive Extension Quadriceps Weakness Quadriceps Spasticity Pain Excessive Ankle Plantar Flexion Hip Flexor Weakness Extension Contracture Excessive Knee Flexion Inadequate Extension ② Causes of Excessive Flexion and Inadequate Extension Inappropriate Hamstrings Activity Knee Flexion Contracture Soleus Weakness Excessive Ankle Plantar Flexion
1) Pathological Mechanism ② Muscle Weakness Insufficient muscle strength Disuse muscular atrophy Neurological impairment ③ Sensory Loss Proprioceptive impairment ④ Pain Trauma or Arthritis Deformity Muscular weakness
1) Pathological Mechanism ⑤ Impaired Motor Control(Spasticity) Overreaction to stretch(i.e., spasticity) Selective control is impaired Primitive locomotor patterns emerge Muscle change their phasing Proprioception may be altered
2) Ankle and Foot Gait Deviation ① Causes of Excessive Plantar Flexion Pretibial Muscle Weakness Plantar Flexion Contracture 30◦ plantar flexion contracture Rigid 15◦ contracture Elastic 15◦ contracture Soleus and Gastrocnemius Spasticity Voluntary Excessive Ankle Plantar Flexion ② Causes of Excessive Dorsiflexion Soleus Weakness Ankle Locked at Neutral Stance Knee Flexion
2) Ankle and Foot Gait Deviation
Stance Knee Flexion Persistent knee flexion during the foot flat support period(mid stance) requires ankle dorsiflexion beyond neutral in order to align the body vector over the foot for standing balance. The amount of dorsiflexion required is proportional to the flexed knee posture. As the body progresses over the supporting foot, the normal sequence of floor contact by the heel, foot flat and forefoot may be altered.
① Causes of Inadequate Knee Flexion and Excessive Extension 3) Knee Abnormal Gait ① Causes of Inadequate Knee Flexion and Excessive Extension Quadriceps Weakness Quadriceps Spasticity Pain Excessive Ankle Plantar Flexion Hip Flexor Weakness Extension Contracture Excessive Knee Flexion Inadequate Extension ② Causes of Excessive Flexion and Inadequate Extension Inappropriate Hamstrings Activity Knee Flexion Contracture Soleus Weakness Excessive Ankle Plantar Flexion
3) Knee Abnormal Gait
Quadriceps Spasticity Quadriceps Weakness Two actions prevent loading response knee flexion. Hyperextension is used when an adequate passive range is available. This provides greater stability for an, otherwise, uncontrollable knee during weight bearing. The anterior body weight vector serves as a knee extensor force. Quadriceps Spasticity Knee flexion through the heel rocker action induces a rapid stretch of the quadriceps. An excessive response by the vasti inhibits the full flexion range. Premature knee extension results.
Hamstrings spasticity Mid stance and terminal stance - Knee flexion action during these phases may represent continued participation of the hamstrings in the primitive extensor pattern or a response to forward trunk lean. The patient’s forward posture to accommodate inadequate ankle dorsiflexion increases the need for hip extensor support. While out of the normal timing, this would be appropriate hamstring response to a functional demand.
Excessive abduction(valgus) refers to excessive lateral deviation of the distal tibia from the center of the knee. Excessive adduction(varus) of the knee is displayed by a medial tilt of the tibia and medial displacement of the foot relative to the knee.
① Causes of Inadequate Extension and Excessive Hip Flexion Hip flexion contracture Iliotibial band contracture Hip Flexor spasticity Pain ② Causes of Excessive Adduction Ipsilateral Pathology Abductor Weakness Adduction Contracture or Spasticity Adductors as Hip Flexors Contralateral Pathology Contralateral Hip Abduction Contracture Excessive Abduction ③ Causes of Inadequate Flexion Hip Flexor Insufficiency Hip Joint Arthrodesis Substitutive Actions
④ Causes of Excessive Abduction ⑤ Causes of Excessive Rotation Ipsilateral Pathology Abduction Contracture Short Leg Voluntary Abduction Contralateral Pathology Contralateral Hip Adduction Contracture Scoliosis with Pelvic Obliquity Excessive Abduction ⑤ Causes of Excessive Rotation External Rotation Gluteus Maximus Overactivity Excessive Ankle Plantar Flexion Internal Rotation Medial Hamstring Overactivity Adductor Overactivity Anterior Abductor Overactivity Quadriceps Weakness
5) Pelvis and Trunk Pathological Gait ① Causes of Anterior Pelvic Tilt Weak Hip Extensors Hip Flexion Contracture or Spasticity Posterior Tilt(Symphysis Up) ② Causes of Contralateral Pelvic Drop Weak hip Abductor Muscles Hip Adductor Contracture or Spasticity Contralateral hip Abductor Contracture Ipsilateral Drop ③ Causes of Ipsilateral Pelvic Drop Contralateral hip Abductor Weakness Short Ipsilateral Limb Calf Muscle Weakness
④ Causes of Backward Trunk Lean Weak Hip Extensors Inadequate Hip Flexion ⑤ Causes of Lateral Trunk Lean Ipsilateral Trunk lean ⑥ Causes of Ipsilateral Trunk Lean Weak hip Abductors Contracture Short Limb Scoliosis Impaired Body Image Contralateral Trunk lean
6. Influence Factor 1) Sensory input(Visual input) Understanding the roles of vision in the control of human locomotion, Aftab E. Patla 2) Navigation 3) Mobility & stability 4) Balance & coordination 5) CPG 6) Obstacle, situation of floor 7) etc.