Gait analysis and physiotherapy treatment Kyungnam college university of Information and Technology Dept. physical therapy Kim Chi Hyok

GAIT Gait is a continual advancing of all anthropometric points the body. -. Active gait phase: advancing the gravity centre. -. Reactive phase: consists of the step and arms swing.

Susanne Klein Vogelbach GAIT cont. Gait is continual escaping from fall, losing and regaining balance. Gait is the highest level of motoric control and automatisation. Susanne Klein Vogelbach

Energy Expenditure Energy expenditure is a basic parameter for assessing the mount of energy used by the individual the activity. It evaluates the mount of energy used while performing physical activity, and the hardness of the physical activity is one of the elements of gait ergonomic analysis. ergonomic analysis: Even if same person, condition given the gait, different elements has between 20 and 15 dermal degree in the gait.

Energy Expenditure Energy expenditure is the mount of energy (express in Kcal or kJ- Average energy expenditure during walking: 1, 7-3, 5Kcal/min or 7, 12-14,65kJ/min), needed for: Performance of the specific external activity by the skeletal muscle, Sustaining the vital processes and correct organism functioning(the cost of keeping the constant body temperature, blood circulation, breathing, etc.)

Energy Expenditure The extent of the gait energy expenditure depends on: Number of muscles involved, (ACTIO – REACTIO) Compensation Intensity and pace of the gait – average of 116 steps/m. Energy used for the essential metabolism depends on the weight and height of the body, age, sex, ambient temperature, diet. ACTIO: active structure(right leg flex. Muscle action) REACTIO: passive structure(left leg fix. Joint, ligament.) Hemiplegia patients gait always ATIO gait. Energy expenditure is higher.

Gait as the highest of motoric control and automatisation Close “co-operation the pyramidal and extra-pyramidal tract determines the appropriate performance of the moves: “If the blacksmith leads the hammer in a way that he uses the pyramidal tract, extra-pyramidal tract provides him with appropriate posture and muscle tone” J. Kreiner Pyramidal tract is responsible for performing the conscious complex moves of the muscle groups. Extra-pyramidal tract is responsible for walking out the automatic moves and regulates the body posture and muscle tone.

GAIT norm Examination of healthy individuals with the help of three-dimensional gait analysis, e.g. VICON. Acquiring objective data concerning the peripheral joint and trunk behaviour during the movement. Analysis of indicator muscle work in the given gait phase.

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Susanne Klein Vogelbach Normal gait - average Average calculated basing on results of thousands of individuals examined with the use of three-dimensional gait analysis. 20% of upper and lower extreme divergencies is rejected, remaining 60% is used to calculate the average for the given population with which patient gait may be compared. Susanne Klein Vogelbach

Normal gait – average. cont. Gait cycle Ranchos Los Amigos(RLA) Prof. Jaquline Perry Gait cycle is described as 100% in the gait analysis and is measured from the moment the heel of the one lower limb is placed on the surface until the heel of the same limb touches the space.

Gait Cycle

Normal gait – average. cont. Gait has 116 steps in one minute. One sec. needs 1.93 steps. Stance phase 60%[1.16 steps.] each step have about 0.3sec. Swing phase 40%[0.77 steps.] each step have about 0.2sec.

Stance phase Comprises 60% of one cycle Initial contact - IC Loading Response - LR Mid-stance - MST Terminal stance - TST

Swing phase Comprises 40% of one cycle Pre-Swing - PSW Initial Swing - ISW Mid-swing - MSW Terminal swing - TSw

Gait Stance phase 60% Swing phase 40% IC ~ 15% LR ~ 15% MSt ~ 15% PSw ~ 10% ISw ~ 10% MSw ~ 10% TStw ~ 10% Foot – Knee – Hip - Trunk Muscle control: - concentric work - excentric - static work - nerve and m. control - endurance - proprioception Motion range: - joint - Muscular

Gait Tests Timed Walking Test General test serves for the gait assessment of patients with various disorders. -. Execution: patient follows the straight line on the chosen distance # Distance: 5m, or 10m, or 20m # Measurement: time and/or compensations number -. Interpretation: results are compared with the previous ones [test, re-test]

Timed Walking Test 대칭적, 완전한 활동 1 정상적 보행, 그러나 운동 혹은 벅찬 활동을 방해하는 피로가 보고 대칭적, 완전한 활동 1 정상적 보행, 그러나 운동 혹은 벅찬 활동을 방해하는 피로가 보고 2 비정상 보행 혹은 일시적 불균형, 10m 를 10초 이내에 보행 가능 3 독립 보행 가능, 10m를 20초 이내에 보행 가능 4 보행 시 편측 만 목발, 지팡이 필요, 10m를 20초 이내에 보행 가능 5 보행 시 양측 목발, 지팡이 필요, 10m를 20초 이내에 보행 가능 6 양측 지지 필요, 10m 보행 시 20초 이상 소요, 때에 따라 휠체어 사용 7 양측지지로 제한적인 몇 걸음 가능, 10m 보행 불가능, 휠체어 사용 8 휠체어에 한정, 독립적 이동 가능 9 휠체어에 한정, 독립적 이동 불가능

Gait Tests cont. Timed “Up and Go” test Test assess the gait balance and fall risk especially among the older patients. -. Execution: patient sits on the stool, ca 45cm, get up, walks 3m, turns back, returns to the stool and sits. [turning back through right and left shoulder] -. Results interpretation: # < 10(14)sec. Norm for the healthy persons under the 65 years # 10(14)~30 sec. High fall risk # > 30 sec. Patient requires help while performing daily activities.

Gait Tests cont. Activity test Foot Ankle Outcome Score[FAOS]. Knee injury and Osteoarthritis Outcome Score[FOOS]. Hip dysfunctions and Osteoarthritis Outcome Score[FOOS]. # Assessments has 5 categories Pain, ADL , Quality of life, Sports & Recreation, Symptoms

Gait Tests cont. FAOS, FOOS, FOOS questionnaires include 5 scales: Pain, other symptoms accompanying the daily life, sport and recreation, and determine how the hip, knee or foot dysfunction influenced the quality of life. Assessed are answers concerning symptoms present in the previous week. Each answer is given points – from 0 to 4. The higher the indicator with the top value of 100, the less symptoms there are, the indicator with the bottom value of 0, the more present are the symptoms.

Gait Tests cont. Edinburgh Visual Gait Score[EVGS] EVGS serves for functional gait assessment of patients recovering from trauma and orthopaedic surgeries in the area of foot, knee or hip as well as neurological disease, strokes, cerebral palsy, neuropathies. EVGS allows for a detailed analysis of the separate body parts: foot, knee, hip, trunk in the specific subphases of The gait with the division into stance and swing phases. Values measured in points are recorded in the system: 2-1-0-1-2. Examined individual may achieve the result from 0 to 34 points. The less points, the more correct gait of the person.

Muscle work with the division into phases

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