All truly great thoughts are conceived by walking Fredrich Nietzsche Gait cycle Basic unit of gait, defined

d from one foot strike to repeat of same foot strike Stride length Distance between sequential corresponding points of contact by opposite feet (normally 38 cm) Cadence Number of steps per unit of time (steps/min) Speed Cadence x Step length Classic terminology of gait is dated because those terms are often not applicable in certain disabilities. Gait is divided into 3 functional tasks: 1 and 2 comprise stance period, 3 swing period 1. weight acceptance, 2. single limb support, and 3. limb advancement. Stance is further divided into intial contact, loading response, midstance, terminal stance, preswing Swing: initial swing, midswing, terminal swing At normal walking speed approximately 60% of a gait cycle is spent in stance and 40% in swing. The relative amount of time in stance decreases as the speed of walking increases. The difference between walking and running: Double limb support usually comprises 2025% of a normal walking gait cycle. As walking speed increases, the time spent in double support decreases, and walking becomes running when there is no longer a period of double support. The determinants of gait were originally described by Saunders, Inman, and Eberhart as natural mechanisms in human gait utilized to minimize the movement and smooth the path of the center of mass (COM). Recently it has been shown that 3 (pelvic rotation, pelvic tilt, and knee flexion) do not significantly minimise the vertical displacement of the center of mass. Instead heel rise of the trailing limb in double-limb support has been shown to be the major contributor The normal COM is approximately 5 cm anterior to S2. The average displacement of the COM is approximately 5 cm in the vertical axis and 5 cm in the horizontal axis for an average adult male step The actual displacement of the COM varies individual height and step length, but is always approximately half of what it would be if it was not for the determinants of gait

1. Heel rise: reduces COM overall displacement by 6-8 mm; major contributor 2. Pelvic rotation: effectively raises COM predicted lowest point by 2-2.5 mm 3. Pelvic tilt (list / obliquity): occurs at midstance, increases effective leg length and lowers COM predicted highest point by 2-3 mm 4. Knee flexion: occurs at midstance and lowers COM predicted highest point by 2 mm 5. Foot and knee motion: ankle pivots on the posterior heel at initial contact; pivot point progresses to forefoot by terminal stance; knee and foot motions act to smooth the motion into a sinusoidal curve 6. Lateral displacement of pelvis: valgus alignment at knees combined with hip adduction places the feet closer together, which allows less excursion of COM in the horizontal plane The COM in walking is at its highest point in midstance during single-limb support, lowest point at initial contact during double support. Interestingly in running, is at its highest point in the flight phase and lowest point during midstance during single-limb support. Walking more costly in energy terms than wheelchair ambulation: the bodys COM must rise and fall with each step during gait, whereas in wheelchair ambulation the COM remains horizontal. Work done in walking a certain distance = Vertical displacement of the COM x body weight x number of steps Comfortable walking speed (CWS) is one in which the energy cost per unit distance is at a minimum (comfort equates with efficiency). In a normal adult, approximately 80 metres/minute or 4.8 km/hour Energy cost of 0.15 mL O2 per kg per meter Abnormal biomechanics results in increased energy cost, which is usually compensated for by a slower walking speed

Kinetics: study of forces or torques that cause joint and limb motion Kinematics: study of motions of joint and limb segments Gait laboratory: multi-camera system for collecting kinematics and a computer to combine ground reaction forces from forceplates to obtain joint forces or torques. In quiet standing, the ground reaction force acts along the line of gravity through the COM and passes in front of the ankle and knee and behind the hip. This allows the hip to be supported by the iliofemoral ligament and the knee by posterior popliteal capsule with no muscular effort

Ankle stability maintained by continuous contraction of gastrocsoleus to produce a stabilizing ankle joint moment.

Gait milestones Neonatal reflex stepping Young infant stepping 1-2 months Walks with support by 6-12 months Walks unsupported by 12-15 months Runs by 18 months Mature gait pattern established by 3 years

Toddlers gait pattern Wider base Reduced stride length No heel strike Little knee flexion during standing Absent reciprocal arm swing External rotation of entire leg during swing phase

COMPASS GAIT Why are we studying gait? Arm swing Stance pre-tibial muscle?