April 30, 2007

Gait Analysis: Techniques and Recognition of Abnormal Gait

Fabian E. Pollo, Ph.D.

Gait analysis in modern terms implies that some type of quantification will take place.
April 30, 2007

Gait Analysis: Techniques and Recognition of Abnormal Gait

Gait analysis involves the measurement of:

1. Temporal / Spatial velocity, cadence, step length, etc. 2. Kinematics - the movement of the body in space without any reference to forces. 3. Kinetics - the forces involved in producing these movements. 4. Dynamic Electromyography - the study of muscular activity patterns during walking.
April 30, 2007

Gait Analysis: Techniques and Recognition of Abnormal Gait

Temporal-Spatial Parameters

1. Stop watch and marks on the floor 2. Gait Pressure Mat

April 30, 2007

Gait Analysis: Techniques and Recognition of Abnormal Gait

Gait Pressure Mat

April 30, 2007

Gait Analysis: Techniques and Recognition of Abnormal Gait

Kinematics can be recorded using a variety of systems and methodologies

Passive Marker Systems use reflective markers and multiple cameras (typically 6 to 8 cameras simultaneously). The cameras send out infra red light signals and detect the reflection from the markers placed on the body. Based on the reflected signals from at least 2 cameras - triangulation of the marker in space is possible.

April 30, 2007

Gait Analysis: Techniques and Recognition of Abnormal Gait

Kinematics can be recorded using a variety of systems and methodologies

Active Marker Systems are similar to the passive marker system but use "active" markers. The markers are triggered to illuminate. This signal is used to triangulate the location of the marker. The advantage is that individual markers work at predefined frequencies and therefore, have their own "identity".

April 30, 2007

Gait Analysis: Techniques and Recognition of Abnormal Gait

Kinematics can be recorded using a variety of systems and methodologies

Electromagnetic Systems track the position (X, Y, and Z Cartesian coordinates) and orientation (azimuth, elevation, and roll) of small sensors attached to various segments of the body as they move through space.

April 30, 2007

Gait Analysis: Techniques and Recognition of Abnormal Gait

Baylor Motion & Sports Performance Center

Vicon Motion Analysis System Twelve MX-40 Cameras 4 Megapixel Resolution 5 Hz 2,000 Hz Passive Marker System Near Infra-Red Ring LEDs Force Platforms Camera/Computer

April 30, 2007

Gait Analysis: Techniques and Recognition of Abnormal Gait

Camera Positioning (Think Volume)

April 30, 2007

Gait Analysis: Techniques and Recognition of Abnormal Gait

Calibration: L-Frame
L- Frame designates lab origin and orientation (Global Coordinate System)

April 30, 2007

Gait Analysis: Techniques and Recognition of Abnormal Gait

Calibration: Wand
Wand defines camera positions in relation to each other in 3D space and corrects for any lens distortion

April 30, 2007

Gait Analysis: Techniques and Recognition of Abnormal Gait

Various Markers Sets and Gait Models dependent on application

April 30, 2007

Gait Analysis: Techniques and Recognition of Abnormal Gait

Direct Linear Transformation

Camera 1 Camera 2 3D Image Identified Markers 3D Image

DLT
Camera 3 Camera 12 Take all 12 Raw Video Camera Views

Virtual Hip Joint Centers

April 30, 2007

Gait Analysis: Techniques and Recognition of Abnormal Gait

Kinematics

April 30, 2007

Gait Analysis: Techniques and Recognition of Abnormal Gait

Kinetics Force Platform

The reaction force produced by the ground is called the Ground Reaction Force (GRF), which is basically the reaction to the force the body exerts on the ground.
April 30, 2007

Gait Analysis: Techniques and Recognition of Abnormal Gait

Kinetics

Use Inverse Dynamics to compute Joint Forces, Joint Torques (Moments) and Joint Power.

April 30, 2007

Gait Analysis: Techniques and Recognition of Abnormal Gait

Electromyography

0.051mm, insulated, hooked wires 25 Gauge Needle

April 30, 2007

Gait Analysis: Techniques and Recognition of Abnormal Gait

Processing
Raw EMG Signal

Rectified EMG Signal

Enveloped EMG Signal

April 30, 2007

Gait Analysis: Techniques and Recognition of Abnormal Gait

Recognition of Abnormal Gait

Question is not whether a gait pattern is abnormal what is primary cause. Requires formal gait analysis Many primary causes are fairly easy to diagnose (i.e. bunions and peroneal nerve dysfunction) Many secondary causes that are not so clear (chronic ligament tears and osteoarthritis)
Gait Analysis: Techniques and Recognition of Abnormal Gait

April 30, 2007

Recognition of Abnormal Gait

Examples 1. Mild Cerebral Palsy 2. Traumatic Brain Injury 3. Medial Compartment Osteoarthritis

April 30, 2007

Gait Analysis: Techniques and Recognition of Abnormal Gait

Cerebral Palsy
9 year old girl with hemiplegia Equinovarus of her right foot
(inverted hindfoot and plantarflexed)

Caused by overpull of the tibialis posterior and/or anterior tibialis Tendons

April 30, 2007

Gait Analysis: Techniques and Recognition of Abnormal Gait

Surgical Options
Split anterior tibialis and transfer tendon to cuboid.

Split posterior tibial tendon and transferred laterally to peroneus brevis tendon

April 30, 2007

Gait Analysis: Techniques and Recognition of Abnormal Gait

Use of Gait Analysis

Determine if the anterior tibialis and/or posterior tibialis was contributing to her deformity. Document her movement pattern for comparison after surgery.

April 30, 2007

Gait Analysis: Techniques and Recognition of Abnormal Gait

Traumatic Brain Injury

45 year male suffered TBI in car accident in 1983 Having Left Knee Pain Gait Evaluation

April 30, 2007

Gait Analysis: Techniques and Recognition of Abnormal Gait

Knee Osteoarthritis
51 year old women with medial compartment OA of left knee Evaluation for OA unloader brace prior to possible High Tibial Osteotomy

April 30, 2007

Gait Analysis: Techniques and Recognition of Abnormal Gait

Knee Osteoarthritis
Knee OA results from local
mechanical factors within the context of systemic susceptibility

Hip-knee-ankle alignment
significantly influences load distribution at the knee and disease progression

Medial compartment more often

affected
April 30, 2007

Gait Analysis: Techniques and Recognition of Abnormal Gait

Knee Loading

Vertical GRF Muscular Forces Reaction force from

external moment

April 30, 2007

Gait Analysis: Techniques and Recognition of Abnormal Gait

Knee Osteoarthritis

Unloader Bracing attempts to reduce that Varus load.

April 30, 2007

Gait Analysis: Techniques and Recognition of Abnormal Gait

Benefits of Gait Analysis

Aids in surgical planning Assessing the efficacy of surgical intervention Bracing issues and medication efficacy can be addressed using gait analysis techniques Evaluation of the rate of deterioration in progressive disorders that affect gait can also aid in understanding a patient's abilities and directing care Quantification for clinical and research
Gait Analysis: Techniques and Recognition of Abnormal Gait

April 30, 2007

April 30, 2007

THANK YOU