Gait Analysis Data Interpretation: Physical Disabilities · % Gait Cycle Pelvic Tilt 30 Ant. 20 10...

AACPDM 2015 Interactions Within and Across Planes – IC #20 1

Gait Analysis Data Interpretation:

Understanding Kinematic Relationships Within

and Across Planes of Motion in Persons with

Physical Disabilities

Sylvia Õunpuu, MSc and Kristan Pierz, MD Center for Motion Analysis

Division of Orthopaedics

Connecticut Children’s Medical Center

Farmington, Connecticut

Disclosure Information

AACPDM 69th Annual Meeting | October 21-24, 2015

Speaker Names: Sylvia Õunpuu, MSc and Kristan Pierz, MD

Disclosure of Relevant Financial Relationships:

We have no financial relationships to disclose.

Disclosure of Off-Label and/or investigative uses:

We will not discuss off label use and/or investigational use in my presentation

Purpose

• To demonstrate the role of motion analysis in

gaining an understanding of the relationship of

joint and segment kinematics within and across

planes of motion for a variety of gait

pathologies


Outline

• Angle and segment definitions

• Definition of within and across plane

interactions

• Case examples of within and across plane

interactions

• Examples are of patients with CP unless

otherwise noted

Objectives:

• Understand the importance of knowing

angle definitions

• Define joint kinematic interactions within

and across planes

• Develop skills to separate primary

deformities vs. compensations in gait

pathology

Angle definition

• The specific body

segments that

make up the angle

• With consideration

for the orientation

of the “viewer”

when looking at

the angle


Joint Angle Definitions

Which

one?

What is this

angle

definition ?

Joint Angle Definitions

• Kinematics for the

trunk, pelvis, hip, knee

and ankle/foot

progression

• Coronal, sagittal,

transverse planes

• Stance and swing

phases of gait

Trunk Obliquity30

-30

Up

Dn

deg

Pelvic Obliquity20

-20

Up

Dn

deg

Hip Ab-Adduction20

-20

Add

Abd

deg

Knee Varus-Valgus

Gait Cycle

30

-30

Var

Val

deg

25% 50% 75%

Trunk Tilt40

-20

Ant

Pos

Pelvic Tilt40

-20

Ant

Pos

Hip Flexion-Extension60

-20

Flx

Ext

Knee Flexion-Extension80

-20

Flx

Ext

Plantar-Dorsif lexion

Gait Cycle

40

-40

Dor

Pla

deg

25% 50% 75%

Trunk Rotation40

-40

Int

Ext

Pelvic Rotation40

-40

Int

Ext

Hip Rotation40

-40

Int

Ext

Knee Rotation40

-40

Int

Ext

Foot Progression

Gait Cycle

40

-40

Int

Ext

25% 50% 75%


Trunk Coronal Plane

• Angle Definition

– the lateral (side to side) inclination of the long axis of the torso relative to the lab coordinate system

– as viewed from the front and perpendicular to the plane formed by the long axis of the torso and the bi-clavicular line

Trunk Sagittal Plane


– the forward

inclination of the

long axis of the torso

relative to the lab

coordinate system

– as viewed by an

observer looking

along a line

connecting the

clavicles

Trunk Transverse Plane


– the motion of the bi-

clavicular line relative

to the lab coordinate

system

– as seen by an observer

looking down the long

axis of the torso looking

from above

Bi-clavicular

line

Direction of

Progression

C7


Trunk

Coronal

(range of motion

1 degree)

Sagittal

(range of motion

3 degrees)

Transverse

(range of motion

5 degrees)

Upper Body Obliquity

30

Up

10

-10

Down

-300 25 50 75 100

% Gait Cycle

Upper Body Rotation

30

Int.

10

-10

Ext.

-300 25 50 75 100

% Gait Cycle

Pelvis Coronal Plane


– Angle of inclination

of the right and left

anterior superior iliac

spine (ASIS) in

relation to the

horizontal

– As viewed from the

front of and in the

pelvic plane

Pelvis Sagittal Plane


– inclination (typically

anterior) of the pelvic

plane with respect to

the horizontal

– as viewed by an

observer looking

along a line

connecting the

ASIS's


Pelvis Transverse Plane


– motion of the ASIS to ASIS line relative to the lab coordinate system (direction of progression)

– as viewed by an observer whose site line is perpendicular to the pelvic plane

Pelvis

Coronal

(range of

motion 8

degrees)

Sagittal

(range of

motion 4

degrees)

Pelvic Obliquity

15

Up

5

-5

Down

-150 25 50 75 100

% Gait Cycle

Pelvic Tilt

30

Ant.

20

10

Post.

00 25 50 75 100

% Gait Cycle0 25 50 75 100

% Gait Cycle

Pelvic Rotation

30

Int.

10

-10

Ext.

-30

Transverse

(range of

motion 8

degrees)

Hip Coronal Plane


– relative angle

between long axis of

the thigh and a

perpendicular to the

pelvic plane

– as viewed from the

front of and in the

pelvic plane


Hip Coronal Plane Kinematic

• Stance

– LR = adduction

– MST/TST/PS = abduction

• Swing

– ISW = abduction

– MSW/TSW = adduction

• ROM = 13°

Hip Abduction-Adduction

0 25 50 75 100 % Gait Cycle

15

Ad.

5

-5

Ab.

-15

(Add=adduction, abd=abduction)

Hip Sagittal Plane


– relative angle between the long axis of the thigh and a perpendicular to the pelvic plane

– as viewed by an observer looking along a line connecting the ASIS's

Hip Sagittal Plane Kinematic

• Stance

– LR/MST/TST = extension

– PS = flexion

• Swing

– ISW/MSW = flexion

– TSW = minimal extension

• ROM = 43° 0 25 50 75 100

% Gait Cycle

Hip Flexion-Extension

45

Flex.

25

5

Ext.

-15

(Flex = flexion, Ext = extension)


Hip Transverse Plane


– motion of the thigh

(as defined by the

knee flexion

extension axis)

relative to the ASIS -

ASIS line

– as viewed by an

observer above the

pelvic plane

Hip Transverse Plane Kinematic

• Stance

– LR = internally rotates

– MST/TST = internally rotated

– PS = externally rotates

• Swing

– ISW = internally rotates

– MSW/TSW = externally rotates

• ROM = 8°

0 25 50 75 100 % Gait Cycle

Hip Rotation

30

-30

10

-10

Int.

Ext.

(Int = internal, Ext = External)

Knee Coronal Plane


– relative angle

between long axis of

the shank and the

long axis of the thigh

– as viewed from the

front of and in the

thigh plane


Knee Coronal Plane Kinematic

• Motion

– negligible

• Position

– neutral

(var=varus=adduction,

val=valgus=abduction)

Knee Sagittal Plane


– relative angle

between the long axis

of the thigh and

shank segments

– as viewed by an

observer looking

along the knee

flexion/extension

axis

Knee Sagittal Plane Kinematic

• Stance

– LR = flexion

– MST/TST = extension

– PS = flexion

• Swing

– ISW = flexion

– MSW = extension

– TSW = extension

• ROM = 60°

Knee Flexion-Extension

70

Flex.

40

10

Ext.

-200 25 50 75 100

% Gait Cycle

(Flex = flexion, Ext = extension)


Knee Transverse Plane


– motion of the shank (as defined by the ankle dorsi/plantar flexion axis) relative to the knee flexion extension axis line

– as viewed by an observer above the thigh plane

Knee Transverse Plane Kinematic

• Stance

– LR/MST/TST = progressive internal rotation

• Swing

– ISW/MSW/TSW = progressive external rotation

• ROM = 11(5)°

Ankle Sagittal Plane


– the relative angle

between a


long axis of the shank

and the plantar aspect

of the foot

– as viewed by looking

along an axis


shank-foot plane


Ankle Sagittal Plane Kinematic

• Stance

– LR = plantar flexion

– MST/TST = dorsiflexion

– PS = plantar flexion

• Swing

– ISW = continued plantar flexion then dorsiflexion

– MSW = dorsiflexion to neutral

– TSW = minimal plantar flexion

• ROM = 30°

0 25 50 75 100 % Gait Cycle

Ankle Plantar-Dorsiflexion

30

Dors

10

-10

Plnt

-30

(Dors = dorsiflexion,

Plnt = plantar flexion)

Foot Progression


– angle between the long

axis of the foot (ankle

center along to space

between 2nd and 3rd

metatarsals) and the

direction of progression

Foot progression angle

Foot Progression Kinematics

• Stance

– LR/MST/TST = progressive external rotation

– PS = internally rotates

• Swing

– ISW/MSW = externally rotates

– TSW = internally rotates

• ROM = 6°

Foot Progression

0 25 50 75 100 % Gait Cycle

30

-30

10

-10

Int.

Ext.

(Int = internal, Ext = External)


Definition:

Interactions within plane:

• Evaluation of the relationships between motion from one joint or segment to another

– Differentiate between primary and secondary gait deviations

– Determine possible causes of gait abnormalities

Coronal Sagittal Transverse

Right = solid, Left = dashed

Definition: Coronal Sagittal Transverse


Sequence of data

interpretation:

1. Individual joint

kinematic –

primary problem

2. Joints and

segments within a

single plane of

motion that are

proximal or distal

Definition:

Interactions across planes:

• Evaluation of the relationships between motion from one plane to another

– Differentiate between primary and secondary gait deviations


Coronal Sagittal Transverse



Sequence of data

interpretation:

1. Individual joint

2. Joints and

segments within a

single plane of

motion

3. Joints and

segments across

multiple planes of

motion

Definition:

How does one “discover” interactions

within and across planes?

• Pre versus post surgical data

comparisons

• Barefoot versus orthosis data

comparisons

• Lift versus no lift data comparisons

• Etc…

• Any SYSTEMATIC DATA REVIEW of

problems and possible causes

Case Examples

• Interactions within planes


Coronal Plane

• Joint and segment angles

– Up vs. down

– Elevation vs. depression

– Abduction vs. adduction

– Varus vs. valgus

Increased Coronal Plane ROM

Increased Coronal Plane ROM

• Primary impairment –

hip abductor weakness

• Associated gait issue –

increased hip adduction

in loading response

• Secondary deviation –

increased coronal plane

range of motion of the

pelvis

304010 13 Left (3/6/2003) 304010 13 Right (3/6/2003)

Trunk Obliquity30

-30

Up

Dn

deg

Pelvic Obliquity20

-20

Up

Dn

deg

Hip Ab-Adduction20

-20

Add

Abd

deg

Knee Varus-Valgus

Gait Cycle

30

-30

Var

Val

deg

25% 50% 75%

Trunk Tilt40

-20

Ant

Pos

Pelvic Tilt40

-20

Ant

Pos


-20

Flx

Ext


-20

Flx

Ext

Plantar-Dorsiflexion

Gait Cycle

40

-40

Dor

Pla

deg

25% 50% 75%

Trunk Rotation40

-40

Int

Ext

Pelvic Rotation40

-40

Int

Ext

Hip Rotation40

-40

Int

Ext

Knee Rotation40

-40

Int

Ext

Foot Progression

Gait Cycle

40

-40

Int

Ext

25% 50% 75%

Right (solid)

vs. Left

(dashed)


Myelomenigocele - Lateral Trunk Lean

Myelo - Lateral Trunk Lean




increased hip abduction

and pelvic drop in

stance

• Mechanism – increased

lateral trunk lean in

stance

221333 29 Right (10/5/2005) 221333 29 Right (10/5/2005) 221333 29 Right (10/5/2005)

Trunk Obliquity30

-30

Up

Dn

deg

Pelvic Obliquity20

-20

Up

Dn

deg

Hip Ab-Adduction20

-20

Add

Abd

deg

Knee Varus-Valgus

Gait Cycle

30

-30

Var

Val

deg

25% 50% 75%

Trunk Tilt40

-20

Ant

Pos

Pelvic Tilt40

-20

Ant

Pos


-20

Flx

Ext


-20

Flx

Ext


Gait Cycle

40

-40

Dor

Pla

deg

25% 50% 75%

Trunk Rotation40

-40

Int

Ext

Pelvic Rotation40

-40

Int

Ext

Hip Rotation40

-40

Int

Ext

Knee Rotation40

-40

Int

Ext

Foot Progression

Gait Cycle

40

-40

Int

Ext

25% 50% 75%

Right side –

multiple gait

cycles

DMD – Lateral Trunk Lean

416407 21 Left (6/17/2015) 416407 22 Left (6/17/2015) 416407 22 Left (6/17/2015)

Trunk Obliquity30

-30

Up

Dn

deg

Pelvic Obliquity20

-20

Up

Dn

deg

Hip Ab-Adduction20

-20

Add

Abd

deg

Knee Varus-Valgus

Gait Cycle

30

-30

Var

Val

deg

25% 50% 75%

Trunk Tilt40

-20

Ant

Pos

Pelvic Tilt40

-20

Ant

Pos


-20

Flx

Ext


-20

Flx

Ext


Gait Cycle

40

-40

Dor

Pla

deg

25% 50% 75%

Trunk Rotation40

-40

Int

Ext

Pelvic Rotation40

-40

Int

Ext

Hip Rotation40

-40

Int

Ext

Knee Rotation40

-40

Int

Ext

Foot Progression

Gait Cycle

40

-40

Int

Ext

25% 50% 75%




increased hip abduction

and pelvic drop in

stance

• Mechanism – increased

lateral trunk lean in

stance Right side –

multiple gait

cycles


Knee Valgus Thrust

Knee Valgus Thrust


none at the coronal knee


“visual” valgus thrust

• Interaction across

plane…in a few minutes


Trunk Obliquity30

-30

Up

Dn

deg

Pelvic Obliquity20

-20

Up

Dn

deg

Hip Ab-Adduction20

-20

Add

Abd

deg

Knee Varus-Valgus

Gait Cycle

30

-30

Var

Val

deg

25% 50% 75%

Trunk Tilt40

-20

Ant

Pos

Pelvic Tilt40

-20

Ant

Pos


-20

Flx

Ext


-20

Flx

Ext


Gait Cycle

40

-40

Dor

Pla

deg

25% 50% 75%

Trunk Rotation40

-40

Int

Ext

Pelvic Rotation40

-40

Int

Ext

Hip Rotation40

-40

Int

Ext

Knee Rotation40

-40

Int

Ext

Foot Progression

Gait Cycle

40

-40

Int

Ext

25% 50% 75%

Pelvic Hiking in Swing

• Visual assessment = “circumduction”

• Kinematic shows hip = neutral

Hip Neutral


Pelvic Drop in Swing

• Visual assessment of hip angle = “typical”

• Kinematic = abduction to keep thigh vertical

Hip Abduction

Knee Varus

C89440

Knee Varus

• Impairment – fixed knee

varus deformity


increased knee varus


hip abduction

389440

389440 3 Left (4/27/2011) 389440 4 Left (4/27/2011) 389440 5 Left (4/27/2011)

Trunk Obliquity30

-30

Up

Dn

deg

Pelvic Obliquity20

-20

Up

Dn

deg

Hip Ab-Adduction20

-20

Add

Abd

deg

Knee Varus-Valgus

Gait Cycle

30

-30

Var

Val

deg

25% 50% 75%

Trunk Tilt40

-20

Ant

Pos

Pelvic Tilt40

-20

Ant

Pos


-20

Flx

Ext


-20

Flx

Ext


Gait Cycle

40

-40

Dor

Pla

deg

25% 50% 75%

Trunk Rotation40

-40

Int

Ext

Pelvic Rotation40

-40

Int

Ext

Hip Rotation40

-40

Int

Ext

Knee Rotation40

-40

Int

Ext

Foot Progression

Gait Cycle

40

-40

Int

Ext

25% 50% 75%

Left side –

multiple gait

cycles


Sagittal Plane

• Joint and segment angles

– Forward vs. backward

– Anterior vs. posterior

– Flexion vs. extension

– Dorsiflexion vs. plantar flexion

Increased Knee Flexion

Increased Knee Flexion

265198 11 Left (3/4/2003) 265198 11 Right (3/4/2003)

Trunk Obliquity30

-30

Up

Dn

deg

Pelvic Obliquity20

-20

Up

Dn

deg

Hip Ab-Adduction20

-20

Add

Abd

deg

Knee Varus-Valgus

Gait Cycle

30

-30

Var

Val

deg

25% 50% 75%

Trunk Tilt40

-20

Ant

Pos

Pelvic Tilt40

-20

Ant

Pos


-20

Flx

Ext


-20

Flx

Ext


Gait Cycle

40

-40

Dor

Pla

deg

25% 50% 75%

Trunk Rotation40

-40

Int

Ext

Pelvic Rotation40

-40

Int

Ext

Hip Rotation40

-40

Int

Ext

Knee Rotation40

-40

Int

Ext

Foot Progression

Gait Cycle

40

-40

Int

Ext

25% 50% 75%

• Impairment – issues

related to crouch gait

– tight/spastic hamstrings

– hip extensor and ankle

plantar flexor weakness

– knee flexion contracture


increased knee flexion

& ankle dorsiflexion

• Secondary deviation -

increased hip flexion

Right side –

multiple gait

cycles


Increasing Anterior Pelvic Tilt

Right

side

• Impairment – reduced

dissociation between pelvis

and femur


decreased hip sagittal plane

ROM (solid)

• Secondary deviations –

increased ipsilateral anterior

pelvic tilt and overall pelvic

range of motion (solid) and

increased contralateral hip

range of motion (dashed)

325783 2 Left (3/25/2002) 325783 2 Right (3/25/2002)

Trunk Obliquity30

-30

Up

Dn

deg

Pelvic Obliquity20

-20

Up

Dn

deg

Hip Ab-Adduction20

-20

Add

Abd

deg

Knee Varus-Valgus

Gait Cycle

30

-30

Var

Val

deg

25% 50% 75%

Trunk Tilt40

-20

Ant

Pos

Pelvic Tilt40

-20

Ant

Pos


-20

Flx

Ext


-20

Flx

Ext


Gait Cycle

40

-40

Dor

Pla

deg

25% 50% 75%

Trunk Rotation40

-40

Int

Ext

Pelvic Rotation40

-40

Int

Ext

Hip Rotation40

-40

Int

Ext

Knee Rotation40

-40

Int

Ext

Foot Progression

Gait Cycle

40

-40

Int

Ext

25% 50% 75%

Increasing Anterior Pelvic Tilt

Increased Plantar Flexion-Knee

Extension Couple

Left

side


Plantar Flex/Knee Ext Couple

• Impairment – increased

plantar flexion knee

extension couple


increased equinus and

knee extension in mid

stance


increased anterior pelvic

tilt

CMT - Equinus in Swing

CMT - Equinus in Swing

• Impairment – anterior

tibialis weakness


increased equinus in

swing

• Compensation –

increased hip flexion in

swing

377823 2 Left (5/24/2004) 377823 2 Right (5/24/2004)

Trunk Obliquity30

-30

Up

Dn

deg

Pelvic Obliquity20

-20

Up

Dn

deg

Hip Ab-Adduction20

-20

Add

Abd

deg

Knee Varus-Valgus

Gait Cycle

30

-30

Var

Val

deg

25% 50% 75%

Trunk Tilt40

-20

Ant

Pos

Pelvic Tilt40

-20

Ant

Pos


-20

Flx

Ext


-20

Flx

Ext


Gait Cycle

40

-40

Dor

Pla

deg

25% 50% 75%

Trunk Rotation40

-40

Int

Ext

Pelvic Rotation40

-40

Int

Ext

Hip Rotation40

-40

Int

Ext

Knee Rotation40

-40

Int

Ext

Foot Progression

Gait Cycle

40

-40

Int

Ext

25% 50% 75%

Right (solid)

vs. Left

(dashed)


Equinus in Swing (Drop foot)

Right

side

• Impairment – anterior

tibialis weakness and

plantar flexor tightness

• Associated gait problem –

increased equinus in swing

(solid)

• Compensation - increased

hip flexion in swing (solid)

A21910

Equinus in Swing

• Impairment – and plantar

flexor tightness

• Associated gait problem –

increased equinus in stance

(solid)

• Secondary deviations -

ipsilateral increased anterior

pelvic tilt in stance (solid),

increased contralateral pelvic

anterior tilt and increased hip

flexion in swing (dashed)

A21910

Equinus in Stance


DMD - Forward Trunk Lean

DMD –Forward Trunk Lean

• Impairment – knee extensor

weakness

• Associated gait impairment –

no knee flexion in loading or

stance

• Compensation – increased

forward trunk lean in stance

• Knee extensor moment

(internal) minimal

430009 22 Left (9/14/2012) 430009 22 Right (9/14/2012)

Trunk Obliquity30

-30

Up

Dn

deg

Pelvic Obliquity20

-20

Up

Dn

deg

Hip Ab-Adduction20

-20

Add

Abd

deg

Knee Varus-Valgus

Gait Cycle

30

-30

Var

Val

deg

25% 50% 75%

Trunk Tilt40

-20

Ant

Pos

Pelvic Tilt40

-20

Ant

Pos


-20

Flx

Ext


-20

Flx

Ext


Gait Cycle

40

-40

Dor

Pla

deg

25% 50% 75%

Trunk Rotation40

-40

Int

Ext

Pelvic Rotation40

-40

Int

Ext

Hip Rotation40

-40

Int

Ext

Knee Rotation40

-40

Int

Ext

Foot Progression

Gait Cycle

40

-40

Int

Ext

25% 50% 75%

Transverse Plane

• Rotations

– Internal vs. external

– Protraction vs. retraction

– Inversion vs. eversion


Internal Hip Rotation

Right

side

Internal Hip Rotation


femoral anteversion


increased internal hip

rotation


internal foot progression


Trunk Obliquity30

-30

Up

Dn

deg

Pelvic Obliquity20

-20

Up

Dn

deg

Hip Ab-Adduction20

-20

Add

Abd

deg

Knee Varus-Valgus

Gait Cycle

30

-30

Var

Val

deg

25% 50% 75%

Trunk Tilt40

-20

Ant

Pos

Pelvic Tilt40

-20

Ant

Pos


-20

Flx

Ext


-20

Flx

Ext


Gait Cycle

40

-40

Dor

Pla

deg

25% 50% 75%

Trunk Rotation40

-40

Int

Ext

Pelvic Rotation40

-40

Int

Ext

Hip Rotation40

-40

Int

Ext

Knee Rotation40

-40

Int

Ext

Foot Progression

Gait Cycle

40

-40

Int

Ext

25% 50% 75%

Right side –

multiple gait

cycles

Pelvic Rotation Compensation

Right

side


Pelvic Rotation Compensation


increased femoral

anteversion

• Associated gait deviation –

increased internal hip

rotation (dashed)

• Pelvic compensation –

increased ipsilateral external

pelvis rotation (dashed)


increased contralateral

internal pelvic rotation

(solid)

Transverse Plane Multiple Level Deformity

Left

Side

Multilevel Transverse Plane

• Primary Impairments –

increased femoral anteversion

and increased external tibial

torsion forefoot abduction

• Associated gait deviation –

internal hip rotation

• Foot progression masks tibial

torsion and foot problems

336309 21 Left (5/8/2009) 336309 21 Left (5/8/2009) 336309 22 Left (5/8/2009)

Trunk Obliquity30

-30

Up

Dn

deg

Pelvic Obliquity20

-20

Up

Dn

deg

Hip Ab-Adduction20

-20

Add

Abd

deg

Knee Varus-Valgus

Gait Cycle

30

-30

Var

Val

deg

25% 50% 75%

Trunk Tilt40

-20

Ant

Pos

Pelvic Tilt40

-20

Ant

Pos


-20

Flx

Ext


-20

Flx

Ext


Gait Cycle

40

-40

Dor

Pla

deg

25% 50% 75%

Trunk Rotation40

-40

Int

Ext

Pelvic Rotation40

-40

Int

Ext

Hip Rotation40

-40

Int

Ext

Knee Rotation40

-40

Int

Ext

Foot Progression

Gait Cycle

40

-40

Int

Ext

25% 50% 75%

Left Side –

multiple gait

cycles


Break

Case Examples

• Interactions across planes

Increased

Pelvic

Transverse

Plane

Motion

• Secondary to

Reduced

Knee

Extension at

Initial

Contact


Increased

Hip

Abduction

in Swing

Secondary to

Reduced

Sagittal

Plane Knee

Flexion in

Swing and

Equinus in

Swing

Increased

Hip

Abduction

in Swing

• Secondary to

Reduced

Sagittal

Plane Knee

Flexion in

Swing and

Pelvic Drop

in Swing

Increased

Coronal

Plane Hip

Abduction

Initial

Contact

• Secondary to

increased

transverse

plane internal

pelvic rotation


Increased

Coronal Plane

Hip Adduction

Loading

Response

• Secondary to

Increased

Transverse

Plane Pelvic

Rotation

Increased

Asymmetric

Coronal

Plane Hip

Motion

• Secondary to Transverse Plane Pelvic

Asymmetry

Hip coronal plane position?


336309 21 Left (5/8/2009) 336309 21 Left (5/8/2009) 336309 22 Left (5/8/2009)

Trunk Obliquity30

-30

Up

Dn

deg

Pelvic Obliquity20

-20

Up

Dn

deg

Hip Ab-Adduction20

-20

Add

Abd

deg

Knee Varus-Valgus

Gait Cycle

30

-30

Var

Val

deg

25% 50% 75%

Trunk Tilt40

-20

Ant

Pos

Pelvic Tilt40

-20

Ant

Pos


-20

Flx

Ext


-20

Flx

Ext


Gait Cycle

40

-40

Dor

Pla

deg

25% 50% 75%

Trunk Rotation40

-40

Int

Ext

Pelvic Rotation40

-40

Int

Ext

Hip Rotation40

-40

Int

Ext

Knee Rotation40

-40

Int

Ext

Foot Progression

Gait Cycle

40

-40

Int

Ext

25% 50% 75%

Increased

Hip

Adduction

in Stance

• Secondary to

Knee

Flexion &

Internal Hip

Rotation

Increased

Pelvic

Obliquity

574887 3 Left (3/13/2012) 574887 3 Right (3/13/2012)

Trunk Obliquity30

-30

Up

Dn

deg

Pelvic Obliquity20

-20

Up

Dn

deg

Hip Ab-Adduction20

-20

Add

Abd

deg

Knee Varus-Valgus

Gait Cycle

30

-30

Var

Val

deg

25% 50% 75%

Trunk Tilt40

-20

Ant

Pos

Pelvic Tilt40

-20

Ant

Pos


-20

Flx

Ext


-20

Flx

Ext


Gait Cycle

40

-40

Dor

Pla

deg

25% 50% 75%

Trunk Rotation40

-40

Int

Ext

Pelvic Rotation40

-40

Int

Ext

Hip Rotation40

-40

Int

Ext

Knee Rotation40

-40

Int

Ext

Foot Progression

Gait Cycle

40

-40

Int

Ext

25% 50% 75%

Secondary to a

Functional Leg

Length

Difference

Pelvic

External

Rotation in

Stance

• Secondary to an Excessive Plantar Flexion Knee Extension Couple (barefoot)


Pelvic

External

Rotation

in Stance

(reduced)

• Reduced

excessive

plantar

flexion knee

extension

couple during

AFO walk

HSP –

Increased

Hip

Abduction

Swing

577425 4 Left (3/27/2014) 577425 4 Right (3/27/2014)

Trunk Obliquity30

-30

Up

Dn

deg

Pelvic Obliquity20

-20

Up

Dn

deg

Hip Ab-Adduction20

-20

Add

Abd

deg

Knee Varus-Valgus

Gait Cycle

30

-30

Var

Val

deg

25% 50% 75%

Trunk Tilt40

-20

Ant

Pos

Pelvic Tilt40

-20

Ant

Pos


-20

Flx

Ext


-20

Flx

Ext


Gait Cycle

40

-40

Dor

Pla

deg

25% 50% 75%

Trunk Rotation40

-40

Int

Ext

Pelvic Rotation40

-40

Int

Ext

Hip Rotation40

-40

Int

Ext

Knee Rotation40

-40

Int

Ext

Foot Progression

Gait Cycle

40

-40

Int

Ext

25% 50% 75%

• Increased

internal pelvic

rotation right

(solid)

HSP –

Increased

Pelvic

Transverse

Range

376481 47 Left (10/5/2009) 376481 47 Right (10/5/2009)

Trunk Obliquity30

-30

Up

Dn

deg

Pelvic Obliquity20

-20

Up

Dn

deg

Hip Ab-Adduction20

-20

Add

Abd

deg

Knee Varus-Valgus

Gait Cycle

30

-30

Var

Val

deg

25% 50% 75%

Trunk Tilt40

-20

Ant

Pos

Pelvic Tilt40

-20

Ant

Pos


-20

Flx

Ext


-20

Flx

Ext


Gait Cycle

40

-40

Dor

Pla

deg

25% 50% 75%

Trunk Rotation40

-40

Int

Ext

Pelvic Rotation40

-40

Int

Ext

Hip Rotation40

-40

Int

Ext

Knee Rotation40

-40

Int

Ext

Foot Progression

Gait Cycle

40

-40

Int

Ext

25% 50% 75%

• Reduced knee

extension

initial contact


Knee Valgus Thrust in Loading?

Apparent

Knee

Valgus

Thrust • Secondary to

increasing

– internal pelvic rotation

– internal hip rotation

– knee flexion


Trunk Obliquity30

-30

Up

Dn

deg

Pelvic Obliquity20

-20

Up

Dn

deg

Hip Ab-Adduction20

-20

Add

Abd

deg

Knee Varus-Valgus

Gait Cycle

30

-30

Var

Val

deg

25% 50% 75%

Trunk Tilt40

-20

Ant

Pos

Pelvic Tilt40

-20

Ant

Pos


-20

Flx

Ext


-20

Flx

Ext


Gait Cycle

40

-40

Dor

Pla

deg

25% 50% 75%

Trunk Rotation40

-40

Int

Ext

Pelvic Rotation40

-40

Int

Ext

Hip Rotation40

-40

Int

Ext

Knee Rotation40

-40

Int

Ext

Foot Progression

Gait Cycle

40

-40

Int

Ext

25% 50% 75%

Neutral

Knee

Moment


Trunk Obliquity30

-30

Up

Dn

Deg

Pelvic Obliquity20

-20

Up

Dn

Deg

Hip Ab-Adduction20

-20

Add

Abd

Deg

Hip Moment2.0

-1.0

Abd

Add

Nm/kg

Hip Power3.0

-2.0

Gen

Abs

W /kg

Knee Varus-Valgus30

-30

Var

Val

Deg

Knee Moment2.0

-1.0

Val

Var

Nm/kg

Knee Power3.0

-2.0

Gen

Abs

W /kg

Ankle Var/Val30

-30

Var

Val

Deg

Ankle Moment2.0

-1.0

Val

Var

Nm/kg

Ankle Power3.0

-2.0

Gen

Abs

W /kg

Coronal Plane

Knee Moment


Knee

Varus

Moment (valgus thrust)

161376 22 Left (12/30/2011) 161376 24 Left (12/30/2011) 161376 25 Left (12/30/2011)

Trunk Obliquity30

-30

Up

Dn

deg

Pelvic Obliquity20

-20

Up

Dn

deg

Hip Ab-Adduction20

-20

Add

Abd

deg

Knee Varus-Valgus

Gait Cycle

30

-30

Var

Val

deg

25% 50% 75%

Trunk Tilt40

-20

Ant

Pos

Pelvic Tilt40

-20

Ant

Pos


-20

Flx

Ext


-20

Flx

Ext


Gait Cycle

40

-40

Dor

Pla

deg

25% 50% 75%

Trunk Rotation40

-40

Int

Ext

Pelvic Rotation40

-40

Int

Ext

Hip Rotation40

-40

Int

Ext

Knee Rotation40

-40

Int

Ext

Foot Progression

Gait Cycle

40

-40

Int

Ext

25% 50% 75%

161376 22 Left (12/30/2011) 161376 24 Left (12/30/2011) 161376 25 Left (12/30/2011)

Trunk Obliquity30

-30

Up

Dn

deg

Pelvic Obliquity20

-20

Up

Dn

deg

Hip Ab-Adduction20

-20

Add

Abd

deg

Hip Moment2.0

-1.0

Abd

Add

Nm/kg

Hip Power3.0

-2.0

Gen

Abs

W/kg

Knee Varus-Valgus30

-30

Var

Val

deg

Knee Moment2.0

-1.0

Val

Var

Nm/kg

Knee Power3.0

-2.0

Gen

Abs

W/kg

Ankle Var/Val30

-30

Var

Val

deg

Ankle Moment2.0

-1.0

Val

Var

Nm/kg

Ankle Power3.0

-2.0

Gen

Abs

W/kg

Coronal Plane

Knee Moment

A closer look…

Summary:

Interactions within a plane:

• Evaluation of the relationships between motion from one joint or segment to another

– Differentiate between primary deviations and compensations


• Sequence of data interpretation:

– Individual joint

– Joints and segments above or below within a single plane of motion


Summary:

Interactions across planes:

• Evaluation of the relationships between motion from one plane to another

– Differentiate between primary deviations and compensations


• Sequence of data interpretation:

– Individual joint

– Joints and segments within a single plane of motion

– Joints and segments across multiple planes of motion

Thank You

Gait Analysis Data Interpretation: Physical Disabilities · % Gait Cycle Pelvic Tilt 30 Ant. 20 10...

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Transcript of Gait Analysis Data Interpretation: Physical Disabilities · % Gait Cycle Pelvic Tilt 30 Ant. 20 10...