Análisis Clínico De La Marcha

Clinical Gait Analysis
Clinical
Biomechanics & Etiology of Common
Walking Disorders
Walking
Jessica Rose, Ph.D.
Assistant Professor, Department of Orthopaedic Surgery
Stanford University School of Medicine
Motion & Gait Analysis Lab
Lucile Packard Children’s Hospital

Teaching Points
• Phases of the Gait Cycle
• Primary Muscle Actions during Gait
• Common Gait Disorders

1Motion Analysis at Stanford
Edweard Muybridge & Leland Stanford 1878

Periods

2

Muscle Activity During Gait

3

Toe Walking
Diplegic Cerebral Palsy

4

3 Foot & Ankle Rockers

Rose J & Gamble JG, Editors. Human Walking 3rd Ed, 2006

5

Calf Muscle Weakness
No Fixed Ankle or Heel Rise
Spastic Cerebral Palsy

Swing Phase

Peak knee flexion in initial swing
Ankledorsiflexion to achieve foot clearance

6

Gait Analysis
•Video
•Kinematics and Kinetics
•Dynamic EMG
•Postural Balance
•Energy Expenditure

Musculoskeletal Computer Models of Gait

7

Diplegic Cerebral Palsy

Diplegic Cerebral Palsy

8

Kinematics & Kinetics
•Kinematics: 3-D Joint Motion
8 Digital Motion Capture Cameras Record
Position of Light Reflective Markers

•Kinetics: Forces Passing Through the Joints
Force Plate Embedded in the Floor Records
Ground Reaction Force Vectors

Kinematics
• Nearly normal hip motion
• Increased knee flexion at IC and stance
• Reduced peak knee flexion in swing
• Increased plantar flexion in terminal
stance
• Internally rotated foot progression

9

Kinetics

Kinetics
• Normal ankle plantarflexor moment
peaks interminal stance
• Increased plantar flexor moment in loading
response “double bump” associated with
increased plantar flexion at IC
• Decreased moment in terminal stance
associated with a reduced forefoot rocker

10

Dynamic EMG
•Footswitch or Markers
•Electrodes
-Surface
-Fine Wire
•Interpretation

Muscle EMG Timing During Gait

11

Dynamic EMG & Kinematics

PosturalBalance
•Force Plate Center of Pressure
• Postural Sway with Eyes Open / Closed

12

Energy Expenditure
Energy Expenditure Index

Pathologic Gait
Neuromuscular Conditions

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•

Equinus
Equinovarus
Pseudo equinus (knees bent, ankles at neutral, forefoot contact)
Jumped (knees bent, ankles true equinus)
Crouch (knees bent, ankles dorsiflexed)
Stiff–knee gait

13Pathologic Gait
Musculoskeletal Conditions
Polio, Dislocation, Arthritis, Muscular Dystrophy

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•
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Pain
Muscle weakness
Structural abnormalities (joint instability, short limb)
Loss of motion
Combinations of above

Antalgic Gait
Pain
• Any gait that reduces loading on an affected
extremity by decreasing stance phase time or
joint forces
• Examples
– “stone in your shoe”
–Painful hip, knee, foot, etc

14

Pathologic Hip Gait
Painful due to Arthritis

• Coxalgic gait
– Intact hip abductors; structural stability
– Lateral shift, hip compression, abductor load
– Contralateral pelvic elevation

Hip Biomechanics
Single-limb Stance Lurch Shifts Center of Mass

Hip Joint is Fulcrum: Hip Joint Reaction Force = pull of abductors + body weight

15Antalgic Gait
Painful Side:
• Shorten stance phase time
• Lengthen swing phase time
• Lengthen step length

Pathologic Hip Gait
Weakness
• Trendelenburg Gait
– Weak hip abductors
– Contralateral pelvic drop

16

Pathologic Hip Gait
Trendelenburg

Coxalgic Gait

Pathologic Hip Gait
Weakness
Gluteus Maximus Lurch muscular dystrophy
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–

Weak gluteus max no pain
Lean backwardsto prevent falling forward

Quadriceps Avoidance polio, SCI, ACL
–
–

Weak quadriceps no pain
Increased knee extension

Drop Foot
–
–

polio, stroke, SCI

Weak dorsiflexors no pain
Increased ankle plantarflexion

17

Cane & Able
Cane is used on able side - contralateral side
1. Allows for reciprocal arm swing
2. Widens base of support
3. Reduces demand on affected side -...