1. Ambulation and Ambulation Aids
chapter 12
Ambulation and Ambulation Aids

2. Gait
= A series of rhythmical, alternating movements of the limbs and trunk that causes a forward progression of the center of gravity (CoG).
Involves a repetitive loss and recovery of balance through displacing and controlling the motion of the CoG in the most efficient manner

3. Gait Cycle
= The series of events that occur between the heel strike of one limb and the next heel strike of the same limb.

4. Figure 12.1a

5. Gait Components
Step length: the distance covered between heel strike (HS) of one limb and HS of the other limb
Stride length: The distance covered between the successive HS of one limb and HS of the same limb
(continued)

6. Gait Components (continued)
Cadence: The speed of gait. It can be measured in the number of steps for a period of time (usually steps/min).
Cadence and time for gait cycle are related: The longer the period of time for the gait cycle, the slower the cadence.
As cadence increases, the time of double support decreases.

7. Figure 12.2

8. Terminology HS: heel strike = IC: initial contact
FF: foot flat = LR: loading response
MS: midstance = MS: midstance
HO: heel-off = TS: terminal stance
TO: toe-off = PS: preswing
ES: early swing=IS: initial swing
MSw: midswing = MSw: midswing
LS: late swing = TSw: terminal swing

9. Gait Cycle Phases Stance phase: Swing phase: Double support:
62% of the gait cycle
From HS of one limb to toe-off (TO) of same limb
Some or all of the body’s weight borne on the limb
Swing phase:
38% of the gait cycle
Time the limb is non-weight bearing
From TO to HS
Double support:
20% of the gait cycle
Both limbs in contact with the ground
One limb in late stance, other in early stance

10. Stance Phases Heel strike (HS):
When the heel strikes the ground
Sometimes called foot strike
Foot flat (FF): When entire sole of foot contacts ground
Midstance (MS): When body is directly over the limb
(continued)

11. Stance Phases (continued)
Heel-off (HO): When heel leaves the ground but ball of foot remains in contact
Toe-off (TO):
When toe leaves the ground
Final phase of gait

12. Swing Phases Early swing (ES): Immediately following TO
Limb CoG begins accelerating forward to move in front of the body’s CoG
Sometimes called acceleration phase
(continued)

13. Swing Phases (continued)
Midswing (MSw):
Limb passes directly beneath the body.
Tibia is perpendicular to the ground.
Late swing (LS):
Limb passes in front of the body in preparation for HS.
Sometimes called deceleration phase.

14. CoG and Gait Purpose of gait is to move the CoG.
CoG is located approximately anterior to S2.
During gait, CoG moves from side to side and from superior to inferior.
(continued)

15. CoG and Gait (continued)
Vertical displacement:
CoG is displaced to vertical peak twice in gait cycle.
Highest point occurs at MS.
Lowest point occurs at double support.
CoG follows sinusoidal path in the vertical direction.
Total vertical displacement is ~2 in. (~5 cm).
Horizontal displacement:
CoG is moved from side to side once in gait cycle.
CoG follows sinusoidal path in the horizontal direction.
Total side-to-side displacement: ~1.75 in. (~4.5 cm).

16. Determinants of Gait Six determinants
Pelvic rotation
Pelvic tilt
Knee flexion at early midstance
Foot and ankle
Ankle and knee
Lateral pelvic motion
Work together to increase gait efficiency

17. Figure 12.3

18. Determinants of Gait: Pelvic Rotation
Pelvic rotation: ~4° to each side
Pelvis rotates left to right and vertically.
Left-to-right rotation depends on swing limb (e.g., right limb leads  pelvis rotates to left)
Amount of swing varies with cadence and step length.
(continued)

19. Determinants of Gait: Pelvic Rotation (continued)
Effect of some rotation occurs at both hips
 Amplitude of sinusoidal wave crest
 Severity of deflections between wave arcs
 Severity of impact with the ground
 Force needed to change direction of CoG from trough to crest wave
Smoothes out deflection points

20. Figure 12.4

21. Determinants of Gait: Pelvic Tilt
Pelvic tilt: ~5°to either side
Pelvis drops inferiorly opposite to weight-bearing (WB) limb.
Some motion occurs at both hips.
Adduction on WB side
Abduction on non-weight-bearing (NWB) side
Effects:
 Amplitude of sinusoidal wave
How does this  effectiveness of hip abductor mechanism?

22. Determinants of Gait: Knee Flexion in Early Midstance
Knee begins to flex immediately after HS and continues to flex (~15°) until FF.
Effects:
 Amplitude of sinusoidal wave crest
 Severity of deflections between sinusoidal wave arcs

23. Figure 12.6

24. Figure 12.7b

25. Determinants of Gait: Foot and Ankle
Talocrural joint
CoG is falling and WB limb shortens to dampen impact: Talocrural joint dorsiflexes.
Plantar flexes immediately following HS to FF.
Dorsiflexes in MS.
Begins to plantar flex immediately after MS.
(continued)

26. Determinants of Gait: Foot and Ankle (continued)
Pronated by FF.
Begins to supinate immediately after FF.
Talocrural center of rotation (CoR) position changes: high at HS, low at MS, high at TO.

27. Determinants of Gait: Ankle and Knee
At HS:
Knee flexes.
Ankle CoR moves high to low.
At FF
Knee begins extension.
Ankle CoR remains low.
At HO
Knee begins flexing to shorten the limb for swing.
Ankle CoR rises, then knee flexion increases as ankle CoR continues to rise.
(continued)

28. Determinants of Gait: Ankle and Knee (continued)
Effects:
 Severity of the deflections between wave arcs
Smoothes out the reversal of motion of the CoG at the low point of its course
Combinations of knee and ankle motions  gradual change in functional limb length throughout gait

29. Determinants of Gait: Lateral Pelvic Motion
Lateral displacement of CoG toward stance limb could be as much as 6 in.
Effect: produces lateral movement of CoG
Hip-knee angle  lateral movement to 1 in. each side

30. Figure 12.8a

31. Figure 12.8b

32. Figure 12.9

33. Figure 12.10a

34. Figure 12.10b 34

35. Figure 12.10c 35

36. Figure 12.11a

37. Figure 12.11b 37

38. Figure 12.11c 38

39. Figure 12.12a

40. Figure 12.12b 40