Michael W Whittle Gait Analysis An Introduction To 4th Edition
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Conclusion: The strong validity and excellent inter- and intra-rater reliability results establish a concrete foundation for use of GaitON- a 2D motion analysis system as a tool for evaluating the running gait of a patient in a clinical setup.
Objective measures of assessment of running gait help to understand abnormal biomechanics that may contribute to injury in runners(10). The advancements in gait analysis technology allows clinicians to break down the running gait cycle into phases and focus on lower body biomechanics in detail. There are different systems available for measuring kinematic data during running. Three-dimensional (3-D) motion analysis is widely accepted as the gold standard for assessing running biomechanics. However, due to its high cost and lack of portability, the utilization of this system is limited to only selected clinics or institutions(3).
A 2D running gait analysis system, is a more affordable and practical solution for field research and clinical use. It uses 2 digital cameras to capture the motion of a runner from the anterior, posterior and the lateral views. Each view is then analyzed by a motion analysis software to obtain information regarding kinematic and kinetic parameters for assessment of biomechanics of running.
There are a number of software available that are widely used by clinicians for conducting a 2D running gait analysis. One such software is Kinovea (version 0.8.15, available for download at ( ), a freeware shown to have high levels of inter and intra-rater reliability, especially during measurement of sagittal plane variables in case of running(7,11). However, the limitations of this software are that the measurements of joint angles have to be done manually so the analysis time is more.
In the present study, we have used a new 2D motion analysis system called GaitON (Auptimo Technologies LLP, India) to investigate the hip and knee running mechanics of a group of runners. We measured the hip and knee angles at the initial contact phase according to Ranchos Los Amigos classification(12). GaitON has an inbuilt running analysis protocol which reduces the number steps required for manual marker digitization, resulting lesser measurement variations & reduced analysis time. If proved valid and reliable, GaitON has potential to become an efficient tool for running gait analysis.
We used Kinovea for establishing validity of GaitON as it has previously been established as a reliable tool for running gait analysis (7,11). Reinking et al, used Kinovea software to establish the inter-rater and intra-rater reliability of 6 different raters varying in experience(11). The study reported high intra-rater ICC values for experienced raters (ICC: 0.75- 0.98) and inexperienced raters (ICC: 0.54-0.99) during assessment of eight sagittal plane variables, In the case of frontal plane variables, both the experienced and inexperienced raters demonstrated lower levels of intra-rater reliability.
The study results helped us to establish GaitON as a valid and reliable software for gait analysis in male runners. Proper precautions such as accurate physical setup and marker placement are needed to minimize parallax and perspective errors. If these are taken 2 D motion analysis systems can provide information about kinematic and kinetic parameters comparable with any 3D software. However the study had some limitations. Firstly, the current study involved quantification of knee and hip angles in sagittal plane only. Secondly, due to the amount of upper body exposure required, the participants who agreed to volunteer for the study were males. Despite these limitations, the study was instrumental in providing clinicians with a new software that is accurate for evaluating the running gait of a patient in a clinical 2D video setup. The software is reliable, simple and reduces total analysis time for a clinician.
Knee osteoarthritis (KOA) is reported to have characteristic kinematics during walking. However, the relationship between Kellgren-Lawrence (K/L) score and the 3D kinematic gait of patients with medial KOA remains unclear. Here, ninety-seven patients with medial KOA and thirty-eight asymptomatic participants were involved. Patients with medial KOA were divided into early, moderate, and severe KOA based on the K/L score. Through kinematic gait analysis, we found a relationship between K/L score and 3D kinematic gait for patients. All KOA knees had a significantly reduced range of motion. As the K/L score was increasing, the knee flexion at the heel strike and 50% of the stance phase increased while the peak knee flexion in the swing phase decreased. In addition, the adduction and femoral rotation increased internally at the heel strike, 50% of the stance phase, and maximum angle of the swing phase. Femoral translation increased anteriorly and distally at the heel strike and 50% of the stance phase. The severe group had more medial translation than the asymptomatic groups. Significant alterations of three-dimensional joint kinematics were identified in subjects suffering various severities in Chinese patients. This study provides an important reference for the treatment options, therapy assessment, and rehabilitation of KOA.
In the past decade, imaging has often been applied to assess KOA clinically, especially radiography7, 8. The Kellgren & Lawrence (K/L) system for grading the severity of osteoarthritis was developed based on radiography7. At present, K/L scores have been widely applied to the assessment of the severity of KOA in clinics. Computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (UT) have also been used to evaluate KOA9,10,11. However, these imaging techniques assess KOA under static conditions and, thus, do not evaluate the functional changes of the disease. Hence, gait analysis, a dynamic method, has been used to explore kinetic and kinematic characteristics of KOA for decades12,13,14,15,16. For example, the knee adduction moment (KAM) has been a significant parameter correlated with medial KOA17. Reduced knee flexion at the heel strike, reduced knee abduction angle at the 50% of the stance phase, and reduced knee flexion range during gait were reported in patients with KOA18,19,20. However, so far, no study has focused on the relationship between six degrees of freedom (6DOF, including flexion/extension, adduction/abduction, internal/external femoral rotation, anteroposterior translation, proximal/distal translation and medial/lateral translation of the knee), and the imaging assessment of the severities in KOA patients. For patients of medial KOA, anatomical structures of the knees, such as osteophytes and deformity, were dependent on the severities of KOA and influenced kinematic alterations of the joints21, 22. Hence, this study aims to explore if and how the kinematic alterations of Chinese patients with medial KOA during walking is related to K/L scores quantitatively.
The process of gait analysis. (A) The doctor is holding the hand-held digitizing probe to identify the nine bony landmarks (greater trochanter, lateral epicondyle, medial epicondyle, lateral plateau, medial plateau, tibial tuberosity, fibular head, medial malleolus, and lateral malleolus). (B) According to the nine bony landmarks, the system sets up the 3D position of tibia and femur. (C) The gait system is collecting trajectories of femur relative to tibia while the subjects are walking in the treadmill.
The study encompasses quantification (introduction and analysis of measurable parameters of gaits), as well as interpretation, i.e. drawing various conclusions about the animal (health, age, size, weight, speed etc.) from its gait pattern.
The pioneers of scientific gait analysis were Aristotle in De Motu Animalium (On the Gait of Animals) and much later in 1680, Giovanni Alfonso Borelli also called De Motu Animalium (I et II). In the 1890s, the German anatomist Christian Wilhelm Braune and Otto Fischer published a series of papers on the biomechanics of human gait under loaded and unloaded conditions.
Although much early research was done using film cameras, the widespread application of gait analysis to humans with pathological conditions such as cerebral palsy, Parkinson's disease, and neuromuscular disorders, began in the 1970s with the availability of video camera systems that could produce detailed studies of individual patients within realistic cost and time constraints. The development of treatment regimes, often involving orthopedic surgery, based on gait analysis results, advanced significantly in the 1980s. Many leading orthopedic hospitals worldwide now have gait labs that are routinely used to design treatment plans and for follow-up monitoring.
A typical gait analysis laboratory has several cameras (video or infrared) placed around a walkway or a treadmill, which are linked to a computer. The patient has markers located at various points of reference of the body (e.g., iliac spines of the pelvis, ankle malleolus, and the condyles of the knee), or groups of markers applied to half of the body segments. The patient walks down the catwalk or the treadmill and the computer calculates the trajectory of each marker in three dimensions. A model is applied to calculate the movement of the underlying bones. This gives a complete breakdown of the movement of each joint. One common method is to use Helen Hayes Hospital marker set, in which a total of 15 markers are attached on the lower body. The 15 marker motions are analyzed analytically, and it provides angular motion of each joint.
Pressure measurement systems are an additional way to measure gait by providing insights into pressure distribution, contact area, center of force movement and symmetry between sides. These systems typically provide more than just pressure information; additional information available from these systems are force, timing and spatial parameters. Different methods for assessing pressure are available, like a pressure measurement mat or walkway (longer in length to capture more foot strikes), as well as in-shoe pressure measurement systems (where sensors are placed inside the shoe). Many pressure measurement systems integrate with additional types of analysis systems, like motion capture, EMG or force plates to provide a comprehensive gait analysis. 153554b96e