Biomechanics of the Normal and the Pathological Gait

Gait analysis has traditionally been carried out in a laboratory environment using expensive equipment, but, recently, reliable, affordable, and wearable sensors have enabled integration into clinical applications as well as use during activities of daily living. Real-time gait analysis is key to the development of gait rehabilitation techniques and assistive devices such as neuroprostheses. This article presents a systematic review of wearable sensors and techniques used in real-time gait analysis, and their application to pathological gait. From four major scientific databases, we identified 1262 articles of which 113 were analyzed in full-text. We found that heel strike and toe off are the most sought-after gait events. Inertial measurement units (IMU) are the most widely used wearable sensors and the shank and foot are the preferred placements. Insole pressure sensors are the most common sensors for ground-truth validation for IMU-based gait detection. Rule-based techniques relying on threshold or peak detection are the most widely used gait detection method. The heterogeneity of evaluation criteria prevented quantitative performance comparison of all methods. Although most studies predicted that the proposed methods would work on pathological gait, less than one third were validated on such data. Clinical applications of gait detection algorithms were considered, and we recommend a combination of IMU and rule-based methods as an optimal solution.

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A Variable Impedance Knee Mechanism for Controlled Stance Flexion During Pathological Gait

IEEE/ASME Transactions on Mechatronics ◽

10.1109/tmech.2011.2131148 ◽

2012 ◽

Vol 17 (5) ◽

pp. 822-832 ◽

Cited By ~ 31

Author(s):

Thomas C. Bulea ◽

Rudi Kobetic ◽

Curtis S. To ◽

Musa L. Audu ◽

John R. Schnellenberger ◽

...

Keyword(s):

Pathological Gait

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The Importance of Being Earnest about Shank and Thigh Kinematics Especially When Using Ankle-Foot Orthoses

Prosthetics and Orthotics International ◽

10.3109/03093646.2010.485597 ◽

2010 ◽

Vol 34 (3) ◽

pp. 254-269 ◽

Cited By ~ 63

Author(s):

Elaine Owen

Keyword(s):

Joint Kinematics ◽

Foot Orthoses ◽

Traditional Beliefs ◽

Vertical Angle ◽

Gait Biomechanics ◽

Normal Gait ◽

Ankle Foot Orthoses ◽

Pathological Gait ◽

Kinematics And Kinetics

This paper reviews and summarizes the evidence for important observations of normal and pathological gait and presents an approach to rehabilitation and orthotic management, which is based on the significance of shank and thigh kinematics for standing and gait. It discusses normal gait biomechanics, challenging some traditional beliefs, the interrelationship between segment kinematics, joint kinematics and kinetics and their relationship to orthotic design, alignment and tuning. It proposes a description of four rather than three rockers in gait; a simple categorization of pathological gait based on shank kinematics abnormality; an algorithm for the designing, aligning and tuning of AFO-Footwear Combinations; and an algorithm for determining the sagittal angle of the ankle in an AFO. It reports the results of research on Shank to Vertical Angle alignment of tuned AFO-Footwear Combinations and on the use of ‘point loading’ rocker soles.

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TEMPORAL AND SPATIAL PARAMETERS OF GAIT IN CHILDREN. II: PATHOLOGICAL GAIT

Developmental Medicine & Child Neurology ◽

10.1111/j.1469-8749.1993.tb11613.x ◽

2008 ◽

Vol 35 (2) ◽

pp. 114-125 ◽

Cited By ~ 17

Author(s):

E. F. Wheelwright ◽

R. A. Minns ◽

R. A. Elton ◽

H. T. Law

Keyword(s):

Spatial Parameters ◽

Pathological Gait ◽

Temporal And Spatial

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Musculoskeletal Modeling as a Tool for Biomechanical Analysis of Normal and Pathological Gait

IFMBE Proceedings - VIII Latin American Conference on Biomedical Engineering and XLII National Conference on Biomedical Engineering ◽

10.1007/978-3-030-30648-9_124 ◽

2019 ◽

pp. 955-963 ◽

Cited By ~ 3

Author(s):

Manuel Cardona ◽

Cecilia García Cena

Keyword(s):

Biomechanical Analysis ◽

Musculoskeletal Modeling ◽

Pathological Gait

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Effects of Ankle Foot Orthoses on the Gait Patterns in Children with Spastic Bilateral Cerebral Palsy: A Scoping Review

Children ◽

10.3390/children8100903 ◽

2021 ◽

Vol 8 (10) ◽

pp. 903

Author(s):

Diogo Ricardo ◽

Maria Raposo ◽

Eduardo Cruz ◽

Raul Oliveira ◽

Filomena Carnide ◽

...

Keyword(s):

Cerebral Palsy ◽

Scientific Data ◽

Cochrane Library ◽

Leaf Spring ◽

Foot Orthoses ◽

Gait Patterns ◽

Functional Scores ◽

Ankle Foot Orthoses ◽

Pathological Gait ◽

The Impact

Background: Cerebral palsy (CP) is the most common cause of motor disability in children and can cause severe gait deviations. The sagittal gait patterns classification for children with bilateral CP is an important guideline for the planning of the rehabilitation process. Ankle foot orthoses should improve the biomechanical parameters of pathological gait in the sagittal plane. Methods: A systematic search of the literature was conducted to identify randomized controlled trials (RCT) and controlled clinical trials (CCT) which measured the effect of ankle foot orthoses (AFO) on the gait of children with spastic bilateral CP, with kinetic, kinematic, and functional outcomes. Five databases (Pubmed, Scopus, ISI Web of SCIENCE, SciELO, and Cochrane Library) were searched before February 2020. The PEDro Score was used to assess the methodological quality of the selected studies and alignment with the Cochrane approach was also reviewed. Prospero registration number: CRD42018102670. Results: We included 10 studies considering a total of 285 children with spastic bilateral CP. None of the studies had a PEDro score below 4/10, including five RCTs. We identified five different types of AFO (solid; dynamic; hinged; ground reaction; posterior leaf spring) used across all studies. Only two studies referred to a classification for gait patterns. Across the different outcomes, significant differences were found in walking speed, stride length and cadence, range of motion, ground force reaction and joint moments, as well as functional scores, while wearing AFO. Conclusions: Overall, the use of AFO in children with spastic bilateral CP minimizes the impact of pathological gait, consistently improving some kinematic, kinetic, and spatial-temporal parameters, and making their gait closer to that of typically developing children. Creating a standardized protocol for future studies involving AFO would facilitate the reporting of new scientific data and help clinicians use their clinical reasoning skills to recommend the best AFO for their patients.

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