An Introduction to Gait Analysis, 4th Ed.

258 Pages·2007·2.66 MB·English

by  Michael W. Whittle BSc MSc MB BS PhD

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For Elsevier:
This book is dedicated to:
Wendy
Jim and Maeve
Sally, Garrie, Samuel and Gregory
Robert and Mia
Tracey, Jermaine and Will
Publisher: Heidi Harrison
Associate Editor: Siobhan Campbell
Production Manager: Elouise Ball
Design: Andy Chapman
Illustrator: Robert Britton
IllustrationBuyer: Merlyn Harvey
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An imprint of Elsevier Limited
First published 1990
Second edition 1996
Reprinted 1997
Third edition 2002
Reprinted 2003 (twice), 2004, 2005
Fourth edition 2007
© 2007, Elsevier Ltd
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form
or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior
permission of the Publishers. Permissions may be sought directly from Elsevier’s Health Sciences
Rights Department, 1600 John F. Kennedy Boulevard, Suite 1800, Philadelphia, PA 19103-2899, USA:
phone: [phone]; fax: [phone]; or e-mail: [e-mail]. You may
also complete your request on-line via the Elsevier homepage (www.elsevier.com), by selecting
‘Support and Contact’ and then ‘Copyright and Permission’.
ISBN 10: 0 7506 8883 1
ISBN 13: 9 780 7506 8883 3
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library.
Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the Library of Congress.
Note
Neither the Publisher nor the Authors assume any responsibility for any loss or injury and/or
damage to persons or property arising out of or related to any use of the material contained in this
book. It is the responsibility of the treating practitioner, relying on independent expertise and
knowledge of the patient, to determine the best treatment and method of application for the
patient.
Printed in China
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Acknowledgments
I would particularly like to thank my wife, Wendy, for her encouragement, support and
tolerance while I have been preparing this book. Particular thanks are also due to
Karen Hood, Jeannette Beach and Locke Davis, who work with me in the gait
laboratory and have taught me so much about clinical gait analysis. The CD-ROM
which accompanies this book contains data generously supplied by Nancy Denniston
and her colleagues at the Children’s Hospital, Denver, and some text written by Chris
Kirtley. The Polygon computer program, used to prepare the interactive multimedia
presentation of gait, was provided through the generosity of Vicon Peak Ltd. Three
other groups have also contributed in different ways to this book: my faculty
colleagues, the students I teach and the patients we have seen in the laboratory. I would
finally like to thank the administrators ofThe University ofTennessee at Chattanooga
for their support.
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Preface
to fourth edition
Gait analysis is the systematic study of human walking, using the eye and brain of
experienced observers, augmented by instrumentation for measuring body
movements, body mechanics and the activity of the muscles. In individuals with
conditions affecting their ability to walk, gait analysis may be used to make detailed
diagnoses and to plan optimal treatment.
Over the past few years, gait analysis has ‘come of age’ and in a number of centers
it is now used routinely to provide the best possible care for certain groups of patients,
most notably those with cerebral palsy. Since the benefits of this approach have been
well established, it is to be hoped that its usage will continue to spread, so that many
more will benefit from the better treatment decisions which can be made when gait
analysis is used.
I am happy to believe that the first three editions of this book have contributed to
this process, by providing a text which does not require a high level of academic
learning to be understood. I have heard from people all over the world that they have
found the book useful and this I find very gratifying.
The next stage in the evolution of gait analysis will hopefully involve improvements
in the ease and speed with which gait data can be collected and interpreted, and
decreases in the cost of the equipment and the skill level needed to use it. Significant
strides have been made in all these aspects since the third edition of the book was
published in 2002 but there is clearly still room for improvement.
The inclusion of a CD-ROM with ‘real’ gait data with this book will, it is hoped,
provide the reader with a better opportunity to get a feel for this fascinating subject.
Michael W. Whittle
2007
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Preface
to first edition
Gait analysis is the systematic study of human walking. It is often helpful in the
medical management of those diseases which affect the locomotor system. Over the
past few years, there has been an increasing interest in the subject, particularly among
practitioners and students of physical therapy, bio-engineering, neurology and
rehabilitation. Most previous books on the subject have been written for specialists and
are thus unsuitable for the student or general reader. I have attempted to write an
introductory textbook, with the aim of providing the reader with a solid grounding in
the subject but without assuming a particular background or level ofprior knowledge.
Chapter 1 is devoted to the basic sciences underlying gait analysis – anatomy,
physiology and biomechanics. It is intended to give the reader who is new to these
subjects the minimum required to make sense of gait analysis. It should also provide a
refresher course for those who have once had such knowledge but forgotten it, as well
as being a convenient source ofreference material. Chapters 2 and 3 deal with normal
gait and pathological gait respectively, showing the remarkable efficiency of the
normal walking process and the various ways in which it may be affected by disease.
Chapter 4 is devoted to methods of measurement, pointing out that gait analysis does
not have to be difficult or expensive but that the more complicated systems provide
detailed information which cannot be obtained in any other way. The final chapter,
Chapter 5, deals with the applications of gait analysis. This is the area in which the
most progress is to be anticipated in the future. The literature of the field is heavily
biased towards research rather than clinical application but the value of the
methodology is gradually coming to be realized in a number of clinical conditions.
I deliberately avoided giving references to theses and conference proceedings, since
these may be difficult to find. Chapter 1 contains no references at all, as everything in
it should be easy to find in standard textbooks. I have restricted the number of
references quoted in the remainder of the book, not through ignorance or laziness but
rather in an attempt to identify only the most important references on particular
topics. These will in turn lead on to other references, should the reader wish to study
that topic in greater detail. Those not familiar with it should ask their librarian about
the Science Citation Index, which uses key references from the past to identify more
recent publications in the same field.
I have used the Système International (SI) units throughout this book. I make no
apology for this – everyone working in this field should be using the measurement
units ofscience, rather than those ofthe grocery store! However, conversions are given
in Appendix 2.
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PREFACE TO FIRST EDITION
Since the origins of this book are international, it is hoped that it will appeal to an
international readership. It was written during my last few months at the University of
Oxford, UK, and my first few months at the University ofTennessee at Chattanooga, in
the USA. It draws on reference material from both sides of the Atlantic and parts of it
were written on journeys across that ocean!
Michael W. Whittle
Chattanooga, Tennessee
May 1990
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1
Basic sciences
All voluntary movement, including walking, results from a complicated
process involving the brain, spinal cord, peripheral nerves, muscles, bones and
joints. Before considering in detail the process of walking, what can go wrong
with it and how it can be studied, it is necessary to have a basic understanding
of three scientific disciplines: anatomy, physiology and biomechanics. It is
hoped that this chapter will provide the rudiments of these subjects for those
not already familiar with them, will review the topic for those who are, and
will also provide a convenient source of reference material.
ANATOMY
It is not the intention of this book to teach in detail the anatomy of the
locomotor system, which is well covered in several other books (e.g.
Palastanga et al., 1989). The notes which follow give only an outline of the
subject, but one which should be sufficient for an understanding of gait
analysis. The anatomical names for the different parts of the body vary
somewhat from one textbook to another; as far as possible the most common
name has been used. The section starts by describing some basic anatomical
terms and then goes on to describe the bones, joints, muscles and nervous
system. Although the arteries and veins are essential to the functioning of the
locomotor system, they will not be described here since they generally affect
gait only indirectly, through their role in providing oxygen and nutrients for
the nerves and muscles and removing waste products.
1
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BASIC SCIENCES
Basic anatomical terms
The anatomical terms describing the relationships between different parts of
the body are based on the anatomical position, in which a person is standing
upright, with the feet together and the arms by the sides of the body, with the
palms forward. This position, together with the reference planes and the terms
describing relationships between different parts of the body, is illustrated in
Fig. 1.1.
Six terms are used to describe directions, with relation to the center of the
body. These are best defined by example:
1. The umbilicus is anterior
2. The buttocks are posterior
3. The head is superior
4. The feet are inferior
5. Leftis self-evident
6. So is right.
The anterior surface of the body is ventraland the posterior surface is dorsal.
The word dorsumis used for both the back of the hand and the upper surface
Sagittal plane
Superior
Posterior
Right
Transverse plane
Left
Anterior
Frontal plane
Inferior
Fig. 1.1 The anatomical position, with three reference planes and six fundamental
directions.
2
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BASIC SCIENCES
of the foot. The terms cephalad (towards the head) and caudad (towards the
‘tail’) are sometimes used in place of superior and inferior.
Within a single part of the body, six additional terms are used to describe
relationships:
1. Medialmeans towards the midline of the body: the big toe is on the medial
side of the foot
2. Lateral means away from the midline of the body: the little toe is on the
lateral side of the foot
3. Proximalmeans towards the rest of the body: the shoulder is the proximal
part of the arm
4. Distalmeans away from the rest of the body: the fingers are the distal part
of the hand
5. Superficialstructures are close to the surface
6. Deepstructures are far from the surface.
The motion of the limbs is described using reference planes:
1. A sagittalplane is any plane which divides part of the body into right and
left portions; the medianplane is the midline sagittal plane, which divides
the whole body into right and left halves
2. A frontalplane divides a body part into front and back portions
3. A transverseplane divides a body part into upper and lower portions.
The term coronal planeis equivalent to frontal plane and the transverse plane
may also be called the horizontal plane, although it is only horizontal when in
the standing position.
Most joints can only move in one or two of these three planes. The
directions of these motions for the hip and knee are shown in Fig. 1.2and for
the ankle and foot in Fig. 1.3.The possible movements are as follows:
1. Flexion and extension take place in the sagittal plane; in the ankle these
movements are called dorsiflexionand plantarflexion, respectively
2. Abductionand adductiontake place in the frontal plane
3. Internal and external rotation take place in the transverse plane; they are
also called medialand lateralrotation respectively, the term referring to the
motion of the anterior surface.
Other terms which are used to describe the motions of the joints or body
segments are:
1. Varus and valgus, which describe an angulation of a joint towards or away
from the midline, respectively; knock knees are in valgus, bow legs are in
varus
3