TERMINOLOGY FOR CLINICAL GAIT ANALYSIS

(Draft #2)

Prepared by Sylvia unpuu Sounpuu@ccmckids.org Gait Analysis Laboratory Department of Orthopaedics Newington Childrens Hospital 181 E. Cedar Street, Newington, CT 06111

July, 1993 Revised April, 1994

Terminology for Clinical Gait Analysis The purpose of this document is to provide a standard terminology to aid in the communication and utilization of gait analysis data amongst professional groups. The attached document (Draft #2) includes common terminology used in clinical gait analysis. Draft#2 has included the comments received at the AACP&DM meeting in October of 1993. These comments were based on the mailing of this document to the majority of Gait Labs in the U.S.A. in August of 1993. This document has not been updated since April of 1994 and is still considered a DRAFT document open for discussion. I would like to thank all those who contriuted. In the majority of cases, I was able to read and encorporate the comments. The comments have been included directly where corrections were needed or where the definitions were enhanced by reader input. Where there are differences in opinions across the readers I have included suggestions directly below the involved definitions. The mechanism to deal with these differences needs to be determined by the Standards committee with any suggestions from the readers at large. There are obviously some areas of contention in this document. These include the following primary topics: 1) Gait cycle terminology. It does not appear that Perrys terminology is well accepted among the majority of readers of this document. Many readers would like the terminology completely changed with suggestions to use the terminology developed by Cochran as a suggestion. Other ideas were also given (see gait cycle below). 2) The terms heel contact, initial contact, heel strike, foot on, foot off etc. have caused a significant amount of problems among the readers with lots of differences in opinions in which terms should be used. As these terms are reasonably self explanatory, I would suggest that we compromize in this area and include all terms even though the information will be redundant. The terms used are generally based on personal preference. 3) There appears to be a lot of confusion about foot/ankle motion definitions of supination/pronation and inversion/eversio. We should probably use one terminology and stick with it. It appears that therapists, orthopaedists and podiatrists all use different terms. 4) Push-off vs roll-off continues to be a debated point but the majority of readers preferred push-off. 5) The angle definitions resulted in the most confusion for the readers, especially the pelvis and trunk. Any suggestions as to how to make this clearer would be helpful. 6) The internal vs external moment debate was brought up by several readers. I think this is one of the more important points to develop a consensus as is results in a lot of confusion in the interpretation of kinetic data. 7) There was discrepancy over conventions for angles with the transverse plane rotations, i.e., internal/ external = positive/negative and the reverse were given. For data interpretation consistency in this area is probably important. All other angle conventions did not receive comments.. 8) It was suggested that joint kinetics should be normalized by weight and height by several readers. As mentioned in the draft#1, this document in no way is intended to be in its final form and I am hoping for continued input from AACP&DM, GCMAS members and others involved in clinical gait analysis. All items are numbered so that you may respond to each definition by referring to the specific reference number. Please also add any terms that you feel should be included and are not in this draft.

1.00 GENERAL TERMS 1.01 1.02 1.03 1.04 1.05 Observational gait assessment: A qualitative visual description of an individuals upper and lower extremities, pelvis and trunk motion during ambulation. Motion analysis: Interpretation of computerized data that documents an individuals lower and upper extremities, pelvis, trunk and head motion during ambulation. Active markers: Joint and segment markers used during motion analysis that emit a signal. Passive markers: Joint and segment markers used during motion analysis that reflect visible or infrared light. Markers: Active or passive (see 1.03, 1.04) objects (balls, hemispheres or disks) aligned with respect to specific bony landmarks used to help determine segment and joint position in motion analysis. Electrogoniometer: An electrical transducer that can be attached to adjacent segments to measure a joint angle. Different designs accommodate changes in joint center of rotation location and three dimensional motion. Line of progression: The patients direction (of progression) during the data collection. Contralateral: The opposite side of the body, i.e. the opposite limb. Ipsilateral: On the same side of the body, i.e., the same limb. Locomotor apparatus: The lower extremities and pelvis that provide the mechanics of walking. Coronal Plane: The plane that divides the body or body segment into anterior and posterior parts. Sagittal Plane: The plane that divides the body or body segment into the right and left parts. Transverse Plane: The plane at right angles to the coronal and sagittal planes that divides the body into superior and inferior parts. Suggestions: 1) use Grays anatomy definitions for 1.11, 1.12 and 1.13. 2) add base of support 2.00 THE GAIT CYCLE 2.01 2.02 Gait Cycle: The period of time from one event (usually initial contact) of one foot to following occurrence of the same event with the same foot. Gait Stride: The distance from initial contact of one foot to the following initial contact of the same foot.

1.06

1.07 1.08 1.09 1.10 1.11 1.12 1.13

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Normalization of the gait cycle: A method used to achieve uniform representation of the gait cycle (or any part of) for the purposes of comparison or averaging data across subjects. Usual method is based on representation of a percentage of the complete cycle or percentage of stance or swing phase. Stance phase (ST): The period of time when the foot is in contact with the ground. Swing phase (SW): The period of time when the foot is not in contact with the ground. In those cases where the foot never leaves the ground (foot drag), it can be defined as the phase when all portions of the foot are in forward motion. Double support (DS): The period of time when both feet are in contact with the ground. This occurs twice in the gait cycle, at the beginning and end of the stance phase. Also referred to as left and right double limb stance or LDLS and RDLS respectively. For example, LDLS refers to the DS after left initial contact. Single support (SS): The period of time when only one foot is in contact with the ground. In walking, this is equal to the swing phase of the other limb. Initial contact (IC): The point in the gait cycle when the foot initially makes contact with the ground; this represents the beginning of the stance phase. It is suggested that heel strike not be a term used in clinical gait analysis as in many circumstances initial contact is not made with the heel. Suggestion: Should use foot strike.

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2.09

Heel contact (HC): When initial contact is made with the heel. Suggestion: Also referred to heel strike.

2.10

Terminal contact (TC): The point in the gait cycle when the foot leaves the ground: this represents the end of the stance phase or beginning of the swing phase. Also referred to as foot off. Toe-off should not be used in situations where the toe is not the last part of the foot to leave the ground. Note: For those cases of pathology where the foot never leaves the ground (foot drag), the termination of stance and the onset of swing may be somewhat arbitrary. The termination of stance and the onset of swing is defined as the point when all portions of the foot have achieved motion relative to the floor. Likewise, the termination of swing and the onset of stance may be defined as the point when the foot ends motion relative to the floor.

2.11 2.12 2.13 2.14

Toe-off (TO): When terminal contact is made with the toe. Foot flat (FF): The point in time in the stance phase when the foot is plantar grade. Heel off (HO): The point in the stance phase when the heel leaves the ground. Phases of the gait cycle: The gait cycle may be further divided into specific sub phases related to normal function; loading response, mid stance, terminal stance, pre-swing, initial swing, mid swing and terminal swing (Perry, 1992). This terminology is very useful for referring to specific portions of the gait cycle when describing pathological gait. The percentages given apply to normal gait.

2.14a Loading response: The initial double support stance period which is defined from initial contact (0%) to 10% of the gait cycle. Suggestions: 1) refer to as initial stance not loading response 2) refer to as early stance 2.14b Mid stance: The first half of the single support from 10 to 30% of the gait cycle and is defined from the time the opposite limbs leaves the floor until body weight is aligned over the forefoot. 2.14c Terminal stance: The second half of the single support from 30 to 50% of the gait cycle and is defined as the time from heel rise until the other limb makes contact with the floor. During this phase body weight moves ahead of the forefoot. Suggestion: refer to as late stance 2.14d Pre-swing: The final double support stance period which is defined from the time of initial contact with the contralateral limb to ipsilateral toe-off. 2.14e Initial swing: The initial third of the swing phase from 60 to 73% of the gait cycle as defined from toe-off to when the swing limb foot is opposite the stance limb. Suggestion: refer to as early swing 2.14f Mid swing: The middle third of the swing phase from 73 to 87% of the gait cycle as defined from the time the swing foot is opposite the stance limb to when the tibia is vertical. 2.14g Terminal swing: The final third of the swing phase from 78 to 100% of the gait cycle as defined from the time when the tibia is vertical to initial contact. Suggestion: refer to as late swing Overall Suggestions: 1) include alternative phases as described by Cochran and Vaughan et al. 2) terminal should indicate a point in time only and the phases should bedefined as early, mid and late. 3) remove all references to % of gait cycle 2.15 Push off: The period in time in late stance (between 40% of stride and toe-off) when there is an ankle plantar flexor moment and simultaneous power generation (see biomechanical terms) of the triceps surae to help advance the limb into swing phase. Suggestion: use roll off not push off 3.00 3.01 TEMPORAL AND STRIDE PARAMETERS Step length: The distance from a point of contact with the ground of one foot to the following occurrence of the same point of contact with the other foot. The right step length is the distance from the left heel to the right heel when both feet are in contact with the ground. Expressed in meters (m).

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Step period: Is the period of time taken for one step and is measured from an event of one foot to the following occurrence of the same event with the other foot, expressed in seconds (s). Stride length: The distance from initial contact of one foot to the following initial contact of the same foot. Sometimes referred to as cycle length and expressed in meters (m). Stride period or Cycle time: The period of time from initial contact of one foot to the following initial contact of the same foot, expressed in seconds (s). Velocity: The rate of change of linear displacement along the direction of progression measured over one or more strides, expressed in meters per second (m/s). Cadence: Rate at which a person walks, expressed in steps per minute. Stance/swing ratio: The ratio of the stance period to the swing period. Walking base (or stride width): The side to side distance between the feet which is typically measured from the ankle joint center. Natural Cadence/Velocity: The rate of walking that is voluntarily assumed. Foot switch: A device that measures the duration of foot contact of the designated part of the foot. Instrumented walkway: A pathway that either contains sensors in the floor or sensors around the walkway that monitor gait. ANGLE DEFINITIONS

In order to interpret gait analysis data, joint angle definitions must be defined. This is important for routine clinical use of gait data for treatment decision-making and for the presentation of research data in publications. The joint angle definitions are system dependent and ultimately depend on the marker alignment and underlying mathematical models. Interpretation of joint kinematic and kinetic data involves a knowledge of the marker placement and an appreciation of the joint models used. It must be clearly stated whether angles are relative (relating the position of one body segment to another) or absolute (segment orientation in terms of a laboratory coordinate system). Labels used in data output should reflect whether angles are relative or absolute. For example, referring to the thigh segment orientation in the sagittal plane as the hip angle is incorrect. Joint angle information should be obtained using three-dimensional techniques and relate to body segment axes, or coordinate systems, as determined by the appropriate anatomy. Ultimately, we need to work toward standardization of angle definitions independent of our marker set placement and gait model (for example, the use of Euler angles for kinematics). This will improve our ability to communicate data across different laboratories. The descriptions given below will be based on the perspective of an observer placed at a certain location in relation to the joint or segment of interest. For example, absolute angles (as defined above) are seen by an observer standing in the laboratory with a particular instantaneous view.

4.01

Upper Trunk Motion: The position of the upper trunk as defined by a marker set (for example, plane formed by the markers on the second rib and lateral to the sternum and C7) relative to a laboratory coordinate system.

4.01a Sagittal Plane Upper Trunk Anterior/Posterior Tilt: Motion of the long axis of the trunk as seen by an observer positioned along a medial-lateral axis of the trunk. 4.01b Coronal Plane Upper Trunk Elevation (Rise)/ Depression(Drop): Motion of the medial-lateral axis of the trunk as seen by an observer positioned along an anterior-posterior axis of the trunk. 4.01c Transverse Plane Upper Trunk Internal (protraction)/ External (retraction) Rotation: Motion of the medial-lateral or anterior-posterior axis of the trunk as seen by an observer positioned along a longitudinal axis of the trunk. Comments: unclear whether angles relative to room or body segments. 4.02 Pelvic Motion: The position of the pelvis as defined by a marker set (for example, plane formed by the markers on the right and left anterior superior iliac spine (ASIS) and the midpoint between the right and left posterior superior iliac spine (PSIS)) relative to a laboratory coordinate system. 4.02a Sagittal Plane Pelvic Anterior/Posterior Tilt: Motion of the long axis of the pelvis as seen by an observer positioned along a medial-lateral axis of the pelvis. 4.02b Coronal Plane Pelvic Elevation (Rise)/ Depression(Drop): Motion of the medial-lateral axis of the pelvis as seen by an observer positioned along an anterior-posterior axis of the pelvis. 4.02c Transverse Plane Internal (protraction)/External (retraction) Rotation: Motion of the mediallateral or anterior-posterior axis of the trunk as seen by an observer positioned along a longitudinal axis of the trunk. Comments: unclear whether angles relative to room or body segments 4.03 Hip Motion: The hip angles reflect the motion of the thigh segment relative to the pelvis. 4.03a Sagittal Plane Hip Flexion/Extension: Motion of the long axis of the thigh as seen by an observer positioned along the medial-lateral axis of the pelvis. 4.03b Coronal Plane Hip Abduction/Adduction: Motion of a long axis of the thigh as seen by an observer positioned along an anterior-posterior axis of the pelvis. 4.03c Transverse Plane Hip Internal/External Rotation: The relative motion between a distal mediallateral axis of the thigh and a medial-lateral axis of the pelvis as viewed by an observer (on the pelvis) looking down the long axis of the thigh. This measure as defined above will provide the relationship between the pelvis and the distal aspect of the femur. This does not necessarily correlate with femoral anteversion.

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Knee Motion: The knee angles reflect the motion of the shank segment relative to the thigh segment. A straight knee is 0 degrees.

4.04a Sagittal Plane Knee Flexion/Extension: Motion of the long axis of the shank as seen by an observer positioned along a medial-lateral axis of the knee. 4.04b Coronal Plane Knee Abduction/Adduction: Motion of the long axis of the shank as seen by an observer positioned along an anterior-posterior axis of the thigh. 4.04c Transverse Plane Knee Internal/External Rotation: The relative motion between a distal mediallateral axis of the shank and a medial-lateral axis of the thigh as viewed by an observer (on the thigh) looking down the long axis of the shank. 4.05 Ankle Motion: The ankle angles reflect the motion of the foot segment relative to the shank segment in most circumstances (sagittal and transverse plane) but there are some exceptions to this, for example, in the transverse plane foot progression (see below). The ankle in the neutral position or 0 degrees refers to no plantar flexion or dorsiflexion. 4.05a Sagittal Plane Ankle Plantar flexion/Dorsiflexion: Motion of the plantar aspect of the foot as seen by an observer positioned along a medial-lateral axis of the ankle. 4.05b Coronal Plane (hindfoot inversion/eversion): Motion of a long axis of the hindfoot as seen by an observer positioned along an anterior-posterior axis of the shank. NOTE: The majority of motion measurement systems set up to obtain full lower extremity kinematics do not provide coronal plane motion of the hindfoot. The signal to noise ratio, skin movement and level of deformity at the foot/ankle seen in patients with neuromuscular disorders makes this measure questionable in its accuracy. I would appreciate further comments on this from people measuring coronal plane ankle motion. 4.05c Coronal Plane Forefoot Supination/Pronation: (I would appreciate any comments on this from people measuring coronal plane motion of the forefoot in relation to the hindfoot) 4.05d Transverse Plane Foot Progression: This is an absolute angle of the relationship between the long axis of the foot as defined by the foot marker placement and model and the direction of progression. This measure does not give any information about tibial torsion. 4.05e Transverse Plane Foot Rotation: The relative motion between a long axis of the foot and a medial-lateral axis of the distal shank (line from medial epicondyle of tibia to lateral head of fibula) as viewed by an observer (on the shank) looking down the long axis of the foot. This measure will not give any information about tibial torsion but would suggest the presence of a forefoot abduction or adduction problem. Note: Across different gait laboratories there is some confusion as to what plots indicate tibial torsion. Tibial torsion should be a consistent value that can be measured during a standing position if the marker placement identifies the distal (bimalleolar) versus proximal axis (knee flexion/extension axis) of the tibia. If the orientation of the foot relative to the proximal axis of

the tibia is given as the angle definition, the tibial torsion angle will include artifacts of foot deformities that may not have anything to do with tibial torsion. Also, if the knee flexion/extension axis is used as the proximal axis, the transverse plane rotation at the knee (which may be an issue in some pathologies) will produce an artifact with respect to the tibial torsion angle. The inconsistencies across labs in how angles are defined only further emphasizes the importance of understanding the angle definitions before data is interpreted. Suggestions: 1) angle definitions for both 2D and 3D systems should be included. 2) add neck motions (flexion/extension, lateral side bending and rotation) 4.06 Motion Description

4.06a Abduction: Movement away from the midline of the body in the coronal plane. 4..06b Adduction: Movement towards the midline of the body in the coronal plane. 4.06c Flexion: Bending of a joint, for example, when the bones comprising a joint rotate towards each other in the sagittal plane. 4.06d Extension: Straightening of a segment, for example when the bones comprising a joint rotate away from each other in the sagittal plane. 4.06e Dorsiflexion: Movement of the foot towards the anterior part of the tibia in the sagittal plane. 4.06f Plantar flexion: Movement of the foot away from the anterior part of the tibia in the sagittal plane. 4.06g Internal rotation: When the distal segment is rotated medially in relation to the proximal segment in the transverse plane. 4.06h External rotation: When the distal segment is rotated externally in relation to the proximal segment in the transverse plane. 4.06i Inversion: Turning inward of the hindfoot. 4.06j Eversion: Outward turning of the hindfoot. 4.06k Varus: Medial angulation posture of the distal segment of a joint. 4.06l Valgus: Lateral angulation posture of the distal segment of a joint. 4.06m Supination: External rotation along the long axis of the foot (between the second and third metatarsal). 4.06n Pronation: Internal rotation along the long axis of the foot (between the second and third metatarsal). Observation: there is a lot of confusion as to the definitions of 4.06i, j, m and n. 4.06o Dorsiflexion Recovery: Movement from plantar flexion towards dorsiflexion during the swing phase.

Added definition. 4.06p Dynamic Range of Motion: General term to indicate joint motion excursion from the maximum angle to the minimum angle during a particular phase(s) in the gait cycle. Added definition. 5.00 PLOT FORMATS

There are two main formats: stance followed by swing phase and swing followed by stance phase. The majority of clinical gait laboratories use stance followed by the swing phase which is consistent with the gait cycle definition of initial contact to the following initial contact. I would like to suggest that we adopt the stance followed by the swing phase in all gait data presentation. I did not receive any comments on the above statement included in draft#1. Generally, joint kinematics are plotted in degrees, joint moments in Newton-meters per kilogram (N.m/ Kg) and joint powers in watts per kilogram (W/kg). Data may be plotted in real time or normalized to percent of the whole gait cycle or normalized to the stance and swing phases separately. There are various advantages and disadvantages of each method. Normalizing to the gait cycle allows for plotting of right and left gait cycles on the same plot or multiple gait cycles (average) on the same plot. This method also gives good information about the timing of toe-off which is lost when normalizing to stance and swing phase separately. Plotting in real time makes it easier to correlate events occurring on one limb with simultaneous events on the contralateral limb, but averaging across multiple strides is not possible. One of the major problems with inconsistencies in plotting formats is the resulting difficulty in communication of gait data. Suggestion: normalize moments to weight and height 5.01 Plotting conventions for joint kinematics (relative angles): positive anterior tilt rise (elevation) internal rotation (protraction) 5.01b Pelvis: anterior tilt rise (elevation) internal rotation (protraction) 5.01c Hip: flexion adduction internal rotation extension abduction external rotation posterior tilt drop (depression) external rotation (retraction) negative posterior tilt drop (depression) external rotation (retraction)

5.01a Upper Trunk:

5.01d Knee:

positive flexion varus internal rotation

negative extension valgus external rotation

5.01e Ankle: dorsiflexion adduction internal rotation 5.01f Foot Progression: internal progression 5.01g Foot Rotation: internal rotation external rotation external progression plantar flexion abduction external rotation

Suggestion: internal rotation should be negative and external rotation be positive. 5.02 Plotting conventions for segment motion:

Terminology is needed for absolute segment orientation, i.e., for the thigh, shank and foot segments in three dimensions. An example may be thigh tilt (anterior/posterior) in the sagittal plane. If anyone has any specific terms that they are using or ideas please make suggestions. Suggestion: top part of segment indicates motion, superior/inferior; right/left (no other comments for this were received) 5.03 Plotting conventions for joint moments: positive extensor moment abductor moment internal rotation moment 5.03b Ankle: plantar flexor moment abductor moment internal rotation moment dorsiflexor moment adductor moment external rotation moment negative flexor moment adductor moment external rotation moment

5.03a Hip/Knee:

Suggestion: replace internal and external rotation moments with inversion/eversion moments (inversion = negative, eversion = positive)

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Plotting conventions for joint powers: positive power generation negative power absorption

5.04a Hip/Knee/Ankle:

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BIOMECHANICAL TERMS Kinematics: Those parameters that are used in the description of movement with out consideration for the cause of movement abnormalities. These typically include parameters such as linear and angular displacements, velocities and accelerations. Segment and Joint Angular Velocities: First derivative with respect to time of the segment or joint angles. Suggestion: include definitions in appendix of Vaughan et al., which are applicable to 3D motion.

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Segment and Joint Angular Accelerations: Second time-derivatives of the segment or joint angles. Suggestion: include definitions in appendix of Vaughan et al., which are applicable to 3D moion.

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Deceleration: A decrease in velocity. Suggestion: A negative rate of change in velocity.

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Acceleration: An increase in velocity. Suggestion: A positive rate in change in velocity

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Kinetics: General term given to the forces that cause movement. Both internal (muscle activity, ligaments or friction in muscles and joints) and external (ground or external loads) forces are included. The moment of force produced by muscles crossing a joint, the mechanical power flowing to and from those same muscles, and the energy changes of the body that result from this power flow are the most common kinetic parameters used. Impulse: Integration with respect to time of a force or moment curve (area under the curve), and is usually employed in ballistic movements to reflect changes in momentum of the associated limbs. Linear impulse is expressed in N-s, angular impulses in N-m-s. Force: May be defined as a push or a pull and is produced when one object acts on another. The units are Newtons (N). Reaction Force: The force a body A exerts on a second body B in response to a force exerted by body B on the body A. The reaction force has equal magnitude but opposite direction relative to the force exerted on the body A by body B. The units are Newtons (N). Resultant ground reaction force (GRF): The vector summation of the three reaction forces resulting from the interaction between the foot and ground. The resultant ground reaction force has three vector components, i.e., the vertical, lateral and fore-aft.

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Force plate: A transducer that is set in the floor to measure about some specified point, the force and torque applied by the foot to the ground. These devices provide measures of the three com ponents of the resultant ground reaction force vector and the three components of the resultant torque vector. Center of pressure: A point on the ground where the resultant ground reaction force can be assumed to act. The center of pressure is typically calculated from the force and torque measured by a force plate. In a two-dimensional case, the center of pressure is the point where the resultant ground reaction force alone (with no torque) can act and have an effect equivalent to the measured ground reaction force and torque. In three-dimensions, however, there is generally no point where the force and torque can be replaced by just an equivalent force. Thus the center of pressure is taken to be the point where either 1) the resultant ground reaction force and the a vertical torque, or 2) the resultant ground reaction force and a torque parallel to the resultant ground reaction (i.e., the torque with minimum magnitude), can act and have an effect equivalent to the measured ground reaction force and torque. (consensus as to which of these methods is most appropriate?) Above definition based on suggestion by a reader.

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Mass moment of inertia: The measure of a body segments resistance to angular motion about a given axis. The units are kg.m2. Moment of Force (torque): The moment of force is calculated about a point and is the cross product of a position vector from the point to the line of action for the force r and the force F (i.e., r x F). In two-dimensions, the moment of force about a point is the product of a force and the perpendicular distance from the line of action of the force to the point. Typically, moments of force are calculated about the center of rotation of a joint. The units are Newton-meters (N-m). Internal Joint Moments: The net result of all the internal forces acting about the joint which include moments due to muscles, ligaments, joint friction and structural constraints. The joint moment is usually calculated around a joint center. A net knee extensor moment, for example, means that the knee extensors (quadriceps) are dominant at the knee joint and the knee extensors are creating a greater moment than the knee flexors (hamstrings and gastrocnemius). Units are Newton-meters (N-m) and usually normalized to the subjects body mass, i.e., N-m/kg. External Moment: The load applied to the human body due to the ground reaction forces, gravity and external forces (not common in clinical gait analysis applications). Kinetic energy: The component of a bodys mechanical energy that is due to its motion.. When a body is at rest the kinetic energy is zero and kinetic energy reaches a maximum at maximum velocity. suggestion: 1) add detail to definition i.e.. linear and angular contribution 2) delete because not proven

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Potential energy: The component of a bodys mechanical energy associated with its position relative to other bodies (including the ground). For example, gravitation potential energy of a body is proportional to the height of the center of mass of a body above the ground. Potential energy can also be developed through stretch of a muscle or tendon and this type of potential energy is sometimes referred to as elastic potential. Potential energy is sometimes also referred to as stored energy.

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Mechanical Energy: Energy state (potential and kinetic) of any limb segment or total body system at an instant in time. It is expressed in Joules (J). Mechanical Power: Rate of change of mechanical energy at an instant in time. Also, the rate of doing work. It is expressed in Watts (W). Mechanical Work: The product of a displacement and the component of force that is collinear with the displacement (i.e., the dot product of the force and the displacement). Mechanical work can also be calculated as the dot product of a moment and an angular displacement. The work done on a system is equal to the change in energy in a system (segment or total body) over that same period of time. It is expressed in Joules (J). Positive Work: Work done by a force or torque when the force or torque and the resulting displacement (linear or angular) have components in the same direction. Concentrically contracting muscles are often said to do positive work. Negative Work: Work done by a force or torque when the force or torque and the resulting displacement (linear or angular) have components in the opposite directions. Eccentrically contracting muscles are often said to do negative work. Couple: A set of force vectors whose resultant is equal to zero. Two force vectors with equal magnitude and opposite direction are and example of a force couple. Above definition added.

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Joint Power: The product of a joint moment and the joint angular velocity. Joint power is said to be generated when the moment and the angular velocity are in the same direction and absorbed when they are in opposite directions. The units are Watts (W). Above definition added.

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Center of Gravity: A single force formed by the convening of all forces of gravity acting in the body. In static standing this occurs at the level of the hips slightly anterior to the ankles. Above definition added.

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Pressure: Force per unit area measured in N/cm2. Above definition added.

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Foot Contact Area: Measurable part of the foot that is in contact with the floor during a defined point of the stance phase. Above definition added.

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Descriptive terms (kinetics): A useful terminology to help define joint kinetic patterns was developed by Winter and is described below (Winter, 1990). A1 - net power absorption at the ankle in mid stance A2 - net power generation at the ankle in terminal stance

K1 - net power absorption at loading response K2 - net power generation in mid stance K3 - net power generation in pre-swing K4 - net power absorption in terminal swing H1 - net power generation at the hip during hip extension H2 - net power absorption at the hip during cessation of hip extension H3 - net power generation at the hip during hip flexion at toe-off Suggestions: 1) omit above definitions because developed for planar data only and do not apply to 3D data (I do not agree with this) 2) Define torque, inverse dynamics, center of gravity, segmental power, joint center (Kane and Levison Dynamics: Theory and Applications McGraw-Hill Inc., 1985.)

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ELECTROMYOGRAPHY (EMG) Dynamic Electromyography: The recording of muscle activation patterns during functional activities such as walking. Electromyogram (EMG): The electrical signal associated with the contraction of a muscle. Motor Unit Action Potential: The electrical signal generated by the summation of the individual action potentials for all the fibers of a single motor unit. Electrodes placed on or in a muscle will record the algebraic sum of all the m.u.a.p.s at a specific point in time. Artifacts: Signals recorded on EMG that come from sources other than skeletal muscle activity, for example, electrodes, cables and ECG. Electrode: Device used on the skin (surface) or in the muscle (wire or needle) to record the intensity and timing of muscle function. Agonist: The term used to describe a muscle(s) which is part of a group of muscles that are producing the dominant moment. Antagonist: The term used to describe a muscle which is acting against the agonist. In other words, the muscle(s) that are co-contracting to produce a moment of force which is opposite in sign to the dominant moment of force. Maximum voluntary contraction: A voluntary contraction in which the person produces a maximum possible force in a muscle or group of muscles. Eccentric Contraction: When a muscle lengthens under tension. Concentric Contraction: When a muscle shortens under tension.

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7.12 7.13

Isometric Contraction: When a muscle has no change in length when under tension. Processing of the EMG Signal

7.13a Raw EMG Signal: Is the original amplified EMG signal before any signal processing. Used primarily to determine the phasic activity of a muscle. 7.13b Full-wave Rectification: The absolute value of the raw EMG signal. Used primarily for phasic activity information and as input for other processing techniques. 7.14c Linear Envelope: Produced by filtering the full-wave rectified signal with a low-pass filter. It is also referred to a moving average signal and is reported in millivolts (mV). The filter cut-off frequency should be indicated along with the type and order. Processing required for averaging EMG signals across strides and/or people. 7.14d Integrated EMG: A measure of the area under the full-wave rectified EMG. Two types of integrators include time and voltage reset. The signal is reported in millivolt-seconds (mV.s) or micro volt-seconds (uV.s). 7.14e Normalization (EMG): The relationship of the raw EMG collected during a specific motion and a reference (EMG during a known level of contraction, known force, relationship to the maximum level in gait). Normalization to a known level of contraction or to a maximum level in gait eliminates the ability to compare signal amplitude between muscles. Normalization also amplifies the noise of signal if it is firing minimally or not at all. 7.14f Ensemble average: The name given to the average pattern of any variable across repeat trials. 7.15 Descriptive Terms (EMG) Interpretation of EMG data is difficult. It is not valid to compare amplitudes between muscles unless the level of activity is normalized to a known level of contraction or force. This is not possible in patients that cannot isolate function of the muscle of interest. One of the most common presentation methods of normal EMG data is with the bar graph. The bar graph does not provide information about the stride to stride and intraperson variability of EMG, the relative changes in EMG amplitude within a gait stride and how the onset and termination of EMG activity may increase and decrease gradually over time. This may lead to misinterpretation of EMG data. Despite the convenience of the bar graph, I would suggest that normative EMG data be presented in the linear envelope format. 7.15a Prolonged activity: EMG activity that continues longer than the expected normal patterns. 7.15b Premature activity: EMG activity that begins earlier than the expected normal patterns. 7.15c Continuous activity: EMG activity that continues throughout the gait cycle. 7.15d Inappropriate activity: EMG activity that occurs during a phase in the gait cycle when activity is typically not present. 7.15e Phasic activity: EMG activity that coincides with the timing patterns of normal EMG. 7.15f Dysphasic: Phasic EMG activity but not occurring at the right time.

7.15g Negligible activity: Minimal to no activity noted throughout the gait cycle. Suggestion: define minimal i.e., 5%, 10%, 20%? 7.15h Curtailed Activity: Activity that begins when expected, but ceases prior to the expected normal cessation of activity. Added definition. 7.15i Erratic activity: No distinctive firing pattern. Added definition. 7.15j Delayed Onset: Activity that begins later than the expected time of onset. Added definition. 8.0 8.01 8.02 8.03 TERMS USED FOR DESCRIPTION OF GAIT Community ambulator: Those who are able to walk indoors and outdoors for the majority of their activities. Ambulatory aids like braces and/or crutches may be needed. Household ambulator: Those who are able to ambulate over short distances on level surfaces in the home. Ambulatory aids like braces and/or crutches may be needed. Exercise ambulators: Walking is limited to therapy sessions with a wheelchair needed for mobility. Suggestion: Also referred to as therapy or therapeutic ambulator. 8.04 8.05 Assistive Devices: Aids used for walking such as walkers, crutches and canes. Descriptive Terms for Normal and Pathological Gait:

8.05a Antalgic gait: Modification of gait pattern due to pain. 8.05b Calcaneus gait: Weight bearing primarily in the area of the heel. 8.05c Crouch: Excessive knee flexion in the stance phase of gait 8.05d Double bump pelvis: Sinusoidal oscillation of the pelvis (two peaks and two valleys) of the pelvis in the sagittal plane. 8.05e Drop foot: Excessive ankle plantar flexion (equinus) in terminal swing due to inactive (or insufficient) dorsiflexors. 8.05f Early heel rise: Premature heel rise in stance. Suggestion: Also known as spring foot. 8.05g Equinus: Prolonged plantar flexion of the ankle. 8.05h Extensor synergy (related to gait): Simultaneous extension of the hip and knee and plantar flexion of the ankle, adduction of the hip and possible internal rotation of the hip.

8.05i Flexor synergy (related to gait): Simultaneous flexion of the hip and knee and dorsiflexion of the ankle with possible abduction and external rotation of the hip in swing. 8.05j Foot flat: Initial contact made with the heel and forefoot simultaneously. Suggestion: foot flat should read foot-flat. 8.05k Gluteus maximus lurch: A posterior trunk and arms deviation to maintain hip extension due to a weak gluteus maximus. 8.05l Heel toe gait: A normal foot contact pattern with initial contact made with the heel followed by foot flat and then heel off. Suggestion: heel toe should read heel-toe. 8.05m Hyperextension: Excessive extension of a joint, beyond normal positioning. 8.05n Lordosis: Excessive anterior angulation of the lumbar spine in the sagittal plane, swayback. Suggestion: use terminology developed by the Scoliosis Research Society, i.e., anterior convexity (or posterior concavity) of lumbar segment of the spine. 8.05o Low (grade) heel contact: Initial contact made with the heel with less than normal dorsiflexion resulting in immediate forefoot contact. 8.05p Patterned movement: Mass flexion or extension movements of an extremity. Suggestions: 1) omit, 2) call Mass movement: an observed kinetic linkage between extremity joint (and sometimes trunk). 8.05q Pelvic drop: Excessive lateral lean of the trunk and contralateral drop of the pelvis due to abductor weakness. Also known as Trendelenburg gait. 8.05r Pelvic hike: Rise of the pelvis in the swing phase with associated drop of the opposite hemipelvis in the stance phase. Used to aid in clearance of the swing limb. 8.05s Pelvic tilt: Angulation of the pelvis from a normal position (normal pelvis = 10 +/- 5 degrees anterior tilt of plane formed by ASISs and PSISs) in the sagittal plane. 8.05t Premature heel rise: Heel rise from the floor prior to the onset of terminal stance (30% of the gait cycle). 8.05u Reciprocal gait: A gait pattern of alternating movements of the lower extremities. 8.05v Scissor gait: A gait pattern involving excessive adduction in swing. Sometimes confounded with simultaneous knee flexion and internal hip rotation with associated problems in limb advancement in swing. 8.05w Steppage gait: A compensation for a clearance problem by excessively flexing the hip and knee in the swing phase. 8.05x Stiff knee gait: Significantly limited knee sagittal plane motion into extension in the swing phase.

8.05y Swing through gait: A form of ambulation when using crutches in which both legs are advanced simultaneously in the swing phase with simultaneous crutch advancement in the stance phase. 8.05z Toe drag: Advancement of the foot in swing with continued contact on the ground. 8.05aa Toe/toe gait: Ambulation on the toe with no heel contact in the stance phase. This is not necessarily associated with excessive equinus, i.e., the knees may also be flexed and the ankle in neutral position. 8.05bb Gluteus lurch: Varying degrees of lateral trunk lean towards the side of hip pathology. Suggestion: should omit because the same as Trendelenburg. 8.05cc Three point gait: Crutches advanced simultaneously with legs moved reciprocally. Added definition. 8.05dd Four point gait: All four supports advanced independently, i.e., typically contralateral crutch with ipsilateral limb. Added definition. 8.05ee Toe heel gait: Initial contact made with the distal aspect of the foot followed by foot flat and then heel off. Added definition. 8.05ff Jump gait: Excessive knee flexion wave during the loading response followed by rapid knee extension during mid stance. Added definition. References: Hoppenfeld, S., Physical Examination of the Spine and Extremities, Prentice-Hall, Inc., New York, 1976. Inman V.T., Ralston, H.J., and F. Todd, Human Walking, Williams and Wilkins, Baltimore, 1981. Perry J., Gait Analysis: Normal and Pathological Function, Slack Inc., Thorofare, NJ 1992. Whittle M., Gait Analysis, An Introduction, Butterworth-Heinemann Ltd., Oxford, 1991. Winter D.A., Chairperson, Units, Terms and Standards in the Reporting of EMG Research. Winter D.A., Definitions, Terms and Conventions Related to Human Gait, Canadian Society for Biomechanics, December 1986. Winter D.A., Biomechanics and Motor Control of Human Movement 2nd Ed., John Wiley and Sons, Inc., Toronto, 1990.