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Normal gait

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In: Orthopedic Management of Children with Cerebral Palsy ISBN: 978-1-63483-318-9
Editors: Federico Canavese and Jacques Deslandes © 2015 Nova Science Publishers, Inc.
Chapter 16
NORMAL GAIT
Alice Bonnefoy-Mazure
and Stéphane Armand
Willy Taillard Laboratory of Kinesiology,
Geneva University Hospitals and Geneva University, Switzerland
ABSTRACT
Walking is the first way of displacement for human and essential for daily life
activities and social participation. The human gait can be analyzed from several points of
view and specialties. The aim of this chapter is to describe from a simple manner the
normal gait in term of gait cycle, acquisition and development of the gait, joint
kinematics, kinetics of the lower limb, electromyography and arm movements.
Keywords: gait cycle, gait maturation, kinematics, kinetics, electromyography and arm
movement
KEY POINTS
Gait involves a large numbers of sub-systems such as skeletal, joint, muscular,
neurologic, vestibular, visual, proprioceptif systems.
The gait cycle is a period of time between any two nominally identical events in the
gait process that serves as a reference in the studies and/or examinations of gait
parameters.
The gait maturation is a long process.
Walking can be described with the support of spatio-temparal parameters,
kinematics, kinetics and electromyography.
Corresponding author: Alice Bonnefoy-Mazure PhD Willy Taillard Laboratory of Kinesiology, Geneva University
Hospitals and Geneva University, Rue Gabrielle Perret-Gentil 4, 1205 Geneve, Switzerland; Email:
alice.bonnefoymazure@hcuge.ch
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16.1. INTRODUCTION
Walking is the most natural mode of locomotion in humans to travel independently and
with an efficient manner. The gait can be defined as a movement consisting of a translation of
the whole body permitted by a repetition of movements of body segments while keeping the
balance. This repetition of movement involves the definition of a cycle.
16.2. THE GAIT CYCLE
The gait cycle could be defined as a period of time between any two nominally identical
events in the gait process [1]. Generally, these two nominally identical events correspond to
the instant where one foot strikes the ground and ends when the same foot strikes again the
ground (called initial contact or IC). During the gait cycle, lower limb considered an alternate
stance phase (foot in contact with the ground) and swing phase (foot without ground contact).
A gait cycle is thus divided in a period of stance phase (about 60% of the cycle) and in a
period of swing phase (about 40% of the cycle) of the lower limbs, right and left (Figure 1). It
is possible to make a sub-division according to the stance and swing phase of the two lower
limbs. When both members are in stance phase, this is a bipodal support (or double support)
and when one of the two members is in stance phase while the other is in swing phase, this is
a unipodal support (or single support).
More specifically, the stance phase can be divided into five functional sub-phases
occurring in the following sequences: initial contact (IC), loading response (LR), midstance
(MSt), terminal stance (TSt) and preswing (PSw) [2]. As the same way, the stance phase is
divided into three functional sub-phases occurring in the following sequences: initial swing
(ISw), mid-swing (MSw) and terminal swing (TSw). However, we prefer to keep a division
according the events occurring during the gait cycle (i.e. first double support, single support,
second double support, and swing phase) [3] that permits a more precise definition of the sub-
phases and avoids confusion in the terms [4] (Figure 1).
Figure 1. Common temporal divisions of the gait cycle.
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Each sub-phases cited below, enables at the lower limbs to realize three functional tasks
of the gait that are: weight acceptance, single-limb support and limb advancement [2].
This gait cycle divided into various phases serves as a reference in the studies or
examinations of gait analysis. Graphics used for its interpretation are usually normalized to
the duration of the gait cycle and the phases are expressed as a percentage thereof. Moreover,
during the gait cycle, several gait characterizations can be done with the temporal
measurements such as: gait speed, cadence, step length, stride length and step width.
The gait speed also known as walking speed, gait velocity, is generally defined as the rate of
motion measured in meters per second and is a scalar quantity. Gait speed predicts the future
health status and it is easy to measure and to interpret, that is why it is recommended as the
“sixth vital sign” [5]. The cadence denotes the number of steps taken in a given time,
generally steps per minutes. A natural or free cadence describes a self selected walking
rhythm. The step length is defined as the longitudinal distance between for example the left
and right heels of the feet when both are in contact with the ground. Stride length is the
distance between two successive placements of the same foot. Finally, step width is as medio-
lateral distance between the left and right foot, also measured when both feet are in contact
with the ground.
16.3. ACQUISITION AND DEVELOPMENT OF THE GAIT
The mean age for onset of independent walking differs between 11 and 14.5 months [6,
7]. Before this age, several steps are necessary to acquire the toddler gait [8]. Indeed, since
the birth, baby learns to lift and to control his head, then, around three months, he is able to sit
without support. After that, we observe that child is able to roll over and around nine months,
he is able to pull himself to stand and then to walk with support. This first gait or primitive
gait according around 12 months, is considered and defined as independent when child can
perform a minimum of 5 steps [9]. During all this period, child is confronted to constantly
growing and changing in term of neuro-musculo-skeletal system to evolve towards a mature
and stable gait pattern.
Indeed, in term of gait patterns, the toddler’s gait pattern differs from adult gait, i.e. from
mature gait. All studies concerning the gait maturation agree that the most important feature
of toddler gait is a large amount of inter and intra-subject variability. In 1980, Sutherland and
collaborators [6] realized a gait analysis on 186 children (age between one and seven years).
This large study, described important differences in term of spatio-temporal parameters, joint
kinematics, ground reaction forces and muscles activation patterns.
Indeed, in term of spatio-temporal parameters, it was observed, that toddlers have a lower
average walking speed, higher cadence, shorter step length, wider support base and a more
prolonged double support phase compared to a mature gait [10]. In term of kinematics,
children fixe their arms in guard position, i.e. with arms in abduction, external rotation and
elbows flexed (to maintain the stability); they position their feet in external rotation and they
have no heel strike. During the stance phase, the hip and knee are not in complete extension
but are simultaneous in flexion during the swing phase [11]. Concerning the kinetics of the
toddler, some differences were observed with a dominance of hip and knee extending
moments during the stance phase of the gait, with a sustained power production for the same
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joint [12-14]. In last, concerning the surface electromyography (EMG), a mature pattern of
muscle recruitment and EMG activation during gait is achieved by an age of 6 to 8 years for
healthy children [15]. Thus, differences between mature gait and toddler gait are
characterized by: less co-contraction during stance phase and improved integration of
descending and stretch-reflex activities in mature gait patterns.
16.4. KINEMATICS
Kinematics is the study of bodies in motion without considering the forces (internal and
external forces) that cause the body movement (Figure 2).Thus, the kinematics analysis
allows to observe and to describe the body movements during the gait. Kinematics includes
the analysis of positions, angles, velocities and accelerations of the body segments and joints.
Joint angles describe the angle between two adjacent segments in a specific plane. The three
commons planes used in description of the gait kinematics are the sagittal plane for the
flexion-extension movements; the frontal plane for the adduction-abduction movements and
the transversal plane for the internal-external rotations. The most studied joints were the
ankle-foot; knee, hip, pelvis and trunk joints in the sagittal plane.
Figure 2. Example of normal kinematic curves (mean +/- one standard deviation) in the three
dimensional planes at self-selected walking speed. First column corresponds to the sagittal plane. The
second column corresponds to the frontal plane. The third column corresponds to the transversal plane.
The vertical line corresponds to end of the stance phase of the gait cycle.
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Ankle Joint and Foot Segment
The analysis of the ankle angle concerns the relative angle between the long axis of the
shank and the long axis of the foot (axis from the calcaneum to the toe). Moreover, the foot
and ankle form a dynamic link between the body and the ground.
The main role and function of the ankle and the foot during the stance phase of the gait is
to produce a wheel-like rolling motion under the foot. This specific function is described in
the literature in terms of three rockers [2]. The action these three functional rockers, namely
named heel (first rocker), ankle (second rocker) and forefoot rockers (third rocker) are the
progression of the leg over the supporting foot (Figure 3).
Figure 3. Illustration of the different foot rockers: heel rocker (or first rocker), ankle rocker (or second
rocker) and forefoot rocker (third rocker).
The two first rockers correspond at deceleration rockers and begin at the initial contact of
the gait cycle, and extend through the loading response. Thus, at the initial contact with the
floor, the ankle is in neutral position to initiate the first rocker and to facilitate the progression
of the limb. After this short period (2% of the gait cycle), the ankle is in plantar flexion
(around 5°) in order to preserve the momentum generated by the fall of the body weight onto
the stance limb. It is referred as the heel rocker. During the single support, the tibia advances
from an 5° of plantar flexion to 15° of dorsiflexion, thus the heel and forefoot are in contact
with the floor and are in stable foot-flat posture. This specific movement is called the ankle
rocker or second rocker. Third and last rocker, named forefoot rocker, occurs during the
second double support and corresponds to the heel rise. At this instant, only the forefoot is in
contact with the floor. The ankle moves rapidly from 15° of dorsiflexion until 20-30° of
plantarflexion. Thus the movement of the foot around the third rocker allows to maintain
height of the center of mass and the propulsion of the body during the gait.
During the swing phase, at the beginning, the ankle is in plantarflexion and the tibia is
behind the body (60% to 73% of the gait cycle i.e. the initial swing). The mid swing (73% to
86% of the gait cycle) corresponds to the period of the gait cycle where the ankle is in
dorsiflexion to able to foot clearance while the terminal swing (86% to 100% of the gait
cycle) enables the ankle to move in neutral position to prepare the initial contact with the
floor.
To conclude in the sagittal plane, the movements of the ankle are important for normal
coordinated gait and regulate the movement of the center of mass. It allows the foot to
accommodate to different grounds, provides shock absorption and also acts as a rigid segment
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for propulsion of the body during the second double support. The range of motion of the
ankle joint during the gait cycle is around 35° for a normal gait.
In the transverse plane, the foot progression angle corresponds at the angle between the
long axis of the foot and the direction of progression. During the first double support and
single support, the foot is in external rotation (around 10°). During the second double support,
the foot has a movement toward internal rotation. During the swing phase, the foot has a
movement toward external rotation. During all the gait cycle, the range of motion of foot
angle progression is around 5°.
During the gait, pronation and supination normally occur in the foot. Indeed, the
pronation is important for optimal movement and shock absorption. During the healthy gait,
the pronation corresponds at the moment where the foot is in contact with the ground and
begins to roll inward, everting slightly with arch flattens. The purpose of the pronation is to
able the foot to adapt to the surface. After the pronation, the foot continues toward supination.
This results in the foot turning slightly outward then changing from a flexible foot to a more
rigid foot, so it can propel the foot and push off from the ground. During this phase the foot
inverts slightly, and the arches become higher, thus enabling the foot to properly roll over the
hallux.
Knee Joint
The analysis of the knee angle concerns the relative angle between the long axis of the
thigh and the long axis of shank. Moreover, the knee has a wide range of function during the
execution of gait, including limb stability during the stance phase, supporting body weight,
deceleration and flexibility to allow limb movement in swing phase.
At the initial contact of the gait cycle, the knee is in full extension and just after, for the
loading response (first double support), the knee is in flexion (around 15°) in order to absorb
the shock of the weight transfer onto the limb and also to maintain stability. During the single
support, the knee is fully extended to optimize the stance stability. During the second double
support, there is a passive knee flexion (around 35°) due to the fact that the ankle moves. This
passive movement prepares the limb to the swing phase. At the beginning of the swing phase,
the knee is in flexion (around 60°) in order to allow the foot clearance and to allow the limb
advancement. The mid swing corresponds at a passive knee extension movement
corresponding at the limb advancement. Finally, at the terminal swing, the knee stays in
extension to prepare the limb for the stance. To conclude in the sagittal plane, the knee
movement plays a major role in order to maintain the stance stability and to allow the
absorption shock. Moreover, the knee movement is intimately associated with the foot and
ankle movements. The range of motion of the knee joint during the gait cycle is around 60°
for a normal gait. In the frontal plane, the movement is negligible (varus or valgus movement)
with a neutral position.
Hip Joint
The analysis of the hip angle concerns the relative angle between the long axis of the
thigh and a perpendicular to the pelvic plane.
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At the initial contact of the gait, the hip is flexed (around 35°) to allow a forward
progression. During single support, the hip joint plays its role of stabilizer to support the limb
loading and to maintain the pelvis and trunk position, while allowing advancement of the
body. During this phase, the hip moves from a flexion position to an extension position
(around 10°). At the second double support, the hip moves quickly from an extension motion
to a flexion motion to allow the body advancement. During the initial and mid swing, the hip
continues its flexion motion to attain its maximal flexion around 35°. During these periods,
the limb is in forward progression, the foot is not in contact with the ground and the limb
swing is a passive movement. The terminal swing enables the limb to position the initial
contact. The hip prepares the limb for stance by stopping flexion. To conclude for the sagittal
plane, the hip movement allows the forward progression of the limb and maintains the pelvis
and the trunk. The range of motion of the hip joint during the gait cycle is around 40° for a
normal gait.
In the frontal plane, it appears that the hip movements are linked with the pelvis
movement. Indeed, when the pelvis is up, the hip is in adduction during the single support
(positive value on the curve around 6°) and then during the second double support, the hip is
in abduction (negative value on the curve, around 7°). During the swing phase, the hip moves
in slight adduction. The range of motion of the hip is around 13°.
Concerning the hip rotation movements, at the loading response, the hip is in internal
rotation and becomes in external rotation at the end of stance phase. At the end of the swing
phase, the hip is in external rotation. During the gait cycle, the range of motion of the hip
rotation is around 8°.
Pelvis Segment
The analysis of the pelvis angle concerns the inclination of pelvis plane with respect to
the horizontal. The movement of the pelvis is minimal during the gait with a range of motion
around 5°. Its inclination toward anteversion (pelvic tilt) is around 10° during the entire gait
cycle. During the first double support, a posterior movement is observed followed by an
anterior movement during the single support phase. During the second double support, a
slight posterior movement is again observed. During the swing phase, the pelvis moves from
a posterior position to an anterior position and then to a posterior position.
In the frontal plane, the pelvis obliquity, the range of motion is around 8°. During the first
double support, the pelvis rises (positive value on the curve pattern) and after it drops
during single support to 7° (negative value on the curve pattern). After that, during the swing
phase the pelvis rises again 8°. During the gait cycle, the pelvis is twice time in neutral
position. In the transversal plane, the pelvis moves from internal to external rotation with a
range of motion around 8-10° depending form the walking speed. The role of this movement
is to assist the forward progression of the swing leg.
Trunk Segment
The analysis of the trunk angle concerns the forward inclination of the long axis of the
torso. The trunk plays an important role in human locomotion. Indeed, the trunk represents
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more than 50% of the body weight and its kinematic maintains the dynamic stability in
individuals. As for the pelvis kinematics, in the sagittal plane the trunk inclination is around
with a range of motion around 3°. Moreover, as the pelvis, the trunk moves between an
anterior and posterior movement during the gait cycle.
In the frontal plane, the trunk position, i.e. the trunk obliquity, is around and with a
range of motion negligible.
In the transversal plane, the trunk has similar movement than the pelvis. The coordination
of the movement between the pelvis and the trunk is depending of the walking speed. If the
walking speed is low, the trunk rotation movements are in phase with the pelvis; if the
walking speed is high, the trunk rotation movements is in anti-phase with the pelvis [2].
Moreover, the trunk plays a major role in postural control in order to allow successful
execution of functional activities as the gait [16, 17].
Thus, the role of trunk movement is mainly to counterbalance the asymmetric kinematic
of the lower limbs [18].
16.5. KINETICS
Kinetics is the study of forces that cause motion of the bodies. Thus the kinetics aims to
characterize the forces that act upon the body and the body segments.
Generation of Ground Reaction Force
The ground reaction force (GRF) is an important force in walking. Indeed, the point of
application of this force found underneath the contacting foot and it is direct opposite to the
body weight. Thus the GRF influences the movement of the entire body during the gait and
the analysis of the shape of the GRF can be derived on the whole-body motion.
During the stance phase of the normal gait, the GRF has a typical pattern with a double
bump corresponding to two maxima surpassing body weight with an intermediate minimum
inferior at the body weight. This specific pattern is often modeled in the literature as an
inverted pendulum moving over a rigid supporting leg [19].
Thus, the generation of the ground force begins at the instant where the foot contacts the
ground i.e. at the IC of the gait cycle. At this specific instant, the body weight is transferred
very quickly on one leg. For this, the foot and the leg act together as shock absorber [2].
Consequently, the impact force is followed by a loading response. During this short period,
the whole foot is in contact with the ground and the vertical GRF increases to attain the first
maximum peak force (F1 on Figure 4). After this first peak, the vertical force diminishes
corresponding at the mid stance phase (F2 on the Figure 4). Indeed during this phase, the
opposite foot is in the mid swing phase, therefore the whole body weight is supported by the
stance limb. The foot and the leg provide a stable platform to able the movement of the body,
like an inverted pendulum [20]. When the heel lifts away from the ground, the GRF starts
increasing once again. This ascending second peak (F3 on the Figure 4) of the GRF
corresponds to the second double support. Finally, the GRF pattern starts descending to zero
with the pre-swing phase and drops to zero when the foot leaves the ground (Figure 4).
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Figure 4. Example of the vertical ground reaction force recorded during the stance phase of the normal
gait cycle.
Joint Kinetics or Joint Moments and Powers
If the GRF and the joint movements are measured and known (as well as the
anthropometric data of the subject), it is then possible to calculate the net joint moments from
a specific model named inverse dynamics.
The net joint moment (or torque or moment of force) corresponds at the net result of
muscular and non-muscular forces (as tension from ligaments and joint capsule) acting
around the joint and causing movement of the joint (Figure 5). Basically, the moment is the
ability of a force to rotate a body about an axis. In classical mechanics, the moment of a force
is the cross product of a force vector with its perpendicular distance from the axis (named
lever-arm distance vector), which causes rotation about this axis. Thus, in the case of the
human gait, for static and quasi-static position, the net joint moment increases if the GRF
increases, or if the lever arm (distance between the joint center and the GRF) increases.
Moreover, the net joint internal moment (corresponding to the joint moment produced by
muscle and soft tissue forces) gives an idea about which muscle group is dominant during the
gait. But in all the cases, this parameter gives no information about the individual muscle
forces. Indeed, it is not possible to measure the net tension or force in the muscles because
there are not enough equations to calculate the large number of unknown i.e. the muscle
forces.
This problem depends of another mathematical field of researcher corresponding at the
optimization approach [21-25]. However, in order to have an idea of the muscles role during
the gait, it is possible to have the electromyography data corresponding to the muscle
activities.
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Moreover, from the inverse dynamics, it is possible to calculate the power output
corresponding at the rate of the energy delivered by muscles to move a joint. Thus the net
joint power parameter is information of how much effort is needed to perform a specific
movement, and about eccentric and concentric contraction (Figure 5).
For the net ankle moment pattern, there is a brief dorsi-flexor moment (negative value on
the curve) to control the foot lowering. This moment is followed by a plantar flexor moment
(positive value on the curve). At the end of the stance phase, there is a peak value for the
plantar flexor moment limiting the ankle dorsi flexion movement around 10-15°. This
moment decreases progressively through the remainder of stance. Concerning the ankle
power pattern, it appears that there is a peak of absorptive power (negative value on the
curve) at the IC, following by a low amplitude power absorption reflecting an eccentric action
of the muscles.
Figure 5. Example of normal kinetic curves in the sagittal plane at typical walking speed. First column
corresponds to the ankle net joint moment and power. The second column corresponds to the knee net
joint moment and power. The third column corresponds to the hip net joint moment and power.
At the end of the stance phase, a peak of positive power (generation of power) appears
corresponding at the push-off in order to propulse the limb into the swing.
For the net knee moment pattern, it is generally observed three flexor moments (negative
values on the curve) and two extensor moments (positive values on the curve). The first peak
appears at the IC of the stance phase and it is a flexor moment in order to control the knee
hyper extension. This first peak is followed very quick extensor moment to ensure stability of
the knee during the loading response and to control the knee flexion movement. Then the
flexor moment diminishes to become negative i.e. an extensor moment at the end of the single
support. During the second double support, a small extensor moment appears to control the
rapid knee flexion. During the mid swing and terminal swing phases, the knee extends and
then the flexor moment increases to control the movement. Concerning the knee power
pattern, it appears that at the first double support, the power is absorbed (negative values on
the curve) linked to eccentric activity of muscles. During single support, a little peak of power
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generation is present to increase the knee extension. At the second double support, peak
power absorption occurs as well as at the end of the terminal swing.
For the net hip moment pattern, an extensor moment (positive values on the curve) is
present at the IC and decreases quickly during first double support. The hip moment is
negative i.e. flexor during the single support and with a peak at the beginning of the second
double support. After that, the flexor moment declines to become positive and then power is
generated when the hip flexes rapidly. Concerning power, there is a period of power
generation (positive values on the curve) at the end of stance phase which helps at the forward
progression of the gait.
16.6. MUSCLE ACTIVITIES OF THE LOWER LIMBS
DURING THE NORMAL GAIT
The human gait pattern is normally fluid and shows continuous movements. It is a natural
and repetitive movement controlled by muscles. Thus, the muscles are the motors of the gait
and accomplish a specific role during the gait cycle. When muscles are actively contracted
under neural control, they produce an electric signal that can be recorded by
electromyography.
The role of each muscle during gait is globally known but different interpretations of
muscle activity can be done. Several causes may be raised: some muscles are biarticular and
act directly on two joints; the action of a muscle in single support, double support or during
swing is different due to opened or closed chain; the position of a joint changes the possible
action of a muscle. Understanding precisely the role of each muscle during normal gait is still
the object of researches. The following description is a simplified overview of muscle control
of the lower-limbs during gait (Figure 6).
At the initial contact, the foot begins its contact with the floor; at this instant, the gluteus
maximus and the biceps femoris help to control hip flexion movement whereas the tibialis
anterior controls and slows down the foot movement.
During the first double support, seven main muscles are in action in order to control the
ankle, knee and hip to maintain the equilibrium while allowing forward progression.
The rectus femoris has an extensor role in order to control and slows down the knee
flexion. Moreover, it absorbs the shock occurring during the loading response. At the same
time, the action of the hamstring is reduced (to flex the knee) whereas the gluteus maximus
action is increased. Indeed, the gluteus maximus and hamstring have a concentric action and
allows to accelerate the hip. Finally, the gluteus medius stabilizes the pelvis.
At the end of the stance phase, the tibialis anterior is just beginning its activity to prepare
the initial swing phase.
During the initial swing phase, the swing leg leaves the ground and advances. To product
this movement, three main muscle groups are in action. The hip flexor muscles i.e. the
adductor longus, the sartorius, the iliacus and the gracilis muscles, have an ongoing activity to
advance the thigh and to create, passively thank of inertia of the leg, the knee flexion. In
addition, the biceps femoris muscle increases the knee flexion and tibialis anterior and
extensor digitorum longus muscles lift the foot from its previously plantar flexed position in
order to prepare foot clearance.
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Figure 6. Representation of muscle activity during a gait cycle. The grey color indicates periods where
the muscles are active during the gait cycle.
During the mid swing phase, thigh continues its advancement and there is a vertical
alignment of the tibia with the foot. During this period, the muscle activity is limited. Iliacus,
sartorius,rectus femoris and gracilis activity have ceased. The tibialis anterior supports and
maintains the ankle position. The contro-lateral gluteus medius supports the pelvis position.
The terminal swing phase corresponds to the end of the gait cycle. This phase prepares
the next stance phase. Three main muscles are in actions. The hamstring muscle have an
action on the hip and knee joints to slow down the forward movement of the leg. The rectus
femoris muscle extends the knee and the tibialis anterior positions the ankle joint to assure the
contact with the ground.
16.7. THE ROLE OF THE ARMS DURING THE GAIT
Linked to the bipedal characteristics of the human walking, the movement the arms is a
typical feature of human walking. Indeed, during walking the arms swing out of phase
relative to the legs but there is no direct link with propulsion.
In several studies this arm swing movement is explained to minimize the body’s angular
momentum around the vertical axis and then to reduce energy expenditure [26-29].
In these studies, the arm movements are often seen as pendulum movement that move
passively due to the thorax movements, gravity and inertia [30, 31].
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However, a net joint moment of the shoulder is present during the gait [32], the arm
swings are not passive and are driven by muscle activities [33]. Muscle activities keep the
swing between legs and arms out of phase [29]. Finally, arm movement during gait is in part
due to the muscle activities (deltoid, latissimus dorsi and trapezius muscles) and in another
part due to passive dynamics as acceleration of the thorax, inertia and gravity [34]. The
implication of arm swing during gait is to reduce energetic cost around 8% [26]. Moreover, it
appears that the arm movements during gait facilitate the movements of the legs. Arms help
to maintain or regain balance and equilibrium after a perturbation or risk of falling.
CONCLUSION
The gait is a daily activity of human beings, the most important and yet most banal.
However, this activity is complex and involves a large numbers of sub-systems such as
skeletal, joint, muscular, neurologic, vestibular, visual and proprioceptif systems.
To better understand the human locomotion is a question that arises for many research
teams. This area of research, because of its richness and complexity, includes a large number
of scientific specialties. Therefore, the aim of this chapter was to simply describe the normal
gait pattern in terms of development, kinematic, kinetic and electromyography parameters.
However, this description stays basic because each sub-chapter could be a specific
chapter and a field of research. Several domains of normal walking have not been addressed
in this chapter, such as motor control, energy expenditure, information integration and
influences from different conditions (e.g: walking inside, outside; walking and performing a
cognitive task). In all the cases, before trying to understand and explain the abnormal or
pathological gait, it is essential to have good knowledge of the great principles of the normal
gait (more details could be found in reference books [2, 4, 35-39].
AKNOWLEDGMENTS
We would like to acknowledge Florent Moissenet for his help with the illustrations.
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