Kinetics of stiff-legged gait: induced acceleration analysis

Treating spastic paretic stiff-legged gait, defined as reduced knee flexion in swing, holds a high priority in the rehabilitation of patients with upper motor neuron lesions. We propose a method to determine the relative contributions of hip, knee, and ankle impairments to this disability. We analyzed the gait of ten patients with stiff-legged gait (SLG) due to a single stroke and ten healthy, able-bodied controls. Using subject specific models, we analyzed the induced accelerations (IA's) at the knee. Knee IA's throughout the gait cycle were calculated and the sum of the IA's was compared to the knee joint angular acceleration estimated from kinematic data. The preswing and early swing IA's were the focus of our examination as these largely determine knee kinematics in swing. Knee angular accelerations estimated from IA's and kinematic data agreed for both controls and patients. Gait cycle IA analysis of individual patients identified highly variable causes of SLG including ankle and hip joint impairments. Induced acceleration analysis (IAA) suggested that multiple impairments, not just about the knee, but also about the hip and ankle, lead to this disability. Individual subjects are likely to have individual reasons for their stiff-legged gait. Defining the link between the patients specific impairments and their gait disability should be a goal of clinical gait analysis. IAA is a useful tool for this purpose with a strong potential for clinical application.