Hareket ve Yürüme Analizi
Özet
İnsan yürüyüşünün mekanik ve nöromotor kontrol dinamiklerini kavramak, patolojik yürüme paternlerinin çözümlenmesi ve etkin tedavi stratejilerinin geliştirilmesi için temel bir gerekliliktir. İki ayaklı lokomosyon, kütle merkezinin yüksek konumu nedeniyle doğası gereği kararsız bir yapıya sahip olsa da; yer reaksiyon kuvveti (YRK), eylemsizlik ve kas kuvvetlerinin dengeli etkileşimiyle ritmik ve enerji tasarruflu bir ilerleme sağlanır. Yürüme siklusu; ağırlık kabulü, tek bacak desteği ve salınan bacağın ilerletilmesi gibi temel görevleri üstlenen beş basma ve üç salınım fazı olmak üzere toplam sekiz faza ayrılır. Bu fazlar boyunca kas grupları, enerji tüketimini optimize etmek ve ayak klirensini başarıyla sağlamak amacıyla koordineli sinerjiler oluşturur. Modern yürüme analizleri; üç boyutlu kinematik, kinetik kuvvetler, dinamik elektromiyografi (EMG), metabolik enerji ve pedobarografi gibi nesnel parametreleri ölçerek klinisyenlere kantitatif veriler sağlar. Bu veriler, özellikle serebral palsi gibi spastik ve deformiteli yürüyüş patolojilerinde kaldıraç kolu disfonksiyonlarını belirlemede, çok seviyeli cerrahi planlamalarında ve işlevsel ortez tasarımlarında kritik bir rol oynar. Sonuç olarak, statik ve dinamik klinik muayenelerin cihazlı yürüme analiziyle birleştirilmesi, rehabilitasyon süreçlerinin başarısını artırarak hekimleri daha doğru klinik çözümlere ulaştırmaktadır.
Understanding the mechanical and neuromotor control dynamics of normal human gait is essential for analyzing pathological walking patterns and developing effective treatment plans. Although bipedal locomotion is inherently unstable due to the high position of the center of mass, rhythmic and energy-efficient progression is achieved through the balanced interaction of ground reaction forces (GRF), inertia, and muscle forces. The gait cycle is categorized into eight distinct phases—comprising five stance and three swing phases—which accomplish critical tasks such as weight acceptance, single limb support, and swing limb advancement. Throughout these phases, muscle groups establish coordinated synergies to optimize energy conservation and ensure adequate foot clearance. Modern quantitative gait analysis offers objective measurements including three-dimensional kinematics, kinetic forces, dynamic electromyography (EMG), metabolic energy assessment, and pedobarography. These parameters are crucial for identifying lever arm dysfunctions, planning single-event multilevel surgeries, and designing functional orthoses, particularly in spastic and deformed gait pathologies like cerebral palsy. Ultimately, integrating static and dynamic clinical examinations with instrumented gait analysis significantly improves the success of rehabilitation processes, guiding physicians toward more accurate and effective clinical solutions.
Referanslar
Koop SE, Schwartz MH, Gage JR. The Identification and Treatment of Gait Problems in Cerebral Palsy. Mac Keith Press; 2009. Accessed January29,2022.https://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=511499&site=ehost-live
Oatis, Carol A. Kinesiology: the mechanics and pathomechanics of human movement. Philadelphia, PA: Lippincott Williams & Wilkins, 2004.
Maitin, Ian. Current Diagnosis and Treatment Physical Medicine and Rehabilitation. McGraw-Hill Education, 2014.
Fahn, Stanley. Principles and practice of movement disorders. Elsevier/Saunders, 2011.
Kandel, Eric R., et al., eds. Principles of neural science. Vol. 4. New York: McGraw-hill, 2000.
Kaymak, Bayram. "FONKSİYONEL ANATOMİ VE KİNEZYOLOJİ." Fiziksel Tıp ve Rehabilitasyon (2019): 17.
Kaymak, Bayram, and Abdullah Ruhi Soylu. "Fundamentals of Quantitative Gait Analysis." Musculoskeletal Research and Basic Science. Springer, Cham, 2016. 93-106.
Alexander, Michael A., Dennis J. Matthews, and Kevin P. Murphy, eds. Pediatric rehabilitation: principles and practice. Demos Medical Publishing, 2015.
Schwarze, Martin, et al. "The added value of orthotic management in the context of multi-level surgery in children with cerebral palsy." Gait & posture 68 (2019): 525-530.
Skaaret, Ingrid, et al. "Impact of ankle-foot orthoses on gait 1 year after lower limb surgery in children with bilateral cerebral palsy." Prosthetics and orthotics international 43.1 (2019): 12-20.
Keyvani Hafshejani, A., et al. "Design and preliminary evaluation of a new ankle foot orthosis on kinetics and kinematics parameters for multiple sclerosis patients." Journal of Biomedical Physics & Engineering 10.6 (2020): 783.
Jafarnezhadgero, Amir Ali, et al. "Rehabilitation improves walking kinematics in children with a knee varus: Randomized controlled trial." Annals of physical and rehabilitation medicine 61.3 (2018): 125-134.
Schasfoort, Fabienne, et al. "Intramuscular botulinum toxin prior to comprehensive rehabilitation has no added value for improving motor impairments, gait kinematics and goal attainment in walking children with spastic cerebral palsy." Journal of rehabilitation medicine 50.8 (2018): 732-742.
Daniels, Katherine AJ, et al. "Changes in the kinetics and kinematics of a reactive cut maneuver after successful athletic groin pain rehabilitation." Scandinavian Journal of Medicine & Science in Sports 31.4 (2021): 839-847.
Yamamoto, Masataka, et al. "Effect of an ankle–foot orthosis on gait kinematics and kinetics: case study of post-stroke gait using a musculoskeletal model and an orthosis model." ROBOMECH Journal 6.1 (2019): 1-7.
Veerkamp, Kirsten, et al. "The effects of electromyography-assisted modelling in estimating musculotendon forces during gait in children with cerebral palsy." Journal of biomechanics 92 (2019): 45-53.
Agostini, Valentina, et al. "Surface electromyography applied to gait analysis: how to improve its impact in clinics?." Frontiers in Neurology 11 (2020): 994.
Steele, Katherine M., et al. "Repeatability of electromyography recordings and muscle synergies during gait among children with cerebral palsy." Gait & posture 67 (2019): 290-295.
Zaino, Nicole L., et al. "Energy consumption does not change after selective dorsal rhizotomy in children with spastic cerebral palsy." Developmental Medicine & Child Neurology 62.9 (2020): 1047-1053.
Kuchen, Daniela Barbara, et al. "Long-term follow-up after patellar tendon shortening for flexed knee gait in bilateral spastic cerebral palsy." Gait & Posture 81 (2020): 85-90.
Look, Nicole, et al. "Radiographic and plantar pressure assessment of pes planovalgus severity in children with cerebral palsy." Clinical Biomechanics 85 (2021): 105364.
Karol, Lori A., and Kelly A. Jeans. "This is a narrative review of the functional evaluation of clubfoot treatment with gait analysis." Annals of Translational Medicine 9.13 (2021).
