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Development of Gait By Electromyography First Edition
Tsutomu And Kayoko Okamoto Digital Instant Download
Author(s): Tsutomu and Kayoko Okamoto
ISBN(s): 9784902473056, 4902473054
Edition: First Edition
File Details: PDF, 17.15 MB
Year: 2007
Language: english
 Development of Gait
by Electromyography
Application to Gait Analysis and Evaluation
Tsutomu Okamoto, Ph.D.
Kayoko Okamoto, Ph.D.

Walking Development Group

Osaka, Japan
Copyright © 2007 by Okamoto & Okamoto

Published by

Walking Development Group

~qTOO3£;PJf~pJT
G-S04 Tenno 2-6, Ibaraki-shi,
llJ
WALKING

Osaka 567-0S76, JAPAN

All rights reserved. No part of this publication may be

reproduced or transmitted in any form or by any means,
electronic or mechanical, including photocopy, recording,
or any information storage and retrieval system, without
permission in writing from the publisher.

ISBN978-4-902473-05-6

Printed in Japan
 Preface

The gait of a human being continues to change over the course of a

lifetime. The first stage is that of neonatal reflex stepping, which is
thought to be the origin of bipedal upright walking in human beings.
This then develops into young infant stepping at the age of one to two
months, followed by inactive stepping and then by voluntary infant
supported walking at the age of six to twelve months. Infants then
acquire independent walking at around the age of one and begin to
acquire mature adult walking at around the age of three.
We have analyzed the detailed changes in the development of human
gait employing electromyography (EMG) which has enabled us to carry
out motion analysis impossible with conventional methods. At present
very little longitudinally analyzed post natal gait development data is
available anywhere in the world because of the difficulty of carrying
out the necessary experiments. It is even more difficult to record
electromyographically the neonatal reflex stepping of newborn babies
or the moment when babies begin upright, independent walking. Even
today the papers that I wrote on this subject in the 1970s and 1980s
continue to be cited.
We have continued up to the present to carry out additional cross-
sectional and longitudinal experiments concerning gait development
from the newborn baby stage to that of infant independent walking and
have in the process accumulated much electromyographical data. The
results of our analysis of normal gait development suggest that it can
not only contribute to the explanation and clarification of human bipedal
upright walking, but also be applied to various areas of research such as
the diagnosis of and therapy for various walking disorders and the
evaluation of the level of gait function restoration and improvement.
We have gathered together in this book the results of our study and
analysis of gait carried out over the last 40 years, in the hope that this
rare elctromyographical data concerning gait development will
contribute to the further development of this field.
Part I contains our analysis, based on movement and muscle activity,
of the development and changes in gait from birth until the age of eight,
that is from the stage of neonatal reflex stepping, thought to be the
origin of bipedal upright walking in human beings, through that of the

iii
acquisition and mastering of infant independent walking to that of the
acquisition of mature adult walking.
Part II introduces our application of this to the analysis and evaluation
of gait. We have created "An Index of Gait Instability" based on the
results of our analysis of the gait development of infant independent
walking, which we apply to research into the nature of human stepping
and the evaluation of the level of restoration of walking functions in the
elderly.
We hope that this book will prove useful to those engages in gait
studies, not only as a basic reference material analyzing the develop-
ment of gait, but also as a basis for research, analysis and application
in various fields that will help to generate new ideas about human gait.

Tsutomu Okamato

iv
 Contents
Preface iii
Contents v

Part I Development of Gait -Birth to Age Eight- 1

1 . Newborn Stepping in Neonates and Young Infants 3

Early neonatal period (1 - 2 weeks) 8

Late neonatal period (3 - 4 weeks) 12
Onset of infant period (1- 2 months) 16
Initial infant period (3 - 4 months) 18
Discussion 20

2 . Independent Walking in Infants 25

1st day of learning to walk 28

2 weeks after learning to walk 30
At around 1 month after learning to walk 32
From 2 to 3 months after learning to walk 34
Subsequent development 36
Standing posture on the 1st day of walking 38
Discussion 40

3. From Newborn Stepping to Mature Walking

- Developmental Changes in One Individual- 45

Neonatal stepping 48
Young infant stepping 50
Infant supported walking 52
Infant walking 54
Immature child walking: unsettled muscle activity 56
Mature walking: toward a mature pattern 58
Developmental period of gait 59
Discussion 61

v
Part II Application to Gait Analysis and Evaluation
-An Index of Gait Instability- 67

4. An Index of Gait Instability

-Based on the Development of Independent Walking- 69

EMG findings during the development of gait 73

EMG activity in unstable walking 79
Criteria for Instability 84
An Index of Gait Instability 86

5. Application of an Index of Gait Instability (1)

-Supported Walking in Normal Neonates and Infants- 89

Until the 1st month of age 92

From 1 to 4 months of age 94
From 6 to 12 months of age 96
Developmental changes in EMG patterns 98
Application of an index of gait instability to supported walking
in babies 99
Discussion 101

6. Application of an Index of Gait Instability (2)

-Recovery of Walking in an Elderly Man after Stroke- 107

1 month after the stroke 110

7 months after the stroke 112
1 year 7 months after the stroke 114
EMG evaluation of walking stability 116
Discussion 117

References 121
Appendix 125
Acknowledgements 131
About the Authors 133

vi
Development of Gait by Electromyography
 EMG experiment of infant walking

The electromyographic (EMG) recordings were done with a pen-writing mUltipurpose

electroencephalograph, using surface electrodes 5 mm in diameter. The skin at each electrode
locus was scratched lightly with a needle, reducing the resistance between pairs of electrodes
to less than 5000 n (Okamoto et aI., 1987).
Neonatal stepping at 3 weeks afte birth
 The purpose of this study was to examine the develop-
mental changes in the functional mechanisms of leg
muscles in newborn stepping over the first 4 months in ten
normal neonates. Neonatal stepping in the first month
showed excessive co-activation, that is, co-contraction pat-
terns of mutual antagonists appeared especially during
stance phase. The discharge patterns of co-contraction in
neonatal stepping began to change to reciprocal patterns in
young infant stepping (after the first month), but excessive
muscular activities associated with a slightly squatted
posture and forward lean still remained . Strong muscle
activities of leg extensors due to a parachute reaction of the
legs before floor contact, not seen in the neonatal period,
began to appear in the young infant period from 1 month
of age to 3 months. We suggest that these gradual changes
of leg muscular activity in newborn stepping are evoked
by development of balance, postural control, and strength,
thereby modulating the neonatal stepping reflex.
 When a newborn infant is held under the arms in an upright
position, well-coordinated walking movements (stepping reflex) appear
to be elicited by tactile stimuli on the soles of the feet as they are
placed on the floor (Fig. 1-1).
McGraw (1940) and Zelazo et al. (1972) have discussed the
significance of early stepping movements for development of adult gait.
Newborn stepping has been an object of study for a long time. Only a
few attempts so far, however, have been made to study characteristics
of newborn stepping by electromyography (EMG).
Forssberg (1985) noted that the lateral gastrocnemius showed
strong activity just before the foot reached the floor (Fig. 1-2). Because
this was like a digitigrade pattern, he concluded that man is born
with a quadrupedal locomotor program. Thelen (1982, 1987), however,
did not find any strong activity in the gastrocnemius before floor
contact (Fig. 1-2) . To further study this problem of the EMG pattern
in the gastrocnemius before foot contact in stepping, it would be
instructive to record EMG data during stepping not only in the neonatal
period (up to 1 month of age), but also in the young infant period
(after 1 month of age).
We have thus closely examined the characteristics of newborn
stepping in ten babies during both neonate and young infant periods in
terms of the functional mechanisms of leg muscles.
Four male and six female neonates were observed from 1 to 4 weeks
after birth. Criteria used for selecting the subjects were that they be
full-term with birth weight between 2500 g and 4200 g. They were
screened by pediatricians to rule out abnormalities and illnesses.
Motor development of each subject was within normal limits.

Fig. 1-1. Newborn stepping at 2 days after birth.

4 Development of Gait
 EMGs of all subjects were recorded from the neonatal period (up to
the 1st month of age) to the young infant period (from 1 to 4 months
after birth) at intervals of 1 to 4 weeks.
To induce newborn stepping, the examiner held the neonate under
the arms with the soles of the feet touching a horizontal flat surface.
Well-coordinated walking movements were observed from around 1
week after birth to around 3 months. We could not induce stepping
simply at will, but tended to be successful when the infants were lively,
crying, hungry, or slightly excited (Figs. 1-1 and 1-2). For analysis we
selected well-coordinated walking movements consisting of three or
more steps.
The EMGs were recorded from six muscles in the right leg (Fig.1-2):
tibialis anterior (fA), lateral gastrocnemius (LG) , vastus medialis (VM),
rectus femoris (RF), long head of biceps femoris (BF) , and gluteus
maximus (GM), and from two to six muscles in the left leg, usually the
TA, LG, RF, and BE

RF: rectus femoris

GM : gluteus maximus (Knee extensor, Hip flexor)
(Hip extensor) Mutual antagonist: SF

SF : biceps femoris
VM: vastus medialis
(Knee flexor, Hip extensor)
(Knee extensor)
Mutual antagonist: RF

LG : lateral gastrocnemius TA : tibialis anterior

(Ankle plantar flexor) (Ankle dorsiflexor)

Mutual antagonist: TA Mutual antagonist : LG

Fig. 1-2. Muscles chosen for recording EMG.

Newborn Stepping in Neonates and Young Infants 5

 Surface electrodes 5 mm in diameter were used. To attenuate
artifacts in the surface electrode recordings, skin impedance was
lowered by scratching loci of the electrodes lightly with a needle before
the electrodes were applied (Okamoto et al., 1987). The EMG
recordings were done with an 18-channel pen-writing electro-
encephalograph (60 mm/sec) with the gain set at 12 mm/0.5mV. An
analog pulse signal from the video recording camera (60 frames/sec)
was recorded simultaneously with the EMGs. The walking cycle was
divided into swing phase (SW) and stance phase (ST) by the video
recordings.
Movement and EMG recordings obtained during newborn stepping
showed some variations both within and among subjects. Variations in
stepping form and EMG patterns appeared to depend to some extent
on how the infant was supported. We thus selected as representative
data those movements and EMG patterns of stepping that were seen
relatively frequently in the neonatal or young infant period being
observed. For purpose of analysis, longitudinal observations were
divided into early neonatal period (from 1 to 2 weeks after birth), late
neonatal period (from 3 to 4 weeks), onset of infant period (from 1 to 2
months), and initial infant period (from 3 to 4 months).

Mature adult walking pattern

We need to examine normal stable adult walking to compare with
gait in terms of developmental processes. Figure 1-3 shows a typical
EMG of adult walking (the subject is a female 29 years of age). From
the basogram, stance and swing phases can be demarcated.
The discharge patterns of the TA and LG, which participate in
movement of the ankle joint, showed an almost reciprocal relationship.
The TA (an ankle dorsiflexor) discharged through most of swing
phase and at the beginning of stance phase, whereas the LG (an ankle
plantarflexor), which participates in push off motion, discharged in a
strong burst in the latter part of stance phase. The hip and knee
muscles, VM, RF, BF, and GM, acted for shock absorption during the
transition from swing phase to stance.

6 Development of Gait
 Typical EMG pattern of normal adult walking

0.5 mv]
k~j~AA:j~A
326 333 339 346 356 365 372 378 388

Tibialis anterior (TA)

Lateral gastrocnemius (LG) -+---M~"""~I M'H~---1<Y,\,~-...."I(NJIN't--t-

Vastus medialis (VM)

Rectus femoris (RF)

Biceps femoris (BF)

Gluteus maxim us (GM)

Plantar flexion
Ankle Dorsiflexion t
Knee Extension
Flexion t
Hip Extension
Flexion

Basogram
* Swing
Pho.e (SW)
Stance Phase
(ST)
Swing
Stance

Foot contact (FC) HC FF HO TO

1 sec
VTR signal .J._"'-"'''''''''''''''Nt'''",,,,'''',_.J,--*-JIJtr-,,_,,f.,.,,,JtUlt.,,--,~
300 350 400

l~( ~~ ~
HC FF HO TO
(Heel Contact) (Foot Flat) (Heel Off) (Toe Off)

Fig. 1-3. Typical adult EMG pattern in leg muscles during walking.
Swing phase (SW: short phase), Stance phase (ST: long phase), Basogram: Foot contact (He,
FF, HO, TO).

Newborn Stepping in Neonates and Young Infants 7

 Early neonatal period
(1 - 2 weeks)

ST sw ST
(R) ~· '·I·'\'·fJ·tW~~t;~i~

TA ",""

LG
,
VM

RF

BF

GM i ,--
(l) I
TA

LG

VM ----~~~--------~------+_----------~~~~~------+_

BF -------------------+------+-------------------~------~.
STANCE (ST) SWING (SW)
1_
___ s e_c __ --'I 0.5 mv

1 week (Y.T.)

NEONATAL STEPPING

Fig. 1-4. EMGs of stepping at 1 week after birth (Y.T.).

SW: swing phase, ST: stance phase, (R): right leg, (L): left leg, TA: tibialis anterior, LG: lateral
gastrocnemius, VM: vastus medialis, RF: rectus femoris , SF: biceps femoris, GM: gluteus maximus.

8 Development of Gait
 Stepping in this period was characterized by quick hip flexion in
which the thigh became approximately horizontal in the first part of
swing phase. The foot was raised forward and dorsiflexed strongly, as
shown in Figures 1-4, 1-5, and 1-6. In the middle part of swing phase,
the leg was often held in the flexed position. Then the foot began to
reach the floor slowly, the knee extending passively along with the hip.
The foot usually contacted the floor with the heel or sole first (Fig.
1-7), but in a few instances toe contact was seen. A fairly squatted
posture was often observed during stance phase.

1 week after birth (Fig. 1-4): In the beginning of stance phase, no

notable activity was seen in the leg muscles examined. In single stance
phase, continuous discharges were frequently observed in the TA,
VM, RF, and GM, activities not usually seen in adult gait. The
discharge patterns of the VM and GM were highly consistent, but
activities at the ankle (the TA and LG) and of two-joint muscles
crossing the knee and hip (the RF and BF) showed slight variations.
That is, at the ankle, a reversed reciprocal (TA+, LG-) pattern was
observed in many cases, but co-contraction (TA+, LG+) and reciprocal
(TA-, LG+) patterns were seen in some of the subjects. Across the
knee and hip, a reversed reciprocal (RF+, BF-) pattern was observed
in many cases, but co-contraction (RF+, BF+) and reciprocal (RF-, BF+)
patterns were observed in some of subjects. In the first part of swing
phase, continuous discharge in the TA was seen in most cases.
Sometimes slight activity of the RF was observed in the same phase.
In the latter part of swing phase, when the leg was extending, activities
were hardly seen in the LG, VM, RF, BF, and GM.

Fig. 1-5. Foot contact of newborn stepping at 2 days after birth.

Newborn Stepping in Neonates and Young Infants 9

 ST SW ST
(R) V, , , , / " " 1,.1/ " I " " , , W. , / , . , , W; " " I I " I WI I I ; .. , I ......r+-
TA 'i~ , ~

LG--________ r-__~--~--------------------+_--+_-----
VM

RF

BF

GM
( L)
TA-""""\

LG

RF

BF L
I
ST SW
1 sec 0.5 mv

2 weeks (A. I.)

NEONATAL STEPPING

Fig. 1-6. EMGs of stepping at 2 weeks after birth (A.I.).

10 Development of Gait
 2 weeks after birth (Fig. 1-6): In the beginning of stance phase,
continuous discharges in many leg muscles were observed more
often than at 1 week after birth, especially in single stance phase.
Continuous discharge patterns of the VM and GM were again
consistent, but EMG patterns of the TA and LG and of the RF and BF
showed some variations. That is, reciprocal, reversed reciprocal, and
co-contraction patterns were seen in those muscles. In the first part of
swing phase, continuous discharge patterns of the TA were similar to
those of 1 week after birth. In contrast to the first week, continuous
discharge in the RF was observed during swing phase in many cases.
In the latter part of swing phase, activity in the BF frequently began to
appear before foot contact.

Foot contact (Fe)

Heel contact with slow leg extension

Foot flat with slow leg extension

EMGs of leg extensors before floor contact

Early neonatal period (1-2 weeks after birth)

Fig. 1-7. Foot contact of stepping in neonatal period (1-2 weeks after birth).
(-): no activity.

Newborn Stepping in Neonates and Young Infants 11

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