Instantaneous segmental energy symmetry index as gait compensation indicator in asymmetrical walking

Purpose: Human body constantly adapts to optimise the energy expenditure. A better understanding of the mechanical energetic costs in lower extremities helps identify the compensatory mechanism adopted in asymmetrical gait. This paper proposes the use of instantaneous segmental energy and normalised symmetry index (SInorm) to examine asymmetrical gait. This approach can provide better overview of gait quality allowing identification of change in segmental energy during different gait phases and contribution of each segment in compensating abnormal walking. Method: An experimental study was carried out to validate this method. Twenty healthy subjects were recruited. Asymmetrical gait was simulated by restricting knee motion during walking using a knee brace. Mechanical energy was determined for each segment of the left and right limbs. Normalised Symmetry Index (SInorm) was then calculated to examine bilateral differences in segmental energy during stance phase and swing phase. Statistical analysis using ANOVA and Tukey-Kramer multiple comparison test to identify asymmetry of the segmental energy (p-value < 0.05). Result: Significant asymmetry of segmental energy occurred during swing phase. Greater asymmetry was observed in kinetic energy than in potential energy. The affected limb segments produced lower kinetic energy than the normal limb. At asymmetrical state, potential energy of the affected limb's foot and thigh were lower than that of the normal segments while the inverse was true for thigh segment. Conclusion: These results suggested that in asymmetrical gait, a form of compensatory mechanism is adopted to walk. This can be observed in the change of instantaneous segmental energy during walking.