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Overview of impairment focussed interpretation
- 1. Overview of Impairment Focussed Interpretation Richard Baker Professor of Clinical Gait Analysis 1
- 2. Principles Relevant Succinct Transparent Evidence based Comprehensive Within the competence of the authors Time efficient 2
- 3. Practice Stage 1: Look at the graphs and identify gait features Stage 2: Interpret what these features mean. 3
- 4. Disclaimers • There are only a certain number of ways you can interpret and report on gait analysis data. • Methods have been developed primarily for use in assessing children with CP for multi-level surgery (May need to be adapted for other contexts).
- 5. Disclaimers • This presentation focuses purely on the interpretation of biomechanical data - other types of data are important but are not specific to the gait analysis process.
- 7. Impairment focussed interpretation • The aim of clinical gait analysis is to: identify the impairments which are most likely to be affecting the gait pattern. • This is achieved by: recognising features in the gait data and relating these to supplementary data
- 8. Terminology: Impairment A problem in body structures or functions such as significant deviation or loss1. • Hip flexion contracture • Gastrocnemius spasticity • Excessive femoral anteversion • Gluteus medius weakness 1WHO International Classification of Functioning, Disability and Health, 2001
- 9. Terminology: Feature A specific aspect of the gait traces that is clinically important (something you can see on a graph) • Increased anterior pelvic tilt throughout the gait cycle • Too much plantarflexion at initial contact • Reduced rate of knee flexion in late stance • Hip rotation within normal limits throughout cycle • Increased plantarflexor moment in early stance
- 11. Terminology: Supplementary data Information which is not represented in the gait graphs. • Limited range of hip extension of clinical exam • Increase in resting tone of plantarflexors • Excessive anteversion as measured by CT
- 12. Impairment focussed reporting • One of the impairments affecting the walking pattern is: – a tight left hip flexor. This is suggested by: – “Single bump pattern” of left pelvic tilt – Too little left hip extension in late stance. and – restricted hip extension on clinical exam Features Supplementary data Impairment
- 13. Process
- 15. Orientation • Get to know the patient • Get to know the walking pattern • Get to know the data
- 16. Orientation to patient • Diagnosis – GMFCS – Topography • Level of function – Functional Assessment Questionaire – Functional Mobility Scale • Reason for referral • Relevant history
- 18. Orientation to patient General impression of gait • Temporal spatial parameters • Gait classification(?) • Impressions from video
- 19. Orientation to walking pattern Hof, A., Scaling gait data to body size. Gait and Posture, 1996. 4: p. 222-223.
- 20. Orientation to data • Temporal spatial parameters • Quality
- 21. Quality • Is the data likely to be representative of the person’s usual walking pattern? • Are there concerns regarding consistency of traces? • Is there any evidence of measurement artefact in the data?
- 22. Quality
- 24. Mark-up 5 characteristics Side: Left Variable: Hip flexion Type: Too much Timing: Late stance Magnitude: Marked
- 25. Normal data 25 Pelvic Tilt 60 0 deg Hip Flexion 70 -20 Flex Ext deg Knee Flexion 75 -15 Flex Ext deg Dorsiflexion 30 -30 Dors Plan deg Pelvic Obliquity 30 -30 deg Hip Adduction 30 -30 Add Abd deg Knee Adduction 30 -30 Var Val deg Pelvic Rotation 30 -30 deg Hip Rotation 30 -30 Int Ext deg Foot Progression 30 -30 Int Ext deg
- 26. Normal data 26 Normative data should be captured for each laboratory – Learning process – Quality assurance process – Should be compared with national/international benchmark data. Requires 15-20 subjects Best age matched – but little evidence of change after age of 6
- 27. Normal data Over a third of gait data from people without gait pathology will lie outside the +/- one standard deviation range. 27 Pelvic Tilit 60 0 deg Hip Flexion 70 -20 Flex Ext deg Knee Flexion 75 -15 Flex Ext deg Ankle Dorsiflexion 30 -30 Dors Plan deg Pelvic Obliquity 30 -30 deg Hip Adduction 30 -30 Add Abd deg Knee Adduction 30 -30 Var Val deg Pelvic Rotation 30 -30 deg Hip Rotation 30 -30 Int Ext deg Foot Progression 30 -30 Int Ext deg Pelvic Tilt 60 0 Ant Post deg Hip Flexion 70 -20 Flex Ext deg Knee Flexion 75 -15 Flex Ext deg Dorsiflexion 30 -30 Dors Plan deg Pelvic Obliquity 30 -30 Up Dow n deg Hip Adduction 30 -30 Add Abd deg Pelvic Rotation 30 -30 Int Ext deg Hip Rotation 30 -30 Int Ext deg Foot Progression 30 -30 Int Ext deg
- 28. Mark-up Too much/little throughout cycle Too much/little for part of cycle Too late/early Too long/short Increased/decreased range Abnormal slope Within normal limits Possible artefact Other
- 29. Increased (throughout cycle) 29 0 Hip Flexion 70 -20 Flex Ext deg Knee Flexion 75 Flex deg -30 Hip 30 -30 Add Abd deg Kne 30 Var deg a a. Increased left hip flexion throughout gait cycle
- 30. Pelvic Tilt Hip Flexion Pelvic Obliquity 30 -30 deg Hip Adduction 30 Add deg Pelv 30 -30 deg Hip 40 Int deg Increased (throughout cycle) 30 b b. Decreased right pelvic obliquity throughout gait cycle
- 31. -20 Ext Knee Flexion 75 -15 Flex Ext deg Dorsiflexion 30 Dors deg -30 Abd Knee 30 -30 Var Val deg Too much (part of cycle) 31 c c. Too much right knee flexion at initial contact
- 32. -20 Ext Knee Flexion 75 -15 Flex Ext deg Dorsiflexion 30 Dors deg -30 Abd Knee 30 -30 Var Val deg Too little (part of cycle) 32 d d. Too little left knee flexion in middle swing
- 33. -20 Ext Knee Flexion 75 -15 Flex Ext deg Dorsiflexion 30 Dors deg -30 Abd Knee 30 -30 Var Val deg Too late 33 e e. right peak knee flexion too late in swing
- 34. Hip Flexion Knee Flexion -30 Hip Adduction 30 -30 Add Abd deg Knee Adduction 30 Var deg -30 Hip 30 -30 Int Ext deg Kne 30 Int deg Too long 34 f f. right hip adducted for too long in stance
- 35. -15 Ext Dorsiflexion 30 -30 Dors Plan deg -30 Val Too short 35 g g. Bilateral dorsiflexion too short in early stance (probably most useful with kinetics)
- 36. Hip Flexion Knee Flexion -30 Hip Adduction 30 -30 Add Abd deg Knee Adduction 30 Var deg -30 Hi 40 -20 Int Ext deg Increased range 36 h h. Increased range of left hip adduction through cycle
- 37. -20 Ext Knee Flexion 75 -15 Flex Ext deg Dorsiflexion 30 Dors deg -30 Abd Kne 30 -30 Var Val deg Decreased range 37 i i. Decreased range of left knee flexion through cycle
- 38. -20 Ext Knee Flexion 75 -15 Flex Ext deg Dorsiflexion 30 Dors deg -30 Abd Kne 30 -30 Var Val deg Decreased range 38 i i. Decreased range of left knee flexion through cycle
- 39. -20 Ext Knee Flexion 75 -15 Flex Ext deg Dorsiflexion 30 Dors deg -30 Abd Kne 30 -30 Var Val deg Abnormal slope 39 j j. Abnormal slope of right knee flexion in early single support
- 40. Hip Adduction Knee Adduction -30 Hip Rotation 40 -20 Int Ext deg Within normal limits 40 k k. Right hip rotation within normal limits through cycle
- 41. -20 Ext Knee Flexion 70 -20 Flex Ext deg Dorsiflexion 30 Dors deg -30 Abd 30 -30 Va Va deg Possible artefact 41 l l. Bilateral knee hyperextension in late single support may be an artefact ? ?
- 42. Hip Adduction Knee Adduction -30 Ext Hip Rotation 30 -30 Int Ext deg Other feature 42 m m. Abnormal pattern of right hip rotation in swing
- 47. Mark-up
- 49. Grouping • Group features and supplementary data that might be related to an impairment. • Identify that impairment. • Fluid process (may require adjustment of groups as understanding of gait data progresses).
- 50. Grouping
- 52. Report • List findings (impairments) • Arrange information in correct order • Add any relevant comments
- 53. Findings
- 55. Add relevant comments • Depends on competence of analyst. “Current AFOs are cast in plantarflexion and then posted (this is within the shoe so not apparent on gait graphs). Sam has a good range of dorsiflexion and it is not clear why this is required. Holding the ankle in plantarflexion allows a little more knee extension in middle stance but this might reduce the stretch on the gastroc during walking which might not be helpful in the long run”.
- 56. Sample report
- 57. Sample report
- 58. Sample report
- 59. Sample report
- 60. Sample report