application of gait analysis
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Application of Gait Analysis
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Introduction
Gait Analysis
Clinical gait assessment Gait research
How can gait analysis be used, particularly in aclinical setting??
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Clinical gait assessment aims to help
individual patients directly.
Gait research aims to improve our
understanding of gait either as an end to
itself or in order to improve medical
diagnosis or treatment in the future.
There is obviously some overlap.
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The technical requirements
Requirement for accuracy of the data. The time spend in collecting the data
Ability of the system to cope with various
types of pathological gait.
There is no use using complicated and
expensive measurement system unless it
provides information which is useful and
which cannot be obtained in an easierway.
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Gait research
Clinical Fundamental Clinical: concentrates on disesase processes
and methods of treatment.
Fundamental: methods of measurement and theadvancement of knowledge in biomechanics,
human performance and physiology.
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Clinical gait assessment
Gait analysis: data gathering.
Gait assessment: omtegrationm of thisinformation with that from other ources for
the purposes of clinical decision making.
Rose (1983)
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Gait analysis is a special investigation.
Interchangeable with gait evaluation.
Gait assessment can be informal and formal. It
is performed for:
- basis of clinical decision making.
- it may help with the diagnosis of an abnormalgait
- used to document patients condition
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Clinical decision making
This has 3 clear steps:
1. Gait assessment
2. Hypothesis formation
3. Hypothesis testing
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Gait assesment
1. Joint angle: at a particular phase of gait cycle.
2. Joint moment: is the internal moment
flexor/extensor?
3. Joint power: is power generation/absorption
taking place?
4. EMG- is the muscle activity consistent with the
kinematic data?
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A hypothesis is formed as to the detailed cause
of any abnormalities present.
Treatment is decided. May involve assessment
under anaesthesia prior to surgery.
Post treatment after a suitable recovery period a
further gait assessment is done to determine
success of the treatment, or to decide on furthercourse of treatment.
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Critical review of the original
diagnosis and the treatment. To find out if correct decisions were made.
If recognise the error if any and to learn from it to
prevent it from happening again and to correct it.
No change in EMG post-op
Main criteria for review:
- general gait parameters
- joint rotations
- estimated external work of walking.
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Total body energy consumption is the best
measure of the success of treatment.
Gage
3 criteria to gauge success:
- walking speed
- energy consumption
- cosmesis
Perry
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Diagnosis of abnormal gait
Detailed diagnosis relating to exact joints and
muscles.
To detect abnormal gait habits and differentiate
them from pathological gait.
Differential diagnosis.
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Documentation of patients
condition To quantify disability
Series of gait assessment for monitoring of the
progress/deterioration
To decide on treatment.
Making the patient and relatives recognise the
progress/deterioration
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Objective monitoring to avoid error of judgementin the investigators.
Early detection in deterioration of gait
Identifying clinical signs
Shape of GRF used empirically to detectingprogress in rehab.
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Litigation
Claims for damage
Litigations against medical negligence
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Conditions benefiting from gait
assessment Gait in elderly: to improve quality of life and toreduce risk of falls and fractures.
Causes of aletered gait in elderly:
- neurological- psychological
- orthopedic
- endocrinological
- general drugs- senile gait and associated conditions
Cunha
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Other conditions
Cerebral palsy
Multiple joint diseases
Knee pain
Hemiplegia
Muscular dystrophy
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The use of gait analysis gives a better insight
into the exact nature of the deficit and the way in
which the patient is able to compensate for it.
This applies to where moments and powers
have been measured.
It may lead to a better understanding of the
pathological condition itself and may also
suggest improved methods of treatment.
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Prosthetic and orthotic management
Alignment and adjustment of the prosthetic limbs
may be improved using objective management
of gait.
Provides an insight into the functioning of
orthosis and to compare different designs and
also permit improvements in existing designs
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Future developments
Exact knowledge of forces in the different
structures in and around the joints.
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Conclusion
Wide acceptance of gait assessment
Walking is not the only thing done analysis
of various other movements:- sit-to-stand
- stair climbing
- starting and stopping walking- stair climbing and descending