Overview of Impairment

Focussed Interpretation

Richard Baker

Professor of Clinical Gait Analysis

1

Principles

Relevant

Succinct

Transparent

Evidence based

Comprehensive

Within the competence of the authors

Time efficient

2

Practice

Stage 1: Look at the graphs and identify

gait features

Stage 2: Interpret what these features

mean.

3

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).

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.

Impairment Focussed

Interpretation

6

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

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

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

Terminology: Feature

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

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

Process

Process

Four steps:

Orientation

Mark-up

Grouping

Reporting

Orientation

• Get to know the patient

• Get to know the walking pattern

• Get to know the data

Orientation to patient

• Diagnosis

– GMFCS

– Topography

• Level of function

– Functional Assessment Questionaire

– Functional Mobility Scale

• Reason for referral

• Relevant history

Orientation to patient

Orientation to patient

General impression of gait

• Temporal spatial parameters

• Gait classification(?)

• Impressions from video

Orientation to walking pattern

Hof, A., Scaling gait data to body size.Gait and Posture, 1996. 4: p. 222-223.

Orientation to data

• Temporal spatial parameters

• Quality

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?

Quality

Process

Four steps:

Orientation

Mark-up

Grouping

Reporting

Mark-up

5 characteristics

Side: Left

Variable: Hip flexion

Type: Too much

Timing: Late stance

Magnitude: Marked

Mark-up

Process

Four steps:

Orientation

Mark-up

Grouping

Reporting

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).

Grouping

Process

Four steps:

Orientation

Mark-up

Grouping

Reporting

Report

• List findings (impairments)

• Arrange information in correct order

• Add any relevant comments

Findings

Arrange information

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”.

Sample

report

Sample

report

Sample

report

Sample

report

Sample

report