Gait Analysis at Your Fingertips:
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1 Gait Analysis at Your Fingertips: Enhancing Observational Gait Analysis Using Mobile Device Technology and the Edinburgh Visual Gait Scale Jon R. Davids, MD; Shriners Hospitals for Children Northern California; Sacramento, CA
2 Disclosure Information The following relationships exist: OrthoPediatrics Consultant Presenter Disclosure Information JON R. DAVIDS, MD Enhancing Observational Gait Analysis Using Mobile Device Technology and the Edinburgh Visual Gait Scale OrthoPediatrics Foundation for Education and Research Board Member
3 Full Handouts Gait Scoring Sheets Links to resources.and more!
4 Decision-making in Gait Surgery History & Physical, Patient Goals Gait Analysis: Kinematics Kinetics EMG Dynamic Pedobarography Pre- & Intra-operative Physical Exams Individualized Surgical Prescription to Improve Gait Radiographs: Hip, Ankle, Foot
5 Gait Analysis Without a Lab = Observational Gait Analysis (OGA) Role of Observational Gait Analysis: No access to 3-dimensional gait lab Frequent documentation of gait pattern change Child that cannot cooperate with 3D Gait Study Very young (less than 5) Behavioral or cognitive issues
6 Observational Gait Analysis Prerequisites Understand Normal Gait Cycle and Select Key Subphases Recognition / Classification of Common Deviations Visual Assessment Systematic Forest / Trees
7 Optimizing Observational Gait Analysis Modern Technology Mobile Videography Cell Phones and Tablets Structured Analysis Edinburgh Visual Gait Scale Case Example
8 High Quality Video: Your Key to Observational Gait Analysis Good observations take time! Videos help take decision-making out of busy clinic Permanent record
9 Principles of Mobile Videography Lighting and Focus Well-lit hallway or room with minimal distractions in background Perspective At least 20 feet distance for coronal At least 10 foot distance for sagittal Quality sagittal video allows for objective observational gait Anyone can get coronal in their clinic! 15 feet 20 feet
10 Principles of Mobile Videography: High Quality Sagittal Video High Quality Sagittal Video = High Quality Observations Panning camera Parallax Problems Cannot see more than 1 stride in-plane
11 Principles of Mobile Videography: High Quality Sagittal Video Camera moves with child with minimal motion artifact Allows for in-plane visualization of more than one stride May require specialized equipment
12 Gimbal Principles of Mobile Videography: Low-Cost Image Stabilization platform that maintains orientation in space despite inclines or rotation Nature Documentaries
13 Gimbal Principles of Mobile Videography: Low-Cost Image Stabilization platform that maintains orientation in space despite inclines or rotation Drones Geopolitical/ Personal
14 Principles of Mobile Videography: Low-Cost Image Stabilization Gimbal platform that maintains orientation in space despite inclines or rotation Selfie Stick with 3 Axis Gimbal $ USD
15 Principles of Mobile Videography: Low-Cost Image Stabilization Without Image Stabilization Hand-held Image Stabilization
16 Principles of Mobile Videography: Skin Markings to Improve Observation Optimal clothing and marking for gait analysis Tight-fitting swimsuit or bike shorts Marking of ASIS, Patella, Tibial Tubercle, and Achilles
17 Technology to Improve Your Video Observations Sports Performance Video Analysis Apps Allow for slow motion analysis Zoom function Can annotate with angles, lines, or shapes Split Screen and Imaging Overlay Options Hudl Technique Free Slomo Free Coach s Eye $4.99 Dartfish Express $6.99
18 Hudl Technique App: Features
19 Optimizing Observational Gait Analysis Modern Technology Mobile Videography Cell Phones and Tablets Structured Analysis Edinburgh Visual Gait Scale Case Example
20 Observational Gait Assessment Scoring Systems Physician Rating Scale Salford Gait Tool Observational Gait Analysis Observational Gait Scale Edinburgh Visual Gait Score Rathinam et al. Gait & Posture 40 (2014)
21 The Edinburgh Visual Gait Score (EVGS) 17 observations/limb 10 Joint Angle Measurements 7 Gait Phase Timing Assessments 6 anatomic levels scored: trunk, pelvis, hip, knee, ankle and foot 3 planes of motion 12 stance phase items and 5 swing phase items
22 EVGS Scoring Six Stops in Gait Video Sagittal Video 1. Terminal Swing/Initial Contact 2. Mid-Stance Sagittal 3. Terminal Stance 4. Mid-Swing Coronal Video 1. Mid-Stance Front 2. Mid-Stance Back
23 EVGS Scoring Six Stops in Gait Video 3 point ordinal scale: 0 within normal range (mean ±1.5 SD) 1 moderate deviation ( SD from mean) 2 marked deviation (> 4.5 SD from mean) Score total of 0-34 per limb; 0-68 per gait cycle Lower is better!
24 EVGS Summary Scoring Worksheet and Grid Phase Trunk Pelvis Hip Knee Ankle Foot IC M St T St M Sw M St Front M St Back Segment Total LIMB TOTALS
25 Optimizing Observational Gait Analysis Modern Technology Mobile Videography Cell Phones and Tablets Structured Analysis Edinburgh Visual Gait Scale Case Example
26 Right Spastic Hemiplegic Cerebral Palsy Preop 1 year post Achilles + Plantar Fascia 2 years post Achilles + Plantar Fascia
27 Preop EVGS Grading: Right Mid Stance Sagittal
28 Preop EVGS Grading: Right Mid Stance Front Coronal
29 EVGS: Right Limb Initial Contact Midstance Terminal Stance Mid-swing
30 Right Limb EVGS Grading Phase Trunk Pelvis Hip Knee Ankle Foot IC M St T St M Sw M St Front M St Back 1 Segment Total LIMB TOTALS PREOP TOTAL = 13
31 EVGS: Left Limb Initial Contact Midstance Terminal Stance Mid-swing
32 Left Limb EVGS Grading Phase Trunk Pelvis Hip Knee Ankle Foot IC M St T St M Sw M St Front M St Back 0 Segment Total LIMB TOTALS PREOP TOTAL = 8
33 Right Limb EVGS Grading Phase Trunk Pelvis Hip Knee Ankle Foot P 1 2 P 1 2 P 1 2 P 1 2 P 1 2 P 1 2 IC Pre 1 year 2 year M St T St M Sw M St Front M St Back Segment Total Resolution of Mid-Swing Stiff Knee at 2 years
34 Left Limb EVGS Grading Trunk Pelvis Hip Knee Ankle Foot Phase P 1 2 P 1 2 P 1 2 P 1 2 P 1 2 P 1 2 IC 2 M St T St 2 M Sw 2 M St Front M St Back 1 1 Segment Total Trunk lean and vaulting resolve at 2 years
35 Total Body EVGS Grading
36 Limitations of EVGS Proximal segments (hip, pelvis) are less accurate than distal segments (ankle, foot) Less experienced observers have lower inter-rater reliability GMFCS III patients have lower scoring reliability than I or II Agreement between observers between 64 92% Agreement to 3D gait analysis is between 60 70% Orozco et al. Gait & Posture 49 (2016)
37 Current Research EVGS vs Kinematics Cell Phone / Gimbel Platform MAC System Simultaneous Capture Refine Technique Other Software Platforms Additional Kinematic Variables Establish Clincial Boundries
38 EVGS Set-Up Sagittal Camera on Gimbal Simultaneous Instrumented Gait Capture Coronal Camera Additional Markings
39 Example EVGS Scoring Worksheet Terminal Swing/Initial Contact R Peak Hip Flexion (EVGS #13) Markedly increased flxn (>60 ) 2 Increased flxn (46-60 ) 1 Normal flxn (25-45 ) 0 Reduced flxn (10-24 ) 1 Severely reduced flxn (<10 ) 2 Knee Position (EVGS #10) Severe flxn (>30 ) 2 Moderate flxn (16-30 ) 1 Normal flxn (5-15 ) 0 Moderate extn (4 flxn - 10 extn) 1 Severe hyperextn (>+10 extn) 2 Foot Position (EVGS #1) Heel Contact 0 Flatfoot Contact 1 Toe Contact 2 For EVGS #1 Foot Position: Look at foot inclination graph at Initial Contact, which is 0.0% of Gait Cycle: If the value is positive, this equates to heel contact. If the value is zero, this equates to flatfoot contact. If the value is negative, this equates to toe contact.
40 Pulse Rate Stethoscope Echocardiogram Heart Function Increasing Patient Complexity Gait Function Hallway Examination Observational Gait Analysis 3D Gait Analysis
41 Optimizing Observational Gait Analysis Modern Technology Mobile Videography Cell Phones and Tablets Image Stabilization Structured Analysis Edinburgh Visual Gait Scale New Possibilities!
42 Full Handouts Gait Scoring Sheets Links to resources.and more!
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