Gait Motion Analysis Ashley Forbes, PT, DPT Ann Marie Schroeder Pace, PT, MPT

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1 Gait Motion Analysis Ashley Forbes, PT, DPT Ann Marie Schroeder Pace, PT, MPT Walking How we get from one place to another 1

2 Reciprocal Symmetric Reproducible Efficient Dynamic Components of gait Stride Swing +Stance= Stride 2

3 Stance Weight acceptance + Single limb support = Stance Limb advancement Pre swing Initial swing Mid swing Terminal swing Swing 3

4 Stride Swing is 40% of stride Stance is 60% of stride Swing + Stance = 100% stride Prerequisites of gait Stability in stance Clearance in swing Pre positioning for initial contact Adequate step length Energy conservation 4

5 Stability in stance requirements Stance foot stable on the floor Major joints function to allow: Advance limb Provide propulsion Trunk stability Body balance Swing clearance requirements Adequate Ankle dorsiflexion Knee flexion Hip flexion 5

6 Swing Phase Advance limb Allow foot clearance Conserve energy Pre position of foot requirements Adequate ankle dorsiflexion Balance between invertors and evertors Appropriate knee position 6

7 Adequate step length requirements Stable and positioned stance side Neutral dorsiflexion, inversion and eversion Adequate hip flexion Full Knee extension Adequate body balance Phases of stance Initial contact * Loading response * Mid stance Terminal stance Pre Swing* *indicates a period of double support 7

8 Phases of swing Initial swing Acceleration of limb Mid Swing Terminal Swing Deceleration of limb Motion analysis assessment Patient and family input Medical History Physical examination Body anthropometrics Data capture Interpretation : graphs and physical exam 8

9 Patient and family input Physical exam Range of motion Strength Selectivity Posture Special tests Ashworth scale Balance assessment 9

10 Body anthropometrics Height Weight Leg length Knee width Ankle width ASIS to ASIS ASIS to greater trochanter Tibial torsion 10

11 Marker placement Static Dynamic Repeat trials Data capture Gait lab data Speed and Distance Timing 11

12 Speed and distance Cadence: The number of steps or strides per minute. Stride length: The distance along the line of progression from current foot contact to the next current foot contact. Step Length: The distance along the line of progression from opposite foot contact to current foot contact. Step time: The time or the percentage of the gait cycle from current foot off to current foot contact. Timing Single Support: The time or the percentage of the gait cycle where the current foot supports the subject. Double Support: The time or the percentage of the gait cycle where both feet are on the ground Opposite Foot Contact: The time or the point as a percentage of the gait cycle where the opposite foot hits the ground. Opposite Foot Off: The time or the point as a percentage of the gait cycle where the opposite foot leaves the ground. Limp Index: The total support (single + double) for this foot divided by the total support for the opposite foot. Will be exactly one for a symmetric walk. 12

13 Gait lab curves Gait lab uses Orthotic decisions Therapy Treatment options Insurance justification Referrals Source: Cascade Source: WalkAide 13

14 Case study Westlake Gait Lab Case Study 10 year old female Left hemiplegic cerebral palsy Last fit with AFO 11/13/2013, has not worn for the last several months Trialed the WalkAide Nov and Dec, 2014 Denied by insurance for a WalkAide Motion Analysis performed

15 Gait Lab Output Barefoot Walk Aide Data Trial 1: Barefoot Trial 2: WalkAide Cadence 1: 118 steps/min Cadence 2: 90.6 steps/min 15

16 1= Barefoot 2= Walk Aide Left Right Cadence steps/min 125 steps/min Cadence steps/min 88.9 steps/min Double Support seconds 0.19 seconds Double Support seconds 0.37 seconds Foot Off 1 63% 61.5% Foot Off % 63.7% Limp Index Limp Index = Barefoot 2= Walk Aide Left Right Opposite Foot Contact % 44.8% Opposite Foot Contact % 51.1% Opposite Foot Off % 3.12% Opposite Foot Off % 14.8% Single Support seconds 0.40 seconds Single Support seconds 0.49 seconds 16

17 1= Barefoot 2= Walk Aide Left Right Step Length meters 0.54 meters Step Length meters 0.56 meters Step Time seconds 0.53 seconds Step Time seconds 0.66 seconds Step Width meters meters Step Width meters 0.19 meters Stride Length meters 1.06 meters Stride Length meters 1.05 meters 1= Barefoot 2= Walk Aide Left Right Stride Time seconds 0.96 seconds Stride Time seconds 1.35 seconds Walking Speed m/s 1.10 m/s Walking Speed m/s 0.78 m/s 17

18 Barefoot Hip Flexion/Extension WalkAide Hip Flexion/Extension 18

19 Barefoot Knee Flexion/Extension WalkAide Knee Flexion/Extension 19

20 Barefoot Ankle DF/PF WalkAide Ankle DF/PF 20

21 Effect of Functional Electrical Stimulation on Asymmetries in Gait of Children with Hemiplegic CP Objectives: quantify gait asymmetries, assess the effect of FES on ambulatory children with CP and evaluate user perspective Subjects: 12 children Outcome Measures: heel toe contact pattern and other temporal spatial parameters of gait Results: Greatest asymmetries were in heel toe contact pattern and double stance times Both improved with stimulation Clear trend toward reduction in affected side preswing double stance time and a move toward symmetry Mean swing time and stance time were close to symmetry with and without stimulation Stimulation was generally tolerated Durham S, Eve L, Stevens C, Ewins D. Effect of functional electrical stimulation on asymmetries in gait of children with hemiplegic cerebral palsy. Physiotherapy. 2004;90:

22 Tolerability and Effectiveness of a Neuroprosthesis for the Treatment of Footdrop in Pediatric Patients with Hemiparetic Cerebral Palsy. Objective: Assess tolerability and efficacy of footdrop neuroprosthesis for treatment of footdrop in children with Hemiparetic CP Pilot Study (small sample size of 10 children) Subjects: children between the age of 7 12 with hemiparetic CP who usually used an AFO Outcome Measures: Primary: fitting and programming tolerance, devicerecorded wear time, daily use diary, satisfaction survey Secondary: PROM and gait lab velocity and ankle kinematics Results: 10/10 patients tolerated fitting and programming of device and wore for 6 weeks 7/10 wore device for entire 3 month study period 6/10 continued to wear device after study completion Wear time: 2 11 hours/day Tolerability and satisfaction were high 6 patients reported complaints with size and bulkiness 2 reported skin irritation 5/10 patients showed increase in gait velocity 7/10 preferred WalkAide over their AFO Meilahn JR. Tolerability and effectiveness of a neuroprosthesis for the treatment of footdrop in pediatric patients with hemiparetic cerebral palsy. AAPM&R. 2013; 5:

23 Acceptability and Potential Effectiveness of a Foot Drop Stimulator in Children and Adolescents with CP Objective: examine the acceptability and clinical effectiveness of a novel, commercially available device that delivers FES to simulate ankle DF. Subjects: 21 individuals, average age 13 years 2 months Outcome Measures: Gait analysis is FES and non FES conditions were performed at two walking speeds over a 4 month period of device use. Results: 19 individuals completed the duration of the study 18 chose to continue use of FES after trial Average daily use was 5.6 hours Improved DF with swing phase (mean and peak) and at foot floor contact, with partial preservation of ankle PF at toe off when using the FES at selfselected and fast walking speeds Gait Speed was unchanged Prosser LA, Curatalo LA, Alter KE, Damiano DL. Acceptability and potential effectiveness of a foot drop stimulator in children and adolescents with cerebral palsy. Dev Med Child Neurol. 2012;54:

24 Contact information Ashley Forbes, PT, DPT Ann Marie Schroeder Pace, PT, MPT

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