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
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?
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
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
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
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
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).
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”.
