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 b...
Disclaimers
• This presentation focuses purely on the
interpretation of biomechanical data -
other types of data are impor...
Impairment Focussed
Interpretation
6
Impairment focussed interpretation
• The aim of clinical gait analysis is to:
identify the impairments which are most like...
Terminology: Impairment
A problem in body structures or functions
such as significant deviation or loss1.
• Hip flexion co...
Terminology: Feature
A specific aspect of the gait traces that is
clinically important (something you can see on a
graph)
...
Terminology: Feature
Terminology: Supplementary data
Information which is not represented in the
gait graphs.
• Limited range of hip extension ...
Impairment focussed reporting
• One of the impairments affecting the walking pattern is:
– a tight left hip flexor.
This i...
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
– Functio...
Orientation to patient
Orientation to patient
General impression of gait
• Temporal spatial parameters
• Gait classification(?)
• Impressions fro...
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 co...
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
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
D...
Normal data
26
Normative data should be captured for each
laboratory
– Learning process
– Quality assurance process
– Shou...
Normal data
Over a third of gait data from people without gait pathology will lie
outside the +/- one standard deviation r...
Mark-up
Too much/little throughout cycle
Too much/little for part of cycle
Too late/early
Too long/short
Increased/decreas...
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
...
Pelvic Tilt
Hip Flexion
Pelvic Obliquity
30
-30
deg
Hip Adduction
30
Add
deg
Pelv
30
-30
deg
Hip
40
Int
deg
Increased (thr...
-20
Ext
Knee Flexion
75
-15
Flex
Ext
deg
Dorsiflexion
30
Dors
deg
-30
Abd
Knee
30
-30
Var
Val
deg
Too much (part of cycle)...
-20
Ext
Knee Flexion
75
-15
Flex
Ext
deg
Dorsiflexion
30
Dors
deg
-30
Abd
Knee
30
-30
Var
Val
deg
Too little (part of cycl...
-20
Ext
Knee Flexion
75
-15
Flex
Ext
deg
Dorsiflexion
30
Dors
deg
-30
Abd
Knee
30
-30
Var
Val
deg
Too late
33
e
e. right p...
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
...
-15
Ext
Dorsiflexion
30
-30
Dors
Plan
deg
-30
Val
Too short
35
g
g. Bilateral dorsiflexion too short in early stance
(prob...
Hip Flexion
Knee Flexion
-30
Hip Adduction
30
-30
Add
Abd
deg
Knee Adduction
30
Var
deg
-30
Hi
40
-20
Int
Ext
deg
Increase...
-20
Ext
Knee Flexion
75
-15
Flex
Ext
deg
Dorsiflexion
30
Dors
deg
-30
Abd
Kne
30
-30
Var
Val
deg
Decreased range
37
i
i. D...
-20
Ext
Knee Flexion
75
-15
Flex
Ext
deg
Dorsiflexion
30
Dors
deg
-30
Abd
Kne
30
-30
Var
Val
deg
Decreased range
38
i
i. D...
-20
Ext
Knee Flexion
75
-15
Flex
Ext
deg
Dorsiflexion
30
Dors
deg
-30
Abd
Kne
30
-30
Var
Val
deg
Abnormal slope
39
j
j. Ab...
Hip Adduction
Knee Adduction
-30
Hip Rotation
40
-20
Int
Ext
deg
Within normal limits
40
k
k. Right hip rotation within no...
-20
Ext
Knee Flexion
70
-20
Flex
Ext
deg
Dorsiflexion
30
Dors
deg
-30
Abd
30
-30
Va
Va
deg
Possible artefact
41
l
l. Bilat...
Hip Adduction
Knee Adduction
-30
Ext
Hip Rotation
30
-30
Int
Ext
deg
Other feature
42
m
m. Abnormal pattern of right hip r...
Multiple features
43
Multiple graphs
44
Systematic approach
45
Alternative mark-up
46
-15
Ext
deg
Dorsiflexion
30
-30
Dors
Plan
deg
-30
Val
deg
3
-3
I
E
de
g
-15
Ext
deg
Dorsiflexion
30...
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.
• Flu...
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 i...
Sample
report
Sample
report
Sample
report
Sample
report
Sample
report
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Overview of impairment focussed interpretation

  1. 1. Overview of Impairment Focussed Interpretation Richard Baker Professor of Clinical Gait Analysis 1
  2. 2. Principles Relevant Succinct Transparent Evidence based Comprehensive Within the competence of the authors Time efficient 2
  3. 3. Practice Stage 1: Look at the graphs and identify gait features Stage 2: Interpret what these features mean. 3
  4. 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. 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.
  6. 6. Impairment Focussed Interpretation 6
  7. 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. 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. 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
  10. 10. Terminology: Feature
  11. 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. 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
  13. 13. Process
  14. 14. Process Four steps: Orientation Mark-up Grouping Reporting
  15. 15. Orientation • Get to know the patient • Get to know the walking pattern • Get to know the data
  16. 16. Orientation to patient • Diagnosis – GMFCS – Topography • Level of function – Functional Assessment Questionaire – Functional Mobility Scale • Reason for referral • Relevant history
  17. 17. Orientation to patient
  18. 18. Orientation to patient General impression of gait • Temporal spatial parameters • Gait classification(?) • Impressions from video
  19. 19. Orientation to walking pattern Hof, A., Scaling gait data to body size. Gait and Posture, 1996. 4: p. 222-223.
  20. 20. Orientation to data • Temporal spatial parameters • Quality
  21. 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?
  22. 22. Quality
  23. 23. Process Four steps: Orientation Mark-up Grouping Reporting
  24. 24. Mark-up 5 characteristics Side: Left Variable: Hip flexion Type: Too much Timing: Late stance Magnitude: Marked
  25. 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. 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. 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. 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. 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. 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
  31. 31. -20 Ext Knee Flexion 75 -15 Flex Ext deg Dorsiflexion 30 Dors deg -30 Abd Knee 30 -30 Var Val deg Too much (part of cycle) 31 c c. Too much right knee flexion at initial contact
  32. 32. -20 Ext Knee Flexion 75 -15 Flex Ext deg Dorsiflexion 30 Dors deg -30 Abd Knee 30 -30 Var Val deg Too little (part of cycle) 32 d d. Too little left knee flexion in middle swing
  33. 33. -20 Ext Knee Flexion 75 -15 Flex Ext deg Dorsiflexion 30 Dors deg -30 Abd Knee 30 -30 Var Val deg Too late 33 e e. right peak knee flexion too late in swing
  34. 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
  35. 35. -15 Ext Dorsiflexion 30 -30 Dors Plan deg -30 Val Too short 35 g g. Bilateral dorsiflexion too short in early stance (probably most useful with kinetics)
  36. 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
  37. 37. -20 Ext Knee Flexion 75 -15 Flex Ext deg Dorsiflexion 30 Dors deg -30 Abd Kne 30 -30 Var Val deg Decreased range 37 i i. Decreased range of left knee flexion through cycle
  38. 38. -20 Ext Knee Flexion 75 -15 Flex Ext deg Dorsiflexion 30 Dors deg -30 Abd Kne 30 -30 Var Val deg Decreased range 38 i i. Decreased range of left knee flexion through cycle
  39. 39. -20 Ext Knee Flexion 75 -15 Flex Ext deg Dorsiflexion 30 Dors deg -30 Abd Kne 30 -30 Var Val deg Abnormal slope 39 j j. Abnormal slope of right knee flexion in early single support
  40. 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
  41. 41. -20 Ext Knee Flexion 70 -20 Flex Ext deg Dorsiflexion 30 Dors deg -30 Abd 30 -30 Va Va deg Possible artefact 41 l l. Bilateral knee hyperextension in late single support may be an artefact ? ?
  42. 42. Hip Adduction Knee Adduction -30 Ext Hip Rotation 30 -30 Int Ext deg Other feature 42 m m. Abnormal pattern of right hip rotation in swing
  43. 43. Multiple features 43
  44. 44. Multiple graphs 44
  45. 45. Systematic approach 45
  46. 46. Alternative mark-up 46 -15 Ext deg Dorsiflexion 30 -30 Dors Plan deg -30 Val deg 3 -3 I E de g -15 Ext deg Dorsiflexion 30 -30 Dors Plan deg h i
  47. 47. Mark-up
  48. 48. Process Four steps: Orientation Mark-up Grouping Reporting
  49. 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).
  50. 50. Grouping
  51. 51. Process Four steps: Orientation Mark-up Grouping Reporting
  52. 52. Report • List findings (impairments) • Arrange information in correct order • Add any relevant comments
  53. 53. Findings
  54. 54. Arrange information
  55. 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”.
  56. 56. Sample report
  57. 57. Sample report
  58. 58. Sample report
  59. 59. Sample report
  60. 60. Sample report

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