What is clnical gait analysis

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What is clnical gait analysis

  1. 1. What is clinical gait analysis? Richard Baker Professor of Clinical Gait Analysis 1
  2. 2. Clinical service 2
  3. 3. Clinical Governance “... a system through which [healthcare] organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish". 3 Scally, G. and L. Donaldson, Clinical governance and the drive for quality improvement in the new NHS in England. British Medical Journal, 1998. 317: 61-65.
  4. 4. Clinical Governance “... a system through which [healthcare] organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish". 4 Scally, G. and L. Donaldson, Clinical governance and the drive for quality improvement in the new NHS in England. British Medical Journal, 1998. 317: 61-65.
  5. 5. What is clinical gait analysis? Richard Baker Professor of Clinical Gait Analysis 5
  6. 6. Clinical Gait Analysis The process of determining what is causing the patient to walk the way they do. Based on: • Instrumented measurement – (essentially objective) • Biomechanical interpretation – (considerable subjectivity) 6
  7. 7. Clinical Gait Analysis The process of determining what is causing the patient to walk the way they do. Deciding how the results of the analysis impact on the management of the child is a separate issue. 7
  8. 8. Why separate gait analysis and clinical decision making? 1. Assurance of the quality of gait analysis data is difficult enough without having to worry about what to do with the results. 8
  9. 9. Why separate gait analysis and clinical decision making? 2. Collecting gait data and making clinical decisions are very different skills requiring very different competencies from staff. 9
  10. 10. Why separate gait analysis and clinical decision making? 3. Gait analysis has come in for considerable criticism because it results in “widely divergent treatment outcomes”. 10 Wright, J., Pro: Interobserver variability of Gait Analysis. Journal of Pediatric Orthopaedics, 2003. 23:288-289.
  11. 11. Two models of provision • Integration of gait analysis and clinical decision making services • Separation of gait analysis and clinical decision making services 11
  12. 12. Integration 12 Gait Analysis Medical imaging Social background Physiotherapy assessmentFamily preferences Surgeon’s expertise Local resources Clinical decision making and management
  13. 13. Integration 13 Treating clinician Referral Gait analysis service Gait analyst Gait analysis clinician Report Report and recommendations
  14. 14. Separation 14 Medical imaging Social background Physiotherapy assessment Family preferences Surgeon’s expertise Local resources Clinical decision making and management Gait Analysis
  15. 15. Gait analyst Referral Gait analysis service Separation 15 Treating clinician Report No recommendations
  16. 16. Clinical Gait Analysis The process of determining what is causing the patient to walk the way they do. Identify the impairments that are most likely to be affecting the walking pattern. 16
  17. 17. Clinical Gait Analysis The process of determining what is causing the patient to walk the way they do. Identify the impairments that are most likely to be affecting the walking pattern. 17
  18. 18. Impairment A problem in body structures or functions such as significant deviation or loss1. • Hip flexion contracture • Gastrocnemius spasticity • Persistent femoral anteversion • Gluteus medius weakness 1WHO International Classification of Functioning, Disability and Health, 2001
  19. 19. Report • Primary output of gait analysis • Often the only product of the gait analysis that the treating clinician receives • Should specify the impairments affecting walking • Is the result of the biomechanical analysis • Written by gait analyst 19
  20. 20. Treatment recommendations • Based on gait report and other considerations • Responsibility of treating clinician • Decision by patient/family 20
  21. 21. Impairments Hip flexion contracture Gastrocnemius spasticity Persistent femoral anteversion Gluteus medius weakness Recommendations Hip flexor release Injection of Botulinum toxin to gastrocnemius Femoral derotation osteotomy Progressive resistive strength training 21
  22. 22. Clinical Gait Analysis The process of determining what is causing the patient to walk the way they do. Identify the impairments that are most likely to be affecting the walking pattern. 22
  23. 23. Interpretation and reporting 23
  24. 24. Relevant What does the referrer want to know? – Specific question in referral – What is wrong with the patient ? (What are the impairments?) – What treatment would you recommend? (only if you are qualified to recommend treatment)
  25. 25. Succinct If the referring surgeon wants to know what is wrong with the patient then you should tell him or her. • Anteverted left femur • Spasticity of left gastrocnemius • Tight hip flexors bilaterally
  26. 26. Transparent Because the interpretation has a considerable subjective element the link between the conclusions and the underlying data should be explicit. The anteverted left femur leads to internal rotation of the left hip and internal left foot progression and is confirmed on clinical exam.
  27. 27. Evidence based The link between conclusion and evidence should be transparent and based on rigorous biomechanics or other evidence. “Good” biomechanical reasoning derives from the well established laws of physics and mathematics and should not required further clinical justification.
  28. 28. Evidence based Good biomechanical reasoning derives from the well established laws of physics and mathematics and should not required further clinical justification. Verifying biomechanical reasoning through clinical studies is a strong protection against poor biomechanics.
  29. 29. Comprehensive Any clinical service has a duty of care to ensure that nothing of clinical importance has been over-looked. This may require consideration of factors that have not been specifically mentioned in the referral letter.
  30. 30. Within competence of authors Clinical recommendations should only be made by clinicians who are competent to make them (have appropriate training, qualifications and professional registration).
  31. 31. Time efficient Reports need to be written in way that is: • time efficient for the author (team reporting?) • quickly and clearly understood by the reader 31
  32. 32. Principles of reporting Reports should be: Relevant Succinct Transparent Evidence based Comprehensive Within the competence of the authors Time efficient 32

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