Penny Hewart


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Peacocks Conference Presentation

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  • I showed Sherlock the special markers we use and explained what we are going to do.
  • The technical data is used in conjunction with measurements of the legs taken by our physio.
  • The markers are carefully placed so they are stuck on top of the correct bones and joints.
  • A standing image is first done to calibrate Sherlock so the computer knows where all his bones and joints are.
  • The he walks several times up and down so we have good amount to data to check that we are measuring his typical way of walking.
  • I then have to process all this data to get the results we need which takes several steps...
  • This is what each of the high tech cameras see – there are 12 of them and then
  • All the different pictures are put together by the computer to give a stick figure walking
  • And from this we can make a skeleton....
  • Or a teddy bear – whoich is what they do in the films but theirs is a bit fancier.....
  • Lots of films use the same equipment so there is a fun side to it too
  • But that is all just pretty pictures – what we really need are lot of graphs which tell us much the ankles, knees and hips are moving. Green lines are right and red are left and the grey bit is what is normal, so you can see that in some graphs there is a difference in left and right and that they are not normal – this is what we will give a report on.
  • And we will also comment on the measures we take and use any x-rays we have of Sherlock’s feet (reference to earlier talk)
  • Penny Hewart

    1. 1. Gait Analysis in the North (GAiN) Penny Hewart Clinical Engineer and administrator, Gait Lab
    2. 2. Who we are... <ul><li>Multidisciplinary team of 3: </li></ul><ul><ul><li>Penny Hewart </li></ul></ul><ul><ul><ul><li>clinical engineer and administrator – full time gait lab so easiest contact (contacts at end of presentation) </li></ul></ul></ul><ul><ul><li>Pat Clements </li></ul></ul><ul><ul><ul><li>physiotherapist – contact via lab or Palmers </li></ul></ul></ul><ul><ul><li>William Bliss (full gait assessments only) </li></ul></ul><ul><ul><ul><li>consultant orthopaedic surgeon – contact via secretary at Freeman </li></ul></ul></ul>
    3. 3. Where we are.... <ul><li>Just (November 2009) moved to Newcastle General </li></ul><ul><li>Sole use of lab </li></ul><ul><li>Separate clinical and seating area </li></ul><ul><li>Warmer! </li></ul><ul><li>Level access </li></ul><ul><li>Good parking – plenty of disabled bays </li></ul>
    4. 4. The new lab...
    5. 5. Services we offer... <ul><li>3D clinical gait analysis </li></ul><ul><li>Video vector (2D) gait analysis </li></ul><ul><li>Orthotic review and fine tuning </li></ul>
    6. 6. Light hearted demo of gait analysis Sherlock Holmes comes to the gait lab – part of a schools presentation on what happens in medical physics...
    7. 7. Explanation of what we will do
    8. 8. Clinical exam <ul><li>Measurement of ankle movement done by our physiotherapist </li></ul>Normal left ankle Stiff right ankle
    9. 9. Sticking the markers on
    10. 10. Standing
    11. 11. Walking
    12. 12. Working at computer
    13. 13. What the infra-red cameras see... (video link removed)
    14. 14. Which is turned into a stick figure... (video link removed)
    15. 15. Which can then be made into a skeleton.... (video link removed)
    16. 16. Or a teddy bear.... (video link removed)
    17. 17. You’re are probably familiar with this use of the equipment...
    18. 18. But the really useful things are the graphs showing angles at the hip, knee etc...
    19. 19. And the clinical exam and x-rays
    20. 20. 3D gait analysis <ul><li>Long process – patient is present for 2 – 3 hours so compliance is important </li></ul><ul><ul><li>Questionnaire </li></ul></ul><ul><ul><li>Clinical exam </li></ul></ul><ul><ul><li>3D kinematics (joint angles) and kinetics (forces and moments) </li></ul></ul><ul><ul><li>Video vector </li></ul></ul><ul><ul><li>EMG </li></ul></ul><ul><li>Review with all staff </li></ul>
    21. 21. The patients we see... <ul><li>The main 3D service was set up for paediatric </li></ul><ul><li>Mainly cerebral palsy </li></ul><ul><li>Others including other neuromuscular, stroke, head injury, musculo-skeletal but only paediatric (at the moment) </li></ul>
    22. 22. Access to 3D gait analysis <ul><li>Referrals only accepted by orthopaedic consultants or CDC at the RVI (who refer simultaneously to orthopaedics) </li></ul><ul><li>This is because patients and results are focused on surgery and we have limited numbers of appointments </li></ul><ul><li>Contact Penny if you have any queries </li></ul>
    23. 23. Access to 3D gait analysis cont... <ul><li>We have a long waiting list – currently 30 weeks and can see a limited number of patients per year </li></ul><ul><li>Very stringent on patients acknowledging appointment </li></ul><ul><li>Support in getting improved number of patients and expanded patient groups would be welcome </li></ul>
    24. 24. Gait reports <ul><li>Long! </li></ul><ul><li>We include all the data so although you may choose to just read the conclusions, the original data is present to give the background for our decisions </li></ul><ul><li>Comments on style and content are welcome </li></ul>
    25. 25. Video vector assessment <ul><li>Access to the service is the same as for 3D </li></ul><ul><li>Includes clinical exam and video with force vector videoing </li></ul><ul><li>Useful for children who would not be compliant with the full assessment </li></ul><ul><li>Slightly shorter report </li></ul>
    26. 26. Orthotic review / fine tuning <ul><li>Team approach – physiotherapist, engineer and ideally an orthotist </li></ul><ul><li>Video vector equipment </li></ul><ul><li>Type and angle of AFO – assess effect </li></ul><ul><li>Fine tuning </li></ul><ul><ul><li>Footwear </li></ul></ul><ul><ul><li>Floor shank angle </li></ul></ul><ul><ul><li>Heel wedges, rockers </li></ul></ul><ul><li>Review </li></ul>
    27. 27. Orthotic aims – ground reaction vector control – example
    28. 28. Accessing the service... <ul><li>Anyone can refer – please contact Penny </li></ul><ul><li>Currently no charge </li></ul><ul><li>We will carry out the assessment then send a report detailing the changes needed then they can be implemented locally </li></ul><ul><li>We also offer a limited on-site outreach orthotic fine tuning service – ask Penny </li></ul>
    29. 29. References to gait analysis in CP consensus document <ul><li>Main uses: </li></ul><ul><ul><li>Teaching </li></ul></ul><ul><ul><li>Determining treatment </li></ul></ul><ul><ul><li>Explaining to patients and families </li></ul></ul><ul><ul><li>Evaluate outcomes </li></ul></ul><ul><ul><li>Classification – no consensus on best way as several types of data to include </li></ul></ul>
    30. 30. Advantages of clinical gait analysis <ul><li>Increased information has helped the development of multi-level surgery so patients get more surgery in one sitting and so less time in hospital, needing rehab and missing schooling / work </li></ul><ul><li>Allows objective review and audit of treatment </li></ul>
    31. 31. Contact details... <ul><li>Best contact is: </li></ul><ul><ul><li>Penny Hewart </li></ul></ul><ul><ul><li>Bioengineering </li></ul></ul><ul><ul><li>RMPD </li></ul></ul><ul><ul><li>Newcastle General Hospital </li></ul></ul><ul><ul><li>Westgate Road </li></ul></ul><ul><ul><li>Newcastle upon Tyne </li></ul></ul><ul><li>Penny.Hewart@ nuth . nhs . uk </li></ul><ul><li>0191 256 3416 </li></ul>