این پاورپوینت توسط دکتر محمد خیاط زاده در کارگاه ارزیابی و توانبخشی مشکلات راه رفتن در کودکان مبتلا به فلج مغزی ارائه شده است. برای مطالعه مطالب بیشتر در این زمینه، لطفا به وب سایت فروردین مراجعه کنید: www.farvardin-group.com

1. Gait Assessment
PRESENTED BY: MOHAMMAD KHAYATZADEH MAHANI
ASSISTANT PROFESSOR IN OT
AHVAZ JUNDISHAPUR UNIVERSITY OF MEDICAL
SCIENCES
FEB 2018
TEHRAN
‫در‬ ‫شده‬ ‫ارائه‬
‫مغزی‬‫فلج‬ ‫به‬‫مبتال‬‫کودکان‬‫در‬‫رفتن‬‫اه‬‫ر‬‫مشکالت‬‫انبخشی‬‫و‬‫ت‬‫و‬‫ارزیابی‬‫تخصصی‬‫کارگاه‬

2. Clinical Gait Assessment
Gait Abnormalities in CP
2
History taking
Physical Examination
Laboratory Gait Analysis
Functional Assessment Tests

3. History taking
 Surgery
 BTX
 Orthosis
 Mobility Aids
 Therapy

4. Physical Examination
o Anthropometry
o Muscle length (extensibility, shortening)
(Deformities/ Contractures)
o Muscle tightness (spasticity, rigidity) and soft tissue
tightness
o AROM and Muscle Power (Strength/ Weakness)
o Postural control and alignment
o Muscle/Postural Tone
o Selective Movement Control

5. Muscle length (extensibility, shortening)
(Deformities/ Contractures)
 Hip Flexor tightness: Thomas Test
 Hip extensor tightness
 Hip adductor tightness
 Hip abductor tightness: Ober Test for tightness of
the tensor fasciae latae or iliotibial band.
 Hip rotator tightness
 Knee flexor tightness: Popliteal angle
 Knee extensor tightness: Duncan-Ely Test
 Foot plantar flexion tightness: Silfverskiold Test
 Foot inversion and eversion

6. Knee Flexor Tightness
 Popliteal angle used to measure
hamstring contracture: Norm 30-40
Degree between tibia and vertical
femur.
 Straight leg lift also reveals tight
hamstrings (flexor tightness at
knees and extensor tightness at
hips): Norm 60
 Tripod Test: A positive sign noted
by increased trunk extension

7. Rotational Tightness
 Femoral antetorsion
 Medial tibial torsion
 Metatarsus adductus

8. Laboratory Gait Analysis
Gait Abnormalities in CP
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 Assessment via high
tech motion capture
and computerized
software then
interpretation by :
1. Gait Deviation Index
2. Gillette Gait Index

9. Laboratory Gait Analysis
Gait Abnormalities in CP
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 Although walking is an activity most of us can manage
without thinking, it is difficult to analyze.
 The eight distinctive phases take place within about one
second.
 The complex of actions on several levels of the body
(ankle, knee, hip, pelvis, trunk and arms) give us a large
amount of data, 96 variables per second, to analyze.
 In a gait lab it is possible to sample and store such data at
a high frequency for further analysis and make
comparison between groups of individuals or/and on
individual basis.

10. Kinematics and Kinetic
Gait Abnormalities in CP
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 Kinematics: Describes the movements
of the body segments (segment
positions and joint angles), 3-D Joint
Motion
 8 Digital Motion Capture Cameras
Record Position of Light Reflective
Markers
 Kinetics: Calculates the forces
controlling the movements, described
in terms of Moments and Power
 Force Plate Embedded in the Floor
Records Ground Reaction Force
Vectors

11. Kinematics
Gait Abnormalities in CP
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 Nearly normal hip motion
 Increased knee flexion at IC and stance
 Reduced peak knee flexion in swing
 Increased plantar flexion in terminal
stance
 Internally rotated foot progression

12. Kinetics
Gait Abnormalities in CP
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13. Kinetics
Gait Abnormalities in CP
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 Normal ankle plantar flexor
moment peaks in terminal stance
 Increased plantar flexor moment
in loading response “double
bump” associated with increased
plantar flexion at IC
 Decreased moment in terminal
stance associated with a reduced
forefoot rocker

14. Muscle EMG Timing During Gait
Gait Abnormalities in CP
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15. Postural Balance
Gait Abnormalities in CP
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 Force Plate Center of Pressure
 Postural Sway with Eyes Open / Closed

16. Energy Expenditure Index
Gait Abnormalities in CP
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17. Functional Assessment Tests
Gait Abnormalities in CP
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 Whilst instrumented gait assessment that provides
quantitative measures of 3D gait kinematics and
kinetics and the electrical activity of muscles remains
the gold standard for gait assessment, in the context
of routine clinical practice it is still restricted by the
fact that it is laboratory based, expensive, time-
consuming and requires a high-level of
interpretation skills.

18. Functional Assessment Tests
( without videotaping)
Gait Abnormalities in CP
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TUG and Modified TUG
 SIX Minute Walk Test/One MWT/
10 Meter Walk Test
 GMFM band D and E
 Dynamic Gait Index

19. GMFM band D
Gait Abnormalities in CP
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20. GMFM band E
Gait Abnormalities in CP
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21. Dynamic Gait Index
Gait Abnormalities in CP
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22. Functional Assessment Tests
( with videotaping)
Gait Abnormalities in CP
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Observational Gait Scale (adapted from Physicians
Rating Scale)
Edinburgh Visual Gait Analysis Interval Testing
(GAIT)
 Gillette Functional Assessment Questionnaire

28. Edinburgh Visual Gait Analysis Interval
Testing (GAIT)
Gait Abnormalities in CP
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29. Edinburgh Visual Gait Analysis Interval Testing
(GAIT)
Gait Abnormalities in CP
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30. Gillette Functional Assessment Questionnaire
Gait Abnormalities in CP
30

31. www.farvardin-group.com
@farvardin_group_channel
@neuroscience4family
@farvardin_group96
‫تخصصی‬‫کارگاه‬
‫ارزیابی‬‫مغزی‬‫فلج‬‫به‬‫مبتال‬ ‫کودکان‬‫در‬‫رفتن‬‫اه‬‫ر‬‫مشکالت‬‫انبخشی‬‫و‬‫ت‬‫و‬
‫اریم‬‫ز‬‫سپاسگ‬