Overview of impairment focussed interpretation
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The document provides guidance on conducting an impairment-focused interpretation of clinical gait analysis data. It outlines a four step process: 1) orientation to the patient, walking pattern, and data; 2) marking features on the gait graphs; 3) grouping features that relate to specific impairments; and 4) reporting the identified impairments and related findings. Key aspects include using terminology precisely, comparing features to normative data, and relating biomechanical findings to supplementary clinical information to identify underlying impairments affecting gait. The goal is to provide an evidence-based, transparent interpretation that identifies the most relevant impairments for clinical decision making.
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Overview of impairment focussed interpretation
- 1. Overview of Impairment Focussed Interpretation Richard Baker Professor of Clinical Gait Analysis 1
- 2. Principles Relevant Succinct Transparent Evidence based Comprehensive Within the competence of the authors Time efficient 2
- 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
- 13. Process
- 15. Orientation • Get to know the patient • Get to know the walking pattern • Get to know the data
- 16. Orientation to patient • Diagnosis – GMFCS – Topography • Level of function – Functional Assessment Questionaire – Functional Mobility Scale • Reason for referral • Relevant history
- 18. Orientation to patient General impression of gait • Temporal spatial parameters • Gait classification(?) • Impressions from video
- 19. Orientation to walking pattern Hof, A., Scaling gait data to body size. Gait and Posture, 1996. 4: p. 222-223.
- 20. Orientation to data • Temporal spatial parameters • Quality
- 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. Quality
- 24. Mark-up 5 characteristics Side: Left Variable: Hip flexion Type: Too much Timing: Late stance Magnitude: Marked
- 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
- 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. -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. -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. 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. -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. 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. -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. -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. -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. 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. -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. 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
- 47. Mark-up
- 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. Grouping
- 52. Report • List findings (impairments) • Arrange information in correct order • Add any relevant comments
- 53. Findings
- 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. Sample report
- 57. Sample report
- 58. Sample report
- 59. Sample report
- 60. Sample report