Gait Assessment

Name of Topic: Gait Assessments

Description of Method: “By definition, gait is a manner of moving the body from one place to the other by alternately and repetitively changing the location of the feet, with the condition that at least one foot is in contact with the walking surface” (Petrofsky, p.463). Gait measurements typically are subjective measures using clinical observations, which can be unreliable, so when clinics are looking for more accurate results they use a technique called computerized gait analysis. During a computerized gait analysis the individual is videotaped, while wearing markers from different angles (ie front, back, lateral views), the individual is then asked to walk in a straight line. A disadvantage to using computerized gait analysis is that it can be costly, because of the infrared videos and visible lights used in this technique.

Major Applications:

The passive marker system was used in a study done by Hillman looking at the effects of Type 1A rotationplasty on gait patterns. This method fixes reflective markers at different points in the body (shoulder, spine, posterior superior iliac spine, greater trochanter, and the lateral side of both the knee and ankle). Each individual was then asked to walk at a pace at which they felt comfortable. There were 6 separate trials taken that recorded movement in the hip, knee and trunk. The motion analysis information was analyzed with ground reaction forces to find torques acting on the hip, knee, and ankle. “Gait analysis revealed fairly normal walking pattern with a slight limp and a lateral lean of the trunk over the ipsilateral limb that led to a reduced joint movement in the hip (Hillman, p. 187).

There appears to be a lack of research analyzing gait while turning, a study done by Petrofsky looked at this idea. “Gait analysis is stylized to a controlled laboratory environment with patients walking in a straight line. It is generally during turns and not straight line that people fall” (Petrofsky, p.470). The study was aiming to use a more objective measure, so they used a three dimensions technique using electrically conductive rubber in the shoe to track time, accelerometers at the joints to track movement and electrodes around the eye to track eye movement. It was found that accelerometer analysis of turns is a better method of gait analysis than just walking in a straight line.

Similarly, Giannikas did a study of the functional outcome following a bone transport reconstruction, for their gait analysis they also did a three dimensional technique. They compared data from the involved leg with data from the uninvolved leg. They found, “it is evident that there is a considerable kinematic and kinetic difference between the affected and unaffected limbs of the patient and control group” (Giannikas, p. 149).

Reliability and Validity: “Reliability testing of observational gait analysis indicates that it appears to be convenient in clinical setting but not a very reliable technique” (Petrofsky, p.463). However in a different study done by McGinely, the found those physical therapists that were studied had a high inter observer reliability using observational gait analysis. The literature on gait analysis has mixed findings and needs further analysis.

Relevance to OT: Gait analysis is important to occupational therapist, because if we are under the belief that a client can ambulate safely. We overlook the process walking when working on ADLs in the clinic. Then when the patient gets home and has difficulty walking