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Post by TimVS on Dec 6, 2007 13:08:44 GMT
I thought it might be interesting to compare notes on our different modus operandii- not really to argue which is best, etc.
So:
1) Do you do it at all?
2) Do you understand what you are looking at/for or are you still a bit baffled?
3) What is your procedure?
4) What, if any, equipment do you use?
5) Do you have any tips or tricks gained over time that you feel might be worth sharing?
6) If you had no access to facilities to do a meaningful gait analysis, e.g if you practised in a glorified broom cupboard with no room to swing a cat, would that adversely affect your practice, and if so, how?
You don't have to answer all of the questions, but there are just a few pointers to get us going. Hopefully this is a thread that beginners and battle scarred veterans can contribute to!
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Post by Admin on Dec 6, 2007 16:26:02 GMT
Hi Tim,
Yep - I do gait analysis (battle-scarred veteran here) ;D.
I use Tekscan, think I know what I'm doing, and my tip is that if you use any type of machine for gait analysis (video, Tekscan or whatever) learn how to use it, and learn its limitations.
Regards,
David
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Post by robertisaacs on Dec 6, 2007 17:33:31 GMT
Yep, i do it too. (beginner, learning every day.) I think it is somewhere between important and vital. Quite often with children the problems are habituated rather than structural and it is not unusual for me to find an unremarkable NWB exam but a problem on gait. I think anyone who says they FULLY understand what they are looking at is very brave indeed. Sometimes baffled, but usually by WHY i see what i see rather than WHAT i see. March patient to the quitest corridor i can find. Roll up trousers to knees. Do the same for the patient. Also get them to remove shoes n socks. Have them walk up and down until i have seen what i want to see. Start with head. Is it tilted left, right forward or back. Does it bob more than expected. Shoulders. Looking for symmetry, roundness and roll. Arm swing / position. Again looking for symmetry. Often reveals problems in contralateral leg. Exagerated can ring alarm bells as can being held rigidly to the side or the classic gunslinger held out away from the body position. Pelvis. Again watching for symmetry, roll, and controll. Knees. Looking for degree of extension / hyperextension / flexion and alignment in the transverse plane (alledgedly  ) Ankles / talocrural joint. Degree of flexion being used, controll and position in swing phase. STJ timing, degree, speed, decelleration and recover of pronation. Mid tarsal inversion. Position during swing phase. I then watch them do a few laps in shoes for comparison. Thats about most of it although I also look for any other gross "abnormalities  . Veering sideways into walls, that kind of thing. Children is completely different and too much to tack on the end of a list like the above. E quipe ment you say? I know nothing of this E quipe ment of which you speak. Is it something which people have in the outside world? I consider myself damn lucky to be working in a building with 4 walls, a dy floor and a roof which does not leak (you lean not to take these things for granted). I did play with sticking markers to people (pencil stuck to a flat bit of EVA stuck to assorted landmarks) a while back but that was just for fun. Watching a bloke remove carpet tape from his shins. Hours of fun for the whole family. Nothing special. I sometimes think of problems as being on a spectrum with pure structural at one end and pure functional at the other. The structural stuff is relativly easy to see in NWB / Static WB and to extrapolate its effect on function. The stuff on the more functional end of the spectrum would be trickier. To be honest i think that SOME form of gait analysis is a requirement for Paeds assessment. Less so for adults. Nice thread Regards Robert |
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Post by dtt on Dec 6, 2007 20:30:09 GMT
Robert Will you stop it !! ;D ;D ;D D |
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Post by dtt on Dec 6, 2007 20:49:04 GMT
. Agreed Agreed Agreed Also perform single leg squat test to load stj and check for internal tibial /femoral rotation levels ( sorry ;D ) Agreed Also squat test keeping heels on the floor to check ankle dorsiflexion I then scan the patient ( pressure plate) and go through the analysis with the patient and ..... Orthotics if required  Cheers Derek |
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Post by robertisaacs on Dec 7, 2007 8:07:23 GMT
I would call that part of the static WB analysis rather than the gait analysis. Good test though.
You lucky swine.
Regards
Robert
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Post by TimVS on Dec 7, 2007 9:15:35 GMT
1) Yes 2) 50/50. Gross movements are ok, fine movements such as MTJ I definitely haven't mastered. Part of the problem is the size of room available - 10 paces max. Then there is trying to decipher the scans, but that's for January! 3) Set up the Matscan, explain procedure. Hopefully they will have arrived with shorts, but usually forget in which case chaps, remove your trollies please, ladies, roll trousers up or if long skirt, well, we won't be assessing the knees today! I usually mark the calc and ant knees. Do a Foot Posture Index while calibrating the mat, then get them to walk up and down watching from side and front. I have to restrict to 5 minutes max as they generally get bored and fed up walking up and down in a limited space. If I see anything unusual like a restricted hip I might check it out and then get tham to walk a bit more focusing on that bit. Then sit them down, show the scans, pretend to them that I know what the scans are indicating, chat through options. All this takes about an hour, including the NWB bits and pieces, most of which I will have done in the initial. 4) Matscan, and I'd like to get into video, so I can slow them down a bit, but I haven't got around to it yet. 5) Just a comment that often when I'm observing I think, 'No, I didn't want to see that as it doesn't fit in with my working diagnosis!' Easy to persuade yourself to see what you want to see. Possibly a weakness of visual analysis. I find it more useful to have a big body diagram and draw lines and arrows all over it rather than notes 6) Deep breath! I'm actually not sure that it would. Except I might miss FHL or other 'functional' SP block, but even there there are usually strong indications in the history and WB/NWB exam. At the moment I would say at least 60-70% of my diagnosis comes from the WB/NWB exam, and I can't think of an instance where my tx plan has changed significantly just from the gait analysis. I'm not at all saying it is unimportant, the assessment would be incomplete without it, but I do wonder how much difference it actually makes in practice. With children it is different, as there are certain wonky patterns, e'g intoeing which are best observed walking, plus with the scan I have a baseline which I can keep comparing at each yearly review. Wait a minute, I think I've just sunk my argument  |
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Post by blinda on Dec 7, 2007 9:50:05 GMT
"Also squat test keeping heels on the floor to check ankle dorsiflexion"
Brilliant! So simple! I`ve trying to find ways to observe ankle equinus in weight bearing.
I usually do all the NW stuff first - passive & non passive, then WB. Must admit, i am also guilty of formulating from this what i should see in gait analysis, rather than what i actually do see.
Cheers,
Belinda
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Post by Admin on Dec 7, 2007 12:35:36 GMT
Then sit them down, show the scans, pretend to them that I know what the scans are indicating, chat through options. All this takes about an hour, including the NWB bits and pieces, most of which I will have done in the initial. I'm not at all saying it is unimportant, the assessment would be incomplete without it, but I do wonder how much difference it actually makes in practice. With children it is different, as there are certain wonky patterns, e'g intoeing which are best observed walking, plus with the scan I have a baseline which I can keep comparing at each yearly review. quote] Hi Tim, You do loads more than me then! BTW, much of the value in having a vertical loading scannning system is that it enables you to take a baseline recording for comparison at a later date (V-useful for in-toeing children) But - the limitations of any gait analysis system is that it only records how that pt is walking, that day, at that time of day, on one type of surface. Diurnal variation, coupled with shod/unshod feet, and different types of terrain mean that your gait analysis results, no matter how accurate the system, are only an approximation of how that pt walks in real life. Don't get me started the accuracy of correction by degree-increments  Cheers - Friday afternoon, one short clinic and then its the weekend ;D |
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Post by robertisaacs on Dec 7, 2007 12:59:36 GMT
 Memo to self. Must get David started on correct by degree increments. Actually i think that it is and excellant idea to measure correction by increments although i would not claim to be more accurate than, say, to the nearest 0.5 degree or possibly even to the nearest whole degree (of course i'd need to round to the nearest degree for that.. I think NOT to measure in this way is frankly irresponsible. Honestly who would'nt? Nice weekend David  . Robert
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Post by dtt on Dec 7, 2007 13:50:24 GMT
Aaahhmm, yes your quite correct Bel, Simple that's me  Nothing wrong with pausing and bringing a "static examination" into/as part of the Gait analysis ? I always guard against patients manufacturing what THEY think I want to see and to integrate helps to avoid this IMHO. As far as the Vertical loading thingy goes I use it AS PART OF the overall diagnostic exam. It does show me / the pt where the main pressure areas ( great for diabetics) are and from my viewpoint early heel lift , joint angles ( calcaneal / stj frontal plane motion),mtj function and pressure distribution throughout the foot. I must confess to varying the intensity of my examination based on the initial presentation of the patient and the severity of the condition inasmuch as I have been known to sit on the wall outside and have a pt run up and down the pavement and do the gait analysis coz I have limited space in the surgery and conversely stopped at a static exam and gait analysis on the pressure plate coz IMO that was all that was needed to restore the Pt to a pain free quality of life Cheers Derek |
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Post by ianl on Dec 7, 2007 17:08:14 GMT
Hi Robert "...think NOT to measure in this way is frankly irresponsible."Not sure what you mean by this. Other than that makes me hugely irresponsible and I've been called worse on a forum!! If your measurements pre-correction (if indeed correction is what we are doing and I do not think we necessarily are) are highly questionable (all kinds of reasons) and if rom can alter significantly during the day in a nonlinear way, so that to measure the same foot at the same time of day the next day is not a guarantee of being in line with a persons individual diurnal rhythms the previous day (what a mouthful). How can you argue that the measurement of degree of correction you have done is any more effective or even relevant? Then of course there is the equipment..... (oops, sorry Robert I mentioned that E word  ). How can it be argued then that to not measure in terms of incremental degree is irresponsible. It is not a problem for me and I'm not all all offended, but it raises an interesting point: If you were brought before the hpc and the pod rep said that your measurements were wrong and therefore your incremental corrections were wrong and you should retrain, how could they justify that? - but it will happen! Looking forward to January, albeit as one whose incremental brainpower measurements seem to be on the decrease and not the increase.  Cheers Ian |
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Post by dtt on Dec 7, 2007 17:33:40 GMT
Hi Ian Ooo You have risen to the bait ;D . I'll let you and Robert sort that one but.. Interesting thought Who can tell you that your measurements were incorrect ?  Surly any diagnosis is based on the OPINION of the practitioner at the time of examination ? I suppose it could be argued if there was a massive difference but in reality do you really believe that would hold water ? Oh do I know how that feels Cya there in Jan on the Friday ;D Cheers Derek |
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Post by TimVS on Dec 7, 2007 18:03:43 GMT
I'm somewhere in between. I think exact measurements to the exact degree are a lot of b****x. Haven't used a tractograph in over 2 yrs. I would love to see 30 angle measuring practitioners lined up with the same foot and see what the degree of variation is, let alone doing the same at different times of day. On the other hand.... I do eyeball the cast and ff/rf relationship beforehand and estimate the degree of posting from there. If I'm not sure I opt for 2 deg by default. I bet my results are up there with the angle danglers ;D I think trying to argue a court case by degrees would make for an interesting fight. Not one that scares me anyway |
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Post by dtt on Dec 7, 2007 21:24:36 GMT
Hi Tim I agree Especially using a chinagraph pencil on skin ( stretch)  You have a vertical pressure loading system . Providing your Rx complies with that, where's the argument ?? ;D D |
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. Veering sideways into walls, that kind of thing. 
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). How can it be argued then that to not measure in terms of incremental degree is irresponsible.
