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11 impairment focussed interpretation (nov 2014)

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Impairment focussed interpretation, Measuring Walking 2014, University of Salford

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11 impairment focussed interpretation (nov 2014)

  1. 1. Overview of Impairment Focussed Interpretation Richard Baker Professor of Clinical Gait Analysis 1
  2. 2. Principles Relevant Succinct Transparent Evidence based Comprehensive Within the competence of the authors Time efficient 2
  3. 3. Practice Stage 1: Look at the graphs and identify gait features Stage 2: Interpret what these features mean. 3
  4. 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. 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.
  6. 6. Impairment Focussed Interpretation 6
  7. 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. 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. 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
  10. 10. Terminology: Feature
  11. 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. 12. Impairment focussed reporting • One of the impairments affecting the walking pattern is: Impairment – a tight left hip flexor. This is suggested by: – “Single bump pattern” of left pelvic tilt Features – Too little left hip extension in late stance. and – restricted hip extension on clinical exam Supplementary data
  13. 13. Process
  14. 14. Process Four steps: Orientation Mark-up Grouping Reporting
  15. 15. Orientation • Get to know the patient • Get to know the walking pattern • Get to know the data
  16. 16. Orientation to patient • Diagnosis – GMFCS – Topography • Level of function – Functional Assessment Questionaire – Functional Mobility Scale • Reason for referral • Relevant history
  17. 17. Orientation to patient
  18. 18. Orientation to patient General impression of gait • Temporal spatial parameters • Gait classification(?) • Impressions from video
  19. 19. Orientation to walking pattern Hof, A., Scaling gait data to body size. Gait and Posture, 1996. 4: p. 222-223.
  20. 20. Orientation to data • Temporal spatial parameters • Quality
  21. 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. 22. Quality
  23. 23. Process Four steps: Orientation Mark-up Grouping Reporting
  24. 24. Mark-up 5 characteristics Side: Left Variable: Hip flexion Type: Too much Timing: Late stance Magnitude: Marked
  25. 25. Mark-up
  26. 26. Process Four steps: Orientation Mark-up Grouping Reporting
  27. 27. 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).
  28. 28. Grouping
  29. 29. Process Four steps: Orientation Mark-up Grouping Reporting
  30. 30. Report • List findings (impairments) • Arrange information in correct order • Add any relevant comments
  31. 31. Findings
  32. 32. Arrange information
  33. 33. 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”.
  34. 34. Sample report
  35. 35. Sample report
  36. 36. Sample report
  37. 37. Sample report
  38. 38. Sample report