Gait analysis

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Strategies for the Assessment of Pediatric Gait Clinical Setting

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Clinical gait analysis is a term that can be applied to numerous method of eualuating a subject's waking pattern. These method muy include ohsemarion, v h itaping, electromyograpby, kinematics, kinetics, and mgetics. Modem gait analysis i s based on the integration of these component metho& of measurement to derive acomplete anaZys&of gait. The data may then be used to help determine the treatnzent course of a patient with ambulatory problems or to document the effects of treatment. The purpose of this article is to provide an overview of the individuul components of gait analysis. Emphasis will be placed on the type of information that can be derivedfiom each component and how the information m q be usedclinically. Normalpediatric kinematics and kinetics are provided with literature referencesforphasic electromyograpby and temporal and stride variables. Two case emmples illushate the clinical utility of gait anaZysis information applied to cerebral palsy in surgical decision d i n g and orthotic mmment. Guidelines are also provided for the refewal of patients to a gait analysis lahoratoty. [Rose SA,0 u q u u S, DeLuca P A Strategies for the m m e n t of pediatric gait in the clinical setting. Pbys Ther. 1991;71:961-980.1
Key Words: Electromyograpby, Gait analysis, Kinematics, kinetic^, Orthotic decision making, Surgical decision making.

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Sally A Rose Sylvia dunpuu Peter A DeLuca

The value of objective gait analysis in clinical decision making has been demonstrated throughapplications for surgical, orthotic, and therapeutic treatment planning.'-lo Normal gait is complex, but pathological gait is even more complex. For example, children with cerebral palsy (CP) have complex gait deviations occurring in three planes of motion, primary deviations are often confounded with compensations, and findings can be missed by

observational gait analysis.ll The gait of children withCP may best be analyzed using a threedimensional (3D) computerized motion measurement system that can aid the clinician in delineating primary problems and secondary compensations. Coupled with information from other measures of gait assessment, the clinician is then able to make more scientific decisions regarding surgical treatment and objectively evaluate the outcome.-'-7

SA Rose, BS, F ,Senior Physical Therapist, Rehabilitation Services and Gait Analysis laboratory, T is Newington Children's Hospital, 181 E Cedar St, Newington, CT 06111 (USA). Address all correspondence to Ms Rose. S Ounpuu, MS, is Kinesiologist, Gait Analysis I.aboratory, Newington Children's Hospital, and Instructor, Department of Orthopaedic Surgery, School of Medicine, University of Connecticut Health Center,10 ~ a l c o t ~ o t c h dFarmington, CT 06032. t ~ , PA Del.uca. MD, is Co-Director, Gait Analysis Laboratory, Director, Cerebral Palsy Service, and Director, Hip and Foot Service, Newington Children's Hospital; Assistant Professor of Orthopaedic Surgery, School o f Medicine, University of Connecticut Health Center; and Assistant Clinical Professor, Department of Orthopaedic Surgery andRehabilitation, Yale New Haven Hospital, 333 Cedar St, New Ha.ven, CT 06510.

The purpose of this article is to review the various components of computerized gait analysis with an emphasis on the type of information that can, and cannot, be derived from each component. A review of normal kinematics and kinetics with references for phasic electromyographic (EMG) activity and time-distance variables forthe pediatric population is provided. Two case examples of children with CP are provided to demonstrate the value of objective computerized gait assessment in neuromuscular disorders, one in which gait analysis information was applied to surgical treatment and outcdme and One demonstrating the evaluation of orthoses. Finally, guidelines of patients a gait ysis laboratory will be reviewed....