 |
 |
Leveraging computerised gait analysis in AposTherapyThe way we walk, our gait, serves not only to indicate the existence of a particular pathology, but can also influence the progression of the pathology. AposTherapy has developed a wealth of knowledge on gait, with peer-reviewed journals publishing findings from our research department. As part of a personalised clinicial pathway, all AposTherapy patients undergo periodical spatiotemporal gait test that can can offer a valid and reliable method of assessing individual patients’ ability to function, provide insight into the possible effects a pathology has on a specific, or related joints, as well as providing an effective, quantifiable measure of treatment outcomes. Normal gait Human locomotion entails balancing on one leg, establishing a support base, while moving the second leg forward to create the next support base. During this process there is a brief period where both legs are in contact with the ground simultaneously, as the body’s weight is transferred from one leg to the other. Each leg reciprocally repeats this series of events. The completion of an entire cycle, by a single leg is called a gait cycle. Every gait cycle has two periods: stance, when the leg is in contact with the ground and swing as the leg travels through the air. Each stance begins with double support, where both legs are in contact with the ground. As one leg receives the weight of the body, performing weight acceptance, the other leg leaves the ground in a terminal stance (heel off and toe off). The point at which one leg has left the ground, having entered swing and the other leg supports the full weight of the body, is known as the single limb support (SLS) phase. Ambulating on two legs subjects the body to significant forces due to the body’s weight, the impact of the feet on the ground and the work of the various muscles involved. These forces subject the joints of the low back and the lower limbs to significant loads. The muscles of the lower limbs partly attenuate these forces, whilst at the same time, moving and stabilising the joints. For example, when the heel makes initial contact with the ground, at the end of a swing, the knee is extended. As the foot is lowered to the ground, the dorsiflexors become active and decelerate the foot motion, thereby absorbing some of the impact. The activity of the dorsiflexors also pulls the tibia forward (reversed action) and this leads to flexion in the knee. This movement is moderated by an eccentric quadriceps contraction, which also absorbs some of the force transferred to the leg from contact with the ground. Clearly, gait involves a complex interaction between the relevant joints and muscle groups and therefore requires the mediation of the nervous system (both peripheral and central), known as neuromuscular control. Any interruption to this delicate interplay can either cause an increase in the loads acting on the joints, or a disruption of neuromuscular control and as is often the case, both actions may transpire. Gait deviations Gait deviations can occur as a result of a number of pathologies which can place extra loads on the joints and further disrupt normal movement patterns, so leading to the development of additional pathologies. Many pathologies carry characteristic gait misalignments. For example, patients suffering from non specific low back pain have reduced gait velocity and take smaller steps, when compared with healthy controls (Lee et al., 2007; Lamoth et al., 2002;Lamoth et al., 2006). Patients suffering from medial knee osteoarthritis have been shown to reduce the single limb support (SLS) in the involved leg with reduced gait velocity (Chen et al 2003, Debi et al 2009). Patients suffering from hip osteoarthritis have a reduced walking speed, as well as a reduction in step length on the uninvolved side. This is probably due to a functional limitation in the hip extension range of motion in the involved side (Gussoni et al 1990). An example of the adverse effects of such gait deviations has been shown in the work of Shakoor et al (2003). Here, researchers found that following a total hip replacement changes in contra lateral knee loading patterns are considered to be responsible for the increased risk of damage to that knee, eventually leading to a total knee replacement (Shakoor et al 2003). In summary, spatiotemporal parameters of gait can offer a valid and reliable method of assessing individual patients’ ability to function, provide insight into the possible effects of one pathology on a specific or related joints, as well as providing an effective, quantifiable measure of treatment outcomes. Spatiotemporal gait parameters applied in AposTherapy Spatiotemporal gait parameters (often referred to as gait-lab results) form a core component of the AposTherapy treatment process. Each patient undergoes a computerised gait-lab test before they are seen by the AposTherapist. The test is monitored by the AposTherapist’s assistant, trained in conducting both the gait-lab examination and administrating pain, function and quality of life questionnaires. A specially developed software system allows the AposTherapist to review the gait-lab results together with the questionnaire scores. Deeper analysis of the patient’s results provides the AposTherapist with a more profound understanding of the individual’s functional status and enables a more effective interview and physically assessment. The patient’s personalised therapy programme draws on both clinical reasoning, derived from the objective gait-lab results, together with the subjective information provided in the questionnaires. AposTherapy provides continuous patient evaluation throughout the treatment process. The gait-lab results offer a crucial resource in monitoring the individual’s progress, as well as enabling the AposTherapist to compare any single patient’s gait-lab results with the cumulative data of other patients suffering from the same pathology. As therapy progresses, the patient’s functional status can be monitored via objective improvements in gait-lab results. Ongoing adjustments to the treatment programme can be based on quantifiable and reliable outcome measures and not only subjective information, or the results of clinical interview. The AposTherapy methodology evolved with a key understanding of the role changes in gait patterns played in various pathologies following the analysis of the gait-lab results of thousands of patients. Effective personalised therapy programmes necessitated the integration of information collected from interviews, physical assessments, imaging, gait-lab results and questionnaire scores. This unique approach to the treatment of musculoskeletal conditions has established AposTherapy as an effective, evidence-based process. Summary Gait is a complex process that demands muscle strength, the integrity of various joints and effective neuromuscular control. Damage in any one of these areas will lead to a deviation from normal gait patterns. Gait deviations increase the risk of additional injuries and further pathology development. Any gait deviations can be reliably and quantifiably assessed in a spatiotemporal gait-lab evaluation, which has become a key element in the AposTherapy patient consultation and assessment process. With these objective measures, the AposTherapist gains a deeper insight into the patient’s condition and is able to precisely monitor and optimize the treatment process. Sources:
Chen, Carl P. C.; Chen, Max J. L.; Pei, Yu-Cheng; Lew, Henry L. MD; Wong, Pong-Yuen; Tang, Simon F. T. Sagital Plane Loading Response During Gait in Different Age Groups and in People with Knee Osteoarthritis. American Journal of Physical Medicine & Rehabilitation: April 2003 - Volume 82 - Issue 4 - pp 307-312 |
 |
 |
|
