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Academy Advanced Course: Gait Analysis for P&O
Practitioner interest in objective gait analysis has been gradually increasing in recent decades as more and more clinically relevant information has been published. In fact, an informal e-survey last fall suggested that the single topic most members of the American Academy of Orthotists and Prosthetists wanted to be explained in-depth was instrumented gait analysis. In September, the Academy's first advanced course on this topic debuted at Northwestern University and quickly sold out.
I was fortunate to be able to attend this three-day program, and can confirm that it was one of the most intensive courses ever offered in O&P. The faculty from the Prosthetic and Orthotic Center and from the Research Lab at Northwestern did an outstanding job of showing us the clinically pertinent information that can be gleaned from formal gait analysis reports. The mandatory textbook, daily written exams and nightly readings emphasized and expanded on the information from the lectures, and made it clear that this was a challenging curriculum.
Generous use of video clips of orthotic and prosthetic patients' gait patterns provided the framework for we clinicians to understand what was being studied. With practice, we were soon able to see how the kinematic and kinetic graphs documented in detail the gait deviations we had identified visually. In fact, by the final day, we were working in small groups and recognizing gait defects from the graphical data alone - without even watching the patients walk.
Dr. Perry's text on clinical gait analysis was the foundation for the Academy's inaugural Advanced Course.
We also learned more about how to read a scientific publication with the critical eye of an experienced clinician, and to recognize when the data reported did not support the conclusions drawn. Just learning how to recognize scientific blarney was worth the cost of the tuition!
This Advanced Course will be offered again in the fall of 2002, and I would encourage any experienced clinician with an interest in this area to attend. It is probably too much material for the novice, however. Since the content is largely based on Dr. Perry's text titled "Gait Analysis", it might help you keep up with the pace if you read over this excellent summary of clinical gait analysis procedures. It is available from Amazon.com for about $55.00 USD at www.amazon.com/exec/obidos/ASIN/1556421923/qid=1003535564/sr=8-1/ref=sr_8_3_1/103-8490178-7132645
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This gentlemen's case was presented and discussed in depth at the Gait Analysis course at Northwestern University.
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With the kind permission of the faculty, I am excerpting one of the case presentations from the course to illustrate the kind of information offered in this course. This gentleman has obviously survived a Cerebral Vascular Accident and has a number of gait pathologies as a result.
Although it will take some time to download these video clips over a dial-up connection, they show how this gentleman walked during his gait analysis trials, both with and without his orthosis. You might want to try to list as many gait deviations as you can before looking at the data from the instrumented analysis that follows. If you are playing the clips with the free Windows Media Player, right click over the image and select "REPEAT" for a continuous loop.
Cerebral Vascular Accident 1 Cerebral Vascular Accident 2
One of the best indications of an improved gait is when the patient's self-selected walking speed increases after treatment. This chart summarized the temporal and spatial data from this case.
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Note that although this individual walks faster and with a longer stride with his AFO, all of his temperospatial parameters are still far from normal. This is typical when the patient has severe neuromuscular deficiencies that cannot be overcome fully by an orthosis.
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The final three slides show key objective findings documenting the positive effect of this man's orthosis. Although an experienced clinician can draw many inferences from visual gait analysis, we cannot see the internal moments that affect the joints. This patient's data show clearly that, with the orthosis, the forces on his knee are much more normal. This confirms that the orthosis has effectively eliminated pathologic forces as a result of the stroke that might have damaged his knee if they had continued long term.
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Knee hyperextension motion is reduced and occurs later in stance phase with the AFO.
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Ankle positioning is much more normal in both stance and swing phase with the orthosis.
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Notice that the internal knee moments are dramatically reduced and far closer to normal with the orthosis.
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S.D.
Thank you for sharing info on the S.D.our profession will benefit greatly from sharing the hours of your work. Thanks ,John Micheal !!!
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Re: Options
Thankyou for your info. My 15 year old son started an apprenticeship in September 2003 in November of the same year he was in an accident that resulted in him losing his right arm I have been told a 4 quarter amputaion. Currently he has to... read more
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Re: Re: Options
Forequarter amputation is in many ways a special case in upper limb loss because all of the arm is absent, and only the chest wall remains. The lack of any arm remnant makes it difficult to stabilize the prosthesis and restricts the abilit... read more
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Re: Re: Re: Options
Do you have any suggestions on getting a posthetic shoulder (I am a 4 quarter amputee) that would not strap on but actually beable to adhere to an undershirt and put a shirt over it?
Please email me directly at britseth@aol.com
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Re: Re: Re: Re: Options
Unless you wear a very tight undershirt, I think any shoulder cap attached to it would likely displace and wind up being more annoying than useful. But, with an elastic shirt such as worn for active sports, this might work OK.
I'd be in... read more
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Re: Re: Re: Re: Re: Options
SO helpful...thank you. I have never seen a suspended shoulder cap like that...very refreshing! I am having a difficult time finding the writing about pads in athletic shirts...can you forward a link?
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Re: Re: Re: Re: Re: Re: Options
The URL is http://www.oandp.com/news/jmcorner/2004-06/2.asp . --John Michael CPO
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shoulder disarticulation
Hi
really good info.
i need ur help. my husband met with an accident 3 months before and lost his left hand from shoulder ( almost same as shown in the article)and left leg above knee.
i am in search for upper extremity functional pros... read more
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Re: shoulder disarticulation
Thank you for this inquiry. When both limbs are amputated on the same side, this complicates rehabilitation considerably. I would encourage consideration be given to obtaining an evaluation and opinion from a rehabilitation hospital with ... read more
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Shoudler disarticulation follow up
Very helpful article. Thanks John. Any follow up photos of the finished arm?
THX,
RK
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Re: Shoudler disarticulation follow up
I have a few photos of a S.D.finished If interested email at magur@comcast.net.
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Re: Re: Shoudler disarticulation follow up
i need information i loss my arm shoulder by sarcoma
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Re: Shoudler disarticulation follow up
No, because the patient's prosthetist always does the delivery and follow-up. But, I'll be consulting for them next month, so I'll ask how this gentleman is doing and see if I can get permission to post some "after" shots. --John Michael ... read more
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SD fitting
That was a nicely done article: informative, clear pictures, and realistically written. Thanks
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Re: SD fitting
I'm glad this short summary of many, many hours of work was helpful. Since most practitioners learn visually, I am trying to include photos that show details so the case report narrative can be brief and to the point.
--John Michael CPO
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Re: Re: SD fitting
Sr. John Michael C.O.P. Estimado John, la Sociedad Mexicana de Ortesistas y Protesistas, Asociación Civil, le agradece su participación en el "Foro de Discusión sobre la Educación de Ortesistas y Protesistas en America Latina" celebrado en ... read more
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Re: Re: Re: SD fitting
Gracias, Alberto-
I was very pleased to be present at this important SMOPAC meeting, and will be featuring it in next month's Corner.
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