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Instrumented Gait Analysis
Availability
Please visit the following websites for more information about the Instrumented Gait Analysis:
Classification
Supplemental: Cerebral Palsy (CP)
Short Description of Instrument
Instrumented Gait Analysis is a standard diagnostic laboratory procedure present in many clinical facilities which treat patients with gait dysfunction or other disorders of human movement. These clinical facilities evaluate individuals with the goal of quantifying their movement disorder and determining the specific anatomic, physiologic, or functional causes of their movement pattern. The information can then be used to assist in planning the treatment approach.
 
The testing involves a detailed physical examination, and measurement of multiple joint motions, mechanical forces at multiple joints, and electrical activity in multiple muscles collected while the person is walking or making the affected motion. Video recording, measurement of foot pressure and measurement of the energy cost of walking are also common aspects of this evaluation if needed to describe the movement problem.
 
Specific measures included in instrumented gait analysis include:
 
  • Physical examination
  • Temporal-spatial gait parameters (e.g., step length, step width, speed)
  • Kinematics (joint angles)
  • Kinetics (ground reaction forces, joint moments and powers)
  • Electromyography (muscle activation and timing)
  • Metabolic Consumption (oxygen cost and consumption)
Comments/Special Instructions
Instrumented motion analysis is commonly conducted across multiple conditions including barefoot, wearing shoes, and using any assistive devices (such as ankle foot orthoses or walkers). Comparing across conditions allows clinicians to evaluate walking ability and inform treatment decisions. Note that evaluations of ankle foot orthoses should be compared to shod (with shoe) conditions, when possible, to evaluate the relative effect of the shoe and orthosis. All data is typically compared to a database of normative values from typically-developing children. Other tasks such as stair ascent/descent, running, walking at multiple speeds, squatting, or other tasks of daily living can also be performed to inform treatment planning.
 
Participants must be able to understand and follow verbal directions.
Scoring
A clinical report provides a summary of the instrumented gait analysis. This includes  a full description of the physical examination, temporospatial gait parameters, kinematics, kinetics, electromyography data, and metabolic consumption during gait. Comparisons to controls (i.e., typically-developing children) provide an assessment of impairment and functional ability.
 
Administration Time: 1–3 hours (dependent on number of test conditions)
Rationale/Justification
Instrumented gait analysis provides a quantitative assessment of gait and other movements that can be used to evaluate disease progression, and inform treatment planning. Measures of kinematics, kinetics, and elecgromyography during gait have been shown to be reliable and accurate across a wide range of clinical populations, including children with cerebral palsy (Gage et al., 2009; Schneiberg et al., 2010; Schwartz et al. 2013; Schwartz et al., 2004). Measures of gait analysis have also been shown to predict changes in gait after a wide variety of surgical procedures or while using assistive devices, such as ankle foot orthoses.
References
The Identification and Treatment of Gait Problems in Cerebral Palsy 2nd Edition Gage JR, Schwartz MH, Koop SE, Novacheck TF. (Editors). New York: Mac Keith Press; (2009).
 
Additional References:
 
Arnold AS, Liu MQ, Schwartz MH, Ounpuu S, Delp SL. The role of estimating muscle- tendon lengths and velocities of the hamstrings in the evaluation and treatment of crouch gait. Gait Posture. 2006;23(3):273–281.
 
Arnold AS, Liu MQ, Schwartz MH, Ounpuu S, Dias LS, Delp SL. Do the hamstrings operate at increased muscle-tendon lengths and velocities after surgical lengthening? J Biomech. 2006;39(8):1498–1506.
 
DeLuca PA, Davis RB 3rd, Ounpuu S, Rose S, Sirkin R. Alterations in surgical decision making in patients with cerebral palsy based on three-dimensional gait analysis. J Pediatr Orthop. 1997;17(5):608–614.
 
Kadaba MP, Wootten ME, Gainey J, Cochran GV. Repeatability of phasic muscle activity: performance of surface and intramuscular wire electrodes in gait analysis. J Orthop Res. 1985;3(3):350–359.
 
Mackey AH, Walt SE, Lobb GA, Stott NS. Reliability of upper and lower limb three- dimensional kinematics in children with hemiplegia. Gait Posture. 2005;22(1):1–9.
 
McGinley JL, Baker R, Wolfe R, Morris ME. The reliability of three-dimensional kinematic gait measurements: a systematic review. Gait Posture. 2009;29(3):360– 369.
 
Ries AJ, Rozumalski A, SchwartzMH. Do ankle-foot orthoses improve gait for individuals with cerebral palsy? Gait& Posture. 2013;38:S20–S21.
 
Schneiberg S, McKinley P, Gisel E, Sveistrup H, Levin MF. Reliability of kinematic measures of functional reaching in children with cerebral palsy. Dev Med Child Neurol. 2010;52(7):e167–173.
 
Schwartz MH, Rozumalski A, Truong W, Novacheck TF. Predicting the outcome of intramuscular psoas lengthening in children with cerebral palsy using preoperative gait data and the random forest algorithm. Gait Posture. 2013;37(4):473–479.
 
Schwartz MH, Viehweger E, Stout J, Novacheck TF, Gage JR. Comprehensive treatment of ambulatory children with cerebral palsy: an outcome assessment. J Pediatr Orthop. 2004;24(1):45–53. Sorsdahl AB, Moe-Nilssen R, Strand LI. Test-retest reliability of spatial and temporal gait parameters in children with cerebral palsy as measured by an electronic walkway. Gait Posture. 2008;27(1):43–50.
 
Steinwender G, Saraph V, Scheiber S, Zwick EB, Uitz C, Hackl K. Intrasubject repeatability of gait analysis data in normal and spastic children. Clin Biomech (Bristol, Avon). 2000;15(2):134–139.
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