Abstract
IntroductionBrand's four reasons for clinical tests and his analysis of the characteristics of valid biomechanical tests for use in orthopaedics are taken as a basis for determining what methodologies are required for gait analysis in a clinical rehabilitation context.Measurement methods in clinical gait analysisThe state of the art of optical systems capable of measuring the positions of retro-reflective markers placed on the skin is sufficiently advanced that they are probably no longer a significant source of error in clinical gait analysis. Determining the anthropometry of the subject and compensating for soft tissue movement in relation to the under-lying bones are now the principal problems. Techniques for using functional tests to determine joint centres and axes of rotation are starting to be used successfully. Probably the last great challenge for optical systems is in using computational techniques to compensate for soft tissue measurements. In the long term future it is possible that direct imaging of bones and joints in three dimensions (using MRI or fluoroscopy) may replace marker based systems.Methods for interpreting gait analysis dataThere is still not an accepted general theory of why we walk the way we do. In the absence of this, many explanations of walking address the mechanisms by which specific movements are achieved by particular muscles. A whole new methodology is developing to determine the functions of individual muscles. This needs further development and validation. A particular requirement is for subject specific models incorporating 3-dimensional imaging data of the musculo-skeletal anatomy with kinematic and kinetic data.Methods for understanding the effects of interventionClinical gait analysis is extremely limited if it does not allow clinicians to choose between alternative possible interventions or to predict outcomes. This can be achieved either by rigorously planned clinical trials or using theoretical models. The evidence base is generally poor partly because of the limited number of prospective clinical trials that have been completed and more such studies are essential. Very recent work has started to show the potential of using models of the mechanisms by which people with pathology walk in order to simulate different potential interventions. The development of these models offers considerable promise for new clinical applications of gait analysis.
Highlights
Brand's four reasons for clinical tests and his analysis of the characteristics of valid biomechanical tests for use in orthopaedics are taken as a basis for determining what methodologies are required for gait analysis in a clinical rehabilitation context
A particular requirement is for subject specific models incorporating 3-dimensional imaging data of the musculo-skeletal anatomy with kinematic and kinetic data
Rehabilitation is a clinical discipline and this paper will concentrate on clinical gait analysis
Summary
For the purposes of this paper gait analysis will be assumed to refer to the instrumented measurement of the movement patterns that make up walking and the associated interpretation of these. Gait analysis should reveal information that is useful to the clinician and this will generally require that results are reported in terms analogous to accepted clinical concepts It must be cost-effective, that is the benefit of performing the test must be worth the cost. Prediction of outcomes takes this one stage further to being able to determine which management option is best and how the patient will be after that intervention This sequential analysis of the four potential purposes of clinical tests reveals a progression from just requiring reliable and precise measurements to the additional requirement of having an understanding of how such information is incorporated into clinical practice. The state of the art is that the measurement component of gait analysis can reasonably be described as an objective process whereas the interpretation component is predominantly subjective
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