Gait and Foot Pressure-Aaron Tracy

7/23/2019 Gait and Foot Pressure-Aaron Tracy

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Foot Pressure and Gait inFoot Pressure and Gait in

Children with Cerebral PalsyChildren with Cerebral Palsy

Aaron TracyAaron Tracy

MS 2, Sackler School of MedicineMS 2, Sackler School of Medicine

American programAmerican program


2/22

Thanks toThanks to

Dr. Uri GivonDr. Uri Givon

Institute for Motor Performance,Institute for Motor Performance,

Motion Analysis Laboratory, TelMotion Analysis Laboratory, TelHashomer HospitalHashomer Hospital


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OverviewOverview

Gait valuationGait valuation

!erebral Palsy!erebral Palsy

"hat are #e loo$in% at&"hat are #e loo$in% at&ImportanceImportance


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Gait-DefinitionGait-Definition

'epetitious se(uences of lo#er limb'epetitious se(uences of lo#er limb

motion to move the bo)y for#ar)motion to move the bo)y for#ar)

#hile maintainin% stance stability#hile maintainin% stance stability


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Gait EvaluationGait Evaluation

Gait evaluation metho)sGait evaluation metho)s

Lo# techLo# tech

* Direct vie#in%Direct vie#in%

* +i)eotapin%+i)eotapin%* PT tests - minutes, // m, etc0PT tests - minutes, // m, etc0

* +isual %ait scores+isual %ait scores

Hi%h techHi%h tech* !omputeri1e) 2D %ait analysis!omputeri1e) 2D %ait analysis


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Low Tech MethodsLow Tech Methods

Direct vie#in%Direct vie#in%

* !heap!heap

* Irrepro)ucible, patient tire)Irrepro)ucible, patient tire)

+i)eotapin%+i)eotapin%

* 'epro)ucible'epro)ucible

* Allo#s for slo# motionAllo#s for slo# motion

* 'e(uires minimal e3pertise, e(uipment'e(uires minimal e3pertise, e(uipment


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Low Tech ContdLow Tech Contd

PT testsPT tests* !heap an) pretty easy to perform!heap an) pretty easy to perform

* Describe tolerance, not %ait (ualityDescribe tolerance, not %ait (uality

* Patient %ets tire)Patient %ets tire)

+isual %ait scores+isual %ait scores* +ali)ate), cheap, vi)eotape) #al$s+ali)ate), cheap, vi)eotape) #al$s

* 'e(uire e3perience'e(uire e3perience* Poor manPoor mans %ait labs %ait lab


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!i"h Tech- #D $nalysis!i"h Tech- #D $nalysis

4 Analy1in% by 5oint an) byAnaly1in% by 5oint an) by

phasephase

4 Inte%ration of fin)in%sInte%ration of fin)in%s

4 6patiotemporal6patiotemporal

parametersparameters

4 7inematic 8 $inetic7inematic 8 $inetic

measurementsmeasurements

4 MGMG

4 techni(ue for evaluatin% an)techni(ue for evaluatin% an)recor)in% the electricalrecor)in% the electrical

activity pro)uce) by s$eletalactivity pro)uce) by s$eletal

musclemuscle

4 Pe)obaro%raphPe)obaro%raph


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%u&&ary of Low Tech%u&&ary of Low Tech

9ase) on e3aminer:s e3perience9ase) on e3aminer:s e3perience

;on (uantitative;on (uantitative

;on repeatable;on repeatableAn e)ucate) %uess, but is it still aAn e)ucate) %uess, but is it still a

%uess&%uess&

* This is #hat #e are %oin% to e3amineThis is #hat #e are %oin% to e3amine


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Cerebral PalsyCerebral Palsy

A %roup of permanent )isor)ers in the )evelopmentA %roup of permanent )isor)ers in the )evelopmentof movement an) posture causin% activity limitationsof movement an) posture causin% activity limitations

that are attribute) to nonpro%ressive )isturbancesthat are attribute) to nonpro%ressive )isturbances

that occurre) in the )evelopin% fetal or infant brainthat occurre) in the )evelopin% fetal or infant brain

Motor )isor)ers often accompanie) by )isturbancesMotor )isor)ers often accompanie) by )isturbances

of


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Cerebral Palsy ContdCerebral Palsy Contd

9alance is a si%nificant problem in9alance is a si%nificant problem in

most chil)ren #ith !Pmost chil)ren #ith !P

Gait Abnormalities can affectGait Abnormalities can affect

movement at the hip, $nee an) an$lemovement at the hip, $nee an) an$le


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'hat we are lookin" at('hat we are lookin" at(

3aminin% the %ait an) foot pressure of3aminin% the %ait an) foot pressure of

=/ chil)ren #ith !erebral palsy ->rom=/ chil)ren #ith !erebral palsy ->rom

Levels ?2 on GM>!6 6cale0Levels ?2 on GM>!6 6cale0

* GaitGait

Usin% Lo# tech metho)s -vi)eo analysis0Usin% Lo# tech metho)s -vi)eo analysis0!omplete) by Dr.!omplete) by Dr.GivonGivon

>M6 an) GM>!6>M6 an) GM>!6

* >oot pressure>oot pressure@ebris -Hi%h Tech Trea)mill0@ebris -Hi%h Tech Trea)mill0

AimAim!ompare our lo# tech evaluations to the!ompare our lo# tech evaluations to thehi%h tech evaluations of these same patientshi%h tech evaluations of these same patients


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'hy('hy(

Many chil)ren have %ait )isor)ersMany chil)ren have %ait )isor)ers

#hich can be treate) #ith sur%ery#hich can be treate) #ith sur%ery

9efore sur%ery, preoperative9efore sur%ery, preoperative

plannin% is necessaryplannin% is necessary

Gait analysis can ai) in this plannin%Gait analysis can ai) in this plannin%


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Measurin" Motor FunctionMeasurin" Motor Function

= Different Types of 6corin% metho)s= Different Types of 6corin% metho)s

that are use) -GM>!6 an) >M60that are use) -GM>!6 an) >M60

ach one can be use) by itself toach one can be use) by itself to

measure but optimal results aremeasure but optimal results are

obtaine) #hen use) to%etherobtaine) #hen use) to%etherprovi)e a clear picture of the ambulatoryprovi)e a clear picture of the ambulatory

capabilities of a chil) #ith !Pcapabilities of a chil) #ith !P


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GMFC%GMFC%

The Gross Motor >unctionalThe Gross Motor >unctional

!lassification 6cale -GM>!60!lassification 6cale -GM>!60Palisano, '.Palisano, '. et alet al. -?B0. -?B0* +ery %oo) inter an) intrarater reliability+ery %oo) inter an) intrarater reliability

* Provi)es a means of )escribin% chil)ren:sProvi)es a means of )escribin% chil)ren:s

locomotor function ran%in% from runnin% an)locomotor function ran%in% from runnin% an)

#al$in% in)epen)ently to re(uirin% assistance#al$in% in)epen)ently to re(uirin% assistance

to move a #heelchairto move a #heelchair

* Has limitations Distance #al$e)Has limitations Distance #al$e)

!hil) may be limite) to a certain )istance!hil) may be limite) to a certain )istance


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GMFC% %caleGMFC% %cale

https


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FM%FM%

>unctional Mobility 6cale ->M60>unctional Mobility 6cale ->M60Graham, H.Graham, H. et alet al. -=//E0. -=//E0

* Use) to classify chil)ren #ho areUse) to classify chil)ren #ho are

ambulatory base) on their #al$in%ambulatory base) on their #al$in%ability at , /, an) // metersability at , /, an) // meters


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FM% %caleFM% %cale

http


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)ebris Tread&ill)ebris Tread&ill

+i)eo courtesy of ###.1ebris.)e+i)eo courtesy of ###.1ebris.)e


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!y*othesis!y*othesis

The lo# tech metho) #ill beThe lo# tech metho) #ill be

sufficient for certain analyses but #illsufficient for certain analyses but #ill

not be as accurate as the hi%h technot be as accurate as the hi%h tech

metho)metho)


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+&*ortance of $LL this+&*ortance of $LL this

nly = 2D %ait labs in the ;TI'nly = 2D %ait labs in the ;TI'

country of Israelcountry of Israel

* ne here -Tel Hashomer0ne here -Tel Hashomer0

* Tel AvivTel Aviv

If proven vali), coul) allo# for %aitIf proven vali), coul) allo# for %ait

analysis throu%hout entire countryanalysis throu%hout entire country

'e)uce travel for pts.'e)uce travel for pts.

6ave JJJJJJJ6ave JJJJJJJ


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,E%T+O.%((,E%T+O.%((

Gait and Foot Pressure-Aaron Tracy

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