Clinical Gait Analysis Theory And Practice PdfBy Sienna B. In and pdf 04.05.2021 at 07:40 8 min read
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- Chris Kirtley, MD PhD (Auth.)-Clinical Gait Analysis. Theory and Practice
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Metrics details. Quantitative gait analysis can provide a description of joint kinematics and dynamics, and it is recognized as a clinically useful tool for functional assessment, diagnosis and intervention planning. Clinically interpretable parameters are estimated from quantitative measures i.
Chris Kirtley, MD PhD (Auth.)-Clinical Gait Analysis. Theory and Practice
Gait analysis with motion capture MoCap during rehabilitation can provide objective information to facilitate treatment decision making. However, designing a test to be integrated into healthcare services requires considering multiple design factors.
It is a challenge that goes beyond the gait analysis case study because service design methods commonly focus on the entire service design macro-level.
This study aims to extract design considerations and generate guidelines to integrate MoCap technology for gait analysis in the hospital rehabilitation setting. Specifically, the aim is to design a gait test to assess the response of the applied treatments through pre- and post-measurement sessions.
We focused on patients with spasticity who received botulinum toxin treatment. A qualitative research design was used to investigate the integration of a gait analysis system based on inertial measurement units in a rehabilitation service at a reference hospital.
The extracted design considerations and guidelines increase the applicability and usefulness of the gait analysis technology, improving the link between technologists and healthcare professionals. The proposed methodological approach can also be useful for service design teams that deal with the integration of one service into another. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting Information files. Competing interests: The authors have declared that no competing interests exist. Although we are not conscious of its complexity, gait is a complex activity for human beings.
It requires high motor control, and its pathologies have a harmful effect on personal autonomy and daily life activities [ 1 ]. Clinical gait analysis is especially important in the treatment of hemiparetic individuals after a stroke or other causes , because they experience numerous impairments in walking skills that are reflected in the gait pattern [ 8 ].
In this regard, clinical gait analysis based on MoCap technology can be defined as the instrumented measurement of movement patterns that comprise walking and the associated interpretation of these patterns[ 2 ].
A MoCap instrumentation that is extensively used in biomedical research is optical technology gold standard , which tracks the position of reflective surface markers with infrared cameras. Another instrumentation is technology based on inertial measurement units IMU , which are electronic devices that measure rotations rotation matrices, Euler angles, quaternions, etc. Regarding their differences, optical technology is more accurate than IMU technology, which could present drift errors.
However, it requires a camera infrastructure and sometimes presents shadowing problems [ 14 ]. In contrast, the IMU technology is more economical and portable and has been recently used in wearable technology [ 15 ], which could encourage cloud data processing and information exchange in the context of the Internet of things [ 16 ].
MoCap gait analysis is widely used in clinical research; however, certain factors have prevented the spread of this technology in hospital rehabilitation [ 17 , 18 ]. Nowadays, gait evaluation relies mostly on observational criteria. These systems involve high technical complexity, requiring the application of a strict protocol for accurate and repeatable measurements [ 2 , 19 , 20 ].
The massive amount of information they provide requires complex processing methods [ 8 , 21 , 22 ]. Currently, the professionals involved in this type of analysis must be highly qualified [ 2 ], which conflicts with the present needs for simplicity, usability, and intuitiveness [ 23 ]. Because of the challenges that servitisation poses, it should be added as an additional research objective. Designing an integrated test in the biomedical field is particularly complex because multiple stakeholders have different needs.
Solutions that involve all users patients, doctors, therapists, etc. This includes family members and people close to patients proxies , who are especially affected by the situation that the patient experiences [ 25 , 26 ]. Therefore, we address a problem that goes beyond the development of the technology by investigating how to apply a certain technology gait analysis to a specific context hospital rehabilitation services.
If we assume that the design object is a service and not only the technology that measures movement, the use of specific service design techniques [ 27 , 28 ] will allow us to predict failures, extract critical points, and consider the intangible and contextual part of the product [ 15 ]. These methods are aligned with the patient-centred care PCC philosophy, which is a priority in the healthcare field [ 29 ] and shares its philosophy with human-centred design HCD [ 30 ].
Despite the uncertainty in health services timing, diagnoses, resources per patient, etc. To achieve this, the involvement of users in the design process is key [ 31 ]. However, these methods, although highly flexible, are commonly focused on the entire service design [ 27 , 30 ].
Service design methods and the theoretical basis of service-dominant logic [ 32 ] aim to guide service innovations and are focused on the perspective of the whole company. Wetter et al. Thus, contributions are needed to connect design methods with real situations and problems, producing pragmatic, empirical, and micro-level approaches.
In terms of service design, this situation has particularities and implications that are essential to consider. How can the gait test be included in the hospital as an additional medical test? What additional materials must be designed, developed, or adapted for the gait test? Which professionals will guide it? Is there a lack of certain professionals in the macro-service?
This article qualitatively evaluates a MoCap gait analysis system during its integration in a hospital rehabilitation environment, constructing the research through design methods. We focus on a specific case study of neurological patients with spasticity in the lower limbs who are treated with botulinum toxin.
Thus, we present design considerations and guidelines for the improvement and adaptation of the system, which can be extrapolated to other scenarios at both the service design and hospital environment levels.
In the results section, the guidelines are structured into six main themes. Finally, in the discussion section, we discuss the advantages and benefits that an integrated gait analysis test would introduce in rehabilitation services. A qualitative research design was used to provide design considerations and guidelines to integrate the MoCap technology for gait analysis in a hospital rehabilitation service.
The methodological approach was based on contrasted methodologies from the field of service design, which were materialised through observation techniques during system use , semi-structured interviews, and workshops with healthcare professionals.
The interpretivism paradigm and the qualitative methods are naturally closer than quantitative methods to design practice [RW. According to Blanco et al. The study was conducted in accordance with relevant ethical guidelines, including a verbal explanation and written informed consent from the participants. The first version of the system was implemented in Since then, it has been used in numerous public and private projects both in hospitals healthcare field and companies ergonomics field.
The system has been incorporating the concerns of the professionals involved in the projects engineers, doctors, ergonomists, prevention technicians, etc.
The measurement validity of the MoCap system is largely determined by the accuracy of the sensors it uses. They filter and process the signal internally to directly send the rotation information. The gait test of this study is aimed to be used as a medical test based on pre- and post-measurement sessions for the applied rehabilitation treatments.
These reports can be used to make decisions about the treatments continue treatment, change to another, increase the intensity, etc. In this regard, it should be noted that this study does not focus on the gait report, how it is designed, or what information it contains. Instead, we present a more global perspective of the service design. This service provides rehabilitative assistance to return the highest degree of functional capacity and independence to the patient as possible, favouring family, social, and work reinsertion.
It is organised into areas of hospitalisation, outpatient consultation, and therapy physiotherapy, occupational therapy, hydrotherapy, electrotherapy, and speech therapy. We were focused on evaluating the gait of patients with spasticity when they receive treatment with botulinum toxin. The choice of these patients makes it possible to extrapolate the results to other patients with more favourable physical or cognitive conditions. Spasticity is a symptom that affects a large group of patients after suffering from neurological damage.
Negative effects include pain, decreased mobility, contractures, and muscle spasms, which can interfere with daily life activities and sleep to a greater or lesser degree. The causes are diverse; some of the best-known causes are stroke [ 44 ], multiple sclerosis [ 45 ], post-traumatic brain damage [ 44 ], spinal cord injury [ 46 ], cerebral palsy, amyotrophic lateral sclerosis, and polyradiculitis. The botulinum toxin treatment aims to treat focal spasticity via muscle infiltration with reversible paralytic action after 4 to 6 months [ 44 , 47 , 48 ].
Although there are other possible treatments for spasticity, for this study, the observed efficacy, personalised patient needs dose, muscles to be inoculated, etc. The gait test can aid the doctor in decisions [ 49 ] regarding 1 continuing to apply the treatment, 2 detecting whether the infiltrated muscles are adequate, and 3 maintaining or modifying the dose. Discover, define, design, and develop are the most common phases of service model development [ 28 ], constituting the global structure and philosophy that we follow.
However, in this paper, as claimed in the literature [ 33 ], we delved into the specific methods related to our case study, providing the methodology design, reasoning, and how the specific methods were used and applied. Consistently, we contextualised the study design through a theoretical framework based on methods endorsed by the scientific community.
Our scenario started from an existing gait test based on IMU technology. In this context, we proposed a methodological approach to qualitatively assess three dimensions of the test, which gave rise to our research phases: 1 the user-product proximity effect, 2 the effect on and value in the service, and 3 user interactions.
The theoretical framework of this approach was based on the following contrasted methodologies from the field of service design and HCD which, as we have seen, is related to the PCC philosophy :.
Table 1 shows the construction of the research methodology. Three assessment dimensions phases led to concrete research questions, which were answered with different user profiles participants through observation techniques, semi-structured interviews, and workshops.
Regarding the participants mentioned in Table 1 , the relationship established with the doctors was possibly due to previous meetings in which they showed a shared interest in integrating a gait analysis system into their service. A relationship was established with the patients with the six doctors in Table 1 , who conducted the patient rehabilitation and recruited them face-to-face during the consultation. The interest in improving rehabilitation through gait analysis was communicated to the patients and proxies.
No one refused to participate in the study. The sample size of patients and proxies phase 1 was determined by the concept of saturation , which was defined by Glaser and Strauss [ 50 ] and has been widely used in qualitative research. Saturation has been reached when adding more participants to the study does not generate additional insight or information.
In this way, the measurement sessions were repeated until saturation was reached with 13 patients and 10 proxies. The sample size of doctors was six Phases 1, 2, and 3 , which corresponds to the number of physicians involved in the analysed rehabilitation service and the applied treatment.
In the following sections, each phase of the methodology is explained in depth, including the specific research objectives, participants, and study design. Phase 1 aims to learn from observing the use of the MoCap system in its context. The strategy in this step was to perform the gait test in the rehabilitation service, carrying out an observation focused on understanding the effect on the involved actors patients, proxies, and professionals.
The first test was performed a few minutes before receiving the botulinum toxin treatment, and a follow-up was performed a month later. The patients had been diagnosed by the rehabilitation service of the hospital in the evaluation consultation and were selected for the study by meeting the following inclusion criteria:.
Proxies were recruited through the snowball method because they were dependent on the patient section. Doctors were also purposively sampled because they represented different profiles two heads, three specialists, and a resident doctor. In each measurement session, the patients were instrumented with the MoCap sensors Fig 2 and walked naturally 6 m in a straight line at a self-selected speed. When the distance was completed, the patient turned around and walked back in the opposite direction.
This operation was repeated to measure up to 25 strides.
E-book download Clinical Gait Analysis: Theory and Practice TXT,PDF,EPUB
Validity and intra- and inter-rater reliability of the Observational Gait Scale for children with spastic cerebral palsy. Quantitative gait analysis systems provide accurate information, but the high cost of these instruments makes observational analysis more affordable to clinical practice. To establish criterion validity and the intra- and inter-rater reliability, the observational data were compared with motion analysis data, between the two sessions and between the raters. The weighted kappa test was applied to analyze the concordance between the evaluations. New observational strategies are needed to improve the psychometric properties of the items relating to the hip and pelvis.
Request PDF | On Mar 31, , Andrew King published Chris Kirtley, Clinical Gait Analysis: Theory and Practice, Churchill Livingstone () pages.
EBOOK [P.D.F] Clinical Gait Analysis: Theory and Practice TXT,PDF,EPUB
Clinical Gait Analysis takes a fresh look at the study of human gait. Using an easy-to-read writing style, the author reviews the biomechanical principles, techniques and clinical approach to the assessment of walking disorders. Both theory and practice are brought into focus, and currently contentious issues are highlighted to encourage critical thinking. An accompanying CD provides an assortment of electronic material to complement the text, including normative 3D data on a variety of activities and clinical cases.
Gait analysis is the systematic study of human walking, using the eye and brain of experienced observers, augmented by instrumentation for measuring body movements, body mechanics, and the activity of the muscles. Forensic Gait Analysis details the more recent, and rapidly developing, use of gait analysis in the forensic sciences. The book considers the use of observational gait analysis, based on video recordings, to assist in the process of identification or exclusion.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without either the prior permission of the publishers or a licence permitting restricted copying in the United Kingdom issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1T 4LP. Notice Knowledge and best practice in this field are constantly changing. As new research and experience broaden our knowledge, changes in practice, treatment and drug therapy may become necessary or appropriate.
Да. К счастью, Дэвид это обнаружил. Он проявил редкую наблюдательность. - Но ведь вы ищете ключ к шифру, а не ювелирное изделие.
Что-то сказанное панком не давало ему покоя. Я прихожу сюда каждый вечер.