Gait affects more than just a patient’s legs. Over time, improper gait can add strain to multiple parts of the body and even cause injuries. Physical therapists can use different types of gait analysis to evaluate pain, discomfort, and abnormal movements a patient experiences while walking, running, or standing.
Although gait plays a role in how all humans move and walk, gait issues mostly affect athletes, surgery patients, and the elderly, who are more susceptible to injury. PTs can use gait analysis to pinpoint specific problem areas that cause pain or dysfunction, then create a treatment plan that addresses their patient’s issues. For instance, PTs commonly implement a gait training program based on a patient’s gait analysis to improve balance, range of motion, flexibility, and strength.
By using modern tools and methodologies, PTs can better evaluate their patients’ gait patterns to diagnose injuries and other issues. Physical therapy clinics must choose what types of gait analysis to offer based on factors such as accuracy, cost, and difficulty of use.
Observational gait analysis
Observational gait analysis is a physical therapist’s primary clinical tool for evaluating a patient’s gait. An observational gait analysis usually begins with a physical examination, followed by a visual evaluation of how the patient walks, runs, stands, and moves.
By performing an observational gait analysis, PTs can quickly understand their patients’ gait patterns and detect any major abnormalities. Other types of gait analysis require specialized equipment, but an observational analysis can be performed using live observation or video footage of a patient walking. Sometimes a PT will use a checklist to take note of areas of pain, possible asymmetry, and other issues. Then they can compare their notes to a video recording of the patient’s gait to complete their assessment.
Because it is limited to a visual assessment, an observational gait analysis provides little information about the causes of a patient’s pain, dysfunction, or unusual movement patterns. However, performing an observational gait analysis enables PTs to establish a baseline of a patient’s typical gait pattern and narrow the focus of future assessments.
Video technology
PTs often use tools like video and computer software to support their evaluations. Videotaped observational gait analysis (VOGA) is a practical, affordable technique that enables more reliable assessments without the high cost of specialized equipment.
By recording a gait analysis on video, PTs can thoroughly evaluate their patient’s gait without tiring them out with repeated exercises. Augmenting an observational gait analysis with video is particularly useful for examining athletes, who typically experience more complicated gait problems than the average person.
Like any observational gait analysis, an assessment’s quality largely depends on a PT’s level of clinical experience. However, useful features like slow-motion replay and freeze-frame can help provide more precise information about a patient’s movements. In some applications, PTs use software to analyze the video footage and identify unusual movements.
Pros:
- Requires no specialized equipment
- Can be performed in almost any environment
- Costs less than instrumented gait analysis
Cons:
- Provides less accurate data about gait
- Limits assessment to external observation
- Depends on the individual PT’s expertise
Kinematics
Although observing how a patient walks can tell PTs a lot about their gait pattern, they need other types of gait analysis to complete the picture. Kinematics is a form of instrumented gait analysis that assesses how joints move without considering the external forces that affect them. In a clinical setting, kinematic data provides a mathematical analysis of the movement of a patient’s joints across the sagittal, horizontal, and frontal planes. By recording a patient’s range of motion throughout the gait cycle, PTs can determine the possible underlying causes for changes in motion.
However, kinematic data cannot be obtained through mere observation, so PTs must use specialized equipment to collect these measurements. The most commonly used tools in kinematic gait analysis are wearable sensors, which are placed on specific areas of a patient’s body, like the feet or hips. PTs can then closely monitor muscle movement to better understand the range, speed, and direction of the patient’s movements.
Because there is a tendency to focus too much on the sagittal plane during observational gait analysis, PTs rely on instrumented types of gait analysis to evaluate multiple areas of the body at once. Kinematic measurements are often recorded in three dimensions to create a more realistic representation of a patient’s gait, such as a 3D model of the sagittal and frontal planes.
Pros:
- Provides a more holistic gait analysis
- Enables 3D reconstruction of a patient’s gait
Cons:
- Requires specialized equipment
- Must be performed in a laboratory setting
Electrogoniometry
An electrogoniometer measures joint angles to assess the flexibility and mobility of a joint during dynamic functional activities. Although clinicians often use a traditional goniometer to measure joint angles, an electrogoniometer provides higher-resolution measurements with little variation to improve the reliability and accuracy of kinematic data.
3D motion capture
Thanks to recent advancements in technology, PTs can quantitatively measure kinematic data and recreate a patient’s gait in 3D. Three-dimensional motion capture typically falls into one of two categories: marker-based or markerless motion capture.
In marker-based motion capture, a PT will place markers on a patient’s feet and legs. The marker-based motion capture system then detects the position of these landmarks on the body and reconstructs their 3D trajectories to improve the accuracy of a gait analysis. In a markerless motion capture system, multiple cameras view a patient from all angles while deep learning algorithms reconstruct a patient’s gait in 3D. Compared to a marker-based technique, markerless gait analysis does not require a patient to wear heavy devices that can cause physical discomfort or distort their normal gait pattern.
