Diagnostic gait analysis use in the treatment protocol for cerebral palsy

Abstract

Gait analysis is the detailed examination of precisely measured human motion to better understand the pattern and the mechanisms producing the specific gait pattern. Its history closely parallels the development of computer power which also allowed other medical imaging techniques such as magnetic resonance imaging (MRI) to become useful diagnostic tools. Gait analysis is a very useful tool that is used in carefully planned IRB approved research studies to analyze the pathology of different gait patterns and to develop an understanding of how these respond to planned interventions such as bracing, therapy, or surgery. Gait analysis is also a useful diagnostic tool to be applied to an individual patient with the goal of measuring the patients' unique and particular gait to generate a more informed prescription for a treatment plan to improve the tested individual's gait function. Regardless, if the gait analysis is being done for research or diagnostic purposes, the analysis should be done in a well-defined medical facility with medical grade quality control to assure the validity of the testing. The results of this testing should be interpreted by a team of experts of the disease process being studied. The basic diagnostic clinical gait laboratory doing diagnostic testing on the gait of children with ambulatory cerebral palsy should include as a minimum a motion capture system that allows measuring threedimensional kinematics, that is synchronized with a dynamic electromyography (EMG) system, and force plate to measure the ground reaction force. A pedobarograph system to assess foot posture, a system to perform indirect calorimetry to measure the energy cost of walking, and a community activity monitoring system are other components of the laboratory that can provide diagnostically useful information. For children with ambulatory cerebral palsy,the complexity of the gait assessment usually means this is carried out in a tertiary care center with high volume experience in managing these problems.