Clinical Gait Analysis and Its Role in Treatment Decision-Making

IV. An Opportunity to Learn from Documented Treatment Outcome

In many centers, a routine part of clinical gait analysis is to re-evaluate each preoperative patient about a year after surgery. At this time, the preoperative test procedures are repeated so that comparisons can be made. The clinician becomes more aware of the specific outcomes related to the patient and can begin to understand the complex relationships between primary, secondary and compensatory gait abnormalities. The wealth of knowledge that has accumulated over time using this systematic approach for the treatment of gait abnormalities in cerebral palsy is phenomenal (as evidenced by the body of literature cited below).

This systematic approach also has other benefits. The quantitative nature of gait analysis facilitates prospective clinical research and the development of a large database of pre- and postoperative analyses facilitates retrospective research. Routinely doing postoperative gait analyses will allow the systematic evaluation of the effects of surgery on specific populations, or the outcomes of specific procedures. This has led to many beneficial changes in the approach to surgical treatment in the patient with cerebral palsy. The approach allows an increased understanding of the ramifications of certain procedures, such as gastrocnemius lengthening,^[15] and the surgical treatment of equinovarus foot deformities.^[16] Gait analysis techniques have resulted in the development of the rectus femoris transfer,^[17,18,19] an understanding of the difference in effectiveness of the rectus femoris transfer as compared with the rectus femoris release,^[20] and an appreciation of the significance of the location of distal rectus transfer site.^[21] It has also led clinicians away from specific procedures, such as the hip adductor transfer.^[22] Another benefit of routinely implementing gait analysis, is that it provides a means to directly assess the effects of similar procedures -- such as the medial hamstring versus medial and lateral hamstring lengthening^[23] and hamstring lengthening with^[18] or without a simultaneous rectus femoris procedure^[24] --on functional outcome.

Cite this: Clinical Gait Analysis and Its Role in Treatment Decision-Making - Medscape - Sep 01, 1999.

Table 1. Summary of Ankle Dorsiflexion in the Clinical Examination of Patients 1, 2 and 3
Patient	Knee Position	Side	Passive Motion	Dorsiflexion Strength
1	fully extended	left	0°	2 out of 5
1	flexed to 90°	left	5°	2 out of 5
2	fully extended	left	5°	2 out of 5
2	flexed to 90°	left	10°	2 out of 5
3	fully extended	left	0°	1 out of 5
3	flexed to 90°	left	10°	1 out of 5

Table 2. EMG Pattern of Activity in Three Patients to Determine Tibialis Posterior and Tibialis Anterior Function
Patient	Muscle	Pattern of Activity
1	tibialis posterior	active in terminal swing with variable activity in stance
1	tibialis anterior	active in late stance, at toe off and in initial swing
2	tibialis posterior	negligible activity
2	tibialis anterior	active in late stance, at toe off and in initial swing with variable activity in late swing and from initial contact through mid-to-late stance
3	tibialis posterior	continuous activity in swing through mid-to-late stance depending on the gait cycle
3	tibialis anterior	variable premature activity of a late stance burst and normal activity in swing and prolonged activity through mid stance

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Clinical Gait Analysis and Its Role in Treatment Decision-Making

IV. An Opportunity to Learn from Documented Treatment Outcome

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