Post on 14-Feb-2018
transcript
7/23/2019 Gait and Foot Pressure-Aaron Tracy
1/22
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
7/23/2019 Gait and Foot Pressure-Aaron Tracy
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
7/23/2019 Gait and Foot Pressure-Aaron Tracy
3/22
OverviewOverview
Gait valuationGait valuation
!erebral Palsy!erebral Palsy
"hat are #e loo$in% at&"hat are #e loo$in% at&ImportanceImportance
7/23/2019 Gait and Foot Pressure-Aaron Tracy
4/22
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
7/23/2019 Gait and Foot Pressure-Aaron Tracy
5/22
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
7/23/2019 Gait and Foot Pressure-Aaron Tracy
6/22
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
7/23/2019 Gait and Foot Pressure-Aaron Tracy
7/22
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
7/23/2019 Gait and Foot Pressure-Aaron Tracy
8/22
!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
7/23/2019 Gait and Foot Pressure-Aaron Tracy
9/22
%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
7/23/2019 Gait and Foot Pressure-Aaron Tracy
10/22
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
7/23/2019 Gait and Foot Pressure-Aaron Tracy
11/22
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
7/23/2019 Gait and Foot Pressure-Aaron Tracy
12/22
'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
7/23/2019 Gait and Foot Pressure-Aaron Tracy
13/22
'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%
7/23/2019 Gait and Foot Pressure-Aaron Tracy
14/22
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
7/23/2019 Gait and Foot Pressure-Aaron Tracy
15/22
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
7/23/2019 Gait and Foot Pressure-Aaron Tracy
16/22
GMFC% %caleGMFC% %cale
https
7/23/2019 Gait and Foot Pressure-Aaron Tracy
17/22
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
7/23/2019 Gait and Foot Pressure-Aaron Tracy
18/22
FM% %caleFM% %cale
http
7/23/2019 Gait and Foot Pressure-Aaron Tracy
19/22
)ebris Tread&ill)ebris Tread&ill
+i)eo courtesy of ###.1ebris.)e+i)eo courtesy of ###.1ebris.)e
7/23/2019 Gait and Foot Pressure-Aaron Tracy
20/22
!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)
7/23/2019 Gait and Foot Pressure-Aaron Tracy
21/22
+&*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
7/23/2019 Gait and Foot Pressure-Aaron Tracy
22/22
,E%T+O.%((,E%T+O.%((