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Sigal Portnoy and Isabella Schwartz

Department of Rehabilitation, Hadassah Hospital, Jerusalem

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Traumatic patients or patients with neurological pathologies:

•

Post stroke• Cerebral palsy 

• Poliomeyalities

• Multiple sclerosis

• Amputations

• Traumatic brain injury 

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Gait disorders take many forms.Simple observation is sometimes insufficient fordiagnosing the cause.Is the impairment caused by a spastic muscle or doesmuscle weakness compels compensation to occur?

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Complications:

•Energy consuming

•Extensive pressure on the joints

•May cause atrophy on the paretic side

•Risk of falling

•Unaesthetic

Polio-related muscle atrophy 

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Baclofen pump

Patient with motor impairments are often treated with walking-aids,orthotics/prosthetics and given physiotherapy sessions.

The physician may administer muscle/nerve injections, baclofen pump orcorrective surgery to enhance motor capabilities.

Botulinum injection

Corrective surgery 

Muscle strengthening

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The goals of the new Gait and Motion

Laboratory at Hadassah Hospital are:

To design, develop and validate new tools, in bothhardware and software, that will generate precise

quantitative data, assist in patient evaluation andpatient physiotherapy sessions, in the clinic or home.

To utilize the developed tools in daily  patient’

evaluations, monitor of the patient’s progress andperform assessments of the effectiveness and efficacy of different treatments.

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Temporal parameters

Spatial parameters

Symmetry index (0=symmetry; 200=asymmetry)

MS patients Normal

 Velocity [m/s] 0.37±0.2 0.81±0.4

Cadence[steps/min]

65.9±27.1 86.9±34.3

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The presence of spastic muscles, e.g. the

ankle plantar flexors or the quadriceps, incombination with hamstrings weakness,causes knee hyperextension.

This gait disorder causes asymmetrical gait

and can be painful as a result of stress to theligaments and tendons at the back of the knee(Bleyenheuft et al, 2010).

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A classical 3-point principalsupport created with inelastic straps

and lockable splints.

The hinges permit restriction of extension and flexion in 10° intervals.

PCM® (Phase Change Material), a

temperature regulating material thatprevents heat build up.

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Complete physical evaluation:• ROM•

Muscle tonus

Gait analysis:• Spatio-temporal

parameters

• Sagittal knee angle inthe paretic knee

Dynamic EMG

Functional evaluation:• Six-Minute Walk Test• 10m walk test• Timed-up-and-go test• Berg balance scale

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• Transcranial magnetic stimulation (TMS) is a noninvasive technique which appliesbrief magnetic pulses to the brain via high currents passed through an

electromagnetic coil.

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• Standard TMS coils are limited to activation of 

only cortical brain regions (depth <1.5cm)

• The deep TMS system (Brainsway Ltd.) enablesactivationof deep brain structures.

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• This study will determine the effect of deep TMS onrehabilitationoutcomes of acute ischemic stroke patients.

• Methods: 40 patientswho have had an acute stroke.

• Study/control group will receive 7 sessions (15 min) of deep TMS/shamtreatments delivered over the motor strip of the affected hemisphere.

• The evaluations will include functional motorassessment (FAC), neurological status (NIHSS),

 ADL functions (FIM), and dynamic EMG andmotion analysis .

• Evaluations will be conducted 30 and 90 daysafter treatmentconclusion.

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• Motion analysis is an important tool that is used to understand thecomplexities of movement.

• Such a detailed description of function has been valuable fordetermining both non-operative and operative managementguidelines for individuals with abnormal gait patterns.

•The new Hadassah gait and motion laboratory is currently equipped with the state-of-the-art motion capture and telemetric EMG device.

• With both clinical practice and research underway, we aim to design,develop and validate new tools that will generate precise quantitativedata, assist in patient evaluation and patient physiotherapy sessions.

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