SUMMARY
In this chapter we have attempted to provide an overview of the methods, procedures, and strategy for utilizing instrumented movement analysis to assist with the clinical interpretation of gait deformity in children.
Focusing on the functional subdivisions that naturally occur during normal walking, and identifying the specific critical events that must be accomplished in each phase of gait, we have developed a framework that can be used for both instrumented and observational gait analysis and that can be applied to children and adults. By providing a brief description of modern computerized systems for movement analysis and linking measurements from these systems to functional tasks and critical events, we hope that instrumented gait analysis will be less intimidating and more clinically relevant to the pediatric physiatrist. Controversy remains regarding the value of IGA and its place on the modern rehabilitation service, with staunch advocates (8,10,35,52,53) and ardent detractors alike (54,55). It is our hope that armed with a solid background in the principles of gait analysis and an objective and impartial understanding of the benefits and limitations of current methodologies (56), every pediatric physiat- rist can make the best clinical choices for the complex neuromuscular patients who rely on their decisions.PEARLS, PERILS, AND RESOURCES
■ Instrumented gait analysis (IGA) supports decision making for the child with walking problems, but doesn't replace a sound clinical and technical understanding of normal gait.
■ Normal gait is naturally cyclical and symmetric, so any movement asymmetry should be investigated.
■ There are 13 critical events that must occur during 8 distinct phases of the gait cycle to produce a normal gait pattern. Each critical event has functional significance, and so provides a link between observed gait abnormalities and possible interventions.
■ IGA provides evidence of absent, altered, or delayed critical events, and provides the framework for identifying treatments to directly address these functional limitations.
■ While skill, experience, and practice are required to fully utilize IGA results for clinical interpretation, by following the strategy outlined in this chapter, the process can be less intimidating and more clinically relevant to the pediatric physiatrist.
Resources
Gage JR. The Treatment of Gait Problems in Cerebral Palsy. London: Mac Keith Press;2004.
Inman VT, Ralston HJ, Todd F. Human Walking. Baltimore: Lippincott Williams & Wilkins;1981.
Kirtley C. Clinical Gait Analysis, Theory and Practice. Philadelphia: Churchill Livingstone-Elsevier;2006.
Perry J. Gait Analysis: Normal and Pathological Function. Thorofare, NJ: Slack, Inc.;1992.
Sutherland D. Gait Disorders in Childhood and Adolescence. Baltimore: Lippincott Williams & Wilkins;1984.
Acknowledgments
The authors wish to gratefully acknowledge Laura Borgstede, MS; Nancy Denniston, MS, MA; and the staff of the Center for Gait and Movement Analysis (CGMA) at The Children's Hospital, Denver, for their tireless assistance in preparing this manuscript.
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