Hi, I'm Tracy.
And I'm Will. And in this lecture series,
we're going to be covering observational gait analysis. Um, so first of all,
we're going to be discussing it,
talking about the why and the how as well as some advantages and some
disadvantages of it.
And then we're going to go into the next series after a lecture after that is
going to be a systematic approach to performing an observational data analysis.
Um, as part of this lecture series, you are going to need this form.
This is the JAKC observational gait analysis form.
You can find this either on our website with this lecture series,
or if you're watching this on YouTube in the description below,
we certainly would love for you to reach out to us with any comments or
questions again, you can put those down in the comment section below.
Let's dive in! Any
good lecture needs to start off with definitions.
So that's what we're going to dive into now. Uh,
so observational gait analysis is basically the observation of a patient's gait
with the intent to identify specific deviations from a normal gait pattern.
And for this it's really important that you do understand what a normal gait
pattern looks like. If you've got a good concept of that,
basically the deviations are going to stick out to you very strongly cause
you'll know what to expect as far as the range of motion,
if a particular phase is missing, et cetera.
So if you haven't reviewed gait in a while, um,
we certainly recommend that you would check that out, um,
before diving any deeper into this lecture series. Um,
the other thing that as you get from an observational gait analysis is that
these deviations that we observe are going to help to assist, uh,
in pinpointing different impairments or functional deficits that a patient may
be experiencing.
And now observational gait analysis does cover a wide range of applications.
So from video to different photos or using like apps on people's
phones as well. Um, but for this lecture,
we're particularly going to talk about what we would refer to as the clinicians'
eye or basically your direct observation of the patient and different
things that you can write down or note from,
from your patients' gait that you see. So,
observational gait analysis. Um, there's a lot of pros to it,
but unfortunately there are also a lot of cons. Um,
so we'll just dive into those little bit here.
So for observational gain analysis, it's so easy to perform...
Anywhere. Like I do it in the airport.
Like I will watch people walk while I'm waiting for flights.
Like you can literally observe people's gait anywhere.
Yes, it is so easy. There's almost no excuse not to do it because literally,
like you said, you can do it anywhere and you can do it on any surface.
You can do it indoors, you could do it outdoors. You don't need any equipment.
And honestly it doesn't even take that much space to do it. Um,
so this could honestly be easily done from taking your patient from the waiting
room back to the treatment area.
Totally.
So there's almost no excuse not to use this in your treatment. Um,
unfortunately there's a lot of cons that go with this as well. Um, first of all,
being that it's a primarily qualitative measure.
So we don't get a score from this. Like we don't say, Oh,
we got a score of 40 on their gait. Like that doesn't make any sense.
We don't have that aspect of it. Um,
unfortunately the research hasn't really gotten away to be able to make that
happen. And so really the current evidence for observational gait analysis is
unfortunately quite poor. Um, the other thing is it's also transitory,
so there's no permanent record other than like,
if I were performing an analysis,
what I happened to write down at that given point in time. So, you know,
a patient may be presenting with an impairment, but if I didn't write it down,
then there's no record of that,
that we can go and reference where other measures can do that.
So the only thing is,
is that when we start to look at reliability and validity...
Hold on, can we,
let's just review those terms one more time just to make sure we're all on the
same page with those terms that we've heard before, but it's always good to, uh,
to refresh our memories on.
Absolutely. So reliability is basically the ability to perform a test basically,
and then repeat that test and get the same result.
So when we look at like inter-rator, for example, reliability, um,
that's between, like, let's say you, the viewer and ourselves, um,
if we had perfect reliability, then these values that you see here, um,
a perfect reliability would actually be one, whereas horrible,
like absolutely zero reliability is zero. So when we look at here,
interrater reliability is about half of perfect.
So what that actually says is about half the time,
if you and I were doing the same exact test on the same exact person,
we would actually disagree about half the time on what we actually saw.
Now it gets really,
really bad when you actually look at the intra-rater reliability.
So intra-rater reliability is the ability for myself to do a test.
And then to repeat that test again with myself and the same person,
and basically the score of that is the intra-rater reliability.
So for observational gait analysis,
a little less than half the time, I will actually disagree with myself.
That's bad. It's really bad.
That's pretty much one of the worst research elements I think you could have.
That hurts.
So now when we get into validity,
so validity is basically the ability of a tool to measure what it's supposed to
actually be measuring. So here, when we look at this value, we see again,
it's a little around half, maybe about a little more than that.
So from a research standpoint, we would say that this is a modest validity.
So it kind of measures what it's supposed to be measuring.
Not exactly great for what you want to be doing to say like, Oh yeah,
observational gait analysis. Is the end all be off.
So like, Will, why then do we do this?
No, that is a good question.
So why, why did we do this? That wasn't great. Uh,
great news on the evidence behind it, but think about it provides you,
it allows you to kind of complete this clinical picture of your patient when you
combine it with a subjective history,
which includes the patient's history and the etiology behind the complaint,
maybe their past medical history and their comorbidities and their goals.
And then you add in your objective measures, your range of motions,
your strength, your sensation testing,
and then you even do some outcome measures, right? You test their Berg,
the Berg balance score, or their gait speed on a 10 meter walk test.
Then you step back and you look at them walk and you take this kind of global
picture of them. Great.
Now you've got kind of the whole picture of that patient and, um,
and really provides a lot of, um, context to that patient. Right?
So if you combine all of that and you don't just look at their gait,
you don't just look at their range of motion.
Now you've got a full picture of what that patient looks like.
So you're saying observational gait analysis is like a gateway
into looking at your patients?
Fool. It hurts me to say yes,
yes. The dad jokes have arrived. Good, good, good. Oh, well,
you've been warned. Um,
also the nice thing about this is that you can identify specific gait
impairments with this, right?
You can have your patient walk statically on kind of a, a level surface,
but you can also change it up.
You can have them walk on an unlevel surface at different speeds.
You can ask them to do some coordination drills with that,
with turning or holding something in their hands.
And then you can even slow it down and really look at like the motor control
behind the patient. Um,
and then finally it gives you kind of really great potential intervention
strategies, right?
If I look at a patient and I see that they're having trouble accepting weight
during loading response,
that's gonna cue me in not only to make sure that I've tested maybe their quad
strength in my objective measures,
but also I'm thinking about my treatment strategies, you know,
probably going to look at some quad strengthening under load.
Yeah. It's a really great functional look into what the patient's doing,
even outside of what you can be able to document for an evaluation.
It's a great picture of the patient that you happen to be seeing.
And it's so functional because so many people come to our clinic and say that
they have trouble walking and they don't say,
I think I only have four minus out of five strength in my quad.
That doesn't happen. You'll never hear that.
Thank goodness though. Thank goodness. Yeah, we were functional weight.
Like walking is a big part of what we do. So next up,
we're going to be talking about and dive in a little bit into the next lecture,
are gait analysis forms. Uh,
so unfortunately the research that is out there is using these forms.
So they're not great as far as clinical practice and the strengthening, uh,
really the reliability and validity of what you do. Um,
but they're great ways to teach you how to do an analysis and to come at it with
a systematic approach.
And so that's why we offer this and why we're going to include this as part of
our series here. Um,
the nice thing about these is that they do give you a list of the deviations or
big things that you should be on the lookout for. Um, not all inclusive,
but at least a good starting point.
They also organize that information in terms of anatomical parts of the
body. So like, you know,
this is a particular example that might happen at a knee versus a hip.
And then also organize the information in terms of which phase or task of gait
that deviation is happening also. Um, so great tools to be, to be working with,
especially as you're really learning and getting more acquainted with
observational gait analysis. So next step,
we're going to dive into a couple of gait analysis tips.
The first one that we'd like to start off with is to prepare the patient.
So this is ensuring that you've got the best visibility of all of their joints
and what we mean by that is basically if they were coming in, like,
let's say they had like a really heavy jacket or sweater and you couldn't really
see what the trunk was doing. Maybe you might have them take that off. If,
if able, or even more importantly,
let's say they had really baggy pants and you couldn't see like what the knee or
the thigh was doing during their gait cycle. Well,
you might want them to have them roll them up past the knee so you can get a
good understanding of what's actually happening in the leg.
During the walking cycle.
This could really even start kind of at the front desk, you know,
them saying that they're coming in for knee pain, you know,
you can help educate your front desk (staff) to say, when you come,
could you bring a pair of shorts so that then we can really take a look at it.
Absolutely other things that we also recommend are actually removing against
safely, uh, assistive devices or orthotics.
So one of the things, that sounds kind of weird to say, actually, um,
but what that allows you to do is if you can do it safely,
it gives you a better picture of what the patient actually is capable of.
And what's actually going on with their body.
Assistive devices and orthotics do have an active role in what's happening in an
individual's gait cycle.
So sometimes if you have those things on top or they're wearing those things or
utilizing those things,
it can sometimes cloud what's happening with the patient when you're performing
your analysis.
So you're saying barefoot is best.
Yeah. Barefoot's best. Absolutely. So next then you,
you jump into your global assessment. This is that time,
especially when you first see the patient that you're performing this kind of
overall look at what's happening with the individual.
So this is a time to look at, you know, how fast are they walking?
Are they walking slow or are they unstable? How's their step length looking,
or what kind of support are they using and any other big global deviations that
you might happen to notice. Um, we're not getting too specific here,
but this is just kind of like your overall, um, look,
to be able to kind of guide where you're going to go next with things. Next up,
we're going to dive into the specific assessment.
So this is where you're actually going to take a more systematic approach where
you're going to start, for example, from the toes and the feet,
and then work your way step-wise up the body.
So going from the ankle to the knees, the hip and so on, so forth,
this is also your opportunity to look at the patient from multiple angles too.
So we highly recommend checking the patient's gait from both the lateral view,
as well as an anterior posterior view as well. Um,
not all deviations can be seen from just one of these angles.
So you got to make sure that you're getting up,
you're walking around the patient and you're really seeing what's going on from
those different angles. Next step is to select your reference limb.
And for this...
Not an arm... Don't select an arm. A reference
leg.
Really starting with with the leg, so for example,
if a patient comes in and they have an orthopedic issue,
let's say knee pain and you know,
we're looking at their or performing a data analysis on them, you know,
probably the person's painful side is going to be our reference side or the side
that we're going to be most interested in.
It's not saying that we're not looking at the other side,
but we want to kind of have that as a primary interest point.
And that's kind of our starting point for our assessment.
It's very easy to jump between the two limbs. And often we have seen that,
that gets a lot of information gets lost if that's what happens.
Yeah.
I will say even just that moment of like selecting the left versus the right
limb, like slows me down and calms me down,
especially when I have a patient coming in with a very kind of abnormal gait
pattern. That's a little bit overwhelming even just saying,
I'm just going to look at the right side right now,
calms me down and gives me a little bit of structure.
And so for people who do have bilateral involvement,
obviously you do want to look at both sides, but start off with one side,
make sure to complete the analysis there and then perform a separate analysis
for that opposite side.
Next up is you want to review the form and you want to kind of strategize or
plan out what you're going to do with the patient.
So before if we happen to be doing like a case study,
or if you happen to be seeing a patient and you're going to use the form,
you actually want to make sure that you're looking over it kind of re
familiarized yourself with it. Even if you use it pretty often.
It's a good thing to go,
just check back and make sure that you know exactly how you want to approach the
form,
whether that be from like the top down or from the bottom up or different phases
of gait that you want to look at first, all of these things,
you kind of want to have a good sense of how you're going to approach it before
you start. The other thing is that, um, for example,
if a patient needs a rest break in between looking
at their gait, um,
that also gives you an opportunity to see what you've completed so far and where
you want to go in the analysis after that.
And then finally for the last thing is, do you want to actually mark the form?
So here in this particular form that we're going to be using is just a check
box, so super easy. Um, but of course, if you see anything else,
something that might not be on the form because the form is again,
not all inclusive. Um, you want to make those notes as well.
Anything that you can document and is based on what you're seeing in the patient
is going to help to strengthen your analysis and give you more information, um,
to be able to compare to later and to get a better overall picture for the
patient. So in the next lecture,
what we're going to be covering again is this JAKC observational gait analysis
form. Uh, it's a great little form then again,
add some focus and guidance to the analysis. And again,
it's super simple checkbox format in order to perform that.
So take a break.
We'll see you in the next lecture where we kind of dive in a little bit deeper
into a, into JAKC's observational gait form.