Hi, I'm Will..
And I'm Tracy. And for this lecture,
we are going to be going into some detail into this form.
This is the JAKC's observational gait analysis form. So for this lecture,
go ahead and print off the form so you can follow along as Will takes you
through some detailed descriptions of the different things on this form.
So the JAKC observational gait analysis form comes from this book here,
"Observational Gait Analysis: A Visual Guide".
And if you're wondering what the JAKC stands for,
it's literally the author's initials. So they were really original in that one.
So, uh, this is really a great little tool,
and this is probably my favorite gait analysis form that I have seen. Um,
one of the things, first of all, it's not bad to look at.
We've got a lot of color here,
which a lot of the other forms are definitely lacking. Um,
but that color has a lot of functionality. So for this one,
we see like this blue here, if you go to the top,
like it says weight acceptance, or the yellow single limb support,
red is swing limit advancement.
All of these things kind of give you a little bit of clue in about what's
happening at that particular point in time.
So this is very focused on really the three tasks of gait,
and that comes from Jacquelin Perry's gait analysis book. Um, side note,
that book is Tracy's coffee table book.
She's amazing guys. She's amazing. She's the gait god...dess. Goddess?
She's, she's fantastic.
But those three tasks that this form goes into are really,
they're the functional part of gait that you really do want to hone in on
because that's what probably your patient's complaining about the most.
So the other thing about this is that it is a simple checkbox format,
so it's super easy to go through. It's easy to read through. Um,
and so it just has a lot of clinical utility as well as being a great training
tool. So let's go into this a little bit further. So here we're looking at the,
at the top of kind of the header of this form.
So here we see that we've got the different illustrations of all of the
different phases here. And again,
these are the eight phases as defined by Rancho Los Amigos.
So this is initial contact, loading response, mid stance,
terminal stance, pre swing, initial swing, mid swing,
and terminal swing. So one of the things I really love about this,
particularly when you get into the three tasks of gait is for example,
often when you look at, when people think about stance versus swing,
they think of pre swing as being part of stance still.
But the way that this form organized it is actually pre swing is a part of swing
limit advancement. So again, this,
this form is really starting to kind of cue you into more of the functional
aspects of what you should be looking at. Um, so let's,
we're going to dive in now into the ankle. All right.
So as we get here to the ankle and as we go through the different joints, um,
we're not going to be covering all of the different things,
but kind of the big ones that think usually have tend to have the most
misconception or I think are the things that you need to be able to see.
So as we go through these ones that we're going to highlight,
we're also going to have short little video clips as we talk through these too.
Um, so let's go ahead and get into here.
So when we look at the ankle in initial contact,
there's three main ways that we can get that initial contact to occur. Um,
one is a fore foot contact.
So this is where as the foot hits the ground and the toes are actually the first
thing to make contact with the ground, a flat foot contact,
which is where the toes and the heel actually hit at the same exact time.
So the whole flat part of the foot hits the ground, um, uniformly.
And then finally is abbreviated heel contact.
So this is where the heel is the first thing to make contact with the floor.
But traditionally, this is also kind of paired with the one below it,
the inadequate dorsiflexion.
So the toes actually aren't very high off of the ground. So it's very,
basically the toes are almost immediately on the ground after the heel makes
contact. Now jumping over to loading response,
we have foot slap was an extremely common thing to see...
And hear...
And hear, yes,
it is probably one of the most audible things of all of us here. Um,
so foot slap is extremely common.
It's one of those things that you're definitely going to be able to hear and
see. Um,
and then also in that same exact phase is you could potentially see inadequate
dorsiflexion as well, and we'll show a clip of that.
So getting now to just the single limb support task, uh,
the biggest thing here that we like to note is excessive dorsiflexion.
So this is kind of common.
It happens with a couple of other things that we'll be seeing in here as well.
And as we go now into the swing limit advancement, um,
the big one here that we like to talk about is the contralateral vault.
So contralateral vault is kind of a weird one to observe in here. Um,
but basically what happens is the contralateral side. So not the side,
that you're actually looking at,
but the side opposite of that actually goes into plantarflexion and kind of the
person rises up on their toes and they raise their whole body up into the air.
And what that does, it allows our reference limb, the one that we're looking at,
to actually clear the ground. So for example,
if they have inadequate dorsiflexion, like the one, the one that's above it,
and they're not clearing the ground very well,
occasionally they may actually go up on the toes of the other side or perform a
contralateral vault in order to clear the foot.
So the, the, the deviation is then, uh, the decrease in dorsiflexion,
but you're seeing that on the other side with the contralateral vault. Okay.
Yep.
So now as we go into the calcaneus and the toes, um, here,
obviously we got the excess inversion and eversion that can happen really
throughout the whole entire cycle. Um, inversion's really only seen, uh,
alone is seen in the swing phase. Um,
the biggest place we do see that though is for the inversion or eversion is
mostly in single limb support where you've actually placed the weight of the
body. Um, this is where you're going to note it.
And really has the most clinical significance as well. Um,
other things obviously like this is,
these would be things for the toes that you would have to have their shoe off.
So if you don't have the shoe off, which occasionally it is, okay, then,
you know, you're not going to capture these things. The,
probably the biggest one and probably again,
another one that one is of significant clinical importance is the,
what's it called the inadequate MTP X,
which is inadequate metatarsal-phalangeal extension. Um,
so this is basically where an individual gets to that terminal stance and really
almost a pre swing. And basically their limb is behind them.
They've placed all of the weight into the ball of the foot or right around those
met heads. And the, uh,
basically the tarsals are now going into a little bit of extension.
The toes are extending. Um, that's a very,
very important part of the gait cycle.
It really starts to kind of wind up the tension in the quad or sorry,
the calf muscle to kind of help to guide that foot forward, um, in this way.
Yeah, it's like the cock of the gun and it's like, everything is ready to go.
Um, but if they don't have that toe extension,
it's not going to go as fast and as far as you want it to go.
So definitely a big thing to be looking out for. Next,
we're going to dive into the knee.
So obviously inadequate extension and flexion,
as long as you know your normal gait pattern those things are going to be
extremely clear for you to be able to see.
The big ones that we're going to cover are really in that second column when you
get into single limb support. Um,
and what we see here in really a misconception happens between
hyperextension and extensor thrust the best way that we like to describe this
as hyperextension really just refers to the position that the knee happens to be
in. So for example,
if they put their leg out and their leg just assumes a position of
hyperextension, right from the get go,
then that would be called hyper-extension, which is basically a genu-recurvatum.
So an extensor thrust is where there's actually a movement into that
hyperextension, or really, I mean, it doesn't even have to be hyperextension.
Um,
and so what should we would see there is you might see a slightly flex knee or a
straight or straightened knee that then has a forcible movement
into that extension extension position or hyperextension position.
So hyperextension is really just a static held position of hyperextension and
extensor thrust is a forceful movement into that extension. So, Will,
if somebody had extensor thrust,
would I mark extensor thrust and the hyperextension on the form? Absolutely.
It could. Yeah.
So then we get into this and probably my favorite one on this is the wobble. A
hilarious name for a deviation, but wobble is basically is looking at,
um, instability within the knee joint. So for an individual here,
they're going to basically be going into flexion and extension of the knee and
kind of an alternating pattern.
So it's really a sign of that knee doesn't have great control over it,
Or proprioception awareness of where that joint is in space and you see it kind
of trying to figure out where it belongs. And then finally in that last one is,
um, the thrust. And then on either side of that,
you see a varus or valgus thrust. Usually you would select two of these,
two of these boxes. Um, so like obviously we we've,
you're aware with varus and valgus positioning of the knee.
And so if they do have that position of the knee,
you could just select those individually.
But if they happen to have a thrust or a forceful movement into that position,
then you would select, for example, like varus and thrust at the same time.
And this is sort of similar to what we were talking about with the
hyperextension and extensor thrust.
So somebody could have a varus deformity just by itself,
or they could have a varus thrust that's occurring.
So as now we get into the swing phase, um, big things that we can see,
um, are things, again, inadequate flexion or extension,
but we can also see an extensor thrust at that point in time,
or even an excess contralateral flexion that can occur as well.
All right, next up, we dive into the thigh here.
And so the thigh is a really crucial one to get,
because looking at the thigh gives you a picture of what's actually happening up
in the hip joint,
so important for your patient to have shorts or for the pant legs to be rolled
up. So you can see that thigh. Um, so obviously here,
we've got flexion and extension, and if you've got a good understanding of your,
your gait mechanics, then those things are gonna pop out really easily to you.
Also things like circumduction really common thing to be able to be able to see,
um, in addition to abduction and adduction,
the big one that we want to talk about here is both medial rotation and lateral
rotation, particularly when it comes to stance phase.
So when you're looking at an individual's lower extremity,
and let's say for medial rotation,
sometimes you might have an individual who has a valgus deformity at their knee,
or what appears to be one,
but sometimes if you get a good picture of what's happening in the thigh,
and eventually up to the hip,
they may actually be presented with a really significant medial rotation.
That's actually causing issues further down.
So it's important that when you're doing analysis like this,
that you capture things like that.
So you get a good overall picture with what's happening at the patient.
And that you're not just assuming that something further down the body is
independent of anything else that's happening. Um,
you can also see that in like a lateral rotation as well.
So here they may be having like a toe-out kind of position or a wide base of
support.
And if you didn't look at the thigh or kind of up into what's happening at the
hip joint,
you might miss that they may actually have an external rotation position of
their hips, either from tightness or some other pathology...
...Which will change your interventions.
Exactly. Next up is the pelvis.
So the pelvis is really a key point when you're talking,
especially about the efficiency of somebody's gait pattern,
and it can be also really difficult place to get a good observation of what's
happening. Um, for example,
a lot of people have like long shirts that might go down past the pelvis.
So this might be a good opportunity to see if they can help to pull up that
shirt or maybe roll it even into like,
like the top of their shorts or the top of their pants,
so that you can kind of get a good picture of what is happening in the pelvis.
Um, big thing that we like to talk about here. One is in the,
in the single limb support is an excess anterior tilt.
So this is common in patients who might have, um, gluteus maximus weakness,
um, or occasionally even like weak abdominal muscles as well. Um,
and then other big ones that you see in this,
the same one are either inadequate,
backward rotation or excessive backward rotation. So inadequate, you know,
let's say you have somebody who has very stiff back, very stiff pelvis and hips.
You may not actually get a whole lot of rotation going through there.
And then it's actually causing a loss of efficiency at that time.
Whereas excessive, uh, backward rotation,
you might see this more in like a neurological population,
such as an individual who had a stroke,
who has a lot of difficulty in kind of moving that pelvis in the rotational
sense. Now, as we go into the swing limb advancement, um,
there's obviously a couple of things that here are the different head drops that
can occur the Trendelenburg style of patterns that you might see within the
hips. Um,
but other ones that we're looking here is really looking at the forward
rotation, the most notable one being inadequate forward rotation.
So when somebody is taking a forward step,
there should also be a forward pelvic rotation that goes along with that,
that's gonna allow the person to get a nice step length and again,
to get a lot of efficiency out of their walking cycle.
So that's another big thing that we're looking for is,
are they actually getting like that five degrees?
And it's not much only five degrees of a forward rotation within the pelvis.
Yeah, kind of, rather than walking like a tin soldier, we're just,
the legs are moving. There should be a little bit of movement that's happening,
um, at the pelvis as well.
And finally, on the form we get to the trunk.
Now we're not going to go through much of this,
but basically these are these really stick out pretty strongly.
So this is either a forward lean, a backward lean, a left, or a right. So here,
you're just making sure to note it in whichever phase or whichever task it
happens to be presenting itself. Now, overall with this form,
the biggest thing that you want to do is to make sure to practice over and over
and over again,
the best way to get to gain analysis as a strong skill of yours,
and to really develop what we would say like your clinical eye is to practice.
So use this form, use some case studies, uh, you know,
continuously try it with different patients. Again,
the more experience that you have with it,
the better you're going to be with it.
And even the better that you'll be without it as well.
So next thing that we're going to be doing is actually reviewing a case study.
So the next video you'll see in this series is a case study video where you'll
actually perform this. So again, if you haven't printed this off yet again,
the link for this is in the description below.
So go and print that off in our next video,
you'll be watching the video and actually performing the analysis,
along with it. Um,
big things here is make sure you didn't Mark anything that you didn't see if you
miss something that's okay, but you also don't want to be making stuff up, um,
because you want to have a good clinical picture.
There's always a next time for doing a gain analysis as well.
So just because you didn't get it that first time doesn't mean that you've
missed the whole boat. You know,
there's always another opportunity to get more gain analysis the next time you
see a patient. So, um, big things also,
as you're going through the case study for yourself, um,
we certainly encourage you to play the video multiple times.
There also be a slow motion feature in there as well.
So you'll be able to kind of get a really nice long look at what's happening
with the patient.
It might be our little cue as to why we firmly believe in
videoing your patients during their data analysis,
because it makes it so much easier to review numerous times in order to
use this form to the best. Absolutely.
And it's a great way to start off practicing. Definitely. Yes.