Is clinical gait analysis useful in guiding rehabilitation therapy decisions in patients with spinal cord damage?

Ms Stella Kravtsov1, Dr  Anna Murphy1, Dr  Barry Rawicki1, Dr Peter New2

1Clinical Gait Analysis Service, Monash Health, Cheltenham, Australia

2Spinal Rehabilitation Service, Caulfield Hospital, Caulfield, Australia

 

Aim

Walking is a priority for patients following incomplete spinal cord damage (ISCD) due to trauma or non-traumatic conditions. Rehabilitation directed at improving walking requires outcome measures that are valid, reliable and timely in order to optimize patient management and resource utilization. Three-dimensional gait analysis (3DGA) can play a more prominent role in the assessment of walking in patients with ISCD. The aim of this project was to report how the 3DGA findings of patients with ISCD referred to a Clinical Gait Analysis Service (CGAS) targeted clinical management to optimize walking.

 

Method

3DGA data were collected on 40 adults (26 males; 19-83 years) with ISCD. Following clinical assessment and placement of 18 retroflective markers on the skin of participants, patients walked barefoot at preferred speed along a 10m walkway. Data were analysed according to a standardized clinical protocol. Participant level of ISCD was classified as either tetraplegia or paraplegia. Years post injury, reason for referral, clinical question and recommendation based on clinical gait analysis (CGA) were collated and summary statistics calculated.

 

Results

Reasons for referral to the CGAS were predominantly to assist with management decisions (52.5% of patients). 3DGA data suggests the most common cause of gait dysfunction in ISCD occurs in the sagittal plane. The prescription of an ankle foot orthosis was made for 52.5% of patients. A recommendation was made on 7 occasions where it was incongruent to the referrer’s proposed intervention.

 

Significance of the findings to allied health

This study demonstrates the clinical utility of CGA in guiding clinicians in their decision making regarding management options for gait dysfunction in people with ISCD, in addition to identifying treatment options of limited clinical effectiveness.