Clinical gait analysis 1973-2023: Evaluating progress to guide the future.

Clinical gait analysis has been used to inform treatment for over 50 years. Over that period there have been significant advances in motion capture technology and software development, driven in part by innovations in biomechanics. The aim of this paper is to review the current state of the art in gait analysis, mapping progress over the last five decades using the collective experience of the community of researchers and clinicians.An online survey was circulated to gait analysts to canvas opinion and responses were received from 229 people from 28 countries.Respondents identified the greatest progress in the areas of hardware, automation of processes, and software development. Despite laboratories being better equipped, many of today's challenges would have been very familiar to those working in 1973. Better algorithms and more evidence are needed to establish a secure link between gait analysis data and clinical decision making. Biomechanical models require further refinement to overcome well known limitations. Despite innovation, clinical gait analysis remains relatively unknown in the wider healthcare field.Growth in the global Gait Analysis communities and advances in remote communication technology have created new opportunities for taking on this challenge over the next 50 years. Hopefully, future innovation will lead to clinical gait analysis becoming more accessible, more flexible to real world mobility and more able to exploit emerging advanced modelling techniques.

Gait compensations caused by foot deformity in cerebral palsy.

Cerebral palsy (CP) is a complex syndrome, with multiple interactions between joints and muscles. Abnormalities in movement patterns can be measured using motion capture techniques, however determining which abnormalities are primary, and which are secondary, is a difficult task. Deformity of the foot has anecdotally been reported to produce compensatory abnormalities in more proximal lower limb joints, as well as in the contralateral limb. However, the exact nature of these compensations is unclear. The aim of this paper was to provide clear and objective criteria for identifying compensatory mechanisms in children with spastic hemiplegic CP, in order to improve the prediction of the outcome of foot surgery, and to enhance treatment planning. Twelve children with CP were assessed using conventional gait analysis along with the Oxford Foot Model prior to and following surgery to correct foot deformity. Only those variables not directly influenced by foot surgery were assessed. Any that spontaneously corrected following foot surgery were identified as compensations. Pelvic rotation, internal rotation of the affected hip and external rotation of the non-affected hip tended to spontaneously correct. Increased hip flexion on the affected side, along with reduced hip extension on the non-affected side also appeared to be compensations. It is likely that forefoot supination occurs secondary to deviations of the hindfoot in the coronal plane. Abnormal activity in the tibialis anterior muscle may be consequent to tightness and overactivity of the plantarflexors. On the non-affected side, increased plantarflexion during stance also resolved following surgery to the affected side.

Recovery of muscle strength following multi-level orthopaedic surgery in diplegic cerebral palsy.

Muscle strength changes following multi-level surgery in cerebral palsy and the impact of rehabilitation on functional recovery are largely unknown. The aim of this study was to quantify lower limb muscle strength changes in children with spastic diplegia after multi-level orthopaedic surgery and to compare the efficacy of progressive resistance strengthening (RS) versus active exercise (AE). Twenty children with spastic diplegia (mean age 12.5 years) participated in this prospective randomised controlled trial. Participants underwent multi-level orthopaedic surgery. Routine physiotherapy commenced immediately after surgery. At 6 months post-operatively, children were randomly assigned to the resistance strengthening RS (n=11) or active exercise AE (n=9) group and received intensive physiotherapy for 6 weeks. Gait, motor function and maximum isometric muscle strength in five lower limb muscle groups were measured pre-operatively and at 6 months (before and after intensive physiotherapy) and 12 months. As part of the study, we developed and validated a myometry protocol. Despite kinematic improvements, there was significant reduction of muscle strength (p<0.05) in all muscle groups at 6 months post-operatively. Following 6 weeks of intensive physiotherapy, both groups showed significant improvement in muscle strength, GMFM scores and gait parameters. Resistance training showed some advantages over active exercise. At 1 year after surgery, strength did not reach pre-operative values in some muscle groups but the benefit from physiotherapy was maintained. In conclusion, we quantified objectively the reduction in muscle strength 6 and 12 months following multi-level surgery. Furthermore, we demonstrated significant improvement in muscle strength, gait and function following post-operative strength training.

Femoral muscle attachment locations in children and adults, and their prediction from clinical measurement.

Accurate representation of children's musculo-skeletal anatomy is becoming increasingly important to biomechanical techniques such as gait analysis. This study used magnetic resonance imaging to examine the locations of the femoral insertions of the psoas, vastus medialis and gastrocnemius muscles in five adults and 17 children (including 7 children with cerebral palsy). The relationship of muscle attachment locations with age and bone geometry was then determined. Scaling techniques and external measurements of parameters such as femoral anteversion/antetorsion were shown to have potential for prediction of the locations of femoral muscle attachment points. It was shown that femoral anteversion can be modelled geometrically as occurring proximal to the lesser trochanter.