Anna T Murphy1, Stella Kravtsov2, Morgan Sangeux3, Barry Rawicki4, Peter W New5. 1. Clinical Gait Analysis Service, Kingston Centre, Monash Health, Cheltenham, VIC, 3192, Australia; Faculty of Medicine, Nursing and Allied Health Sciences, Monash University, VIC, 3800, Australia. Electronic address: AnnaT.Murphy@monashhealth.org. 2. Clinical Gait Analysis Service, Kingston Centre, Monash Health, Cheltenham, VIC, 3192, Australia. Electronic address: Stella.Kravtsov@monashhealth.org. 3. Biomech-Intel, Marseille, France; The Murdoch Children's Institute, Parkville, VIC, 3052, Australia; The University of Melbourne, Parkville, VIC, 3052, Australia. 4. Clinical Gait Analysis Service, Kingston Centre, Monash Health, Cheltenham, VIC, 3192, Australia; Faculty of Medicine, Nursing and Allied Health Sciences, Monash University, VIC, 3800, Australia. Electronic address: Barry.Rawicki@monashhealth.org. 5. Faculty of Medicine, Nursing and Allied Health Sciences, Monash University, VIC, 3800, Australia; Spinal Rehabilitation Service, Caulfield Hospital, Alfred Health, Caulfield, VIC, 3162, Australia; Rehabilitation and Aged Services Program, Department of Medicine, Monash Health, Cheltenham, VIC, 3192, Australia; Epworth-Monash Rehabilitation Medicine Unit, Monash University, VIC, 3800, Australia. Electronic address: Peter.New@monashhealth.org.
Abstract
BACKGROUND: Three-dimensional gait analysis (3DGA) has not previously been considered by consensus panels of spinal cord experts for use in studies of patients with spinal cord damage (SCD), yet it is frequently used in other neurological populations, such as stroke and cerebral palsy. RESEARCH QUESTION: How does 3DGA impairment based reporting guide individualised clinical decision-making in people with incomplete SCD? METHODS: Retrospective open cohort case series recruited 48 adults with incomplete SCD (traumatic or non-traumatic spinal cord dysfunction) referred to the Clinical Gait Analysis Service (CGAS), Melbourne, Australia. Three-dimensional gait data were used to identify gait impairments by the multidisciplinary clinical team. Gait patterns were classified using the plantarflexor-knee extension couple index and the Gait Profile Score (GPS). The reason for referral and the recommendations made post-3DGA were collated in decision trees to extrapolate the potential value of 3DGA in decision making for targeted intervention in this population. RESULTS: Participants with SCD generally walked at a reduced gait speed. When grouped by neurological level, the tetraplegia group had a significantly lower GPS, but no specific gait patterns emerged. Participants were primarily referred to the CGAS to direct clinical intervention decisions. The most frequent recommendation following 3DGA was the prescription of an ankle foot orthosis and in some cases, the recommendation was incongruent with the referrer's proposed intervention. SIGNIFICANCE: 3DGA can provide specific guidance in management plans for gait of patients with incomplete SCD and may help to avoid inappropriate or unnecessary interventions. This sample of patients referred to the CGAS demonstrates its clinical utility in guiding clinicians in their decision making to target individualised intervention.
BACKGROUND: Three-dimensional gait analysis (3DGA) has not previously been considered by consensus panels of spinal cord experts for use in studies of patients with spinal cord damage (SCD), yet it is frequently used in other neurological populations, such as stroke and cerebral palsy. RESEARCH QUESTION: How does 3DGA impairment based reporting guide individualised clinical decision-making in people with incomplete SCD? METHODS: Retrospective open cohort case series recruited 48 adults with incomplete SCD (traumatic or non-traumatic spinal cord dysfunction) referred to the Clinical Gait Analysis Service (CGAS), Melbourne, Australia. Three-dimensional gait data were used to identify gait impairments by the multidisciplinary clinical team. Gait patterns were classified using the plantarflexor-knee extension couple index and the Gait Profile Score (GPS). The reason for referral and the recommendations made post-3DGA were collated in decision trees to extrapolate the potential value of 3DGA in decision making for targeted intervention in this population. RESULTS:Participants with SCD generally walked at a reduced gait speed. When grouped by neurological level, the tetraplegia group had a significantly lower GPS, but no specific gait patterns emerged. Participants were primarily referred to the CGAS to direct clinical intervention decisions. The most frequent recommendation following 3DGA was the prescription of an ankle foot orthosis and in some cases, the recommendation was incongruent with the referrer's proposed intervention. SIGNIFICANCE: 3DGA can provide specific guidance in management plans for gait of patients with incomplete SCD and may help to avoid inappropriate or unnecessary interventions. This sample of patients referred to the CGAS demonstrates its clinical utility in guiding clinicians in their decision making to target individualised intervention.
Authors: Isabel Sinovas-Alonso; Diana Herrera-Valenzuela; Roberto Cano-de-la-Cuerda; Ana de Los Reyes-Guzmán; Antonio J Del-Ama; Ángel Gil-Agudo Journal: Front Hum Neurosci Date: 2022-04-04 Impact factor: 3.473
Authors: Diana Herrera-Valenzuela; Isabel Sinovas-Alonso; Juan C Moreno; Ángel Gil-Agudo; Antonio J Del-Ama Journal: Front Bioeng Biotechnol Date: 2022-07-06