The Value of Information Resulting from Instrumented Gait Analysis: The Physiatrist

Gait analysis has a long history and tradition, from the pioneering work of Muybridge and Inman continuing through contemporary times with the development of modern computer-based analysis systems capable of describing the kinematic, kinetic, and muscle activation patterns of gait in unusually rich detail . Over the past several decades, instrumented gait analysis has emerged as a powerful tool in the research setting . Through descriptive and experimental studies, gait analysis has advanced our understanding of normal gait, identified and quantified the biomechanical and motor control abnormalities of pathologic gait, and documented the usefulness of various therapeutic interventions. In contrast to the established role that quantitative gait analysis has achieved as a research tool, the clinical use of gait laboratories and gait analysis by physiatrists and other rehabilitation care providers is uncommon . With the exception of diagnostic and surgical planning purposes in children with spastic paralysis, which has been largely driven by orthopedic surgeons, instrumented quantitative gait analysis has not been systematically adopted for the evaluation of gait in other patient populations . In the rehabilitation literature, there are intriguing case reports of gait analysis improving patient care, and evidence that instrumented gait studies can aid in the diagnosis and determination of the pathomechanics of some gait abnormalities . However, there is not a substantive body of data that clearly identifies the groups of patients, or the gait abnormalities commonly managed by physiatrists in which instrumented studies are beneficial to overall care and function . Perhaps because of this, efforts by proponents to expand its role in the management of adults with disabling gait problems from a variety of neurological and musculoskeletal disorders has met with limited success . Moreover, and perhaps more troubling, there is little spontaneous interest or call for expanding the use of this technology by most physiatrists. The current state of clinical gait analysis in the practice of medical rehabilitation raises several important and timely issues that the physiatrist needs to consider. These are best addressed by clearly separating the research role of gait analysis from its use as a clinical procedure . In light of the limited data and uncertainty over the role of gait analysis in the care of adults with impaired ambulation, this chapter will focus on the important conceptual and practical barriers that limit its clinical use by the physiatrist . The barriers and limitations listed in Table 1 combine recommendations from a recent National Center for Medical Rehabilita-