Penny Hewart

Gait Analysis in the North(GAiN)

Penny HewartClinical Engineer and administrator,

Gait Lab

Who we are...

• Multidisciplinary team of 3:– Penny Hewart

• clinical engineer and administrator – full time gait lab so easiest contact (contacts at end of presentation)

– Pat Clements• physiotherapist – contact via lab or Palmers

– William Bliss (full gait assessments only)• consultant orthopaedic surgeon – contact via

secretary at Freeman

Where we are....

• Just (November 2009) moved to Newcastle General

• Sole use of lab• Separate clinical and seating area• Warmer!• Level access• Good parking – plenty of disabled bays

The new lab...

Services we offer...

• 3D clinical gait analysis

• Video vector (2D) gait analysis

• Orthotic review and fine tuning

Light hearted demo of gait analysis

Sherlock Holmes comes to the gait lab – part of a schools presentation on

what happens in medical physics...

Explanation of what we will do

Clinical exam• Measurement of ankle movement done by

our physiotherapist

Normal left ankle Stiff right ankle

Sticking the

markers on

Standing

Walking

Working at computer

What the infra-red cameras see...(video link removed)

Which is turned into a stick figure...(video link removed)

Which can then be made into a skeleton....

(video link removed)

Or a teddy bear....(video link removed)

You’re are probably

familiar with this use of the equipment...

But the really useful things

are the graphs

showing angles at the

hip, knee etc...

And the clinical exam and x-rays

3D gait analysis

• Long process – patient is present for 2 – 3 hours so compliance is important– Questionnaire– Clinical exam– 3D kinematics (joint angles) and kinetics

(forces and moments)– Video vector– EMG

• Review with all staff

The patients we see...

• The main 3D service was set up for paediatric

• Mainly cerebral palsy• Others including other neuromuscular,

stroke, head injury, musculo-skeletal but only paediatric (at the moment)

Access to 3D gait analysis

• Referrals only accepted by orthopaedic consultants or CDC at the RVI (who refer simultaneously to orthopaedics)

• This is because patients and results are focused on surgery and we have limited numbers of appointments

• Contact Penny if you have any queries

Access to 3D gait analysis cont...

• We have a long waiting list – currently 30 weeks and can see a limited number of patients per year

• Very stringent on patients acknowledging appointment

• Support in getting improved number of patients and expanded patient groups would be welcome

Gait reports

• Long!• We include all the data so although you

may choose to just read the conclusions, the original data is present to give the background for our decisions

• Comments on style and content are welcome

Video vector assessment

• Access to the service is the same as for 3D• Includes clinical exam and video with force

vector videoing• Useful for children who would not be

compliant with the full assessment• Slightly shorter report

Orthotic review / fine tuning

• Team approach – physiotherapist, engineer and ideally an orthotist

• Video vector equipment• Type and angle of AFO – assess effect• Fine tuning

– Footwear– Floor shank angle– Heel wedges, rockers

• Review

Orthotic aims – ground reaction vector control – example

Accessing the service...• Anyone can refer – please contact Penny• Currently no charge• We will carry out the assessment then send

a report detailing the changes needed then they can be implemented locally

• We also offer a limited on-site outreach orthotic fine tuning service – ask Penny

References to gait analysis in CP consensus document

• Main uses:– Teaching– Determining treatment– Explaining to patients and families– Evaluate outcomes– Classification – no consensus on best way as

several types of data to include

Advantages of clinical gait analysis

• Increased information has helped the development of multi-level surgery so patients get more surgery in one sitting and so less time in hospital, needing rehab and missing schooling / work

• Allows objective review and audit of treatment

Contact details...• Best contact is:

Penny HewartBioengineeringRMPDNewcastle General HospitalWestgate RoadNewcastle upon Tyne

• Penny.Hewart@nuth.nhs.uk• 0191 256 3416