www.shrinerschildrens.org/aacpdm2018 Gait Analysis at Your Fingertips: Enhancing Observational Gait Analysis Using Mobile Device Technology and the Edinburgh Visual Gait Scale Jon R. Davids, MD; Shriners Hospitals for Children – Northern California; Sacramento, CA
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www.shrinerschildrens.org/aacpdm2018
Gait Analysis at Your Fingertips:Enhancing Observational Gait Analysis Using Mobile Device Technology and the
Edinburgh Visual Gait Scale
Jon R. Davids, MD; Shriners Hospitals for Children – Northern California; Sacramento, CA
Disclosure Information
The following relationships exist:
•OrthoPediatrics–Consultant
•OrthoPediatrics Foundation for Education and Research
–Board Member
Presenter Disclosure Information
JON R. DAVIDS, MDEnhancing Observational Gait Analysis Using Mobile Device Technology
and the Edinburgh Visual Gait Scale
www.shrinerschildrens.org/aacpdm2018
• Full Handouts• Gait Scoring Sheets• Links to resources
….and more!
Decision-making in Gait Surgery
History & Physical, Patient Goals
Pre- & Intra-operative Physical Exams
Gait Analysis:Kinematics
KineticsEMG
Dynamic Pedobarography
Individualized Surgical Prescription to Improve Gait Radiographs:
Hip, Ankle, Foot
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Gait Analysis Without a Lab = Observational Gait Analysis (OGA)
• Role of Observational Gait Analysis:• No access to 3-dimensional gait lab
• Frequent documentation of gait pattern change
• Child that cannot cooperate with 3D Gait Study• Very young (less than 5)
• Behavioral or cognitive issues
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Observational Gait Analysis
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• Prerequisites• Understand Normal Gait Cycle and Select Key Subphases• Recognition / Classification of Common Deviations
• Visual Assessment• Systematic• Forest / Trees
OptimizingObservational Gait Analysis
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•Modern Technology•Mobile Videography•Cell Phones and Tablets
•Structured Analysis• Edinburgh Visual Gait
Scale
•Case Example
High Quality Video: Your Key to Observational Gait Analysis
•Good observations take time!
•Videos help take decision-making out of busy clinic
•Permanent record
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Principles of Mobile Videography
20 feet
15 feet
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• Lighting and Focus• Well-lit hallway or room with
minimal distractions in background
• Perspective• At least 20 feet distance for
coronal
• At least 10 foot distance for sagittal
• Quality sagittal video allows for objective observational gait• Anyone can get coronal in their
clinic!
Principles of Mobile Videography: High Quality Sagittal Video
•High Quality Sagittal Video = High Quality Observations
•Panning camera•Parallax Problems•Cannot see more than
Left Limb EVGS GradingPhase Trunk Pelvis Hip Knee Ankle Foot
IC 0 0 2
M St 1 0 2
T St 0 0 2
M Sw 0 2 0
M St Front 0 0 0 0
M St Back 0
Segment Total
1 0 0 0 6 2
LIMB TOTALS PREOP TOTAL = 8
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Right Limb EVGS Grading
PhaseTrunk Pelvis Hip Knee Ankle Foot
P 1 2 P 1 2 P 1 2 P 1 2 P 1 2 P 1 2
IC 1 0 0 2 0 0
M St 1 0 0 2 0 0
T St 2 0 0
M Sw 1 2 1 2 0 0
M St Front 1 0 0
M St Back 1 0 0
Segment Total
1 0 0 1 0 0 1 0 0 1 2 1 6 0 0 3 0 0
1 year
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2 11
2
2 yearPre
Resolution of Mid-Swing Stiff Knee at 2 years
Left Limb EVGS Grading
PhaseTrunk Pelvis Hip Knee Ankle Foot
P 1 2 P 1 2 P 1 2 P 1 2 P 1 2 P 1 2
IC 2
M St 1 1 0 2 1
T St 2
M Sw 2
M St Front
M St Back
Segment Total
1 1 0 6 2 1
www.shrinerschildrens.org/aacpdm2018
2
1
1
1
Trunk lean and vaulting resolve at 2 years
Total Body EVGS Grading
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• Proximal segments (hip, pelvis) are less accurate than distal segments (ankle, foot)
• Less experienced observers have lower inter-rater reliability• GMFCS III patients have lower scoring reliability than I or II• Agreement between observers between 64 – 92%• Agreement to 3D gait analysis is between 60 – 70%
Limitations of EVGS
Orozco et al. Gait & Posture 49 (2016) 14–18.
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• EVGS vs Kinematics• Cell Phone / Gimbel Platform• MAC System• Simultaneous Capture
• Refine Technique• Other Software Platforms• Additional Kinematic
Foot Position (EVGS #1)Heel Contact 0Flatfoot Contact 1Toe Contact 2
For EVGS #1 Foot Position: Look at foot inclination graph at Initial Contact, which is 0.0% of Gait Cycle:
If the value is positive, this equates to heel contact.If the value is zero, this equates to flatfoot contact.If the value is negative, this equates to toe contact.
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Example EVGS Scoring Worksheet
Heart Function
Gait Function
Pulse RateStethoscope Echocardiogram
Hallway Examination
Observational Gait Analysis
3D Gait Analysis
Increasing Patient Complexity
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OptimizingObservational Gait Analysis
www.shrinerschildrens.org/aacpdm2018
•Modern Technology•Mobile Videography• Cell Phones and Tablets
• Image Stabilization
•Structured Analysis• Edinburgh Visual Gait
Scale
•New Possibilities!
www.shrinerschildrens.org/aacpdm2018
• Full Handouts• Gait Scoring Sheets• Links to resources