The history of Gait Analysis
The first indications in the direction of interest in gait analysis are from the era of Aristotle (384-322 BC). In On the gait of Animals Aristotle discussed/outlined the difference between human and animal gait. He had discovered that when a man walks on the ground alongside a wall with a reed dipped in ink attached to his head, the line would not be straight but zigzag. Although this observation was true all his other related conjectures are now known to be false. It was not until the renaissance that science and mathematics started to develop coherently and became the fundamentals for modern gait analysis. The first illustrations were from 1836 and shortly after the first photos to capture gait were made. In 1930 the development of the force plate started, which nowadays plays an important role in gait analysis. Gait analysis has been long only a research tool, but the last decades it is more and more implemented in the clinical practice.
Gait can be defined as any method of locomotion characterized by periods of loading and unloading limbs. This includes running, hopping etc., but walking is the most frequently used gait, providing independence and used for many activities of daily life. Analysis can be defined as a systematic examination and evaluation of data or information, by breaking it into its component parts to uncover their interrelationships. This brings us to the following definition of gait analysis: the systematic examination of human motion, using the eye and the brain of observers, augmented by instrumentation for measuring body movements, body mechanics, and the activity of the muscles.
The biggest challenge with understanding walking is that we do so much of it so effortlessly and subconsciously it is difficult to appreciate the immense complexities involved. The functional versatility allows the lower limbs to adapt to changing surfaces, stairs, doorways and other obstacles. The efficiency in these adaptations depends on free joint mobility and muscle activity. For persons with difficulties in joint mobility and muscle activity during walking (independent of the cause) these necessary adaptations come not for granted. This affects in more or less extent many activities in daily life on all levels: work, household, social and sport.
Identification of dysfunction in walking requires the ability to recognize obvious as well as subtle deviations and the knowledge of how to interpret the observations. The trained eye of the practicing clinician is the most convenient way to do this and permits to assess the problem at any time in any environment. But for the more complex cases gait analysis in a laboratory is necessary. This will lead to more precision, an easier way to revise the way of walking and provide information that cannot be obtained by eye (the force vector and muscle activity). In these gait labs data is recorded and the pathological gait is analysed. The normal function is the model against which the disability is judged. The deviations from the normal walking pattern together with a physical examination define the functional problems which need to be treated.
Patients compensate wherever possible, accepting compensatory reactions which result in a mixture of normal and abnormal motions during walking. The clinician has the challenging task to discover cause and effect in order to know which treatment is the best. With the Clinical Motion Analysis Xystem (CMAX) of Lode a clinician can perform a standardized gait analysis with fixed video cameras, a force plate and electromyography (EMG). With the collected data the clinician can have a detailed look at the walking pattern by going through the gait phases step by step and having synchronized force plate and EMG data as extra information to come to the correct conclusions and treatment.
Gait analysis is mainly used to assess and treat individuals with conditions affecting their walking ability. Furthermore it is commonly used in sports biomechanics to help athletes run more efficiently and to identify posture-related or movement-related problems in people with injuries.
CMAX is mainly used in rehabilitation centres or rehabilitation departments in hospitals. A lot of diseases cause walking problems and due to the enormous impact on daily activity a lot of patients come to the rehabilitation department with questions related to their inability to walk as they used to do. They complain about fatigue, increase in falls, loss of independence or the inability to do activities they normally did, like shopping or sports.
This can be patients with neurological diseases like cerebral palsy, spinal cord injury, traumatic brain injury, stroke or (neuro-)muscular diseases, but also patients with orthopaedic background like amputees, degenerative joint diseases or complex pattern of mixed trauma. All these patients can benefit from a gait analysis.