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Herman J. Woltring
10-19-1989, 04:59 AM
Dear Biomch-l readers,

A highly interesting book from one of the founding fathers of Clinical Gait
Analysis and his collaborators at the Motion Analysis Laboratory, Children's
Hospital and Health Center, 8001 Frost Street, SAN DIEGO, CA 92123, U.S.A.
is:

David H. Sutherland, Richard A. Olshen, Edmund N. Biden & Marilynn P. Wyatt,
The Development of Mature Walking, Mac Keith Press (supported by the Spastics
Society, London, UK) 1988, x+227 pp.
ISBN (UK) 0 632-01902 6, (USA) 0 397 44622 5
Oxford/UK: Blackwell Scientific Publications Ltd (24,00 Pound Sterling)
Philadelphia/US: J.B. Lippincott Co.

with the following table of contents:

Foreword (Martin Bax),

1. Introduction
2. Methods
3. Modeling and prediction regions for motion data
4. Study plan
5. Anthropometric measurements and developmental screening
6. Time/distance parameters by age
7. Joint angles and film tracings
8. Dynamic electromyography by age
9. Force-plate values by age
10. Age and gait
11. Relationshipbetween neural development and walking
12. Relevance to clinical practice
13. Future directions

Appendices
References
Acknowledgements
Index

The following words from the final chapter are worth quoting:

"The keys to the future of gait analysis lie in the ability of new systems to
process data much more quickly than was possible before, in the development
of better descriptive methods to characterize gait, and in the ability to
`simplify' gait analysis to make it accessible to a wider audience.
Consider changes due to faster processing times. In the past it was
impracticable to apply many gait analysis techniques because of the time it
took to process the data, a good example being the monitoring of progress in
stroke or head-injury patients during rehabilitation programs. Such patients
change steadily over the course of their rehabilitation, making even a 2-week
turn-around of data little short of useless. On the other hand, quantitative
analysis of the efficacy of such programs is possible and practical if data
can be processed and returned to the treatment units in 1 or 2 days.
In the past, gait analysis has been used for subjects with relatively sta-
tic disorders, where the planning of treatment encompassed a long period of
time. With shorter turn-around, the latent interest in quantitative measures
of gait for stroke and head-injury patients, for amputees, and in other areas
of movement problems where changes occur quickly, is likely to expand and
become a major part of the business.
Increased speed in analysis is likely to lower significantly the cost of
providing the service, as the staff involved will be able to be more produc-
tive.
Moving for a moment out of the strictly medical field, the ability to ana-
lyze gait quickly also opens doors in the area of sports and other recreatio-
nal activities.
The second issue, that of improved descriptive methods, is important in
that, if methods can be derived which will work for any gait facility, then
the ability to analyze data will be less dependent on individual expertise
and more of a science. Techniques mentioned in this book, for instance, al-
low gait measurements to be expressed as percentiles of normal values and are
applicable in any setting using the same measurement system, and indeed ap-
pear to be applicable to most measurements even if they are made under quite
different circumstances.
The future holds the promise of such descriptive techniques being used
routinely to assess the efficacy of treatments or to categorize subjects as
having particular disorders, or particular subsets of some disorder. Ultima-
tely such techniques may be used to match certain disorders with appropriate
treatments by using the same criteria that the clinician uses but in an auto-
mated way. The advances would be aided by further analyses quantifying the
relationship between motions, electromyographic and force data.
This leads to a third point, that of making gait analysis accessible to
more physicians. So-called `expert systems' now used in some scientific and
commercial applications to apply decision-making rules based on previously
defined criteria almost certainly have application in gait analysis. Such
systems tend to be computer intensive, but, as stated, gait systems are also
becoming more and more dependent on computers. The systems are becoming both
more powerful and less expensive, and it is likely that soon some form of
`expert system' will be used to interpret gait. We believe that the data and
graphics presented in this book could be fundamental ingredients of any ex-
pert system for gait analysis in children.
The ability to set up rules based on the way experts in the field make de-
cisions means that the inexperienced practitioner has to his or her disposal
an `expert in a box' which can aid in decision making, but which can be over-
ruled if clinical experience so dictates. The existence of a system which
can gather and process data and also assist with interpretation is the change
which may make gait analysis a real winner.
It is likely that in the next few years gait analysis will consolidate.
The manufacturers of gait analysis systems will settle into their niches in
the field, and the procedures and practices will become much more standard.
Simply having many centers with common equipment will have the effect of
streamlining the collaborative process.
We feel very positive about gait analysis in our center. It has been used
well with many patients having benefitted. We see no reason why that should
be anything but improved upon by the changes which are upon us."

I can only agree with this (hopefully not all too) futuristic view. However,
similar systems from manufacturers require consolidated views within the users'
community, and it is here that comparative, objective studies between centres
are all-important. There are many `schools of medicine', and the field of cli-
nical gait analysis is no exception. While the field has profited considerably
from leaders such as the San Diego group, the time is now coming to combine the
best results from different centres of excellence throughout the world, and to
standardize protocols for clinical movement (e.g., gait) analysis. I hope that
a technological tool like Biomch-l can provide some help in this respect.

Herman J. Woltring
CAMARC, Eindhoven/NL