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Development of Walking

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  • Development of Walking

    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.

    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


    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-
    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