Gait can be evaluated at three levels of sophistication.
This is part of the standard screening examination and is usually performed in the hallway of the clinic.
Clinical Observational Examination
This examination is indicated if
- the family has reported that the child limps,
- an abnormality is seen during the screening examination,
- the physical findings point to a disease likely to affect gait.
In the hallway of the clinic, observe the child walking from the front, behind, and both sides if possible. Look at the child’s shoes for evidence of abnormal wear. An abnormal gait often falls into readily identifiable categories:
Antalgic gait Pain with weight bearing causes shortening of the stance phase on the affected side.
Intoeing and out-toeing gaits Assess the foot–progression angle for each side. Average the estimated values and express in degrees.
Equinus gait Toe strike replaces heel strike at the beginning of the stance phase.
Abductor lurch or Trendelenburg gait Abductor weakness causes the shoulders to sway to the opposite side.
Instrumented Gait Analysis
Gait can be assessed by using a videocamera to record visual observations. More sophisticated techniques can be used, including dynamic electromyography to assess muscle firing sequences, kinemetric techniques for assessing joint motion, force plate to measure ground reaction forces, and sequence and rate measurements [A, next page]. These values are usually compared with normal values.
Currently, greater attention is being focused on the efficiency of gait by analyzing oxygen consumption and heart rate changes. Over time, we become more concerned about effective and efficient mobility and less about mechanical variations.
The role of the gait laboratory is still controversial. It is clearly an important research tool, but its practicality as a clinical tool remains uncertain.
Clinical observational gait examination Evaluation of the child’s gait is best performed in an open area.
Value of observing foot wear The lack of heel wear (red arrow, left) is evidence of an equinus gait on the left side. Excessive wear on the toes of the shoes is indicative of a more severe degree of equinus (yellow arrows, right) in a child with spastic diplegia.