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Introduction

Gait is the manner in which a person walks or runs. As a key component of the assessment of patient function, gait evaluation can provide diagnostic information about underlying conditions such as functional ankle instability, traumatic brain injury, and low back pain that disrupt these factors.

Observational Gait Analysis

Gait can be evaluated qualitatively or quantitatively. In settings where clinicians are professionally trained in gait analysis, these two techniques are combined to yield comprehensive results that serve as the basis for intervention planning. This chapter focuses on qualitative evaluation using observational gait analysis (OGA) (Box 7-1).

Box 7-1 Observational Gait Analysis

Using an OGA written tool, the presence or absence of the critical events in the gait cycle can be determined. When preparing for your analysis, refer to the following OGA guidelines:

  1. Prepare the area and materials ahead of time.

  2. Avoid clutter in the viewing background.

  3. Have the patient wear clothing that does not restrict viewing of joints.

  4. Ensure that the patient is at a self-selected walking pace; otherwise, gait will be altered.

  5. Position yourself so you can view the individual segments (i.e., if you are observing for forefoot pronation and supination, then squat down so your eyes are in line with the patient's feet).

  6. Observe the subject from multiple views (anterior, posterior, and both lateral views) but not from an oblique angle.

  7. Look at the individual body parts first, then the whole body, then the individual parts again.

  8. Conduct multiple observations or trials.

  9. Conduct the analysis with the patient barefoot and wearing shoes.

  10. Label all video files.

OGA is a functional evaluation of a person's walking or running style where gait deviations are identified from gross observation. Several tools have been developed to guide and organize an OGA such as Rancho Los Amigos Medical Center's Observational Gait Analysis Handbook1 and the Rivermead Visual Gait Assessment (RVGA).2 The patient is asked to walk and/or run with and without shoes on a treadmill or in a designated area. Although this is the most common3 method of gait analysis, it has poor to moderate intrarater reliability.4 Reliability improves with training, experience, by using recorded video that can replay and slow motion, and by using a specific observational tool (Fig. 7-1).

FIGURE 7-1

Sample observational gait analysis tool.

Image not available. Practical Evidence

Using a formal approach to an OGA recorded on a structured form improves reliability.2

OGA tools may be helpful to identify gross gait abnormalities such as those associated with neurological disorders (e.g., stroke, Parkinson's disease); however, these tools lack the sensitivity needed to document subtle gait deviations. For example, a small amount of toeing out might qualify as "unremarkable" on the Los Ranchos Amigos or RVGA OGA instruments, yet, in an athletic ...

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