MSS13 Gait (63.5MB) [20191017].pdf - Gait Dr Michael To Clinical Associate Professor Division of Paediatric Orthopaedics Objectives n n n n Basic

MSS13 Gait (63.5MB) [20191017].pdf - Gait Dr Michael To...

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Unformatted text preview: Gait Dr. Michael To Clinical Associate Professor Division of Paediatric Orthopaedics Objectives n n n n Basic neurophysiology of gait and gait cycle Assessment of gait Common gait abnormalities Gait modifying surgeries in cerebral palsy What’s wrong with his gait? Antalgic gait? Trendelenburg gait? Short limb gait? Neurophysiology of Gait n n n Central nervous system Peripheral nervous system Musculoskeletal system Stroke Cerebral palsy Parkinson disease Spinal cord injury Motor neuron disease Spinal muscular atrophy Peripheral neuropathy Fracture Forensic Science International Volume 264, July 2016, Pages 15-23 Prerequisites of Normal Gait n n n n n Stability in stance Sufficient foot clearance during swing Appropriate swing phase pre-positioning of foot Adequate step length Energy conservation Perry 1985 Gait Cycle n n Stance (60%) and Swing (40%)phase coordination of agonist and antagonist muscles Walking and Running Gait Evaluation n CNS – n PNS – n n History taking Physical examination n Stroke, cerebral palsy, degenerative disease Injury, peripheral neuropathy Musculoskeletal system – Muscle weakness, joint contracture, bone deformity Gait Evaluation n Kinematics describes motion without regard to its causes – n Stride length, range of motion, velocity Kinetics is concerned with the effect of forces and torques on the motion of bodies – Ground reaction force Gait Evaluation n Stride length – n Step length – n Distance by which one foot moves forward in front of the other one Stride width – n Distance between 2 successive placements of the same foot Side to side distance between the 2 feet Cadence – Number of steps in a give time Motion Analysis – Gait Laboratory Infrared camera Video camera Force platform Motion Analysis – Gait Laboratory Infrared camera Video camera Force platform Kinetics and Kinematics Common Abnormal Gait Pattern n Antalgic gait – n n Reduce stance phase due to pain Trendelenburg gait Short limb gait Trendelenburg Gait Perthes Disease Normal Weakness in left gluteus medius Short Limb Gait n Compensation: Knee bending (longer limb) – Circumduction (longer limb) – Tiptoe (shorter limb) – Case Illustration - Cerebral Palsy wing left femoral valgus t hip chronic subluxation rmore, there was no results were negative, d and white blood cell d infection was a possiof presentation but the as well. A normal EEG out seizure as a cause wed a tiny hypodense internal capsule but it ebral dysfunction. The ytopenia, acute confuglobules in sputum and four minor features of diagnosis for his acute o the paediatric intennitoring. He was given ia nasal cannula, analmidazolam for the dyschest physiotherapy. was not required, the from nasal cannula to on POD3. Prophylactic not effectively rule out perative wound infecxplored the wound on ound no signs of infecite where the implant e amount of bone wax te. The wound culture r any organism. Thus, Figure 2 Chest radiograph on postoperative day 1 showing leftsided chest consolidative changes. nasal cannula (2 litres per min) on POD5 and was weaned off on POD9. Chest radiograph on POD9 showed resolved consolidative changes (figure 3). He was subsequently discharged and without any more hip impingement symptoms. DISCUSSION Intramedullary cavity reaming for fixation of long bone fractures leading to increased risk of FES is a well-established concept with a quoted incidence of 0.9–35% and death rate of 1–20% in the literature.4–11 Early diagnosis and timely resuscitation to minimise stress response and hypovolaemia is of paramount important in FES management. The role of steroid and heparin is still controversial at the moment and prophylactic treatment with glucose, alcohol or aspirin are inconclusive as well.12 The symptom onset of FES is usually within 12 to 48 h after triggeringradiograph event. However, these symptoms Figure 1 the Preoperative showing left femoral valgus could be fewforand and thus, and radiologiosteotomy thenon-specifi treatment ofc painful left laboratory hip chronic subluxation cal tests are usually required to strengthen the diagnosis. and femoral locking plate insitu. Positive test findings include the presence of fat globules in blood, urine and bronchoalveolar lavage and also increased presentation of arterial confusion. Furthermore, no pulmonary pressure but none ofthere thesewas investigafever,tions the are blood andspecifi sputum results were negative, 13 100% c.12culture ESR was not issignifi cantly increased blood cell There no accepted definitionand forwhite FES. Rather, it is a Common Gait Abnormalities in Cerebral Palsy n Spasticity of calf muscle results in tiptoeing Common Gait Abnormalities in Cerebral Palsy n Soft tissue contracture results in crouching M/15 spastic diplegic CP with crouch knee gait M/15 spastic diplegic CP with crouch knee gait n n n Soft tissue release Foot stabilization Correct gait abnormalities Adductor magnus Semitendinosus Pre-operative gait analysis showed that the knees were held in flexion and the ankles in dorsiflexion throughout the stance phase (red line – right; blue line – left ; green line – normal) Post-operative gait analysis without ground reaction orthosis showed significant improvement in the kinematics of the knees and ankles in the stance phase; but weakness in the triceps surae leading to residual ankle dorsiflexion and therefore weakening the PF-KE couple resulting in residual knee flexion during the stance phase Post-operative gait analysis with ground reaction orthosis to the ankles showed near normal kinematics in the knees Advances in Management of Gait Abnormalities n n n Improved technology in gait analysis Better understanding of the abnormalities Technological advancement e.g. Robotic assisted gait training – Exoskeleton for paraplegic patients – Conclusion n n n Movement of the body is a complex process involving multiple systems Gait evaluation helps to understand the underlying pathology Advances in technology helps with evaluation and treatment for patients with gait abnormalities THANK YOU [email protected] ...
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