Observational gait analysis

Although observational gait analysis is the therapist's primary clinical tool for describing the quality of a patient's walking pattern, it can be extremely unreliable. Attempts to systematize observational gait analysis and to maximize its reliability (Krebs, Edelstein, & Fishman, 1985; Eastlack, Arvidson, & Snyder-Mackler, 1991) have led therapists to certain conclusions:

• Binary scoring:
  Rating of gait deviations as "mild," "moderate," or "severe" is unreliable; therapists display low rates of agreement in making these judgements. Agreement is much higher when therapists use a binary scale, one with only two categories, like "present" or "absent."

• Focus on slow moving segments
  Therapists agree more often regarding body segments which move slowly. Observational analysis is more reliable when it focuses on proximal segments instead of distal segments, and on stance phase events instead of swing phase events.

• Focus on sagittal plane, then on frontal plane
  Therapists are most reliable in judging gait patterns from the side and from behind or in front. They are extremely unreliable in judging movements which involve rotation of the LE joints.

Observational gait analysis checklist

The checklist, which we use in several laboratory sessions, is a "beginner's version" of ones you might find in various clinics. Adapted from a checklist developed by the Professional Staff Association of Rancho Los Amigos Medical Center (1989), it requires you to make "yes-or-no" decisions about the presence of a short list of gait deficits. The shaded regions are phases of the gait cycle during which you would not see the deficit listed. Thus, the checklist focuses your attention on the unshaded cells, which specify certain deficits during certain parts of the gait cycle.

download Word version of the checklist

Sources:

Eastlack, M.E., Arvidson, J., & Snyder-Mackler, L., et. al. (1991). Interrater reliability of videotaped observational gait analysis assessments. Physical Therapy, 71, 465-472.

Krebs, D.E., Edelstein, J.E., & Fishman, S. (1985). Reliability of observational kinematic gait analysis. Physical Therapy, 65, 1027-1033.

Professional Staff Association of Rancho Los Amigos Medical Center. (1989). Observational gait analysis handbook. Downey, CA: Author.

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Last updated 4-10-02 ©Dave Thompson PT