Gait lab - Glasgow clinical gait analysis service

Clinical Scientists (Bruce Carse and Hannah Carruth)

Physiotherapist (Jennifer Lunan)

Paediatric Orthopaedic Surgeons (Miss Janet McCaul and Mr Mohamed Osman, Royal Hospital for Children, Glasgow)

In the laboratory, we place some skin markers on the legs and trunk using sticky tape and then use 3D motion capture technology to give more information than is possible by simply observing a person walking.

We also use Video Vector Analysis which assists in identifying the forces acting on the legs and help identify how to improve the gait, possibly using an orthosis.

There is also detailed clinical examination which looks at:

• The movement at joints
• Muscle power
• Bone alignment
• The ability to control movement
• Muscle tone
• Balance

Walking is a complex activity involving biomechanical and neurological factors. Biomechanics relates to the movement of the joints and segments of the legs and the forces acting upon them. The neurological aspects involve the control of the muscles by the brain and the nervous system to produce forces. In particular the reactivity of muscles to stretch is of importance. We call this approach to gait analysis ‘Neurobiomechanics’.

For more information, please refer to the following information leaflet provided by the Institute for Physics and Engineering in Medicine: IPEM Gait Analysis Info Leaflet

Children and adults with a physical disability which causes complex walking problems. These tend to be problems that cannot be identified with simple procedures such as observational analysis or routine clinical examination.

Conditions we see include Cerebral Palsy, traumatic brain injuries and other neurological conditions, Myelomeningocele, Muscular Dystrophy, lower limb and foot deformity.

In addition the patient should be:

• At least 4 years old
• Able to cope with a session which can take up to 2.5 hours, although the pace of assessment can be tailored to the patient.
• Able to walk at least 15 metres, independently or using assistive devices or orthoses if appropriate. The use of walking aids is acceptable (e.g. sticks, crutches, rear and forward-facing walkers), however we are not able to assess patients using aids that support the trunk during walking.

Gait analysis for adults and children with amputation is arranged by Prosthetics Service staff within WestMARC, primarily as part of the Scottish Specialist Prosthetics Service.

Please refer to our patient information sheet for more detailed information: WestMARC Gait Service Patient Info Sheet

• Orthopaedic Consultants
• Paediatricians
• Neurologists
• Physiotherapists
• Prosthetists
• Orthotists

Patients (or their parents/carers) should be aware of the referral and it is helpful where appropriate for the referrer to inform the patient’s wider multi-disciplinary team. It is anticipated that the referrer will provide feedback to the patients (or their parents/carers) after the gait report is finalised unless agreed otherwise.

The gait service clinical and administration teams request that referrers observe the following guidance when making a referral:

• Inform the patient being in question that they are being referred for gait assessment, and why.
• Most patients we assess are known to multiple health care professionals. Please provide email addresses for all relevant members of their wider MDT.  We aim to use this to inform them when the likely MDT reporting session will take place. It might also be helpful to let the patient’s wider MDT know that you have referred the patient to the gait service, so please consider informing them at the point of making the referral.
• Ensure the patient is mobile enough to complete the full gait assessment. They should be able to walk at least 15 metres, independently or using assistive devices or orthoses if appropriate. Ideally they would be able walk barefoot during the assessment.  If they use a walking frame (e.g. Kaye walker or Nimbo walker) we may only be able to offer 2D video assessment. Without use of markers for 3D gait analysis, kinematic graphs will not be available for analysis. If the patient uses a walking frame which supports their trunk (e.g. Grillo walker) we are unlikely to be able to provide a meaningful gait assessment. We will do our best accommodate the needs of your patient - so please contact us to discuss this further if you are not sure if they meet the criteria.
• In addition to some ability to walk, during the detailed clinical examination the patient will be required to move between; supine lying, prone lying, side lying on the examination plinth, perform sit-to-stand, lie-to-sit and will also need to follow some basic verbal instructions.  This can take 30-45 minutes. We appreciate that some patients will find this difficult, but if they are unable to do this it can mean the clinical examination is incomplete, making the assessment less useful. Again, we will do our best accommodate the needs of your patient and please contact us to discuss this further.
• It is expected that the referrer will try to prioritise attending the MDT reporting discussion.
• It is assumed that the referrer will provide feedback to the patient/parents/carers unless agreed otherwise with their MDT.

WestMARC Gait Lab Referral Form

Specific Referral Form Guidance

Sections 1 and 2

Please ensure that the patient contact details are correct to minimise delays when arranging appointments.

Section 3 (General)

In order to avoid duplication of work, you can send additional clinic notes which contain the relevant clinical information requested in Section 3 along with the referral form as an attachment. Please indicate if you have attached an additional clinic note - in which case there is no need to complete Section 3.

Section 3 (Primary reason for referral)

This must include the reason for referral, for example:

• Considering an intervention and would like information to assist decision making (e.g. Orthopaedic surgery, SDR, botulinum toxin).
• Deterioration in gait is suspected and objective assessment would assist in identifying management strategies.
• Information to support appropriate orthotic alignment or management.

Referrals should also include a clear clinical question, or information you would like the report to include. This will assist in tailoring the assessment and report to answer the specific clinical question.

Section 5

In rare cases referrers might wish to prearrange a gait assessment (e.g. a one year post-surgery follow-up). If so, please provide a date range when you would like the assessment to be carried out.

General

Please take the time to complete the referral as fully as you can.  This will avoid additional exchanges of emails/phone calls, ensure the patient is assessed without delay, and that the assessment is as patient-centred as possible.

Supplementary information for Gait Analysis report: Gait Report Supplementary Info

NHSGGC Selective Dorsal Rhizotomy Service: NHSGGC Selective dorsal rhizotomy (SDR) toolkit. 

The WestMARC Glasgow Clinical Gait Analysis Service is accredited by the Clinical Movement Analysis Society of UK and Ireland (CMAS)