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The use of Video Gait analysis systems - whats the point ?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by mike weber, Mar 1, 2012.

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    There are threads all the time on Video gait analysis systems

    I have never used one probably never will but maybe I am being closed minded

    So whats the point ?

    Do the systems help change your treatment prescription ?

    or is all for marketing type of thing ?

    or does it really make explaining to patients whats going on ?
  2. Admin2

    Admin2 Administrator Staff Member

  3. Boots n all

    Boots n all Well-Known Member

    l use video system for a number of reasons.

    One is to inform clients and careers of what we see as treatable issues.

    A record of pretreatment that we can reference back to gauge progress.

    Allows me to sit down and review the client if something is troubling me.

    To share this information with another practitioner if need be.

    l only use it for those really challenging Bio clients, yes it can and does influence my treatment for these clients and l never use it with a treadmill !

    There will be a few systems to look at when you get to www.ivo2012.org.au
  4. RobinP

    RobinP Well-Known Member

    If I am honest, it is largely for the patient's benefit.

    You know that you are an honourable professional person and wouldn't BS someone. However, putting yourself in the patient's shoes( pun intended) they are taking your word for it that you are talking sense. Showing them how something is not functioning as you would wish is an important part of acceptance of a treatment regime.

    The only other thing I would point out is that I cannot see subtle things such as timing of heel rise and the point at which someone is pronating(thinking about the active pronator) with the naked eye. Slowing it down allows me to have some definable markers that I can work with and measure. Just to make that clear, I have no desire to measure angles and dangles. It is more about timing ie how many frames until the heel rises etc

    Would also agree with David that I can remind myself about the patient when the patient is not there. Allows me to troubleshoot better.

    Could I do this just with an iPad and some slow motion footage - absolutely. Slow mo is all I want
  5. Boots n all

    Boots n all Well-Known Member

    Not as good as having it showing on a 42 inch big screen TV:D that way everyone can pull up a chair sit back and watch it all unfold, unless you have a really big iPad Robin :confused:
  6. David and Robin

    I also guess you use a treadmill ?

    A treadmill will alter timing and in running rearfoot strikers are more likly to midfoot or forefoot strike

    lawyer for the devil
  7. Boots n all

    Boots n all Well-Known Member

    Nope, never, as l said in my second last line of my first reply "...and l never use it with a treadmill !" l dont even own one, they are BS for gait assessment IMO.

    Most of my clients struggle to walk, the last thing they need is to try and master a tread mill...l am not very clever, l still haven't worked out how others get a walking frame on their treadmill:wacko:

    l am fortunate that when l designed/built my clinical area, l made my gait room 8 mtrs long, with a sitting area recessed on one side and a nice big 42"TV screen opposite, in hindsight 4 mtrs is not wide enough, should have been 6mtrs wide:bash:

    Attached Files:

  8. Bruce Williams

    Bruce Williams Well-Known Member

    I use video to document issues I am usually aware of when I use in-shoe pressure as well. It is important to view knee extension and flexion angles in walking. The same with hip flexion / extension, and ankle joint motion. Posterior views are somewhat helpful to gauge foot add/abduction and internal / external positioning of the foot / limb. All of these can be synced literally or relatively with the in- shoe evaluation which can then lead to significant revelations in foot and lower extremity function, in my opinion.
  9. During my Biomechanics Fellowship, now 27 years ago, we had a slow motion black and white video camera at the California College of Podiatric Medicine that I used with the podiatry students (Eric Fuller was one of them) to be able to point out to them the characteristics of gait while students and patients were walking and running barefoot, in shoes and in shoes with orthoses. I found this a very helpful teaching tool for students and enjoyed it myself since it allowed me to confirm what I saw with my own eyes in at normal walking and running speeds.

    However, I have never used video analysis in my 26+ years of clinical practice since I always felt that I could see quite well enough with my own two eyes at normal walking speeds to make a proper diagnosis. In addition, in my very busy practice, seeing about 25-30 patients a day, it would be impractical to take the extra time to do a video analysis of patients, would require extra space, and would require extra staff in my office, and all of this would need to be passed on to the patient as an extra expense.

    For my specific practice, video analysis is a luxury I choose not to employ for my patients. However, for some practices, video analysis might be helpful in order to either aid in the diagnosis of difficult to treat patients, to increase patient understanding of their specific pathology or to increase the appearance of sophistication of the clinician to the patient.
  10. RobinP

    RobinP Well-Known Member

    Most of the patients I am seeing are not athletes, they are regular people with foot/ankle pain who get the pain when just walking. I'm quite sure that being on a treadmill alters things in the same way that being on a different surface also does or altering cambers can have an effect. It would be ridiculous to try and say that treadmill walking is a true reflection of the situations the people are in day to day. If you wanted to be picky, walking 15 feet on a totally flat surface with non slip flooring in a clinic room is probably not particularly representative either

    That being said, static assessment of sub talar joint axis location is not necessarily a true reflection of the joint axis when walking as it is a constantly changing entity. It is, nonetheless, a valuable indicator and a test that most practitioners are happy to perform. I see gait analysis as a similar tool.

    If I remember correctly(and I can't be sure about this, the human eye can only see something like 1/5 of what a regular video camera will record in terms of frames per second. The rest is "filling" I am very surprised, on a regular basis, the extra little things that I see by slowing things down. Maybe I am just very poor at analysing naked eye data and slow motion allows me to see some things that other people can see without slow motion.

    I reckon that it takes me approx 4 mins to input the patient's name and number, get them on the treadmill and take video footage of barefoot and shod walking. If I am assessing things like pelvic tilt in someone who has ITB and I suspect the gluteus medius is weak/recruitment is poor, it takes a bit longer.

    Video analysis is a tool and in no way replaces clinical skill and biomechanical understanding.
  11. TedJed

    TedJed Active Member

    Interesting question Mike...

    I used to use a treadmill and video for slo-mo replays (was VHS back then...).

    I then came to the conclusion that it didn't change my diagnosis or prescription or treatment. It was amazing though that the patients thought that my service was so 'high tech' because I had a video camera! (c.1986).

    Even today, patients (seeking a 2nd opinion) will come in bringing a print out of their 'pronation angle' from a still image taken from their gait analysis on a treadmill at x podiatry clinic and they are sooo impressed by it.

    I think video gait analysis can be helpful in explaining compensation patterns in gait, especially when a patient can't typically see themselves from behind...

    So, in summary Mike, video gait analysis can be useful for patient understanding and marketing one's practice IMHO.

  12. Jonathan

    Jonathan Active Member

    Robin they teach you well on the Isle.

    Mike, it really depends on what your practice model/cliental base is. It would be a brave business model to have video analysis on the ‘must have’ list if your patients were predominantly geriatric. However, a podiatry clinic with a running or sports focus would find video analysis beneficial – even if it’s just comparing patients movement patterns over time – and nowadays, video software can also provide a wider range of data when integrated with other ‘tools’ such as force plates, pressure plates, EMG and posture.

    ‘Sports and Biomechanics’ forum suggest faster movements i.e. speeds that the naked eye can’t analyse. As Robin alluded, a well trained eye can see detail to approx 5-7 frames per second. Camcorders can record at 50 frames per second and in HD even more detail. When the human eye focus’s of the foot and ankle it is impossible observe the hip or knee.

    The expression ‘seeing is believing’ isn’t 100% accurate as a lot of what we see if created by ‘in-filling’ using detail from memory or previous experiences. What we expect to see is often what our brain delivers – not what is actually happening. Seeing the foot/leg/body move in slow motion allows your brain to handle visual information better than the naked eye – therefore allowing you build a picture of its dynamic behavior. Our brains try to help us more than you think… when we are asked a question we load our brain with an ‘image answer’ and as a result we can glean information. E.g. How many circles are there on the Olympic sign? Not many people answer immediately without picturing it in their minds eye first. Therefore using slow-motion video and observing the ROI repeatedly, even after the patient has left, has its advantages.

    There are plenty of cognitive neuroscientists that specailise in how the brain handles visual information - here is a clip from the Beeb

    Treadmills - clinics would find it hard to justify a 100 meter running track and therefore a treadmill would be a better solution. Sure treadmills do not replicate running 100%, but nor does walking, however once an athlete has started to relax/settled into their natural cadence the foot ‘signature’ isn’t a million miles off. Treadmills differ – a £299.00 New Year special from Agros isn’t going to help anyone.

    But like ALL tools – what really matters it is the quality of the operator, their know-how and how they interpret and use that information.
  13. Jonathan

    Jonathan Active Member

    OMG Has Parish and Bell started up again!!!!!

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