Clinical Examination va. Poly EMG in the Evaluation of Spastic Ankle Equinovarus During Gait
A. Esquenazi, M. Talaty and B. Hirai, MA, Keenan (MossRehab Hospital & Temple University, Philadelphia, PA, USA)
Abstract: Patients with an upper motoneuron syndrome caused by traumatic brain injury commonly develop spasticity. The most common gait problem is caused by spastic ankle equinovarus. This abnormal posture may be caused by a variety of muscles alone or in combination which include tibialis anterior, tibialis posterior, gastrocnemius, soleus and extensor hallucis longus. Clinical differentiation between the several muscles is critical for optimal treatment. Two physicians trained in clinical gait analysis systematically evaluated and observed the walking pattern of 28 patients with spastic ankle equinovarus. They noted their clinical impression regarding the muscle causing the ankle inversion deformity. Patients were then referred for instrumented gait analysis. Temporo-spatial parameters, kinetic data and multi-channel dynamic electromyography with surface and wire electrodes were obtained from the previously mentioned muscles. Using gait analysis as the "gold standard" to determine muscle activation, data analysis demonstrated the clinicians were able to appropriately select the specific muscular cause of the deformity in only 50 % of the cases. This study indicates the importance of using instrumented gait analysis as a diagnostic tool in the treatment of spastic equinovarus.
Gait analysis compromises the assessment of basic cycle parameters (velocity, cadence, stride length), gait phases (stance, swing. double stance), joint kinematics, kinetics (triaxial ground reaction forces), kinesiological EMG and ergonomics (power calculation, oxygen uptake).
Ambitions to apply gait analysis on a larger clinical scale for an individually tailored therapy have not yet been fully achieved. Its present main application is gait research. Correspondingly, the paper will present various studies on gait and movement analysis in hemiparetic subjects:
a) an outcome study on 156 chronic hemiparetic subjects during the course of a 4-week comprehensive rehabilitation programme with the assessment of gait endurance and symmetry.
b) gait analysis including kinesiological EMG for documentation of treadmill training with partial body weight relieve, botulinum toxin injection in the treatment of lower limb spasticity, the immediate effects of ankle-foot orthores and of the gait pattern during facilitation by an experienced Bobath therapist and while walking with a quadricane.