Our evaluation process includes:

1. Welcome and Physical Exam
2. Observe and Videotape Movement
3. Monitor Muscle Activity
4. 3D Motion Capture of Walking and/or Upper Extremity
5. Evaluation Analysis, Review and Recommendation

 

 

 

 

1. Welcome and Physical Exam

We look forward to welcoming you and your child to our lab. Upon arrival we will have a few forms and some paperwork for you to complete before we get started.

Our physical therapist will begin with a physical exam collecting information such as:

• Height, weight
• Body measurements
• Strength and range of motion at the joints,including hips, knees & ankles
• Muscle selectivity and spasticity
• Foot position while standing still
• Medical history including use of orthotics, surgeries and procedures such as muscle injections.

2. Observe and Videotape Movement

During this step of the analysis, our therapist will begin to ask your child to perform certain movements and walk, observing and gathering data that will help determine a care plan.

Various movements are videotaped to be reviewed all of our specialists, and is one way of looking at how a person walks and moves. It allows our team to observe your child over and over again in normal speed, slow motion or one frame at a time. This approach is very limited and only a small part of the complete motion or gait analysis provided at our lab.

Our therapist will first ask your child to walk on a walkway several times in their most natural, relaxed form of walking – barefoot and if possible, without orthotics or assistive devices. Once this has been videotaped, we will begin to add back in any devices they typically rely upon and videotape this as well. These movements are recorded by several different cameras from several different angles.

3. Monitor Muscle Activity

Dynamic Electromyography

After observing and videotaping walking and/or performing upper extremity activities, we will measure how your child’s muscles are functioning during walking. In this part of the evaluation we dynamic electromyography. We are seeking to understand the timing of muscle use during walking and to understand whether certain muscles are “on” or “off”.

Your child will put on a small vest over their clothes and we will attach surface electrodes (similar to what is used for an EKG) to the skin similar to the markers for motion capture – usually on the thigh muscles, hamstrings, the shin and calf muscle, unless your physician requests other specific muscle activity to be measured. The electrodes are then connected to the vest and we begin to record all muscle activity.

We will then guide your child through walking and other activity while all muscles are monitored and recorded.

Electromyography with Fine-Wire Electrodes

In some cases, your physician may need more information than can be gathered using surface electrodes. This is typical when we need to evaluate
muscles that are deeper or under other muscles or may be too small to monitor from the surface of the skin.

This approach uses tiny wires that are inserted through the skin directly into the muscles to be monitored. As an invasive procedure, your child may experience brief pain or irritation with no lasting affects.

4. 3D Motion Capture of Walking and/or Upper Extremities

The 3-dimensional motion analysis evaluation includes several components to measure motion (kinematics), forces (kinetics) and walking characteristics. The results provide an objective and quantifiable understanding of movement allowing our clinical team to accurately describe, analyze and formulate recommendations. Watch a short video clip.

In this part of the evaluation we create a 3-dimensional picture of how your child moves and walks. Small reflective markers, the size of a marble, are used to help the cameras and computer software develop 3D joint motion data. These markers are placed on your child’s skin with a double sided type tape. Markers are placed on specific anatomical landmarks of the pelvis and both lower extremities, and in some cases, the trunk and upper extremities.

Special cameras are located throughout the room and track the markers on your child as they walk, capturing the data needed to create a 3-dimensional picture. This is done as naturally as possible, barefoot and if possible without assistive devices. Your child’s data is compared to normative movement patterns to identify abnormal or unusual motion and any variation from norm. View the Health Watch Daily Check Up story on motion analysis.

Joint Forces

In addition to the markers, we will also measure the forces your child generates when walking. Specifically, we will be measuring the foot/floor contact forces during each walking trial by specialized force platforms, similar to your bathroom scale that measures your weight.

Walking Characteristics (spatial and temporal parameters)

Measurement of average walking velocity, cadence, stride length, gait cycle time, double limb support time and single limb support time are collectively referred to as Stride Characteristics. Our staff compares your child’s stride characteristics to typically developing children’s to identify how your child’s needs may be different.

5. Evaluation Analysis, Review and Recommendation

All of the data from your child’s tests are analyzed and reviewed by our team - physical therapist, engineer and physician. Recommended treatments have included surgery, orthotics prescription, Botox/phenol injections, physical therapy, and electrical stimulation. The team will not recommend intervention that does not work toward the child’s and their family’s goals of improving gait or movement function. There are circumstances when the
current treatment plan will be sufficient and no new interventions will be recommended.

The final report is stored in a database for future reference and post-treatment assessment comparisons. Many patients do follow up for an additional gait or upper extremity analysis to evaluate the treatment and progress the child has made. The entire process from scheduling the appointment to communication of these final results to your referring physician is generally a 6 week time period.