Gait Analysis

The Pros and Cons of 4 Types of Gait Analysis

PTs rely on multiple types of gait analysis to get a complete picture of a patient’s walking pattern to diagnose injuries and develop recovery plans.

Gait affects more than just a patient’s legs. Over time, improper gait can add strain to multiple parts of the body and even cause injuries. Physical therapists can use different types of gait analysis to evaluate pain, discomfort, and abnormal movements a patient experiences while walking, running, or standing.

Although gait plays a role in how all humans move and walk, gait issues mostly affect athletes, surgery patients, and the elderly, who are more susceptible to injury. PTs can use gait analysis to pinpoint specific problem areas that cause pain or dysfunction, then create a treatment plan that addresses their patient’s issues. For instance, PTs commonly implement a gait training program based on a patient’s gait analysis to improve balance, range of motion, flexibility, and strength.

By using modern tools and methodologies, PTs can better evaluate their patients’ gait patterns to diagnose injuries and other issues. Physical therapy clinics must choose what types of gait analysis to offer based on factors such as accuracy, cost, and difficulty of use.

Observational gait analysis

Observational gait analysis is a physical therapist’s primary clinical tool for evaluating a patient’s gait. An observational gait analysis usually begins with a physical examination, followed by a visual evaluation of how the patient walks, runs, stands, and moves.

By performing an observational gait analysis, PTs can quickly understand their patients’ gait patterns and detect any major abnormalities. Other types of gait analysis require specialized equipment, but an observational analysis can be performed using live observation or video footage of a patient walking. Sometimes a PT will use a checklist to take note of areas of pain, possible asymmetry, and other issues. Then they can compare their notes to a video recording of the patient’s gait to complete their assessment.

Because it is limited to a visual assessment, an observational gait analysis provides little information about the causes of a patient’s pain, dysfunction, or unusual movement patterns. However, performing an observational gait analysis enables PTs to establish a baseline of a patient’s typical gait pattern and narrow the focus of future assessments.

Video technology

PTs often use tools like video and computer software to support their evaluations. Videotaped observational gait analysis (VOGA) is a practical, affordable technique that enables more reliable assessments without the high cost of specialized equipment.

By recording a gait analysis on video, PTs can thoroughly evaluate their patient’s gait without tiring them out with repeated exercises. Augmenting an observational gait analysis with video is particularly useful for examining athletes, who typically experience more complicated gait problems than the average person.

Like any observational gait analysis, an assessment’s quality largely depends on a PT’s level of clinical experience. However, useful features like slow-motion replay and freeze-frame can help provide more precise information about a patient’s movements. In some applications, PTs use software to analyze the video footage and identify unusual movements.

Pros:

  • Requires no specialized equipment
  • Can be performed in almost any environment
  • Costs less than instrumented gait analysis

Cons:

  • Provides less accurate data about gait
  • Limits assessment to external observation
  • Depends on the individual PT’s expertise

Kinematics

Although observing how a patient walks can tell PTs a lot about their gait pattern, they need other types of gait analysis to complete the picture. Kinematics is a form of instrumented gait analysis that assesses how joints move without considering the external forces that affect them. In a clinical setting, kinematic data provides a mathematical analysis of the movement of a patient’s joints across the sagittal, horizontal, and frontal planes. By recording a patient’s range of motion throughout the gait cycle, PTs can determine the possible underlying causes for changes in motion.

However, kinematic data cannot be obtained through mere observation, so PTs must use specialized equipment to collect these measurements. The most commonly used tools in kinematic gait analysis are wearable sensors, which are placed on specific areas of a patient’s body, like the feet or hips. PTs can then closely monitor muscle movement to better understand the range, speed, and direction of the patient’s movements.

Because there is a tendency to focus too much on the sagittal plane during observational gait analysis, PTs rely on instrumented types of gait analysis to evaluate multiple areas of the body at once. Kinematic measurements are often recorded in three dimensions to create a more realistic representation of a patient’s gait, such as a 3D model of the sagittal and frontal planes.

Pros:

  • Provides a more holistic gait analysis
  • Enables 3D reconstruction of a patient’s gait

Cons:

  • Requires specialized equipment
  • Must be performed in a laboratory setting

Electrogoniometry

An electrogoniometer measures joint angles to assess the flexibility and mobility of a joint during dynamic functional activities. Although clinicians often use a traditional goniometer to measure joint angles, an electrogoniometer provides higher-resolution measurements with little variation to improve the reliability and accuracy of kinematic data.

3D motion capture

Thanks to recent advancements in technology, PTs can quantitatively measure kinematic data and recreate a patient’s gait in 3D. Three-dimensional motion capture typically falls into one of two categories: marker-based or markerless motion capture.

In marker-based motion capture, a PT will place markers on a patient’s feet and legs. The marker-based motion capture system then detects the position of these landmarks on the body and reconstructs their 3D trajectories to improve the accuracy of a gait analysis. In a markerless motion capture system, multiple cameras view a patient from all angles while deep learning algorithms reconstruct a patient’s gait in 3D. Compared to a marker-based technique, markerless gait analysis does not require a patient to wear heavy devices that can cause physical discomfort or distort their normal gait pattern.

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Kinetics

Kinetics refers to the study of motion and external forces that affect the body. Compared to kinematics, kinetic gait analysis measures parameters such as joint movement, power, and ground reaction force to describe the biomechanics of a patient’s gait. Understanding kinetic forces like power generation and absorption can aid PTs in better understanding a patient’s kinematic data and diagnosing any gait irregularities.

For instance, PTs can use ground reaction force data to interpret abnormal movements in a patient’s gait pattern. As one of the most relevant kinetic parameters in gait analysis, ground reaction force measures how much force is exerted by the body onto the ground, then reflected back onto the body. By using ground reaction force and other kinetic measurements, PTs can estimate joint kinetics and infer information for several musculoskeletal diseases.

Dynamic electromyography

Although muscle activity cannot be measured directly, dynamic or kinesiological electromyography measures the timing and relative intensity of muscle activity. Using sensors placed on specific areas of the body, an electromyogram (EGM) creates an outline of a patient’s gait so a PT can identify possible causes of a gait abnormality.

Although electromyography is a relatively noninvasive technique in gait analysis, it is underutilized in the clinical setting. However, performing an electromyogram can offer huge benefits to a PT’s gait analysis. A surface electromyography (sEMG) gait analysis requires only 15 to 30 minutes, including placing the sensors, and the patient only needs to walk independently for a few minutes.

Pros:

  • Can be performed in 30 minutes or less
  • Records patient progress to assess the effectiveness of the treatment plan

Cons:

  • Cannot be applied in daily life monitoring
  • High variability of gait pattern, even within the same patient

AI-driven tools

Instrumented gait analysis methods are typically found in research applications due to their greater accuracy and reliability, but their higher costs and complexity make them less practical for everyday clinical use.

Advanced technologies like artificial intelligence combine the versatility and cost-effectiveness of observational gait analysis with the accuracy of instrumented analysis like kinematics and kinetics. Newer tools often use mobile apps to measure a patient’s gait, provide accurate data in real time, and record a patient’s improvements and challenges over time.

Exer Gait

AI-driven technology like Exer Gait leverages the power of machine learning to measure, model, and predict a patient’s gait pattern without the need for physical sensors. Instead, it observes a patient using any device with a 2D camera (like a smartphone or tablet), then analyzes this data to identify irregularities in the patient’s gait pattern.

The real power of Exer Gait’s AI-enabled gait analysis is that the technology constantly improves by learning from millions of data points related to gait, like posture, velocity, and direction of movement. The software automatically records data about a patient’s gait during each session, so PTs can easily track their progress over time and adjust their treatment plan as needed.

Pros:

  • Complements all types of gait analysis
  • Enables accurate data collection without specialized equipment
  • Generates objective data, improving longitudinal comparisons (progress over time)

Cons:

  • Requires measured walkway (~16ft) for accurate results
  • Requires iOS tablet/phone (iPhone, iPad)
  • Current metrics less extensive than sensor or multi-camera systems

Transforming gait analysis with the latest technology

PTs depend on accurate gait analysis methodologies to effectively treat patients with gait abnormalities and reduce the risk of future injury. By leveraging specialized tools and software, PTs can use several types of gait analysis to more efficiently assess a patient’s gait and develop a treatment plan customized to their needs.

From the everyday observational gait analysis to more sophisticated methods like kinematic and kinetic analysis or AI-enabled apps like Exer Gait, these different types of gait analysis empower PTs to catch underlying problems sooner and improve patient outcomes faster.

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