"GAIT ANALYSIS and PNF"
GAIT ANALYSIS and PNF Grace McNelis,MS, PT, Chris Pappas,PT,IPNFAI; Tim Josten,PT,IPNFAI; Terry Harrell,MS,PT,IPNFAI,ATC The purpose of the gait analysis lab at Kaiser is to provide objective and accurate information about a person’s movement patterns correlated with muscle function during ambulation. Basically, there are five measurement systems. Three of these focus on the. specific events that constitute the act of walking: motion analysis, dynamic EMG, and force, plate measurements. The two remaining gait analysis techniques summarize the effects of the person’s gait mechanics; stride characteristics and oxygen consumption. It is evident that energy conservation is a basic component of human gait.4 Interruption of the normal gait cycle due to a gait disability results in increased energy expenditure.2 Studies have demonstrated the role of the pelvis in decreasing the vertical displacement of the body, as well as, it’s contribution to step length. Both of these events are functionally significant in decreasing the energy expenditure in gait.3 Pelvic motions that allow for smooth body weight progression with minimal energy cost have been identified in all three planes of motion; sagittal, coronal and transverse ~ Because of our ability to objectively measure pelvic motion and stride characteristics, we decided to study the functional consequence of PNF gait exercises and pelvic patterns on pelvic motion and temporal-spatial gait characteristics. The following case-study was designed to validate our clinical observation that utilization of PNF would improve the gait parameters of pelvic motion and stride characteristics. These improvements inferring increased gait efficiency. Pre- and post-PNF motion analysis and stride characteristics were recorded on the same day using identical testing procedures. The results of our case-study confirmed our clinical premise. Increased normalization of pelvic motion, as well as, improved stride characteristics were recorded post-PNF. This case-study represents a small step toward quantifying the efficacy of PNF. A greater sample size is necessary to show statistical significance to our findings. ‘This case-study begins the process for critically analyzing our clinical expertise. Many questions can be postulated and clinically researched regarding PNF and gait. Although we are privileged to have a full gait lab here at Kaiser, many simple clinical measures have been validated for use in data collection. Clinical research, from case-studies to statistically significant sample sixes, is necessary to improve the quality of clinical practice and paramount in providing efficacy to PNF. Bibliography 1. Bohannon R: Simple Clinical Measures. Physical Therapy VOL 67/No 12, December 1987. 2. Holden MK, Gill KM, Magliozzi MR, Nathan J, and Piehi-Baker L: Clinical Gait Assessment in the Neurologically Impaired; Reliability and Meaningfulness. Physical Therapy, Vol 64\No 1, January 1984. 3. Inman VT, Ralston HI, Todd F: Human Walking. Baltimore, MD, Waverly Press, 1981. 4. Iriman VT: Human Locomotion. Clinical Orthopaedics and Related Research, Number 228. March 1993. 5. Lehmkuhl LD: Mixing One Part Common Sense with Each Part Statistics in Planning the Design and Reporting the Results of Clinical Research in Physical Therapy. Physical Therapy, Vol 67\No 12, December 1987. 6. Perry J: Gait Analysis, Normal and Pathologic Function. Thorofare, NJ, SLACK inc., 1992. 7. Perry J: The Mechanics of Walking in Hemiplegia. Clinical Orthopedics 63:23-3 1, 1969. 8. Trueblood PR, Walker JM, Perry J, and Gronley 1K: Pelvic Exercise and Gait in Hemiplegia. Physical Therapy Vol 69:32-40, 1989. 9. Yekutiel, Dr. M: The role of Vertebral Movement in Gait: Implications for Manual Therapy. Journal of Manual & Manipulative Therapy, Vol 2\No 1\1994. 10. Wang RY: Effect of Proprioceptive Neuromuscular Facilitation on the Gait of Patients with Hemiplegia on Long and Short Duration. Physical Therapy\Vol 74 \No 12, December 1994. Speaker Profiles: Grace McNelis,MS,PT, received her undergraduate degree and Master’s degree in Physical Therapy from the Philadelphia College of Pharmacy and Science, Philadelphia, PA. She worked for the Veterans Administration in Long Beach, CA from 1989-1 991 in the Spinal Cord Injury Unit conducting clinical research and outcome studies on the energy costs of ambulation in the spinal cord population. Combining her interests in clinical research and functional anatomy she began work at the Pathokinesiology Laboratory at Rancho Los Amigos, Downey, CA (1991- 1994). Under the mentors/zip of Dr. Jacqueline Perry, Ms. McNelis worked on research and pre/post surgery gait analysis testing, including use of dynamic EMG. Currently, she is employed at the Motion Analysis Lab at Kaiser, Vallejo, CA where she provides comprehensive gait and upper extremity analysis (dynamic EMG, kinematics, kinetics) for pre- and post-surgical consultations and non-operative recommendations. Ms. McNelis is also an Associate Professor in the Physical Therapy Assistant Program at. the Western Institute of Science and Health, Rhonert Park, CA. Chris Pappas, PT,IPNFAI, is a 1983 graduate from California State University Northridge, and a graduate of the Vallejo PNF Residency Program. As a staff member at Kaiser Foundation Rehabilitation Center since 1984, Mr. Pappas, a clinical specialist, treats both neurologic and orthopedic patient populations and continues to be a primary PNF Instructor in the Vallejo PNF Residency Programs since 1986. Mr. Pappas has also taught PNF abroad and on the national, professional, continuing education circuit for the Institute of Physical Art. Tim Josten, PT,IPNFAI, graduated from California State University at Northridge in 1985. He completed the Vallejo PNF Residency Program at Kaiser Vallejo later that year and was a staff member and instructor at KFRC in Vallejo from 1986 to 1991. Mr. Josten is a primary instructor and trainer for the Institute of Physical Art, and since 1987 has taught PNF and manual therapy courses throughout the United States. Currently, he is a Clinical Specialist and Coordinator of the Physical Therapy Clinic at the Kaiser Napa Medical Offices. Terry Harrell,MS, PT,IPNFAI,ATC is a certified, advanced PNF instructor recognized by the IPNFA and has taught both nationally and abroad. She has been an instructor for the Kaiser PNF Residency Programs since 1991 and presently remains an active member on the faculty and physical therapy staff at KFRC in Vallejo. Ms. Harrell received her Master of Science degree in Physical Therapy from the University of Southern California in 1986. She completed the Vallejo PNF Residency Program in 1988.