CLINICAL GAIT ANALYSIS IN ANKARA UNIVERSITY

by Dr Günes Yavuzer, Dr Haydar Gök

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A view of the gait analysis lab at Ankara University with Professor Sureyya Ergin and Gunes Yavuzer (seated), Haydar Gok and Birsay Demir

The concept of this gait analysis laboratory, to be used by all disciplines within the Ankara University Medical School, was first discussed in 1995, and was the inspiration of Professor Ergin . She worked hard to convince others that gait analysis was an incomparably valuable method and to find sufficient finance to purchase the best equipment available. The proposal written by Prof Ergin and Dr Yavuzer on "The Value of Gait Analysis in the Clinical Decision-Making Process of Patients with Cerebral Palsy and Stroke" was accepted and funded by the Government. The first clinical gait analysis laboratory in Turkey was set up in Ankara University Medical School in 1997.
The new lab, equipped with a Vicon 370 gait analysis system, and 5 tripod-mounted Vicon cameras, is centred around a 10-metre walkway located in a rectangular room. Two force plates (Bertec, Columbus, IL) are mounted in the middle of the walkway. Due to a lack of resources, EMG could not be made ready in time to be used for gait analysis until 2002. Through the tireless efforts of Prof Ergin, the necessary finance was provided from Ankara University and the Government and, besides a 6-channel dynamic electromyography (Motion Lab.), the original Vicon Clinical Manager was updated and the latest Polygon software incorporated.
The laboratory team is co-ordinated by the Department Director Prof Süreyya Ergin and includes the following people: Günes Yavuzer and Haydar Gök, consulting physiatrists providing 40% of their working time and Birsay Demir, technician, with 50% of his time. Prof Turgut Tümer, Mechanical Engineer, and his team from Middle East Technical University, gives technical support whenever necessary.
During the first 6 months after the laboratory was established, a data pool of adults and children was prepared for different age groups of each gender. Children with cerebral palsy, spina bifida, clubfoot and flat feet, as well as adults showing a range of diseases, including stroke, traumatic brain and spinal cord injury, osteoarthritis, sports injuries and mechanical malalignments, constitute the broad spectrum of patients for gait analysis in our laboratory. Patients are referred to our lab by physiatrists, orthopaedic surgeons and sports medicine physicians from all over the country. A guide has been designed and is given to patients and families referred to our lab, to answer the most frequently asked questions before analysis such as, what is gait analysis, and what should I expect during the analysis? Almost 1500 subjects have been analysed up to now, in the context of clinical investigations and invidual case studies.
All the patients referred for gait analysis are first evaluated by either Dr Yavuzer or Dr Gök in terms of physical assessments, joint range of motions and muscle tone. Calibration of the system and anthropometric measures are carried out by our technician. After capturing and processing the data by Dr Yavuzer or Dr Gök, interpretations are made by Prof Ergin, Dr Yavuzer and Dr Gök as a working team. It has been suggested that the gait lab at Ankara University answers the clinical questions regarding the diagnosis and treatment options for patients with neuromusculoskeletal disorders. We aim to collect data and use it for the clinical decision-making processes, student and resident training and for scientific research. Some of the published papers and ongoing clinical research studies by our team are listed below:
Effect of an Arm Sling on Gait Pattern in Patients with Hemiplegia. Yavuzer G., Ergin S. Archives of Physical Medicine and Rehabilitation 2002; 83:960-3.
In this study, the impact of arm slings on gait stability, safety and efficiency in patients with hemiplegia has been evaluated. It was concluded that among other interventions, an arm sling can be applied to improve gait, especially during gait training sessions of patients with hemiplegia who have impaired body image and excessive motion of the centre of gravity.

Spatiotemporal and kinematic gait characteristics of stroke patients. Yavuzer G, Gök H, Ergin S. The Journal of Rheumatology and Medical Rehabilitation 2001; 12: 148-152.
This paper evaluated gait disturbances and the association with age, time since injury, and the functional disability levels of stroke patients.

Yavuzer R, Yavuzer G, Latifoslu O, Ergin S. A New Perspective To Sural Nerve Graft Donor Site Morbidity Assessment: Gait Analysis. Annals of Plastic Surgery 2002; 48:449-450.
It has been shown with this study that heel strike and ankle kinematics were disturbed after sural nerve removal for grafting fascial nerve.

Gök H, Ergin S, Yavuzer G. Kinetic and kinematic characteristics of gait in patients with medial knee osteoarthrosis. ACTA Orthopaedica Scandinavia (In press).
This study evaluated the gait disturbances of patients with medial knee osteoarthritis and gave insights for medical treatment methods.

Gök H., Yavuzer G., Ergin S. Reliability of gait measurements in normal subjects. The Journal of Rheumatology and Medical Rehabilitation (In press).
The reliability of the assessments produced in our gait lab has been demonstrated, and problems and their possible solutions have been discussed.

Yavuzer G., Sonel B., Kutlay S., Ergin S. Use of Gait Analysis in Clinical Decision-Making Process of Patients with Spastic Cerebral Palsy. Journal of Physical Medicine and Rehabilitation (In press).
In this retrospective, descriptive study, medical charts and gait analysis reports of 43 children with spastic CP were reviewed. The mean ± SD of the children was 9.5 ± 5.2 years. 76% had diplegia and 24% had hemiplegia pattern. Kinematic gait analysis revealed excessive pelvic excursion in three of the planes; excessive hip flexion, adduction and internal rotation angles in sagittal, coronal planes and transverse plane, respectively. 25% of the children with spastic CP had crouch and 35% had stiff-knee gait patterns. Excessive plantarflexion (n=16), dorsoflexion (n=14) angles and bony deformities (n=29) were observed in the foot and ankle. Eighty percent of the analysis (n=34) resulted in recommendations for a change in patient care. Ninety-five of these recommendations were specific physical therapy regimens, 46% botulinum toxin injections, 49% bracing, and 7% were for surgery. It is concluded that gait analysis is a tool that enables the clinicians to differentiate gait deviations objectively. It serves not only as a measure of treatment outcome, but also as a useful tool in planning ongoing care.

Yavuzer G, Ergin S., "Effect of Cane Use on Clinical and Gait Characteristics of Patients with Osteoarthritis of Knee," Acta Rheumatologica Turcica (In press).
This study was designed to investigate the effects of cane usage on pain severity, stiffness, physical functioning and gait characteristics of patients with osteoarthritis of the knee. It was concluded that there is no significant effect from cane usage over three weeks on pain severity, stiffness, physical functioning, and kinematic and kinetic gait characteristics of patients with osteoarthritis of the knee.

Gök H., Alt'nkaynak H., Küçükdeveci A., Yavuzer G., Ergin S. Effects of Plastic and Metallic Ankle-Foot Orthoses on Hemiparetic Gait in Stroke. Abstract Book, 3rd World Congress of Neurorehabilitation, Venice, 265-266, 2002.
This study was performed to investigate the effects of different AFOs on hemiparetic gait. It was concluded that both plastic and metallic AFOs efficiently improve gait deficiencies.

Sonel B, Kutlay S, Yavuzer G, Ergin S. The Effects of Botulinum Toxin Type A In Children With Spastic Diplegia: Preliminary Results. Abstract Book, First World Congress of the International Society of Physical and Rehabilitation Medicine, Amsterdam, 141, 2001.
This study was designed to assess quantitatively the effects of botulinum toxin-A injections in patients with spastic diplegia. BTX treatment was found to be effective and safe in patients with spastic diplegia in terms of mobility, muscle tone, functional outcome and gait parameters.

Yavuzer G., Sarmer S, Ergin S. Effect of Silicone Insoles on Gait Pattern in Patients with Pes Planus. Abstract Book, 13th European Congress of Physical Medicine and Rehabilitation, Brighton, 236, 2002.
The purpose of this study was to investigate the effect of silicone over-the-counter insoles on biomechanical gait characteristics of patients with pes planus. Pes planus is an important biomechanical deformity of the foot. Effecting the kinematic and kinetic gait parameters, it may cause severe and disabling pain at the lower extremities. Application of silicone over-the-counter insoles can correct most of the impaired gait parameters.

Yavuzer G, Sonel B, Süldür N, Ergin S. Viscosupplementation Versus Physiotherapy In Knee Osteoarthritis: Short-Term Effects On Biomechanical Parameters of Gait. Abstract Book, 13th European Congress of Physical Medicine and Rehabilitation, Brighton, 242, 2002.
This study was designed to measure and compare the effects of a 3 week physiotherapy (PT) programme and intra-articular Hyaluronan or Hylan G-F 20 injections on biomechanical characteristics of gait. It was found that biomechanical characteristics of gait improved in all of the groups.