Comments appreciated: gait analysis video - what’s strange?

[DomT6]

YouTube - Learning to walk again

The above link is a video my friend made of himself. He was involved in a serious accident which meant he had to have surgery to both his legs, and he has scarring on his face (which is why he wanted to have his face covered in the video – sorry for the bank-robber style disguise!).

He’s happy to be walking again, and he’s going to have further surgery on his face.

He’s dealt with this very positively. But we’ve both been looking at his legs, and something just seems strange. Obviously he’s not back to one hundred percent, and the surgeon said things will take time, but I’ve been looking at his legs for so long, and so has he, that we can’t work out if there’s something “wrong” or if we’re just over-analysing things.

He (and I) would really appreciate your opinions. Do his legs look strange? Or is it just that they’re not fully recovered and he needs to ‘practice’ his walking more?

Part of the video shows him with a jacket, then just a t-shirt, then his t-shirt tucked in. I could also post up videos of him wearing other clothes if that helps.

Thanks, Dominic

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[physiobob]

Firstly this would be better seen with his shirt off and a pair of shorts. It looks like this person does not have or is not using their hip stabilizers. He is shifting his weight for balance on each leg and perhaps the left side is worse than the right.

The hip flexors and adductors doe not appear to be involved correctly and therefore there is slight circumduction in his gait. Really we need to view a much longer walking in either direction rather than 2-3 steps of this small room. Please take some more video and please do provide more information of what his injuries were. The ankle and knee joint movement does not look to bad from a later view although there is a noticable varus deformity or movement about his left knee during the swing phase of walking possibly indicating past injury? Possible weakness of the right peroneal muscles? Did this person have lumbar nerve damage or a higher level neurological injury?

Also he has a problem turning towards the right. If I were to really compare his gait to other altered gait patterns this looks as though he had right or possibly bilateral above knee amputations and is wearing prosthetic legs with really good ankle and knee joints. It appears more at the pelvis/hip/trunk that the issues might be, or very weak as he is overworking the ipsilateral side to compensate during swing for weakness lower down on the swing leg.

Can we see him in shorts and standing front in front and behind on one leg whilst trying the flex the opposite hip to bring the knee towards the ceiling.

Can he balance on one leg or not?

[junior_physiotherapist]

Hallo All,

First ,lets hope to your friend better improvement.

Indeed, we need ur full assessment for your friend,as the approach to managment will depend on proper diagnosis..

As it seems there is some disorders at his gait pattern ,...


Thanks,

[DomT6]

Thanks for the replies, we did a video outside but the light wasn't good - so we'll try it again. In the meantime, here are some videos of him in shorts. The last one is him standing on one leg and bringing the other knee up. Though ive just realised perhaps i misinterpreted that - perhaps one leg should be in front of the other.

anyway, here are the videos, and we'll do some more.

YouTube - Learning to walk again 2

YouTube - Learning to walk again 3

YouTube - Learning to walk again 4

YouTube - Learning to walk again 5

YouTube - Learning to walk again 6

[physiobob]

OK, so the left hip flexor ability is a problem. Also bilaterally he does not have any gluteal control. You can see this because he shifts his body weight over the standing leg when lifting the opposite one off the floor. The pelvis on the swing side should actually drop slightly but this requires contralateral stability which he does not have.

As mentioned in my first post, this looks like a proximal hip/pelvis stability issue as a primary place to start. He needs to be able to lift the knee towards the chest without shifting the trunk to towards the standing leg.

Look forward to see some longer walking in a corridor or outside preferably with a tight t-shirt on so we can see the trunk movement

[ghajina]

First,I appreciate your interest and sincerity.Also pls assess the right dorsiflexors. It seems to be slow clearence.

[physio.smith]

It would be useful to know what injuries he sustained, as this impacts on why he may move the way he does. Are there joint restrictions or neurological deficit etc..
Several things spring to mind when watching him walk.
* Is there neurological involvement, as he does not appear to be engaging certain muscles. This may be due to weakness from lack of use or a lack of innervation (nerve supply) to these muscles. There is little evidence of a heel strike to toe off pattern.
* Was there pelvic / lumbar spine involvement as he has poor dissociation of movement, hanging off of certain joints and muscles, rather than engaging others.
* Is there a leg length deficit, his lack of control of the left hip, with deformity at the knee, and apparant lateral rotation of his tibia indicate there could be.

I agree with above comment that he needs to regain pelvic and hip control. You also need to ensure that there is no leg length difference and that joint ranges are as close to normal as possible. If these are reasonable then there appears to be a need to increase knee extension control, as he appears to walk with slightly flexed knees and poor quads control especially on the left (this may also be due to his lack of hip extension). He also looks like he needs to do work on both hip extensors, with attention to glut med on left. He also appears to not use his calf muscles effectively, with increased activity of ant. tibialis muscles and toe extensor.

I think that a useful place to start would be a full neurological, joint and muscle assessment. Kinetic control exercises are excellent for progressing from little control to higher functional control of muscles. Regaining lower level control in non-weightbearing positions would help, as well as graded functional exercises.

I hope this is useful and that I have not missed the mark completely. Ideally it would be better to see him with only shorts on and as mentioned above walking for more than a couple of steps at a time.

[estherderu]

dear Dominic,

I agree with my colleagues that a good assessment cannot be done with tshirt on. I would like to see this person in (short) shorts only. A video analysis is only part of the assessment and can assist but...

- better light is needed,
- more steps are needed.
I would like to see him standing on one leg for at least 30 sec and see how his whole body reacts.
Better even, can he go to a real gait lab? that would be the best....
However....I do think using you-tube is a smart way of getting information all over the world fast ... very good idea!

good luck with your assessment

[DomT6]

Many thanks for these replies, we appreciate this very much.

Some of the videos posted in the later post are with shorts, but the light is not good and there is no greater number of steps. We need to find a place with good light where we can film a good number of steps from the side. We'll do that with no t-shirt or a tight t-shirt.

Could anyone recommend any exercises that would build up the appropriate muscles and stretches that would loosen up the appropriate areas?

Thanks again.

[physio.smith]

I saw other clips taken, you really need to be barefoot, the boots and socks don't give you a good view of what is going on.
As for exercises...you really need to get a thorough assessment of function done and get a individual program according to your needs.
*If you stretch some muscles without strengthening others you risk further instability problems.
*If you don't strengthen specific muscle, in a specific way, you risk overusing already dominent muscles and missing the ones that really need the work.
As mentioned previously, if a muscle is not fully innervated you will not be able to fully strengthen it.
Your best bet is to see a specialist.
Good luck.