Am J Phys Med Rehabil 1994 Nov-Dec;73(6):421-7
Spaulding Rehabilitation Hospital, Harvard Medical School Division of Physical Medicine and Rehabilitation, Boston, MA 02114.
The purpose of this report is to illustrate the utility of a gait laboratory as a simple, straightforward aid to psychiatric care. The evaluation and management of a patient with spastic paresis and reduced knee flexion in swing (stiff-legged gait), using quantitative gait analysis, are provided. Spastic quadriceps activity during swing was thought to be the cause of reduced knee flexion, based on traditional physiatric history and physical examination. Gait laboratory analysis, including lower extremity kinematic, kinetic and dynamic electromyographic measurements, demonstrated that the quadriceps were not inappropriately active, as had been expected and suggested, instead, that the reduced knee flexion was secondary to dynamic ankle plantar flexor weakness. Modification of an ankle-foot-orthosis and specific exercises to strengthen the ankle plantar flexors were, therefore, prescribed and resulted in kinematic and kinetic improvements at subsequent gait analysis and a subjective feeling by the patient that gait was better. Gait laboratory analysis was useful in determining the optimal rehabilitation plan.