Home » Clinical Scenario – NND

You can download the Gait Analysis Protocol following this link.

Clinical scenario:

François is a 10 year old boy with a Neurological and Neuromuscular Disease. His medical records show a consistently significant delay in his motor development. His current level of the Gross Motor Function Classification reveals that he can walk unsupported with difficulties while walking outside. He falls over in the playground frequently, and has a very limited walking distance, due to early fatigue. Moreover, his physiotherapist is concerned that his walking pattern may deteriorate further, eventually resulting in wheelchair dependency.

François is referred to a specialist paediatric centre of rehabilitation medicine, where his walk-ing pattern is analysed in the gait laboratory. A complete recording of François’ gait pattern, using 3D kinematics, joint kinetics and muscle activation patterns, is performed along with metabolic measurements of the Energy Cost of Walking (ECW). From the gait analysis results, the physiatrist concludes that hyperactivation of the calf muscles is present, while François is walking with slightly flexed knees when standing. This positioning causes compensatory hyperactivation of muscles at other levels, resulting in an overall in-creased ECW.

The physiatrist should decide the therapy, but she can only rely on scattered information derived from some single cases, rather than explicit design rules. Current knowledge shows that chemo denervation of the calf muscles should normalize the hyperactivation, end compensatory activation and decrease the enhanced ECW. However, it would also contribute to a higher knee flexion moment that would drive the knee in further flexion when standing, wors-ening his walking.

This latter phenomenon would call for another therapy known to be effective to counteract knee flexion. Fortunately, the laboratory has applied the EU stand-ards of clinical gait analysis becoming a MD-Paedigree clinical centre.

An additional scan is made and all the information on François’ case is anonymised and uploaded to the system. MD-Paedigree’s disease modelling analysis shows that chemo denervation of the calf muscles could solve the problem, but the effect on knee flexion remains undecided, within acceptable model accuracy. However, the probabilistic model supports the treatment choice and points two matched cases where chemo denervation with additional physiotherapy proved to be successful. The physiatrist is now confident of how she will treat François.

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