2014 GCMAS Annual Conference

We are pleased to offer the following tutorial sessions on Tuesday, June 20th. These sessions will provide insight into clinical and technical questions that are of particular interest to the society. Registration for tutorial sessions is available at reduced rates for GCMAS members and at no cost for student and trainee attendees.

Tutorial #1 - June 24, 8:00 am - 10:00 am
Indications and Explicit Guidance for Bony Surgery Using Gait Analysis

Tom Novacheck, MD; Jean Stout, PT, MS; Adam Rozumalski, MS; Michael Schwartz, Ph.D.
Gillette Children’s Specialty Healthcare

The translation of gait-analysis findings into an explicit clinical treatment plan has been difficult for many clinicians to implement. This course is designed to bridge the gap of understanding for decisions related to bony procedures, primarily in children with cerebral palsy. Drawing from previous research, biomechanical models, new mathematical classification methods, and clinical experience, a method for surgical planning will be illustrated. Specific indications and contraindications for each procedure based on data gathered in a gait analysis center will be described. Surgical techniques will be explicitly described (including intraoperative videos). Limitations of current surgical techniques and goals for future steps to improve the translation of gait analysis and techniques into the surgery will be discussed. Case examples will illustrate both good and poor outcomes. Techniques for assessing outcomes of intervention will be presented which will further reinforce the knowledge incorporated into surgical decision making and problem-centric gait reporting.
Prerequisite knowledge: Gait analysis interpretation skills.

Tutorial #2 - June 24, 10:30 am - 12:30 pm
Toe Walking: Differential Diagnosis and Treatment Decision-making Using Gait Analysis

Kristan Pierz, MD and Sylvia Õunpuu, MSc
Connecticut Children’s Medical Center

Toe walking is frequently seen in childhood and may be the result of a wide variety of underlying etiologies. Although the idiopathic version is common, caregivers need to be aware of underlying, often subtle, etiologies that warrant evaluation and timely treatment. Treatment is generally pursued due to the implications of toe walking which include stance phase instability, foot deformity and eventually foot pain. Differentiation between primary and compensatory causes is required for appropriate treatment decisions. Comprehensive gait analysis measurements can distinguish subtle differences in presentation that can influence diagnosis and treatment options and evaluate treatment outcomes. This tutorial will be divided into two components: introduction to common toe walking pathology and characteristics as defined by motion analysis and related clinical examination measures followed by case studies for a variety of toe walking diagnoses to illustrate the important role of gait analysis in the assessment of toe walking. The tutorial will begin with a selection of videos images of patients who toe walk followed by a brief review of disorders that may result in toe walking (e.g.: spasticity/cerebral palsy, hereditary sensory motor neuropathies, limb asymmetry/leg length difference/hip dysplasia/joint contractures/tumors, sensory integration disorders, and idiopathic/habitual patterning). An overview of the components of a comprehensive assessment of toe walking including the following: visual/video analysis, physical exam, kinematics, kinetics and electromyography (EMG) and how each of these components can support or refute differential diagnoses will then be provided. Relevant gait terminology will also be introduced as a foundation for understanding common language to describe gait pathology.
The tutorial will conclude by revisiting the original cases by focusing on specific gait parameters that define different toe walking etiologies. Clinical exam findings, sagittal plane ankle/knee/hip/pelvis kinematic profiles, and EMG data will be used to support or refute different diagnoses and treatment options. Treatment outcomes for selected cases as evaluated using motion analysis will also be presented.
Prerequisite knowledge: Participants should have a minimum of basic level skills in gait analysis data interpretation including joint kinematics, kinetics and EMG.

Tutorial #3 - June 24, 10:30 am - 12:30 pm
Tissue Issues: How Does Obesity Influence Gait Analysis and Interpretation in Children and Adults

Sarah Shultz1, PhD, ATC, Paul DeVita2, PhD, FASB, Ray Browning3, PhD, FACSM (via web-based resources)

  1. School of Sport and Exercise, Massey University
  2. Department of Kinesiology, East Carolina University
  3. Department of Health and Exercise Science, Colorado State University

Obesity continues to be a global public health problem affecting millions of adults and children. Many obese individuals have limited functional capacity and are at risk of musculoskeletal injury/pathology. Biomechanical research has begun to investigate the relationship between these orthopaedic complications and an obese individual’s ability to participate in physical activity or activities of daily living. Specifically, gait analyses can provide a comprehensive understanding of the association between excess adiposity and impaired musculoskeletal function, but remain difficult to perform with current methodologies. Motion analysis of the obese population poses several challenges for practitioners and researchers, including accurate surface marker placements, excessive skin motion artifact, inaccuracies in body segment parameter estimations, and limited accuracy in EMG data. However, as more obesity-related biomechanical research emerges, new motion capture and segment parameter methodologies have been developed to address these challenges. Participants in this tutorial will become familiar with these population-specific methodologies, as well as understand what specific functional limitations and adaptations are associated with carrying excess mass.

Prerequisite knowledge: Participants should be familiar with biomechanical and gait analysis techniques, including motion capture, ground reaction forces and EMG.

Tutorial #4 - June 24, 2:00 pm - 4:00 pm
From Body to Joints to Muscles: An Integrative Multi-Scale Assessment of Ankle and Foot Function in Human Locomotion

Kota Z. Takahashi1, Benjamin D. Robertson1, Dominic J. Farris2, Stephen J. Piazza3, and Gregory S. Sawicki1

  1. North Carolina State University, Raleigh, NC, USA
  2. The University of Queensland, Brisbane, QLD, Australia
  3. The Pennsylvania State University, University Park, PA, USA

Recent advancements in motion capture techniques, functional imaging, and computational modeling have enabled a multi-scale assessment of human locomotion spanning levels of whole body, joints, and individual muscles. These tools combined, have highlighted the importance of ankle-foot structures in: (1) regulating the metabolic energy cost in normal and pathological gait, (2) optimizing movement capacity in athletes, and (3) inspiring designs of wearable devices for mobility enhancement. In this tutorial, we will overview the latest tools in musculoskeletal biomechanics, and will present a series of integrative studies that are shaping the fundamental principles governing human locomotion.

Prerequisite knowledge: No particular prerequisite knowledge is required. This tutorial should be accessible for anyone attending the GCMAS meeting.