Observational Gait Form Guidelines 1. General Members of the department of Physical Therapy of the University Medical Centre Nijmegen St Radboud designed the Observation Gait Form. This is an adaptation of the original form developed by J. Perry, Rancho Los Amigos Hospital, California, which was specifically intended for patients who suffered a stroke. Sander Geurts (Sint Maartens-kliniek, Nijmegen) first translated the form into Dutch. De Witt and Holdrinet modified the form (published in the reader for the course of Functional Gait Training) in 1988. The modified form was designed specifically for patients suffering with orthopedic disorders of the lower extremities (LE). The current version takes into account the eleven most commonly seen deviations as observed at University Medical Centre Nijmegen Department of Physical Therapy. To perform a gait analysis, the following items are required: = Standard video camera and recorder with the ability to view “frame to frame” and to “freeze frame.” + The camera will be placed so one can view the subject's entire body while walking. 2. Analysis General: = Overall gait analysis. = Areas of observation include: general, trunk, pelvis, hip, knee, and ankle. = Each area is divided into a specific motion deviation which may or may not be present. = Scoring will occur during stance phase or swing phase. Use freeze frame and / or slow motion, as needed. = If a motion is not possible during stance phase or swing phase, the block is colored grey.Rater:, Video #; Patient #: OVERALL SEVERITY OF GAIT DISORDER: No Gait Disorder Severe Gait Disorder t z 3 za ea STANCE PHASE SWING PHASE Item Question LE | Early Mid Late Early Late General] 1 _|is ashortened stance present? Left 9 i 2 ea Right ot 2 a Trunk |__2 [is the trunk positioned anterior tothe hips? oi 2 3 isa lateral flaxion present? Left] 0 1 2 If or2,is lateral flexion to RorL?_ Right] 01 2 _ If or 2, is lateral flexion to R or L? 4 |is the arm-swing recuced? Left o 1 2 Right o + 2 Pelvis | 5 _|Is the posterior rotation excessive? tet Fe ee] oo 1 2 toe Hip 6 is the extension reduced? ee o 1 2 -. Knee 7 |is the extension reduced? eee a 012 nn a 8 [isthe flexion movement absent? . ae 9 |Is the flexion reduced? Saat ae pees 10 __|Is the extension absent? oo peeeen EG Ankle |” 11 [isthe plantar flexion reduced? Normal Fairly disturbed Severely disturbed3. Available scoring possibi OVERALL SEVERITY OF GAIT DISORDER: No Gait Disorder Very Severe Gait Disorder E 2 3 Eee IE [STANCE PHASE: item ‘Question ue | eoiy [wa | tne Gonorat | 1 [isa chortoned stance prosont? Lett o 12 ig o 12 ‘Trunk |_3_ [isthe trnk positioned anterior to the hips? one ['s2latoraltexton present? tet fo 1 2 ttoratonertoLd, iom[o 1 2 1 0r2, toRortols 5 [isthe camswing reduced? Peivis | 6 fs the poster rotation excessive? Hip | 7 fs the extonsion educwd? Knee | 0 [le the extension duced? 9 isthe tenon movement assent? 10 [lets Hexion reduced?” 11 [sine extension absent? ‘ankie | 12 |s te plantar exion reduced? [Legend: = ce Normal Sb Fairly disturbed ia ‘Severely disturbed 3.1 Information regarding the items: Circle the number associated with the subject's disturbance. If no disturbance is present, record 0. Make sure to indicate score in the appropriate row (left or right). When a disturbance is present, use your best judgment to distinguish between 1 and 2.3.2 Points of Importance * While scoring, do not interpret. = During sagittal recording, only score the side facing the rater. + It is recommended that no more than two walking cycles are observed prior to recording your score. = In the case of a clear and constant disturbance, one walking cycle should be sufficient to score. * Be aware of the phase of the gait cycle you are scoring. 4, How to score each item. 4.1 Overall Severity of Gait Disorder OVERALL SEVERITY OF GAIT DISORDER: No Gait Disorder Severe Gait Disorder 1 z 3 7 Ee According to your best judgement, circle the number which indicates the overall severity of the subject's gait disorder. Rate this section before rating the items. 4.2 General Item 1: Is a shortened stance present? STANCE PHASE: SWING PHASE tem ‘Question ve | ean Mia Late. Eary | Late Gonerat| 1 | shortened stance present? Late o 12 e Fight o 1 2 If shortened stance on either lower extremity is present, score 1 or 2 in the appropriate row (R or L), according to your best judgement. 4.3. Trunk Item 2: Is the trunk positioned anterior to the hips? ‘STANCE PHASE ‘SWING PHASE. Item Question ue | any Mia Late, Early | tate Trunk | 2 [sthe munk postioned anterior tothe hips? o 12 During normal gait, the trunk will be located above or slightly anterior to the pelvis. If trunk is above or slightly anterior to the pelvis, score 0. If the trunk is clearly anterior to the pelvis, score 1 or 2 according to your best judgement.Item 3: Is lateral flexion present? STANCE PHASE SWING PHASE, tom ‘Question ue | eany Mia Late Early | Late Trunk | 3 featatoralnexion present? tat 0 1 2 1f10r2,ieleteraltewonto orl ight|o 1 _2 WV tor 2 is ltera texion to Ror L7f Normally, minimal lateral flexion occurs according to the side of stance (ie: stance phase on L lower extremity=slight lateral flexion to the L, etc.). Score 0 if slight lateral flexion occurs toward (ipsilateral) the side of stance. If any lateral flexion occurs away from (contralateral) the stance side, score 1 or 2 according to your best judgement. If increased lateral flexion occurs toward (ipsilateral) the side of stance, score 1 or 2, according to your best judgement. Item 4: Is the arm swing reduced? ‘STANCE PHASE SWING PHASE tem Question ue] eanty Mie Late. Early [Late Trunk | 4 ls the arm-owing reduced? Lett O12 Fgh oe Since trunk rotation can only be observed from above and arm swing is a result of trunk rotation, arm swing will be used for scoring. Normally, arm swing is alternating and symmetrical. Observe the movement of the shoulder together with the movement of the elbow. If arm swing is normal, score 0. If arm swing is reduced on the L, R, or both, score 1 or 2 in the appropriate row, according to your best judgement. 4.4 Pelvis Item 5: Is the posterior rotation excessive? STANGE PHASE SWING PHASE tom Question te | cay [ms i cary [tne Pavia | & fate postorotton excessive? tot [oe e412 iif O12 Normally, the pelvis rotates 5° forwards and 5° backwards about a vertical axis. This amount of movement is not perceptible. If no noticeable rotation of the pelvis occurs, score 0. If noticeable rotation, specifically posterior rotation, occurs, score 1 or 2, according to your best judgement.4.5 Hip Item 6: Is extension reduced? STANGE PHASE SWING PHASE tem: ‘Question Le Late eaty [tate Hip | 6 [ste extension reused? Lat oi eu oe From mid stance until the beginning of the bipedal phase, the hips extends from 0° to 10°, Maximum hip extension is reached at the moment of heal off during late stance phase. The angle is observed between the thigh and the trunk / pelvis. If hip is extending during late stance phase, score 0. If hip is not extended during late stance phase, score 1 or 2 according to your best judgement. 4.6 Knee Item 7: Is the extension reduced? ‘STANCE PHASE SWING PHASE tem ‘Question ue | eary Mid tor | early [Late knee | 7 [the extension resuced? Lett —— 7 - 1 Fagn = 1 Normally, there is an extension movement of the knee in late swing phase. The knee should reach or almost reach 0° but should not hyperextend. If complete extension of the knee is achieved, score 0. If complete extension is not achieved, record 1 or 2 according to your best judgement. Examples to record 1 or 2 for item. + Extension movement occurs in late swing phase but full extension is not achieved. * Absence of knee movement during late swing phase, ie: “stiff knee” gait. Item &: Is the flexion movement absent? ‘STANCE PHASE ‘SWING PHASE. Item ‘Question Le any | tate Knee | & [emo terion movement abeont? Lett Fight Early Mig Normally, a flexion movement of the knee occurs during early stance phase (0°- 25°). If the movement occurs, score 0. If this movement does not occur (stiff knee gait), score 1 or 2 according to your best judgement.Item 9: Is the flexion reduced? (0°- 25°). If the movement occurs, score 0. If the movement occurs STANCE PHASE SWING PHASE tom Question ue Early mis [tate | cory [tne @- | the fexonresueee? tet] 01 2 —ae ee = ign] ose L i Normally, a flexion movement occurs at the knee during early stance phase but less this occurs, score 0. If near full extension is not reached, score 1 or 2 than 25°, score 1 or 2 according to your best judgement. Item 10: Is the extension absent? STANCE PHASE ‘wing PHASE tom ‘Question te | eany i Early Knee | 10 |is tha extension absent? Lett F O12 Fight a1 2 Normally, during mid stance phase, the knee nearly reaches full extension. If according to your best judgement. 4.7 Ankle Item 11: Is the plantar flexion reduced? ‘STANCE PHASE SWING PHASE | ttm Question ue | eony [mia Late early [toto Takis | 11 [tre plantar fexon educec? tet 2 ee righ 12 bee Normally, approximately 20° of plantar flexion is reached during late stance phase. This movement will allow for heel off in late stance, and heel strike during early stance of the opposite leg. If approximately 20° of plantar flexion is reached, score 0. If heel off does reach 20° or does not occur before heel strike of the opposite leg, score 1 or 2 according to you best judgement.