The Case for gait analysis as part of the management of incomplete spinal cord injury

Incomplete spinal cord injury at ASIA (D) level often leads to major gait re-education attempts for patients and staff. Walking prognosis usually depends upon muscle power loss, degree of spasticity present, type of lower limb joint deformity developing and availability of treatment. As an adjunct to physical examination and observation, instrumented gait analysis can inform treatment, since three-dimensional dynamic joint range motion (kinematics) and estimation of joint forces occurring at the hip, knee and especially ankle/foot (kinetics) can be combined with walking EMG and energy cost tests to understand fully a gait deficit. This should then assist the clinical decision-making process. Knowledge of the effects of any dynamic contracture on the available redundancy within ipsilateral limb joints, and information about muscle actions obtained by calculating joint forces (including moments and powers) improves overall knowledge of gait cycle abnormality. Such gait analysis has revolutionised the management of spasticity in walking cerebral palsy children by guiding surgical and other treatments. Similar improvements could be looked for in incomplete SCI patients whose gait pattern is not ideal. Dynamic energy cost estimations could also be used as an outcome measure to study improvements after treatment: whether this is orthotic, pharmacological or following physiotherapy or surgical techniques.