Example: Case MVC

This is a clinical case report presented as an example of a gait analysis.

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History:

38 year old female

diagnosed with polymyositis

also 5 years post motor vehicle crash resulting in right femur fracture and neurological damage at L1/L2 on left

Polymyositis is an inflammatory muscle disease that causes varying degrees of decreased muscle power. The disease has a gradual onset and generally begins in the second decade of life. Polymyositis rarely affects persons under the age of 18. The most common symptom is muscle weakness, usually affecting those muscles that are closest to the trunk of the body (proximal). Eventually, patients have difficulty rising from a sitting position, climbing stairs, lifting objects, or reaching overhead. In some cases, distal muscles (those not close to the trunk of the body) may also be affected later in the course of the disease. Trouble with swallowing (dysphagia) may occur. Occasionally, the muscles ache and are tender to touch. Patients may also feel fatigue and discomfort and have weight loss or a low-grade fever.

Impairments:

Right lower extremity 2 cm shorter than left

Decreased sensation below L1/L2 on left

Muscle weakness (score out of 5)

Muscle Group	Right	Left
Hip abductors 5 2                            Hip extensors 2 5                            Hip Flexors 3 1                            Knee extensors 4 2                            Ankle dorsiflexors 2 1                            Ankle plantarflexors 2 1

Functional Limitations:

Difficulty with ambulation on all surfaces, uses cane outside the home

Gait Evaluation:

Reason for referral: Rehabilitation treatment recommendations, especially with respect to bracing

Test conditions: Barefoot walking without assistive or orthotic devices

Highlights of results for Case MVC

Impairments creating functional problems

• Right leg length discrepancy

• Bilateral ankle dorsiflexor weakness (much worse on left)

• Left knee extensor weakness

Right leg 2 cm shorter than left AND left foot drop (exaggerates difference)

Primary gait findings:

Leg length discrepancy = asymmetrical vertical pelvic motion

Left foot drop = increased ankle plantar flexion in swing phase

flat foot at initial contact

Secondary Compensations:

increased left knee flexion, hip flexion, and hip abduction in left swing phase

Left knee extensor weakness

Primary gait findings:

Knee hyperextended with flexor moment

Secondary Compensations:

increased left hip extensor moment and power

Some increased ankle plantar flexor eccentric work (at end range)

Treatment recommendations:

Flexible ankle foot orthosis on left

Flexible to allow body to progress over left foot in late stance phase and substitute for eccentric function of ankle plantar flexors

Consider casting orthosis in 5 deg of plantar flexion to enhance eccentric plantar flexion function

Right shoe lift to correct leg length discrepancy

Reassess need for orthosis on right after above completed