Authors (including presenting author) :
LO TM(1), WU MS(2), SIT SY(3), YU WK(1), Lau FO(1)
Affiliation :
(1) Physiotherapist, Physiotherapy Department, TPH
(2) Physiotherapist, Physiotherapy Department, AHNH
(2) Physiotherapist, Physiotherapy Department, SH
Introduction :
Gait training is fundamental for patients’ return to walk in community after stroke and has always been a challenge in novice newly working in neurologic rehabilitation setting. Traditionally the clinical reasoning ability of novice relies heavily on mentorship and individual’s intuitiveness and learning ability.
Gait analysis is complicated and not easy to be grasped in a single assessment especially by novice while the description in assessment also varies among physiotherapists owing to their training and experience. A standardized video tapping approach plus use of a common tool in gait analysis would indicate better the progress of a patient and more helpful in communication among therapists.
Objectives :
1.To select and adopt a common tool in gait analysis in rehabilitation of stroke in Tai Po Hospital
2.To establish simple clinical reasoning relationship among observed parameters, kinematic deviations and possible causes in gait analysis
3.To make use of software program to assist novice in the process of clinical decision making and selection of interventions
Methodology :
In March 2019, Wisconsin Gait Scale (WGS) with its high inter-rater and intra-rater reliability and good construct and concurrent validity in ambulation was selected as the common tool for observational gait analysis in stroke. While procedure in video-tapping the performance in walking was standardized and procedural manual prepared.
At June, two physiotherapists with over 15 years of experienced in stroke rehabilitation conducted literature review and established simple logic among kinematic problems, physical deficits and the possible causes derived. This reasoning was written into the software File-maker Pro which present a step–by-step guide with build-in probing questions for problem identification, reconfirmation might be needed by further assessment which facilitate treatment selection in junior staff. In-service trainings were conducted on scoring of WGS, video taking procedure and pathological gait in stroke in June and July.
Result & Outcome :
From July to December 2019, 13 physiotherapists with experience ranged from less than one year to over 25 years applied the “Technology Enhanced Gait assessment” to 48 supervised walkers of stroke survivors. 88% of them agreed that the set up procedure for Observational Gait Analysis (OGA) was clear and simple. More than two-third (69%) of them found the OGA and the Technology Enhanced Gait assessment helpful in clinical decision-making though 31% found the operation quite complicated. All of them agreed that the tool could upgrade their gait assessment skill in stroke patient though 31% of them agree to a certain extent only, while 62% fully agreed and 8 % very much agreed.
Conclusion
With the advancement in Information technology, clinical decision making in gait re-education by physiotherapist should not be remained at an intuitive level which is subjective and not favor communication and information exchange. This pilot effort in development of technology enhanced gait assessment provide us with an insight and shed light on the use of big data in helping novice in future.
