Gait and motion analysis research focuses on understanding the basic principles of movement, deciding on and improving treatment options for patients, and measuring outcomes.

  • Medical Champion: Tom Novacheck, MD
  • Clinical Scientist: Michael Schwartz, PhD
  • Clinical Research Coordinator: Meghan Munger

Biomechanics of Human Movement

Human movement is extremely complex, requiring precise coordination of our muscles, bones and nerves. Our research in biomechanics of human movement focuses on understanding the basic principles of movements such as walking, running, and using our arms and hands.

We study the fundamental ways the body coordinates forces produced by muscles—acting on bones as levers—to produce smooth, stable, and efficient motions. Basic knowledge helps us recognize how various orthopedic, neurological, and muscular conditions can impede motions critical to daily living. This research also helps us design optimal treatments aimed at the source of the problem, rather than just manage symptoms.

Featured studies:

Ankle-Foot Orthosis (AFO) Stiffness

Led by Adam Rozumalski, MS

In this study, we want to understand how the mechanical properties of ankle-foot orthoses (braces) affect gait (walking). Our AFO stiffness study will help determine the optimal orthotic stiffness for each patient, based on individual characteristics such as strength, spasticity and walking speed.


Treadmill Gait

Led by Adam Rozumalski, MS

There are many advantages to using a treadmill (rather than walking on level ground) to study gait. Treadmills allow us to carefully control speed and slope and easily monitor functions such as energy efficiency. Walking or running on a treadmill, however, differs from true gait in several subtle but important ways. Our treadmill gait study examines these differences and finds methods for using a treadmill to collect clinically relevant data.


Dynamic Motor Control

Led by Michael Schwartz, PhD

The human body’s ability to coordinate the timing and magnitude of muscle forces is critical for generating motion. Many complex medical conditions, such as cerebral palsy, can reduce dynamic motor (muscle) control. We study ways to measure motor control.

The goals of the dynamic motor control study are to:

  • Assess motor control levels before and after treatments.
  • Determine the importance of motor control in treatment outcomes.
  • Design therapies that might improve motor control.

The Role of Energy Expenditure in Differentiating Between Movement Disorders in Children with Neuromuscular Conditions

Led by Jean Stout, PT, MS

The energy that the human body requires in order to walk depends on a variety of factors. By analyzing the energy expenditure during sitting and walking, we seek to identify different types of high muscle tone in children who have cerebral palsy. This information will help guide treatment decisions for management of high muscle tone.


Fatigue

Led by Jean Stout, PT, MS

Fatigue is a common problem for children who have cerebral palsy or other neuromuscular conditions. Understanding the numerous factors that contribute to fatigue is important for creating customized treatment plans for each patient. This research is in the early stages of development. The project proposes to use currently available technology to measure fatigue in muscles during walking.


Decision Support Research

Deciding which treatment is best for each person can be a challenging task. At Gillette, many of our patients have complex medical conditions, and the combinations of treatment options available to them can be equally complex.

Three-dimensional gait analysis plays an important role in deciding which treatment combinations are most likely to be successful for each patient. Our goal is to develop methods of improving treatments for people who have disorders that impair movement. We base these methods on the biomechanics of human movement, statistics and clinical experience.

Featured studies:

Reliability of Physical Examination

Led by Jean Stout, PT, MS

This study assesses and improves the reliability and accuracy of common clinical measures, such as strength and spasticity. These measures are important when deciding which treatments to provide to patients and when to assess the effectiveness of those treatments.


Quantitative Measures of Spasticity

Led by Katie Walt, PT, DPT

At Gillette, many of our patients have complex medical conditions, such as cerebral palsy, that cause spasticity. Spasticity (unusually tight and stiff muscles) affects growth, causes muscle spasms, impairs movement, and leads to excess energy consumption and discomfort.

Traditionally, spasticity is measured by physical examination. We are developing methods to measure spasticity using noninvasive equipment that simultaneously monitors muscle activity, joint motion and joint resistance. This research will lead to a more accurate, objective and repeatable way to measure spasticity, enhancing treatment planning and outcomes assessment.


Computer Simulation of Orthopedic Surgery

Led by Michael Schwartz, PhD

Orthopedic surgery often involves a complex realignment of multiple muscles, bones and joints in the same surgical setting. By using computer-simulated surgeries, we can better determine the optimal amount and type of realignment needed for any particular patient. This leads to improved results and minimizes negative side effects. In this study, we focus on computer simulation for a relatively new surgery for treatment of crouch gait: distal femoral extension osteotomy and patellar tendon advancement.


Optimal Orthosis Prescription

Led by Michael Schwartz, PhD

At Gillette, many of our patients use ankle-foot orthoses (AFOs) to assist and enhance the function of the calf muscles and to help stabilize the foot during walking. In this study, we use modern computer data-mining algorithms to predict patient responses to five of the most commonly used types of AFOs. This information helps Gillette specialists identify the best AFO design for each patient.


Dynamic Assessment of Thumb Position

Led by Ann Van Heest, MD

While the Center for Gait and Motion Analysis at Gillette focuses on walking, we also perform motion analysis on the arm and hand. We devote considerable resources to assessments and treatment plans related to arm and hand movement. This study will use new motion capture technology and modeling to dynamically measure thumb motion during various tasks. The goal of our research is to produce a simple, inexpensive and portable system for assessing arm and hand movement and planning treatments in a number of settings.


Outcomes Analysis

Outcomes analysis is arguably the most important part of research within the Center for Gait and Motion Analysis at Gillette. Outcomes analysis allows us to examine the results of our treatment approaches. It helps us better understand:

  • The biomechanics of human movement.
  • Our use of gait analysis to guide treatment decisions.
  • Our use of the treatments themselves.

When outcomes look good, we can reasonably assume that our understanding, decisions and treatments are correct. When outcomes are not as good as we would like them to be, we know we have an opportunity to improve. By measuring outcomes, we get crucial information to help us improve results.

Featured studies:

Ambulatory Monitoring

Led by Michael Schwartz, PhD

Instrumented three-dimensional gait analysis, as performed in the Gillette Center for Gait and Motion Analysis, is the gold standard for measuring human motion. The process, however, has some limitations.

Instrumented three-dimensional gait analysis:

  • Occurs in a controlled environment.
  • Is restricted to dry, level-ground walking.
  • Is costly and time-consuming.
  • Doesn’t directly measure how a patient moves in daily life.

In this study, we are developing a small, inexpensive, nonintrusive (in-shoe) device for monitoring a number of important gait measures. Once completed, we’ll use this device to track recovery after treatment and evaluate daily function and capacity in a variety of conditions.


Foot Treatment Outcomes

Led by Sue Sohrweide, PT

In the Gillette Center for Gait and Motion Analysis, we routinely use a multisegment foot model to guide our clinical decisions. We have also collected pre- and postoperative multisegment foot data on a large number of patients. Now we’re beginning to use this model to determine the effectiveness of a procedure called a calcaneal lengthening osteotomy with/without a plantar flexion osteotomy of the first ray. Typically, we perform this procedure on patients who have planovalgus foot deformity—a common problem for patients who have cerebral palsy.

This study will give us a better understanding of current treatment methods and provide direction for future treatment options for foot deformity.


Long-Term Selective Dorsal RhizotomyOutcomes

Led by Nanette Aldahondo, MD

Our Center for Gait and Motion Analysis actively measures and publishes short-term treatment outcomes. There is, however, almost no data from any gait and motion center documenting long-term outcomes of treatments. This study examines the long-term effects of treatments for cerebral palsy—a comparison of selective dorsal rhizotomy (SDR) surgery to standard cerebral palsy treatments without SDR. This study examines matched cohorts of patients in early adulthood and assesses important factors such as pain, function and quality of life.


Long-Term Outcomes of Distal Femoral Extension Osteotomy and Patellar Tendon Advancement

Led by Tom Novacheck, MD

Distal femoral extension osteotomy and patellar tendon advancement (DFEO-PTA) is a promising, relatively new treatment for persistent crouch gait in children and adolescents who have cerebral palsy. As pioneers in this treatment, our Center for Gait and Motion Analysis studies short-term outcomes and technique optimization for this surgery. We are now examining long-term outcomes to assess important issues such as maintaining the surgical correction and addressing later complications from the procedure.


Recent Publications

  • Barton GJ, Hawken MB, Holmes G, Schwartz MH. (2015) A gait index may underestimate changes of gait: a comparison of the Movement Deviation Profile and the Gait Deviation Index. Computer Methods in Biomechanics and Biomedical Engineering, 18(1), 57-63. doi:10.1080/10255842.2013.776549 [doi]
  • Esbjornsson, A. C., Iversen, M. D., Andre, M., Hagelberg, S., Schwartz, M. H., & Brostrom, E. W. (2015). Effect of intra-articular corticosteroid foot injections on walking function in children with juvenile idiopathic arthritis. Arthritis Care & Research, doi:10.1002/acr.22624 [doi]
  • Gutknecht, S. M., Schwartz, M. H., & Munger, M. E. (2015). Ambulatory children with cerebral palsy do not exhibit unhealthy weight gain following selective dorsal rhizotomy. Developmental Medicine and Child Neurology, 57(11), 1070-1075. doi:10.1111/dmcn.12784 [doi]
  • Ketema, Y., & Gebre-Egziabher, D. (2015). Experimentally derived kinetic model for sensor-based gait monitoring. Journal of Biomechanical Engineering, doi:10.1115/1.4032047 [doi]
  • Ries, A. J., Novacheck, T. F., & Schwartz, M. H. (2015). The efficacy of ankle-foot orthoses on improving the gait of children with diplegic cerebral palsy: A multiple outcome analysis. PM & R : The Journal of Injury, Function, and Rehabilitation, 7(9), 922-929. doi:10.1016/j.pmrj.2015.03.005 [doi]
  • Rozumalski, A., Novacheck, T. F., Griffith, C. J., Walt, K., & Schwartz, M. H. (2015). Treadmill vs. overground running gait during childhood: A qualitative and quantitative analysis. Gait & Posture, 41(2), 613-618. doi:10.1016/j.gaitpost.2015.01.006 [doi]
  • Steele, K. M., Rozumalski, A., & Schwartz, M. H. (2015). Muscle synergies and complexity of neuromuscular control during gait in cerebral palsy. Developmental Medicine and Child Neurology, doi:10.1111/dmcn.12826 [doi]
  • Ries AJ, Novacheck TF, Schwartz MH. A data-driven model for optimal orthosis selection in children with cerebral palsy. Gait Posture. 2014 Sep;40(4):539-44. PMID: 25065629
  • Pinzone O, Schwartz MH, Thomason P, Baker R. The comparison of normative reference data from different gait analysis services. Gait Posture. 2014 Jun;40(2):286-90. PMID: 24831115
  • Schwartz MH, Rozumalski A, Novacheck TF. Femoral derotational osteotomy: surgical indications and outcomes in children with cerebral palsy. Gait Posture. 2014 Feb;39(2):778-83. PMID: 24268697
  • Esbjörnsson AC, Rozumalski A, Iversen MD, Schwartz MH, Wretenberg P, Broström EW. Quantifying gait deviations in individuals with rheumatoid arthritis using the Gait Deviation Index. Scand J Rheumatol. 2014;43(2):124-31. PMID: 24090053
  • MacWilliams BA, Rozumalski A, Swanson AN, Wervey RA, Dykes DC, Novacheck TF, Schwartz MH. Assessment of three-dimensional lumbar spine vertebral motion during gait with use of indwelling bone pins. J Bone Joint Surg Am. 2013 Dec 4;95(23):e1841-8. PMID: 24306707
  • Steele KM, Seth A, Hicks JL, Schwartz MH, Delp SL. Muscle contributions to vertical and fore-aft accelerations are altered in subjects with crouch gait. Gait Posture. 2013 May;38(1):86-91. PMID: 23200083
  • Schwartz MH, Rozumalski A, Truong W, Novacheck TF. Predicting the outcome of intramuscular psoas lengthening in children with cerebral palsy using preoperative gait data and the random forest algorithm. Gait Posture. 2013 Apr;37(4):473-9. PMID: 23079586