Gait

Gait is the most important way for people to move. As such it is crucial to functionality and thus participation. Persons with haemophilic arthropathy are characterised by their typical posture (chapter 10b) and gait alterations. According to the International Classification of Functioning, Disability, and Health (icf) (who 2001) (www.who.int/classifications/icf), musculoskeletal alterations in haemophilia may stem from structural and functional abnormalities, which have traditionally been evaluated radiologically or clinically. Radiological scores strictly focus on the structural aspects of impairment, whereas clinical scores address both the structural and functional features of impairment. There are two main options to describe gait patterns: visualisation and technical (instrumented) gait analysis. Recently an interest in the biomechanical status of haemophilic joints has emerged. Due to the rapidity of movement, simple direct observation of gait is rarely sufficient to give any insight into the pattern of limb movement, or to determine the biomechanical causes of an abnormal human gait. In instrumented gait analysis, physics and mathematics are applied to unravel the biomechanics of a pathological human gait and pinpoint which joint or muscle system is responsible for the functional deficit. In contrast to radiological and clinical examinations performed in a supine position, the uniqueness of instrumented gait analysis is that it assesses the patient during the act of walking, under weight-bearing conditions. This is of utmost importance, as pain induced by weight-bearing activities significantly influences the functional performance of arthropathic joints. The aim of this chapter is to give some practical starting points, explanations of parameters used and evidence available in gait assessment.