Walking Impairments: Clinical Observation and Rehabilitation Principles

The book primarily discusses walking in adults, with only marginal coverage of walking in children and the elderly. It does not examine the basic anatomy and physiology of walking, as these are assumed to be known. Rather, it is focused on a) capturing, by visual observation only, the kinematic alterations relevant to clinical decisions, no matter how small the joint movements to be detected are, b) how to infer the underlying dynamics from the observable kinematics, c) how to infer the potential pathologies underlying the visible alterations and d) how to design rehabilitation solutions once the mechanics of gait alteration are understood.

The book is structured in five main parts, with parts 1-4 covering points a) to d); the fifth "special" part is focused on "psychogenic/neurofunctional" alterations, the biomechanics of the foot during walking, and the potential role of instrumental gait analysis.

Walking involves the motion of all body segments, which visibly rotate around joints due to hidden forces. The relationship between any given pathology and any walking alteration is not univocal. This lack of direct correspondence makes it difficult to infer the dynamical alterations underlying visually observable anomalies and to disentangle original impairments from adaptive behaviours. Therefore, the capacity to detect visually a given impairment may not help taking clinical decisions unless observations are framed within a theory-based interpretation strategy. Instrumental gait analysis cannot substitute this clinical process based on a circular interaction between data and theory.

Many books on gait analysis in health and disability start from the anatomical and physiological basis of walking and then list the main types of gait alterations that can be clinically observed. The proposed book follows the opposite logic: you start observing the patient and learn how to infer the underlying dynamics reasonably.

This book will be of interest to physiatrists, physiotherapists, neurologists, orthopaedic surgeons, osteopaths, podiatrists and orthotists, as well as residents and students in these disciplines.