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Sorry to state the obvious, but isn't this what we do 99.9% of the time? Isn't this the reason that creates the need for compensations and pathologies over time?
This was in answer to "In response to my point about "It seems obvious (but I can't see where it has been mentioned in this thread so far) that in the interests of accuracy someone (its going to be me, obviously) should point out that any measurements taken with F-scan or any other vertical loading gait analysis system are only measuring gait on one surface - a flat, hard one. "
Graham, check out some pavement, insides of shoes, going uphill and coming downhill, then tell me if you stick by your assertion about being on a hard flat surface 99.9% of the time.
As most of us don't walk around bare foot, unless you compare this to inshoe with and without orthoses it's not very useful.
Graham,
Unless you are collecting data from your patients in a normal environment your data is only showing how orthoses are working on a hard, flat surface.
Barefoot data collection is not less useful nor more useful than in-shoe data collection, just different. It records certain gait parameters. It is fairly rough and ready. It is useful for the reasons I mentioned before, and also useful as a patient education tool.
Unfortunately there are simply too many variables present to make either version of VLSs very accurate - I'll mention a few:
Diurnal variation, inability to test on more than one type of weightbearing surface, how the patient/subject is feeling on the day, proximal (to the ankle) joint/tissue disfunction or pathology, footwear (for in-shoe systems).
Unless you are collecting data from your patients in a normal environment your data is only showing how orthoses are working on a hard, flat surface.
The hard flat surface, while man made and not ideal, IS the norm for most people most of the time.
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Unfortunately there are simply too many variables present to make either version of VLSs very accurate - I'll mention a few:
Diurnal variation, inability to test on more than one type of weightbearing surface, how the patient/subject is feeling on the day
The variables exist in all aspects of treatment applications. Utilizing the footwear of the client on a surface which IS the norm for the majority of the time, we can at least demonstrate a positive/negative affect, and fine tune as necessary, our orthoses to be as functional as it can be for "most" situations. In cases where there are special considerations re: surface, the F-SCAN is mobile!
Question? How do you, beyond outcome measures, determine what prescription to apply to your orthoses and what effect these have on multiple gait parameters/variables?
__________________
Graham Curryer
None of us know what we are doing, but some of us know more about what we are not doing than others!::
The hard flat surface, while man made and not ideal, IS the norm for most people most of the time.
Question? How do you, beyond outcome measures, determine what prescription to apply to your orthoses and what effect these have on multiple gait parameters/variables?
Are you saying that your pavements and walkways in Canada are absolutely flat and that there are no hills/dips
I post most of my prescription orthoses 2 degs FF, sometimes I use a RF post too. Its a little simplistic, but it seems to work quite well......
Agreed-upon outcomes (between pt/practitioner) are the best way to measure how well orthoses are working (IMO) since we don't know for sure what "normal" parameters of gait are. I think CP mentioned in a previous post that normal for one pt may not be normal for another?
Graham, you also stated:
"The variables exist in all aspects of treatment applications" which is absolutely true. However we are discussing, and you are defending a technique which puports to scientifically measure absolute or near-absolute gait parameters and alterations of gait parameters using orthoses. You are also suggesting that your results can be extrapolated to include gait on all normal surfaces, which you insist is mostly (you suggested 99,0% of the time) hard and flat, like a gait lab, or clinic floor if you like.
For me the existence of those variables alone will ensure that your data cannot be as accurate as you suggest.
Would you like to comment on diurnal variation and how that might affect your data?
Are you saying that your pavements and walkways in Canada are absolutely flat and that there are no hills/dips
Come on David, you are being podantic. Despite variations in cambre and pitch the basic interface between the foot and shoe and shoe and foot is Flat! Not what the foot was designed to perform on every step.
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I post most of my prescription orthoses 2 degs FF, sometimes I use a RF post too. Its a little simplistic, but it seems to work quite well......
2 degrs FF Valgus or varus? RF post when, why and what? Why? Based on what biomechanical framework?
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Agreed-upon outcomes (between pt/practitioner) are the best way to measure how well orthoses are working
Are they? What have you changed with the orthoses? Is it causing pressures and alterations in timing which, with your extensive knowledge, would concern you? Has symetry been established? Have you used the same Rx for both sides? How did you determine that the same Rx was approriate for both sides?
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since we don't know for sure what "normal" parameters of gait are. I think CP mentioned in a previous post that normal for one pt may not be normal for another?
We have a good idea what we would regard as ideal (Winter/Perry et al). Agreed, what is normal for one is not normal for another. Therefore, why would you give basically the same Rx to everyone?
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However we are discussing, and you are defending a technique which puports to scientifically measure absolute or near-absolute gait parameters and alterations of gait parameters using orthoses. You are also suggesting that your results can be extrapolated to include gait on all normal surfaces, which you insist is mostly (you suggested 99,0% of the time) hard and flat, like a gait lab, or clinic floor if you like.
For me the existence of those variables alone will ensure that your data cannot be as accurate as you suggest.
Not absolutely scientific, but adding more objectivity than just the human eye and a belief structure. I'm not suggesting that the data is as accurate as we would like, only better than without it! Or are you concerned with what you may find?
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Would you like to comment on diurnal variation and how that might affect your data?
No! This doesn't account for night shift workers
__________________
Graham Curryer
None of us know what we are doing, but some of us know more about what we are not doing than others!::
Interesting quote from you on your UK mail base regarding this thread. Someone dared you to post this on this arena. I thought I'd save you the trouble!
Quote:
"Listen mush, Bald Aussie professors dispensing journal articles is scarcly the basis for an efficient system of academic peer review!. Supreme academic endorsement derives from a manadate from the community not some farcical Publication ceremony!"
Interesting!
__________________
Graham Curryer
None of us know what we are doing, but some of us know more about what we are not doing than others!::
Come on David, you are being podantic. Despite variations in cambre and pitch the basic interface between the foot and shoe and shoe and foot is Flat! Not what the foot was designed to perform on every step.
2 degrs FF Valgus or varus? RF post when, why and what? Why? Based on what biomechanical framework?
Podantic eh?
Appropriate/funny - or do you mean pedantic
Anyhoo I'm absolutely serious when I say that the "basic interface between the shoe and foot" and the shoe and ground is not flat.
What incremental values do we use to post our orthoses? Degrees - titchy.
Usually 2 to 4 degrees. Are you still insisting that in Canada the ground (remember that shoe-wear contributes to this too) does not vary by more than 2 to 4 degrees much of the time (forget Shopping Malls - any of your patients who work in a Shopping Mall will certainly be spending much of the time on a hard flat surface)?
I cast in neutral and post according to what I see on the cast. If I need to stick my finger under the cast laterally to make the heel bisection more vertical I post valgus, if I need to stick my finger under the cast medially I post varus. If the pt has post tib dysfunction I will usually use a RF post. If I observe minimal heel-strike/early heel-raise I may want to try heel-lift. Its not much more complicated than that for me or my pts.
Note: Obviously this is not my complete orthoses Rx protocol.
You asked if I used the same Rx for both sides. Why would I do that?
You ask if symmetry has been established. Why would you want to establish symmetry as a measure of success? I'm not symmetrical, neither are you, nor most of the people reading this forum thread....
You talk about adding more objectivity than just the human eye and a belief structure. Certainly, that is the value of any gait analysis system which can produce quantifiable data.
Do you know what diurnal variation actually is, and the ramifications of diurnal and circadian variation for any type of measurement involving the musculoskeletal system?
I would point out that blind adherence to one particular gait analysis system could be seen by some as a belief structure
Finally, the quote made on the Uk forum, if you didn't recognise it, is a take-off from Monty Python (Life of Brian, if I'm not mistaken) - its a theme we have running through quite a few threads - sad, innit.
Anyhoo I'm absolutely serious when I say that the "basic interface between the shoe and foot" and the shoe and ground is not flat.
Time for a new thread here I think
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What incremental values do we use to post our orthoses? Degrees - titchy. Usually 2 to 4 degrees.
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I cast in neutral and post according to what I see on the cast. If I need to stick my finger under the cast laterally to make the heel bisection more vertical I post valgus, if I need to stick my finger under the cast medially I post varus
Considering the significant inter and intrtra relator errors in measurments and the evidence indicating static measurments of percieved positional anomolies has no correlation to dynamic function I am supprised that a clinician of with your experience and accademic reading still practices with these techniques!
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You ask if symmetry has been established. Why would you want to establish symmetry as a measure of success? I'm not symmetrical, neither are you, nor most of the people reading this forum thread....
Time for a new thread here!
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Do you know what diurnal variation actually is, and the ramifications of diurnal and circadian variation for any type of measurement involving the musculoskeletal system?
Yes. But I always smile when a Brit, pushed into a corner, resorts to the pompous use of an ancient language. Latin is perhaps best used in the bedroom than in a crass attempt at ridicule!
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I would point out that blind adherence to one particular gait analysis system could be seen by some as a belief structure
The F-Scan does not replace an assessment, but adds to the information gleaned from one's clinical assessment and treatment approach. Regardless of which biomagic principal we lean to.
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Finally, the quote made on the Uk forum, if you didn't recognise it, is a take-off from Monty Python (Life of Brian, if I'm not mistaken) - its a theme we have running through quite a few threads - sad, innit.
As an X pat I had the benefit of The Life of Brian. Many of my North American Collegues didn't, and would be offended by this statement. Care and diplomacy is generaly advised when posting on any public/professional arena.
Regards
Am off to Montreal to pick up a buddy from the old country - will be back Monday. A good weekend to all
__________________
Graham Curryer
None of us know what we are doing, but some of us know more about what we are not doing than others!::
Interesting quote from you on your UK mail base regarding this thread. Someone dared you to post this on this arena. I thought I'd save you the trouble!
Quote:
Quote:
"Listen mush, Bald Aussie professors dispensing journal articles is scarcly the basis for an efficient system of academic peer review!. Supreme academic endorsement derives from a manadate from the community not some farcical Publication ceremony!"
Interesting!
Thanks for saving me the trouble.
In context this was part of a sting of monty python rip offs from the holy grail (not the life of Brian) sketch
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King Arthur: The Lady of the Lake, her arm clad in the purest shimmering samite held aloft Excalibur from the bosom of the water, signifying by divine providence that I, Arthur, was to carry Excalibur. THAT is why I am your king.
Dennis: [interrupting] Listen, strange women lyin' in ponds distributin' swords is no basis for a system of government. Supreme executive power derives from a mandate from the masses, not from some farcical aquatic ceremony.
starting with bel saying she did'nt vote for me and dave as the science police. I'm sorry you feel it was inappropriate. I suspect CP can take it. We're all gifted a certain number of hormones, if some of us choose to waste them growing hair thats our problem!
For the benefit (or not) of any who are curious (if any are) the rest was:-
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And how'd they get that, eh? By exploiting the sagital plane facilitators. By hanging on to scientific pedantry which perpetuates the clinical relevance and theoretical differences in our profession...well i didn`t vote for them...
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You don't vote for the science policy
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How do you become one then
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The moderator of the site, his posts clad in purest italics, held aloft a copy of Kirby's "biomechanics of the normal and abnormal foot" from the bosom of japmaonline thus signifying by almost divine endorsment that WE should be the science policy."
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"Listen mush, Bald Aussie professors dispensing journal articles is scarcly the basis for an efficient system of academic peer review!. Supreme academic endorsement derives from a manadate from the community not some farcical Publication ceremony!"
Thanks for bring it up though.
Now, back to business.
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We have a good idea what we would regard as ideal (Winter/Perry et al).
Numerous times on this thread i have asked you to provide a rationale / evidence for what you / they regard as ideal and how they arrived at this. YOu continue to evade the question. Until this issue is addressed the real world relevance of gait analysis is moot. I could say that a pressure track straight down the lateral border is "ideal", issue an orthotic with a 20 degree through medial wedge and claim success! Drawing ones own target then congratulating oneself for hitting it (the gunslinger falacy) is NOT valid science!
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Do you know what diurnal variation actually is, and the ramifications of diurnal and circadian variation for any type of measurement involving the musculoskeletal system?
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Yes. But I always smile when a Brit, pushed into a corner, resorts to the pompous use of an ancient language. Latin is perhaps best used in the bedroom than in a crass attempt at ridicule!
This is not pompous use of ancient language, this is accurate use of proper terminology. Unless you know of another more concise english word for "diurnal".
Your ad hominem is unhelpful to this discussion. As is your attempt to shift a scientific debate onto personal grounds. I suggest you stick to the debate at hand or i suspect this thread is heading for the padlock of doom (if its not already).
In context this was part of a sting of monty python rip offs from the holy grail (not the life of Brian) sketch
Yes, well done, Mr Isaacs of Kent, spotted the loony in 1.8 seconds... Sorry, no more Python.
PS I was referring to DH as the loony (in an affable/friendly way of course, as he mistook the sketch) NOT anyone else!!! I`ll just stop digging now.....
Cheers
Bel
Last edited by blinda : 17th October 2008 at 10:41 AM.
Reason: `twas pointed out that it could be taken the wrong way!
Re: Theoretical research question
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Linear Mode
