Why are we even using something as subjective as observational analysis? Doing so doesn't tell us EXACTLY what needs to be fixed! We need the objective damage diagnosis so we could map recovery to the protocols used!
Influence of Observers’ Motor Imagery Abilities on Observational Gait Analysis Using the Wisconsin Gait Scale: A Study Among Physical Therapists Treating Stroke Patients
Review began 02/04/2025
Review ended 04/11/2025
Published 04/13/2025
© Copyright 2025
Maru et al. This is an open access article
distributed under the terms of the Creative
Commons Attribution License CC-BY 4.0.,
which permits unrestricted use, distribution,
and reproduction in any medium, provided
the original author and source are credited.
DOI: 10.7759/cureus.82163
Influence of Observers’ Motor Imagery Abilities
on Observational Gait Analysis Using the
Wisconsin Gait Scale: A Study Among Physical
Therapists Treating Stroke Patients
Takayuki Maru , Shun Sawai , Shoya Fujikawa , Ryosuke Yamamoto , Takato Nishida ,
Yusuke Shizuka , Hideki Nakano
1. Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto, JPN 2. Department
of Rehabilitation, Junshin Kobe Hospital, Kobe, JPN 3. Graduate School of Health Sciences, Kyoto Tachibana University,
Kyoto, JPN 4. Department of Rehabilitation, Kyoto Kuno Hospital, Kyoto, JPN 5. Department of Rehabilitation, Tesseika
Neurosurgical Hospital, Kyoto, JPN 6. Department of Physical Therapy, Faculty of Rehabilitation and Care, Seijoh
University, Tokai, JPN
Corresponding author: Hideki Nakano, nakano-h@tachibana-u.ac.jp
analysis and more years of experience have better motor imagery skills than their counterparts.
Categories: Psychology, Physical Medicine & Rehabilitation, Therapeutics
Keywords: controllability of motor imagery test, observational gait analysis, physical therapist, stroke, wisconsin gait
scale
Introduction
Many patients with stroke present with gait disturbances that significantly impair their mobility in daily life[1]. Gait autonomy is directly related to the ability of patients with stroke to lead independent lives.
Therefore, gait evaluation and intervention are important in stroke rehabilitation. However, the gait of
patients with stroke varies because of the various symptoms that occur depending on the brain regions
affected by the stroke. Specifically, many temporally and spatially complex abnormal gait patterns are
observed, such as asymmetrical gait, extension thrust pattern with excessive knee joint extension during the stance phase, and circumduction gait with toe clearance by hip abduction during the swing phase [2,3].
Therefore, it is necessary to evaluate and treat abnormal gait patterns in each individual patient. In
addition, abnormal gait patterns in patients with stroke are not only directly attributable to functional
decline due to stroke but also include those caused by compensating for functional decline in other parts of the body [1,4]. Therefore, abnormal gait patterns in patients with stroke are complex, and intervention is important after an accurate assessment.
In many cases, the gait of patients with stroke is evaluated by observational gait analysis by rehabilitation professionals, such as physical therapists [5]. An objective evaluation technique (This is the only thing that should be used!)using three-dimensional (3D) motion analysis has recently been developed [6], but it is costly and time-consuming. Furthermore, free software using markerless motion capture has been designed to solve this problem, but its accuracy is low[7]. These factors have led to the widespread use of observational gait analysis in stroke rehabilitation compared with objective gait analysis techniques. Physical therapists need accurate observational gait analysis. Many studies have developed assessment tools to accurately evaluate abnormal gait patterns in patients with stroke [8,9]. The Wisconsin Gait Scale (WGS) is an evaluation index that assesses the gait of patients with stroke both temporally and spatially [10]. The WGS can improve the accuracy of observational gait analysis by evaluating gait according to the gait cycle and body parts [11]. In addition, the WGS is related to other gait parameters, such as 3D gait analysis and gait speed [12,13], and has moderate construct validity for gait, balance, and functional measures in patients with acute stroke [14]. Thus, it has been suggested that using the WGS may improve the accuracy of observational gait analysis for patients with stroke. However, although the WGS assists in improving the accuracy of observational gait analysis of patients with stroke by itemizing the points to be focused on to evaluate the presence or absence of abnormal gait patterns accurately, it is necessary for the physical therapist who evaluates the patients to have a high level of observational gait analysis ability. Thus, physical therapists must perform accurate observational gait analysis, and evaluation indices, such as the WGS, have been developed to support this.
Motor imagery is the cognitive process of imagining that one is exercising without actually performing the movement or tensing the muscles [15]. It improves motor performance even when no movement is being performed and is used in motor skill acquisition and rehabilitation [16]. Motor imagery is a mental activity that involves the internal generation of the visual and kinesthetic aspects of movement. In contrast, behavioral observations, such as observational gait analysis, involve mental processes that evoke internal motor representations of the observed movement [17,18]. Thus, behavioral observations and motor imagery, such as observational gait analysis, have demonstrated similar mental activities. Since both motor imagery and behavioral observation involve mental simulations of movement, an observer's motor imagery ability may influence the accuracy of observational gait analysis. Furthermore, motor imagery and motor execution share neural activity, indicating that motor-related brain regions are involved in both processes [19].Review ended 04/11/2025
Published 04/13/2025
© Copyright 2025
Maru et al. This is an open access article
distributed under the terms of the Creative
Commons Attribution License CC-BY 4.0.,
which permits unrestricted use, distribution,
and reproduction in any medium, provided
the original author and source are credited.
DOI: 10.7759/cureus.82163
Influence of Observers’ Motor Imagery Abilities
on Observational Gait Analysis Using the
Wisconsin Gait Scale: A Study Among Physical
Therapists Treating Stroke Patients
Takayuki Maru , Shun Sawai , Shoya Fujikawa , Ryosuke Yamamoto , Takato Nishida ,
Yusuke Shizuka , Hideki Nakano
1. Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto, JPN 2. Department
of Rehabilitation, Junshin Kobe Hospital, Kobe, JPN 3. Graduate School of Health Sciences, Kyoto Tachibana University,
Kyoto, JPN 4. Department of Rehabilitation, Kyoto Kuno Hospital, Kyoto, JPN 5. Department of Rehabilitation, Tesseika
Neurosurgical Hospital, Kyoto, JPN 6. Department of Physical Therapy, Faculty of Rehabilitation and Care, Seijoh
University, Tokai, JPN
Corresponding author: Hideki Nakano, nakano-h@tachibana-u.ac.jp
Abstract
Observational gait analysis is a simple gait assessment commonly used in rehabilitation. However, the effect of an observer’s experience and ability on gait analysis has not been clarified. This study aimed to describe observers’ motor imagery ability using the Wisconsin Gait Scale (WGS), an evaluation index for observational gait analysis in patients with stroke. Thirty-two physical therapists participated in this study. All participants observed a gait video of a patient with a stroke and performed observational gait analysis using the WGS. The number of correct answers to the WGS for each participant was then calculated according to the correct answers created by two physical therapists with experience in treating patients with stroke. In addition, we evaluated the participants’ motor imagery ability using the Controllability of Motor Imagery Test (CMI-T). Multiple regression analysis was performed to examine the factors related to the number of correct WGS answers, with the dependent variable being the number of correct WGS answers and the independent variables being years of experience and CMI-T scores. Next, a hierarchical cluster analysis was performed using the number of correct WGS answers and years of experience as variables, and the CMI-T scores were compared between the two clusters. The results showed that the number of years of experience was selected as a factor significantly related to the number of correct WGS answers. Clusters with more correct WGS answers and more years of experience had substantially higher CMI-T scores than those with fewer correct answers and less experience. In conclusion, physical therapists with better observational gaitanalysis and more years of experience have better motor imagery skills than their counterparts.
Categories: Psychology, Physical Medicine & Rehabilitation, Therapeutics
Keywords: controllability of motor imagery test, observational gait analysis, physical therapist, stroke, wisconsin gait
scale
Introduction
Many patients with stroke present with gait disturbances that significantly impair their mobility in daily life[1]. Gait autonomy is directly related to the ability of patients with stroke to lead independent lives.
Therefore, gait evaluation and intervention are important in stroke rehabilitation. However, the gait of
patients with stroke varies because of the various symptoms that occur depending on the brain regions
affected by the stroke. Specifically, many temporally and spatially complex abnormal gait patterns are
observed, such as asymmetrical gait, extension thrust pattern with excessive knee joint extension during the stance phase, and circumduction gait with toe clearance by hip abduction during the swing phase [2,3].
Therefore, it is necessary to evaluate and treat abnormal gait patterns in each individual patient. In
addition, abnormal gait patterns in patients with stroke are not only directly attributable to functional
decline due to stroke but also include those caused by compensating for functional decline in other parts of the body [1,4]. Therefore, abnormal gait patterns in patients with stroke are complex, and intervention is important after an accurate assessment.
In many cases, the gait of patients with stroke is evaluated by observational gait analysis by rehabilitation professionals, such as physical therapists [5]. An objective evaluation technique (This is the only thing that should be used!)using three-dimensional (3D) motion analysis has recently been developed [6], but it is costly and time-consuming. Furthermore, free software using markerless motion capture has been designed to solve this problem, but its accuracy is low[7]. These factors have led to the widespread use of observational gait analysis in stroke rehabilitation compared with objective gait analysis techniques. Physical therapists need accurate observational gait analysis. Many studies have developed assessment tools to accurately evaluate abnormal gait patterns in patients with stroke [8,9]. The Wisconsin Gait Scale (WGS) is an evaluation index that assesses the gait of patients with stroke both temporally and spatially [10]. The WGS can improve the accuracy of observational gait analysis by evaluating gait according to the gait cycle and body parts [11]. In addition, the WGS is related to other gait parameters, such as 3D gait analysis and gait speed [12,13], and has moderate construct validity for gait, balance, and functional measures in patients with acute stroke [14]. Thus, it has been suggested that using the WGS may improve the accuracy of observational gait analysis for patients with stroke. However, although the WGS assists in improving the accuracy of observational gait analysis of patients with stroke by itemizing the points to be focused on to evaluate the presence or absence of abnormal gait patterns accurately, it is necessary for the physical therapist who evaluates the patients to have a high level of observational gait analysis ability. Thus, physical therapists must perform accurate observational gait analysis, and evaluation indices, such as the WGS, have been developed to support this.
Furthermore, motor imagery shares some neural activity with behavioral observations, such as observational gait analysis [20]. In particular, the premotor-parietal and somatosensory networks are commonly activated during motor imagery and action observation [21]. As described above, action observation and motor imagery, such as observational gait analysis, are similar in that they mentally rehearse movements and share common neural substrates. Notably, the premotor cortex has been reported to be associated with movement observation and may remarkably influence visual-motor imagery [22]. Thus, the accuracy of observational gait analysis may be related to motor imagery ability. However, the relationship between observed gait analysis and motor imagery remains unclear due to the limited number of studies. Clarifying the role of motor imagery in observational gait analysis may allow for the examination of teaching methods aimed at improving physical therapists' skills.
This study focused on motor imagery ability and clinical experience as factors affecting the accuracy of
observational gait analysis. In particular, we examined the following research questions: (i) Is motor imagery ability associated with the accuracy of observational gait analysis? (ii) How does clinical experience affect the ability to perform an accurate gait assessment? Therefore, this study aims to address these research gaps by focusing on the following specific objectives: (1) Evaluate the relationship between motor imagery ability and the accuracy of observational gait analysis. (2) Determine the influence of clinical experience on observational gait analysis performance. (3) Compare motor imagery ability between groups with high versus low observational accuracy. We hypothesized that physical therapists with higher accuracy in observational gait analysis would have better motor imagery ability than their counterparts.
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