Computerized gait analysis can open up a flood of revenue sources for the private practitioner.

Part of the bane of the PT’s existence is equipment investment. Sometimes it seems that, to survive in today’s marketplace, the physical therapist must become a “tekkie,” waiting to jump on the latest innovations. In an era when technology is evolving from month to month, it is easy to become confused as to what equipment is a wise investment, especially for the private practitioner with a limited budget. One of the gray areas has always been diagnostic equipment, as the prevailing philosophy has always been that you are working from a diagnosis—not making a diagnosis. In fact, traditionally, many PTs will not have diagnostic equipment; they will refer the patient if diagnostics are necessary. However, in certain areas, diagnostic equipment is not just a good idea; it is a good investment. One field to which this school of thought applies is computer-aided gait analysis. Not only can an investment in a state-of-the-art gait analysis system enhance your practice, it can open the door to new sources of revenue.

The Nature of the Beast

Traditionally, video cameras were used to record and study the motion of patients. However, a taped or photographed image from a single camera is still two-dimensional, whereas the human body moves in three dimensions. Recent technological breakthroughs have made 3-D analysis a reality. It generally consists of a marriage of equipment and software that enables the therapist to analyze the patient’s actual real-time gait. The therapist not only gets a realistic picture of the patient’s gait, but also an evaluation of the patient’s joint movements, coordination, and muscle control. The equipment gives a PT the entire picture of how the patient walks, and what is taking place in that patient’s body during that stride.

Dr. Craig Lowe, DPM, MS, DABPO, retired in 1993 from a successful career as a podiatric physician and surgeon, and has a 24-year background in the manufacture of orthopedic footwear. Lowe likens the recent breakthroughs in gait analysis to the introduction of computerized eye exams in podiatry. “It used to be that an eye exam was a long process,” according to Lowe. “’‘Sit down.’ ‘Put your chin here.’ ‘What’s the smallest line you can read?’ ‘Which is clearer, A or B?’ Now it’s a matter of, ‘Put your chin here, and look at the red dot. Thank you.’ I’m not saying the old method didn’t work; I’m saying that new technology is far more efficient and vastly more accurate.

“With computerized technology, we can fully pronate patients, stand them on a mat in a normal gait, and position them any way we feel we should. We can measure relaxed or neutral calcaneal stance positioning. At the same time, the computer software is creating a record of everything along the way.”

Norman Murphy, PhD, lectures to clinicians around the world on the uses and applications of computerized gait analysis. In fact, a method of calculation, the Murphy 4P Method, bears his name. “Computerized gait analysis captures foot plantar tactile contact time and force,” states Murphy, and displays a selection of calculated data for analysis including pressure maps (image profiles) of pressure distribution on plantar surface, pressures and forces during gait displayed in time graphs, position and trajectories for center of force (CoF) during stance phases of gait, and force and pressure time integrals (impulse). All of these evaluations provide a virtual “crystal ball” for the PT because when timing, trajectory and/or symmetry in foot function, gait and/or posture is off, torque is generated, and stress is transmitted along and within the tendons and muscles, ligaments and bones. Torque and stress are mechanical components that, continuously over time, wear and tear body tissues.”

Lowe also emphasizes the revolutionary role that computerized gait analysis systems are playing in the fitting of orthotics. “In the casting process, there are many fail points. That’s because there are so many people involved in the process; the more people involved, the greater the potential for error. It starts with the person taking the cast. If he or she is careful, you get a great cast. If he or she is having a bad day, you might get something that doesn’t even resemble a human foot. What if enough plaster isn’t used and it dries too thin? Too much plaster is just as bad. With the newer analysis equipment, the results are transmitted directly to the lab or downloaded online, so the lab sees exactly what the doctor saw.”

There are many arguments in favor of an investment in pressure-assessment devices. There are, similarly, many arguments in favor of a Rolls-Royce. The question, then, becomes one of practicality. How would pressure-mapping systems benefit the PT in private practice?

Keys to the Gait

First and foremost, digital technology allows the smaller PT practice to become competitive with larger clinics and hospitals. A PC and a pressure-mapping system results in complete and thorough assessments previously found only in clinics and hospitals equipped with costly diagnostic facilities. Second, the PT who makes this investment is on a more competitive footing with other practices. We live in an era when patients often research their conditions and are attracted to state-of-the-art equipment. Many PTs report receiving phone calls from patients who live a great distance away because they read in a Yellow Pages ad that a particular office has pressure-mapping equipment.

Another area where this equipment is proving invaluable is the insurance industry. “There is a record of everything,” says Lowe. “Proof of medical necessity. If, for example, a patient has a neuroma, not only will your scans help you explain things to the patient, they also can be transmitted instantly to the patient’s insurance provider. There is no danger of misinterpretation or dispute. So not only can this equipment potentially pay for itself in terms of expediting reimbursement, it is also armor against denial.”

However, the major avenue of profit is in a wave that is just beginning—the aging baby boomer. “The baby boom generation is very health-conscious,” says Lowe. “Prior to this generation, the tendency was to always look for a quick fix, to want to take a pill. If people experienced pain, they would buy analgesics or get a prescription. Today, people realize this is just palliative; the medication masks the symptoms without curing [the ailment]. So the health-conscious generation wants both cures and a way to achieve them without taking a pill.”

Because of reductions in revenue and increasing competition from other clinicians, such as orthopedic surgeons, many PTs have gone in the direction of industrial consultation. “If a PT takes on an industrial consultation role,” according to Lowe, “gait analysis equipment can be a tremendous asset. Now that the baby boomers are hitting their mid-50s, there is a preventive medicine mentality in the industry. Companies want to work with—not against—therapists, create injury-free workplaces, and eliminate the potential for injury. Rather than a reactive profession, many PTs are becoming proactive and marketing their skills as ergonomic consultants. The ability to run workers through gait analysis and make recommendations could be an economic firestorm.”

Gait-analysis systems are also, obviously, invaluable in the field of footwear consultation. This can be a massive source of revenue for a PT in a large industrial situation. “One of the keys to an injury-free workplace is ergonomic footwear,” says Lowe. “Most companies don’t put any effort into this area. A company requires lifting belts, buys ergonomic chairs and keyboards, and the worker comes in wearing whatever was on the ‘Below $30’ shelf at [a sporting goods store] that weekend. A PT with a computerized gait analysis system can scan workers to provide ergonomic footwear, which can greatly increase comfort, reduce fatigue, increase productivity, and reduce injury.”

A computerized gait analysis system can also detect when shoes are worn out and whether a person is wearing shoes compatible with his/her feet. Furthermore, it is easy to convince a patient of the validity of what you are saying if the evidence is right there on a colorful screen. Some PTs even show the patient the screen and ask them if they can point to the problem spots. Frequently, they are able to detect them without prompting.

In the matter of payment, both data collection and actual therapy are covered by a number of codes. The CPT code for gait analysis is 97750, and this is exclusive of therapeutic procedures and orthotic intervention.

Although the number of applications in which a PT can increase business are only as limited as that PT’s imagination, one final area for thought is referring physicians. If you are well-networked with referring physicians, having this equipment can dramatically increase your referrals. Patients who have foot problems, such as geriatric and bariatric patients, diabetics, Charcot foot sufferers, and individuals with pain from overpronation, can all benefit from your new capabilities.

Last, but far from least, there is the psychological benefit. A patient can see his or her progress on the screen, in living color. You could point to the screen and say, “Look! This is where you were, and this is where you are now.” Nothing could be more encouraging.

Wilson Davies, MS, is a contributing writer for Physical Therapy Products.