Dear Robert and others,

I am pleased that there is an increasing number of   practitioners  who put
single outcome pressure measurement parameters,  as for example the purity
index, in their right perspective

As Robert rightly states:
>>>
I use other factors than COM though in my interpretation and I don't change
the lower legend on the fscan to try and view exactly what I have scanned.
I look at the FT curves, looking for symmetry, limb speed symmetry,
sagittal timing, COP progression as well as 1st MP loading in relation to
hallux loading + other factors depending on the clinical case.  I take all
information though in context with my clinical evaluation and the specifics
of the actual clinical case so I am not obsessed with just getting a higher
score and blinkered by thinking the equipment can make the diagnosis for
me. The equipment is just another diagnostic tool to help me hopefully
deliver better outcomes to those patients where I cannot get all the
information I need via other methods.
>>>

As gait is a  very complex event, I do not believe that the gait quality
can be pinned down by one or even a few  single variables. Predominantly
looking to one single outcome variable may hide some important gait
features and the chance for the"bump against the dents" syndrome to occur
is very real. This is not to say that that these variables  may not be
useful, but the practitioner should stay vigilant and should first  look to
classical data ( F-T curves, loading rates etc...) as well, to see if they
all point in a similar direction or to the same type of gait dysfunction.
Therefore, when purchasing pressure measuring equipment, I would strongly
advise any candidate buyer to first attend good biomechanical seminars or
workshops (as the ones Norman and colleagues use to give at the PFOLA
congresses) and talk to people with a broad clinical experience. There is
much more in gait pressure data than just looking to maximal pressures and
CoM variables. You have to maximize  your equipment  investment to maximal
clinical usefulness. so both you as practitioner and the patient benefit
from it.

As Howard put it recently, in order to increase the outcome success rate
from 75% to 85%, most patients will not bother to pay more. But this also
implies  that the practitioner has the (moral) obligation to boost the
biomechanical quality of his gray cells to  comparatively higher  levels of
knowledge and experience.

Just  some upcoming  reflections I could not resist.
Regards to all
Bart


*******************************************************************
Bart Van Gheluwe
Laboratory of Biomechanics
Vrije Universiteit Brussel -Fac. LK
Vakgroep BIOM
Pleinlaan 2, 1050 Brussel, Belgium
Tel.: 02/629.27.33 (31)
Fax: 02/629.27.36
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