Important Safeguards
WriteStep is designed to be used for writing, weight bearing activities or as a walking gait evaluation system for those participants who ambulate without the use of walkers and should be used under the supervision of therapists, physicians, orthotists or other qualified professionals. Professional discretion must be used when evaluating clients who ambulate with canes, crutches or other similar devices. Individuals who exhibit footdrop or drag or shuffle the feet during ambulation are not candidates for this system. WriteStep should not be used for evaluation of activities involving jumping, running, sliding or similar movements. As when testing or treating any client with gait or balance disorders, cognitive or memory impairments, appropriate supervision must be maintained throughout the evaluation or treatment.

Improper use of WriteStep pads can result in damage to the gait system and/or personal injury. To preserve the functional life of your WriteStep and to insure the safety of your clients, please read "Testing and Analysis Procedures" and "Product Care and Storage Tips" prior to using your WriteStep.

Gait Testing And Analysis Procedures

Pad Preparation And Setup
1. Choose a flat smooth surface that is approximately 8 to 10 meters long and free of moisture, dirt and/or other obstructions.
2. Place the six, 1/2-meter long WriteStep pads end to end, aligning the numbers, lines and edges.
3. Remove the protective inserts from between the pink layer of vinyl and the white layer and place them back into the carrying case.
Important: Do not discard the protective inserts!
4. Next, activate each WriteStep pad by lifting then gently lowering the pink covers. Check to be sure that no wrinkles, raised edges or incidental images are present.

Analysis Procedure
1. Begin with the subject standing 1 to 2 meters in front of the WriteStep pads.
2. Instruct the subject to walk normally in a straight-line progression to a point 1 to 2 meters beyond the end of the WriteStep pads.
3. Examine the footprints left on the pads. Begin calculating gait parameters if you feel the image created is a valid gait representation. If you feel the pattern is atypical, erase the marks by lifting the pink covers and repeat the test procedure.
4. Once gait measurements have been taken and you are finished using the pads, replace the protective inserts between the pink and white vinyl layers on each pad. Always store the pads with the inserts in place.

Collecting Temporal Gait Data

(Normative data and diagrams are provided in this guide)
Step Length: To determine step length, measure the distance from the base of one heelmark to the base of the next heelmark, (which will be of the opposite foot), keeping the tape measure parallel to the line of progression. Hash lines are provided to aid in referencing the base of the next heelmark.

Step Width: Step width is determined by drawing lines, perpendicular to the line of progression and at the position of the lateral malleolus, through consecutive left and right footsteps. Using the lines for a reference, measure the transverse distance between foot centers.

Stride Length: Stride length is calculated by measuring the distance from the base of one heelmark to the base of the next heelmark created by the same foot.

Toe In And Toe Out: To determine toe-in/toe-out, center the axis of the goniometer at the level of the lateral maleolus. Position one arm of the goniometer parallel to the line of progression. Take the other arm of the goniometer and bisect the second ray of the foot. Toe-in/toe-out angles are expressed in degrees.

Cadence: To determine cadence, instruct your client to ambulate for one minute and count the number of steps taken during this time. Cadence is expressed in steps per minute. If you have limited space, or if your client cannot ambulate for one minute, use fractions of a minute and adjust your measurements. Be sure to document accordingly.

Velocity: Velocity, or walking speed, can be determined using a stopwatch and a measured walkway. Gait velocity is expressed as a ratio of meters/second or meters/minute. Create a measured walkway by separating two WriteStep pads and allow sufficient distance, (30 meters is ideal), between the pads. Coordinate your stopwatch start and stop activation with heel contact on a WriteStep pad. Divide the time measured into the distance between these heel contact points. Be sure your client is ambulating when you begin and end your timing. Velocity can also be determined using the following formula:

Static and Dynamic Foot Support Patterns: A WriteStep gait analysis will also provide you with information regarding static and dynamic foot support patterns. Examine your client's footprints to gather data on arch indexes, orthotic efficacy and abnormal foot support patterns. Trace and record foot images using clear transparencies. Abnormal weight bearing patterns are identified when decreased or increased imaging regularly occurs in a particular portion of the foot. This information can be used to alert practitioners to the need for further gait evaluation and/or the need for orthotic intervention. Actual weight bearing pressures, however, should not be inferred from these images.

Using In Your Treatment Program

The images left on the WriteStep pads can also be used as part of your treatment program. Depending on your client's needs, you can design a walking pattern using your own footsteps as reference points. For instance, suppose your client exhibits an increased toe-out angle following a hip replacement procedure. Create your own gait pattern with the desired angle incorporated and ask your client to follow in your footsteps. Many clients are able to self-correct their own pattern just by receiving the visual feedback provided by WriteStep.

Similarly WriteStep can also be used to document and aid in correcting problems such as unequal step lengths, abnormal stride lengths and increased step widths. Several important balance studies have found strong correlation between falling in the elderly and gait measures such as increased step widths, decreased stride lengths and decreased ambulation velocities. Use WriteStep to create customized gait patterns designed to challenge and improve balance, strength and control.

Due to the significant cost and high injury and mortality rates associated with falls in the elderly, the U.S. Health Care Administration will reimburse treatment for clients identified to be at high risk for falling. WriteStep provides the necessary supportive objective data required for your documentation.

For Occupational/Physical Therapists And Adapted Professionals

If you have ordered our OT Package (or even if you ordered the PT Package but you're an OT or other professional) you will be amazed with the possibilities available to you, and your clients will be delighted. Our OT Package consists of 3 blank pads, enabling you to create and design your own program or evaluation tool.

Here are some ideas to get you started:
1. Foot art: Write the alphabet with your toes, draw the numbers up to 20 and/or create simple foot-drawn works of art.
2. The Cat Walk: Create geometrical designs on the pads using your footprints. For example, create a square with four steps, a triangle with three, an octagon with eight, and so on. Try creating circles, rectangles, diamonds and stars, spirals, zigzags, figure 8s and well, you get the idea!
3. Copy Cat: Create a complex or unusual forwards or backwards walking pattern and have the next person try to repeat the pattern. This is a great way to motivate group participation in balance activities.
4. An Amazing Feet: Walk on your heels across the pads stepping on every 10 centimeter hash mark. Try it again, but, this time, walk on your toes.
5. Bear Stretch: Begin on your hands and knees placing your fingertips at the start of a pad. Making sure your knees remain stationary, "walk" forwards over your hands as far as possible, then "walk" back again.
6. Hand Braids: For this activity you will need to align two or three pads together. Begin again on the hands and knees, but, this time, place both hands fully on the center of a WriteStep pad. Braid by placing the left hand over the right, then right hand over the left forming arcs to the sides while keeping the knees stationary.
7. Drawing: Using a finger or a blunt object, lines and images may be drawn and then easily erased.
8. Puzzles: Pads can be gripped together to create a large drawing and then jumbled up for puzzling back together.
9. Memory: A line/figure can be drawn, erased and then redrawn from memory by the client. One pad can also be used to create a line drawing and a second pad secured for the client to copy the drawing.
10. Games: Create Tic Tac Toe, Dot To Dot, etc.
11. SI: Use the pads to create handprints and images that can be erased and repeated.
12. Rhythm/Coordination: A therapist can place a hand sequence on a pad (right, right, left, left) and have the client place their hands over it or on a separate pad repeating the sequence.
13. Evaluation: Use the pads to evaluate hand placement, rhythm, coordination, fine-motor skills and more!
14. Wall Art: Place pads up on a wall at eye level for clients to reach from their wheelchair.
Be creative, you're good at it!

Product Care and Storage Tips

With proper care, the vinyls in WriteStep are long lasting. To preserve the working life of the pads, it is essential that the mat separator be inserted between the pink vinyl cover and the white base layer after each evaluation or treatment session. Prolonged contact between the two vinyls may cause damage and produce a permanent color bleed from the pink vinyl to the white. Avoid placing or storing the pads where they will receive excessive exposure to the sun or to high temperatures. Pads that are warmed to room temperature will produce the highest quality images.

Storing the pads in cold temperatures will not damage the pads. However, if the pads are placed on a cold floor, image clarity may be reduced. If this occurs, move the pads to a warmer location or use a non-slip carpet beneath the pads to provide insulation from the floor.

Avoid the use of high-heeled or similar styled shoes that may damage the pad surface. Keep the gait testing and treatment area clear of dirt and sand.

After use, store the pads inside their carrying case and on a flat surface. Storing the pads in an upright position may deform the surface.

Through normal use, dust and dirt may accumulate between the cover and base causing image quality to be reduced. Clean the pads using warm water, mild soap and a soft cloth. Do not use abrasive cleaners or solvents on the pads.

Normal Gait Data For Adult Men And Women

Customary walking speed - Individual variation ranges approximately 10% from the above figures.

Sources: 'Gait Analysis, Normal and Pathological Function', J. Perry (1992)
Murray, MP, J Bone Joint Surg 46A(2):335-360, 1964
Murray, MP, Arch Phys Med Rehabil 51:637-650, 1970

Source: Kluge Children's Rehabilitation Center Gait Lab Data, Charlottesville, VA Dr. Mark Abel, Medical Director