GAIT TRAINING, PRE-AMBULATION PROGRAMME, ASSISTIVE DEVICES AND GAIT PATTERNS, RECENT ADVANCES IN GAIT ANALYSIS

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pres.title = "Gait Analysis in Stroke Rehabilitation - Case Study";
pres.author = "MPT Physiotherapy";

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// ══════════════════════════════════════════════════════════════
// SLIDE 1 – TITLE
// ══════════════════════════════════════════════════════════════
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  s.addText("A Comprehensive Case Study", {
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    { text: "Date: June 2026", options: { color: C.gold, fontSize: 11, fontFace: "Calibri" } },
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// ══════════════════════════════════════════════════════════════
// SLIDE 2 – PRESENTATION OVERVIEW
// ══════════════════════════════════════════════════════════════
{
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  addHeader(s, "Presentation Overview", false);

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    { num: "01", label: "Patient Introduction", sub: "Demographics, diagnosis, referral" },
    { num: "02", label: "Baseline Gait Assessment", sub: "Clinical + instrumented findings" },
    { num: "03", label: "Gait Deviations Identified", sub: "Kinematic, kinetic, EMG analysis" },
    { num: "04", label: "Goal Setting", sub: "SMART goals & expected outcomes" },
    { num: "05", label: "Rehabilitation Programme", sub: "Evidence-based interventions" },
    { num: "06", label: "Progress & Reassessment", sub: "4-week & 8-week gait data comparison" },
    { num: "07", label: "Outcome & Discharge", sub: "Functional outcomes and home plan" },
    { num: "08", label: "Clinical Implications", sub: "Gait analysis in stroke practice" },
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// ══════════════════════════════════════════════════════════════
// SLIDE 3 – PATIENT INTRODUCTION
// ══════════════════════════════════════════════════════════════
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  addHeader(s, "Patient Introduction", false);
  sectionLabel(s, "Case Demographics");

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    ["Name (ID)", "Mr. A.K.  |  Male, 58 years"],
    ["Diagnosis", "Left MCA ischemic stroke"],
    ["Onset", "8 weeks prior to admission"],
    ["Dominance", "Right-handed"],
    ["Affected side", "Right hemiplegia"],
    ["Co-morbidities", "Hypertension, T2DM"],
    ["Occupation", "Retired school teacher"],
    ["BMI", "27.4 kg/m²"],
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    bullet("Chief complaint: Unable to walk independently"),
    bullet("Right upper & lower limb spasticity (MAS Grade 2)"),
    bullet("Foot drop on right side (weak dorsiflexors)"),
    bullet("Shoulder subluxation – right shoulder"),
    bullet("Cognitive status: Intact (MMSE 26/30)"),
    bullet("Mood: Mild depression (PHQ-9: 10)"),
    bullet("Prior to stroke: Independent ambulation, active lifestyle"),
    bullet("Referred by: Neurologist for gait rehabilitation"),
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}

// ══════════════════════════════════════════════════════════════
// SLIDE 4 – BASELINE GAIT ASSESSMENT
// ══════════════════════════════════════════════════════════════
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  addHeader(s, "Baseline Gait Assessment", false);
  sectionLabel(s, "Week 0 – Initial Evaluation");

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  // Outcome measures
  const measures = [
    { title: "10-Metre Walk Test", val: "0.42 m/s", norm: "1.2–1.4 m/s", status: "red" },
    { title: "6-Minute Walk Test", val: "105 m", norm: "400–700 m", status: "red" },
    { title: "Timed Up & Go (TUG)", val: "38 sec", norm: "< 12 sec", status: "red" },
    { title: "Stride Length", val: "0.65 m", norm: "1.3–1.5 m", status: "red" },
    { title: "Cadence", val: "62 steps/min", norm: "100–120/min", status: "red" },
    { title: "Berg Balance Scale", val: "22/56", norm: "> 45", status: "red" },
  ];
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// ══════════════════════════════════════════════════════════════
// SLIDE 5 – INSTRUMENTED GAIT ANALYSIS FINDINGS
// ══════════════════════════════════════════════════════════════
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  addHeader(s, "Instrumented Gait Analysis – Baseline Findings", false);
  sectionLabel(s, "3D Motion Capture + EMG + Pedobarography");

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        "Reduced hip extension at terminal stance (−5° vs +10° normal)",
        "Knee hyperextension in mid-stance (genu recurvatum)",
        "Absent knee flexion in swing (5° vs 60° normal)",
        "Reduced ankle dorsiflexion at initial contact (foot drop)",
        "Pelvic hike +12° compensating for toe clearance",
        "Trunk lateral lean toward affected side",
      ]
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        "Reduced vertical GRF on right (52% body weight vs 100%)",
        "Delayed weight acceptance on right",
        "Reduced push-off GRF — weak plantar flexors",
        "Asymmetrical loading: 65% left / 35% right",
        "Reduced propulsive impulse",
        "Increased double-support phase (48% vs 20% normal)",
      ]
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    {
      title: "EMG Analysis",
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      items: [
        "Tibialis anterior: absent activation in swing (foot drop)",
        "Gastrocnemius: premature activation (early stance)",
        "Rectus femoris: prolonged stance-phase activation",
        "Hamstrings: co-contraction with quadriceps (stiff knee)",
        "Gluteus medius: weak & delayed activation",
        "Erector spinae: asymmetric excessive activation",
      ]
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  s.addText("Pedobarography: Reduced plantar pressure under right forefoot; increased pressure under lateral midfoot — equinovarus pattern", {
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// ══════════════════════════════════════════════════════════════
// SLIDE 6 – GAIT DEVIATIONS ANALYSIS
// ══════════════════════════════════════════════════════════════
{
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  addHeader(s, "Gait Deviations – Analysis and Causes", false);
  sectionLabel(s, "Problem-Cause-Strategy Framework");

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  s.addText("Deviation Observed", { x: 2.55, y: 0.95, w: 2.6, h: 0.3, fontSize: 10, bold: true, color: C.white, fontFace: "Calibri", fill: { color: C.teal }, align: "center", valign: "middle", margin: 0 });
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  s.addText("Physiotherapy Strategy", { x: 7.55, y: 0.95, w: 2.2, h: 0.3, fontSize: 10, bold: true, color: C.white, fontFace: "Calibri", fill: { color: C.green }, align: "center", valign: "middle", margin: 0 });

  const rows = [
    ["Initial Contact", "Foot drop (no heel strike)", "Tibialis anterior weakness", "AFO, FES, TA strengthening"],
    ["Loading Response", "Reduced wt acceptance right", "Weakness + fear", "WB training, biofeedback"],
    ["Mid-stance", "Genu recurvatum (knee hyperext.)", "Quad spasticity / weakness", "Knee brace, quad control ex."],
    ["Terminal Stance", "Reduced push-off", "Plantar flexor weakness", "Calf strengthening, RAGT"],
    ["Pre-swing", "Increased double support time", "Poor balance & timing", "Balance training, treadmill"],
    ["Swing Phase", "Circumduction / hip hiking", "Foot drop + weak hip flex.", "FES, hip flexor activation"],
    ["Trunk / Pelvis", "Lateral trunk lean", "Weak gluteus medius", "Lateral hip strengthening"],
  ];

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// ══════════════════════════════════════════════════════════════
// SLIDE 7 – GOAL SETTING
// ══════════════════════════════════════════════════════════════
{
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  lightSlide(s);
  addHeader(s, "Goal Setting – SMART Framework", false);
  sectionLabel(s, "Short-Term (4 weeks) & Long-Term (8 weeks)");

  // Short-term
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    bullet("Improve FAC score from 2 to 3 (requires supervision)"),
    subBullet("Patient able to walk 10m with supervision + AFO"),
    bullet("Increase 10MWT speed to ≥ 0.6 m/s"),
    subBullet("Indicate transition to limited community walking"),
    bullet("Reduce TUG time to < 25 seconds"),
    bullet("Improve Berg Balance Score to ≥ 32/56"),
    bullet("Achieve controlled knee flexion in swing (≥ 30°)"),
    subBullet("Via 3D motion analysis at Week 4"),
    bullet("Activate tibialis anterior during swing (EMG biofeedback)"),
    bullet("Patient education: weight-bearing and fall prevention"),
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  // Long-term
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    bullet("Achieve FAC 4 (independent on level surfaces)"),
    subBullet("Independent ambulation without therapist supervision"),
    bullet("10MWT speed ≥ 0.8 m/s (household ambulation)"),
    subBullet("Classified as limited community ambulatory"),
    bullet("6MWT ≥ 250 m (community ambulation threshold)"),
    bullet("TUG < 15 seconds (reduced fall risk)"),
    bullet("Berg Balance Score ≥ 45/56"),
    bullet("Symmetric weight distribution: 45–55% right"),
    subBullet("Confirmed by pedobarography and force plates"),
    bullet("Return to outdoor ambulation on uneven surfaces"),
    bullet("Home exercise programme independence"),
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}

// ══════════════════════════════════════════════════════════════
// SLIDE 8 – REHABILITATION PROGRAMME
// ══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  addHeader(s, "Evidence-Based Rehabilitation Programme", false);
  sectionLabel(s, "Gait Analysis-Guided Intervention Plan");

  const interventions = [
    {
      title: "1. Task-Specific Gait Training",
      color: C.navy,
      points: ["Overground gait training 45 min/day, 5x/week", "Progressive speed & distance targets", "Dual-task training (cognitive + motor)", "Obstacle negotiation & uneven surfaces"],
    },
    {
      title: "2. Body-Weight Supported Treadmill (BWSTT)",
      color: C.teal,
      points: ["20–30% BWS initial → progressive reduction", "Treadmill speed 0.3 m/s → 0.8 m/s", "High repetition stepping for neuroplasticity", "Manual facilitation of swing-phase knee flexion"],
    },
    {
      title: "3. Robot-Assisted Gait Training",
      color: C.orange,
      points: ["Lokomat 3x/week (Weeks 1–4)", "Guided physiological gait trajectory", "Real-time kinematic biofeedback", "Evidence: Meta-analysis (Chen 2024, PMID 38647534)"],
    },
    {
      title: "4. Functional Electrical Stimulation (FES)",
      color: C.green,
      points: ["Peroneal nerve FES for foot drop correction", "Triggered at toe-off for swing-phase activation", "Tibialis anterior strengthening (30 min/day)", "Reduces circumduction & energy cost"],
    },
    {
      title: "5. Neuromuscular Strengthening",
      color: "7B1FA2",
      points: ["Gluteus medius: clam shells, lateral band walks", "Quadriceps: sit-to-stand, step-ups", "Plantar flexors: calf raises, resistance band", "Tibialis anterior: resisted dorsiflexion"],
    },
    {
      title: "6. Balance & Proprioception Training",
      color: "0277BD",
      points: ["Perturbation training on foam surface", "Single-leg stance progression", "Weight-shift biofeedback platform", "Ankle strategy facilitation"],
    },
  ];

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  const startX = 0.28, startY = 1.05;
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    const row = Math.floor(i / 3);
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    intv.points.forEach((pt, j) => {
      s.addText("• " + pt, {
        x: x + 0.1, y: y + 0.55 + j * 0.37, w: colW - 0.2, h: 0.33,
        fontSize: 9, color: C.white, fontFace: "Calibri", wrap: true, margin: 0,
      });
    });
  });
}

// ══════════════════════════════════════════════════════════════
// SLIDE 9 – ASSISTIVE DEVICE PROGRESSION
// ══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  addHeader(s, "Assistive Device & Orthotic Progression", false);
  sectionLabel(s, "Device Selection Based on Gait Analysis Findings");

  const stages = [
    { week: "Weeks 1–2", device: "Parallel Bars\n+ Therapist Assist", reason: "Maximum support; safe initiation of stance & step training; assessment of weight-bearing capacity", gait: "3-point\ngait (modified)" },
    { week: "Weeks 3–4", device: "4-Wheeled Walker\n+ AFO (Ankle-Foot Orthosis)", reason: "Transition to device ambulation; AFO controls foot drop (rigid or hinged type based on spasticity grade)", gait: "Modified 3-point\n→ 2-point" },
    { week: "Weeks 5–6", device: "Quad Cane\n+ AFO", reason: "Improved balance allows progression from walker; quad cane provides wider base for hemiplegic gait", gait: "2-point gait\n(contralateral cane)" },
    { week: "Weeks 7–8", device: "Standard Cane\n(+ FES instead of AFO)", reason: "Near-independent ambulation; FES replaces static AFO for active muscle stimulation; cane held in left hand", gait: "Reciprocal 2-point\nor independent" },
  ];

  stages.forEach((st, i) => {
    const y = 1.05 + i * 1.08;
    // Week label
    s.addShape(pres.ShapeType.rect, { x: 0.3, y, w: 1.3, h: 0.9, fill: { color: C.gold }, line: { type: "none" } });
    s.addText(st.week, { x: 0.3, y, w: 1.3, h: 0.9, fontSize: 10.5, bold: true, color: C.navy, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 });

    // Device
    s.addShape(pres.ShapeType.rect, { x: 1.65, y, w: 2.0, h: 0.9, fill: { color: C.navy }, line: { type: "none" } });
    s.addText(st.device, { x: 1.65, y, w: 2.0, h: 0.9, fontSize: 10, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 });

    // Reason
    s.addShape(pres.ShapeType.rect, { x: 3.7, y, w: 4.5, h: 0.9, fill: { color: "F0F6FA" }, line: { color: "D0DDE5", width: 0.4 } });
    s.addText(st.reason, { x: 3.82, y: y + 0.05, w: 4.28, h: 0.82, fontSize: 9.5, color: C.navy, fontFace: "Calibri", valign: "middle", wrap: true, margin: 0 });

    // Gait pattern
    s.addShape(pres.ShapeType.rect, { x: 8.25, y, w: 1.5, h: 0.9, fill: { color: C.teal }, line: { type: "none" } });
    s.addText(st.gait, { x: 8.25, y, w: 1.5, h: 0.9, fontSize: 9.5, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 });

    // Arrow between stages
    if (i < 3) {
      s.addShape(pres.ShapeType.downArrow, { x: 4.5, y: y + 0.9, w: 0.3, h: 0.15, fill: { color: C.gold }, line: { type: "none" } });
    }
  });

  // Header row
  [["Week", 0.3, 1.3], ["Device / Orthosis", 1.65, 2.0], ["Clinical Rationale (Gait Analysis)", 3.7, 4.5], ["Gait Pattern", 8.25, 1.5]].forEach(([t, x, w]) => {
    s.addText(t, {
      x, y: 0.82, w, h: 0.22,
      fontSize: 9, bold: true, color: C.midGray, fontFace: "Calibri", align: "center", margin: 0,
    });
  });
}

// ══════════════════════════════════════════════════════════════
// SLIDE 10 – PROGRESS AT 4 WEEKS
// ══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  addHeader(s, "Progress Assessment – Week 4 Gait Analysis", false);
  sectionLabel(s, "Comparison: Baseline vs Week 4");

  s.addText("Outcome Measures", {
    x: 0.3, y: 0.95, w: 9.4, h: 0.3,
    fontSize: 12, bold: true, color: C.navy, fontFace: "Calibri",
  });

  // Table header
  const hCols = [["Measure", 0.3, 2.8], ["Baseline (Wk 0)", 3.15, 2.2], ["Week 4", 5.4, 2.2], ["Change", 7.65, 2.0]];
  hCols.forEach(([t, x, w]) => {
    s.addShape(pres.ShapeType.rect, { x, y: 1.3, w, h: 0.35, fill: { color: C.navy }, line: { type: "none" } });
    s.addText(t, { x, y: 1.3, w, h: 0.35, fontSize: 10.5, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 });
  });

  const rows4 = [
    ["10MWT (m/s)", "0.42", "0.61 ✓", "+45%", true],
    ["6MWT (m)", "105", "162", "+54%", true],
    ["TUG (sec)", "38", "24 ✓", "−37%", true],
    ["FAC Score", "2", "3 ✓", "+1 level", true],
    ["Berg Balance", "22/56", "35/56 ✓", "+13 pts", true],
    ["Stride Length (m)", "0.65", "0.88", "+35%", true],
    ["Knee flex. swing (°)", "5°", "28°", "+23°", true],
    ["TA EMG (swing)", "Absent", "Present (partial)", "Goal met", true],
  ];
  rows4.forEach((row, i) => {
    const y = 1.65 + i * 0.43;
    const bg = i % 2 === 0 ? "F0F8FF" : C.white;
    s.addShape(pres.ShapeType.rect, { x: 0.3, y, w: 2.8, h: 0.4, fill: { color: bg }, line: { color: "D5E3ED", width: 0.3 } });
    s.addText(row[0], { x: 0.4, y, w: 2.6, h: 0.4, fontSize: 10, bold: true, color: C.navy, fontFace: "Calibri", valign: "middle", margin: 0 });
    s.addShape(pres.ShapeType.rect, { x: 3.15, y, w: 2.2, h: 0.4, fill: { color: bg }, line: { color: "D5E3ED", width: 0.3 } });
    s.addText(row[1], { x: 3.15, y, w: 2.2, h: 0.4, fontSize: 10, color: C.red, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 });
    s.addShape(pres.ShapeType.rect, { x: 5.4, y, w: 2.2, h: 0.4, fill: { color: bg }, line: { color: "D5E3ED", width: 0.3 } });
    s.addText(row[2], { x: 5.4, y, w: 2.2, h: 0.4, fontSize: 10, color: C.green, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 });
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    s.addText(row[3], { x: 7.65, y, w: 2.0, h: 0.4, fontSize: 10, bold: true, color: C.green, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 });
  });

  s.addText("Short-term goals met: FAC 3 ✓  |  10MWT ≥ 0.6 m/s ✓  |  TUG < 25 sec ✓  |  Berg ≥ 32 ✓  |  Tibialis anterior EMG activation present ✓", {
    x: 0.3, y: 5.18, w: 9.4, h: 0.38,
    fontSize: 10, bold: true, color: C.white, fontFace: "Calibri", fill: { color: C.green }, valign: "middle",
  });
}

// ══════════════════════════════════════════════════════════════
// SLIDE 11 – FINAL OUTCOMES AT 8 WEEKS
// ══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  addHeader(s, "Final Outcomes – Week 8 Gait Analysis", false);
  sectionLabel(s, "Discharge Assessment");

  // Kinematic improvements
  card(s, 0.3, 1.05, 4.5, 4.2, C.white);
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.05, w: 4.5, h: 0.38, fill: { color: C.navy }, line: { type: "none" } });
  s.addText("Functional & Kinematic Outcomes", { x: 0.3, y: 1.05, w: 4.5, h: 0.38, fontSize: 11, bold: true, color: C.gold, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 });
  const wk8 = [
    ["10MWT", "0.82 m/s  ✓  (Goal: 0.8)"],
    ["6MWT", "268 m  ✓  (Goal: 250 m)"],
    ["TUG", "14.2 sec  ✓  (Goal: <15)"],
    ["FAC Score", "4 – Independent level  ✓"],
    ["Berg Balance", "47/56  ✓  (Goal: 45)"],
    ["Stride Length", "1.18 m  (Norm: 1.3)"],
    ["Knee flex. swing", "48°  (Norm: 60°)"],
    ["Weight distribution", "43% right / 57% left"],
    ["Gait symmetry", "Improved – ratio 0.82"],
  ];
  wk8.forEach(([lbl, val], i) => {
    s.addText(lbl + ":", { x: 0.45, y: 1.52 + i * 0.38, w: 1.6, h: 0.32, fontSize: 10, bold: true, color: C.teal, fontFace: "Calibri", margin: 0 });
    s.addText(val, { x: 2.1, y: 1.52 + i * 0.38, w: 2.5, h: 0.32, fontSize: 10, color: C.navy, fontFace: "Calibri", margin: 0 });
  });

  // Clinical interpretation
  card(s, 5.1, 1.05, 4.6, 4.2, C.white);
  s.addShape(pres.ShapeType.rect, { x: 5.1, y: 1.05, w: 4.6, h: 0.38, fill: { color: C.teal }, line: { type: "none" } });
  s.addText("Clinical Interpretation & Discharge Plan", { x: 5.1, y: 1.05, w: 4.6, h: 0.38, fontSize: 11, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 });
  s.addText([
    bullet("All long-term goals met or near-met"),
    bullet("Achieved limited community ambulation (FAC 4)"),
    bullet("Gait speed crossed household threshold (0.8 m/s)"),
    { text: " ", options: { breakLine: true } },
    bullet("Residual deficits at discharge:", true),
    subBullet("Knee flexion in swing still reduced (48° vs 60°)"),
    subBullet("Mild residual asymmetry in weight distribution"),
    subBullet("Push-off still reduced — ongoing calf strengthening"),
    { text: " ", options: { breakLine: true } },
    bullet("Discharge plan:", true),
    subBullet("Standard cane for community; AFO for uneven terrain"),
    subBullet("Home exercise programme (HEP) provided"),
    subBullet("Monthly outpatient gait review for 3 months"),
    subBullet("Wearable IMU provided for step count monitoring"),
  ], { x: 5.25, y: 1.52, w: 4.25, h: 3.6 });
}

// ══════════════════════════════════════════════════════════════
// SLIDE 12 – GAIT ANALYSIS TOOLS USED
// ══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  addHeader(s, "Gait Analysis Tools – Applied in This Case", false);
  sectionLabel(s, "Instrumentation & Technology Used");

  const tools = [
    { name: "3D Motion Capture", icon: "🎥", desc: "Retroreflective markers on skeletal landmarks; high-speed cameras from multiple angles; 3D kinematic waveforms for each joint", use: "Kinematic analysis at baseline & discharge" },
    { name: "Force Plates", icon: "⚡", desc: "Ground reaction force measurement; timing and magnitude of loading, weight acceptance, and push-off", use: "Kinetic analysis; symmetry ratios" },
    { name: "Surface EMG", icon: "📡", desc: "Activation patterns of TA, gastrocnemius, quadriceps, hamstrings, gluteus medius during gait cycle", use: "Muscle timing analysis; FES targeting" },
    { name: "Pedobarography", icon: "👣", desc: "Foot pressure distribution mapping; identification of equinovarus, lateral loading patterns, toe-off deficits", use: "AFO prescription; plantar pressure outcomes" },
    { name: "IMU Wearables", icon: "📱", desc: "Accelerometers + gyroscopes in wearable patches; real-world gait monitoring outside the lab", use: "Weekly community ambulation monitoring" },
    { name: "Clinical Tests", icon: "📋", desc: "10MWT, 6MWT, TUG, FAC, Berg Balance Scale — standardised outcome tools applied at each assessment point", use: "Functional outcome measurement" },
  ];

  tools.forEach((t, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    const x = 0.28 + col * 3.22;
    const y = 1.08 + row * 2.15;
    card(s, x, y, 3.1, 2.0, C.white);
    s.addShape(pres.ShapeType.rect, { x, y, w: 3.1, h: 0.42, fill: { color: C.navy }, line: { type: "none" } });
    s.addText(t.icon + "  " + t.name, { x: x + 0.08, y, w: 3.0, h: 0.42, fontSize: 11, bold: true, color: C.gold, fontFace: "Calibri", valign: "middle", margin: 0 });
    s.addText(t.desc, { x: x + 0.1, y: y + 0.48, w: 2.9, h: 0.95, fontSize: 9.5, color: C.navy, fontFace: "Calibri", wrap: true, margin: 0 });
    s.addShape(pres.ShapeType.rect, { x, y: y + 1.5, w: 3.1, h: 0.42, fill: { color: "E8F4F8" }, line: { type: "none" } });
    s.addText("Used for: " + t.use, { x: x + 0.1, y: y + 1.5, w: 3.0, h: 0.42, fontSize: 9, color: C.teal, fontFace: "Calibri", italic: true, valign: "middle", margin: 0 });
  });
}

// ══════════════════════════════════════════════════════════════
// SLIDE 13 – RECENT ADVANCES
// ══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: "0A2240" };

  // Gold accent top
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.08, fill: { color: C.gold } });
  s.addText("Recent Advances in Gait Analysis for Stroke Rehabilitation", {
    x: 0.4, y: 0.15, w: 9.2, h: 0.55,
    fontSize: 20, bold: true, color: C.white, fontFace: "Calibri",
  });
  s.addShape(pres.ShapeType.line, { x: 0.4, y: 0.72, w: 9.2, h: 0, line: { color: C.gold, width: 1.5 } });

  const advances = [
    {
      title: "AI & Machine Learning",
      color: "1A5276",
      items: [
        "CNN models classify stroke gait patterns from IMU data automatically",
        "Deep learning estimates EMG-equivalent muscle activity without electrodes (Khant et al., 2025)",
        "Real-time fall risk prediction via edge-AI / TinyML on wearable chips",
      ]
    },
    {
      title: "Robot-Assisted Gait Training",
      color: "1A7A5A",
      items: [
        "Lokomat: exoskeleton + BWSTT with kinematic feedback",
        "Meta-analysis (Chen et al., 2024): RAGT significantly improves gait speed, balance, kinematics post-stroke",
        "Cochrane review (Mehrholz 2025): Electromechanical training improves independent walking odds post-stroke",
      ]
    },
    {
      title: "Wearable IMU Systems",
      color: "6E2FA0",
      items: [
        "Multi-sensor patches for real-world gait monitoring outside the lab",
        "Validated for spatiotemporal gait parameters (Bavan et al., 2026)",
        "Enables telerehabilitation and remote gait monitoring post-discharge",
      ]
    },
    {
      title: "Virtual Reality & Biofeedback",
      color: "1A5E8A",
      items: [
        "VR environments simulate obstacles, dual tasks, and community challenges",
        "Real-time visual/auditory gait biofeedback during walking",
        "Increases engagement and task specificity in gait retraining",
      ]
    },
    {
      title: "Markerless Motion Capture",
      color: "7A4010",
      items: [
        "Computer vision (OpenPose, MediaPipe) extracts joint positions from video",
        "No skin markers needed; usable in any clinic with a camera",
        "AI pose estimation matches lab accuracy for spatiotemporal parameters",
      ]
    },
    {
      title: "FES & Closed-Loop Control",
      color: "1A7085",
      items: [
        "Gait event-triggered FES activates TA at toe-off automatically",
        "Closed-loop FES systems adapt stimulation to real-time gait kinematics",
        "Portable FES systems (e.g. WalkAide, Bioness) shown effective in community use",
      ]
    },
  ];

  advances.forEach((adv, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    const x = 0.22 + col * 3.25;
    const y = 0.85 + row * 2.32;
    s.addShape(pres.ShapeType.roundRect, { x, y, w: 3.1, h: 2.18, fill: { color: adv.color }, line: { type: "none" }, rectRadius: 0.1 });
    s.addText(adv.title, { x: x + 0.1, y: y + 0.06, w: 2.9, h: 0.38, fontSize: 10.5, bold: true, color: C.gold, fontFace: "Calibri", margin: 0, wrap: true });
    adv.items.forEach((pt, j) => {
      s.addText("› " + pt, { x: x + 0.1, y: y + 0.46 + j * 0.54, w: 2.9, h: 0.5, fontSize: 9, color: C.white, fontFace: "Calibri", wrap: true, margin: 0 });
    });
  });
}

// ══════════════════════════════════════════════════════════════
// SLIDE 14 – CLINICAL IMPLICATIONS
// ══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  addHeader(s, "Clinical Implications of Gait Analysis in Stroke Rehab", false);
  sectionLabel(s, "Translating Evidence to Practice");

  const implications = [
    { num: "01", title: "Precision Treatment Planning", color: C.navy, text: "Gait analysis identifies the specific phase and mechanism of each deviation. This case: EMG showed absent TA activation → targeted FES, not generic exercise. Kinematic analysis showed stiff knee → specific RAGT and biofeedback, not generic strengthening." },
    { num: "02", title: "Objective Outcome Measurement", color: C.teal, text: "Quantitative gait data (m/s, symmetry ratio, joint angles) allows precise tracking of recovery. Surgical recommendation changes 52% of the time when objective gait data is added to clinical observation (Campbell's 2026). Same principle applies to physiotherapy decision-making." },
    { num: "03", title: "Assistive Device Optimisation", color: C.orange, text: "Gait analysis directs progression: from walker → quad cane → standard cane in this case, each justified by improved FAC, balance score, and kinematic data. AFO type (rigid vs hinged) was chosen based on spasticity grade and kinematic ankle data." },
    { num: "04", title: "Neuroplasticity-Based Training", color: C.green, text: "Task-specific, high-repetition gait training drives cortical reorganisation. BWSTT + RAGT maximise stepping repetitions. Gait analysis confirms that the correct sensory input (heel strike, weight acceptance) is being delivered to the nervous system." },
  ];

  implications.forEach((imp, i) => {
    const y = 1.08 + i * 1.08;
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    s.addText(imp.num, { x: 0.3, y, w: 0.6, h: 0.92, fontSize: 18, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 });
    s.addShape(pres.ShapeType.rect, { x: 0.95, y, w: 2.4, h: 0.92, fill: { color: imp.color }, line: { type: "none" } });
    s.addText(imp.title, { x: 1.0, y, w: 2.3, h: 0.92, fontSize: 11.5, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", wrap: true, margin: 0 });
    card(s, 3.4, y, 6.3, 0.92, C.white);
    s.addText(imp.text, { x: 3.52, y: y + 0.06, w: 6.1, h: 0.82, fontSize: 9.5, color: C.navy, fontFace: "Calibri", wrap: true, valign: "middle", margin: 0 });
  });
}

// ══════════════════════════════════════════════════════════════
// SLIDE 15 – REFERENCES & CONCLUSION
// ══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkSlide(s);
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.08, fill: { color: C.gold } });

  // Split: left = conclusion, right = references
  s.addText("Conclusion", {
    x: 0.35, y: 0.15, w: 4.5, h: 0.5,
    fontSize: 18, bold: true, color: C.gold, fontFace: "Calibri",
  });
  s.addShape(pres.ShapeType.line, { x: 0.35, y: 0.68, w: 4.3, h: 0, line: { color: C.gold, width: 1.2 } });

  s.addText([
    { text: "This case demonstrates that gait analysis is not merely diagnostic — it is a ", options: { color: "C0D8E8", fontSize: 11, fontFace: "Calibri" } },
    { text: "therapeutic compass", options: { color: C.gold, bold: true, fontSize: 11, fontFace: "Calibri" } },
    { text: " in stroke rehabilitation.\n\n", options: { color: "C0D8E8", fontSize: 11, fontFace: "Calibri", breakLine: true } },
    { text: "Key take-aways:\n", options: { color: C.white, bold: true, fontSize: 11, fontFace: "Calibri", breakLine: true } },
    { text: "• Baseline gait analysis identified 7 specific deviations across all phases\n", options: { color: "B0CCE0", fontSize: 10.5, fontFace: "Calibri", breakLine: true } },
    { text: "• Each deviation was addressed with a targeted, evidence-based intervention\n", options: { color: "B0CCE0", fontSize: 10.5, fontFace: "Calibri", breakLine: true } },
    { text: "• Progressive reassessment with gait analysis guided device and treatment changes\n", options: { color: "B0CCE0", fontSize: 10.5, fontFace: "Calibri", breakLine: true } },
    { text: "• All primary goals achieved in 8 weeks (FAC 2 → FAC 4)\n", options: { color: C.gold, bold: true, fontSize: 10.5, fontFace: "Calibri", breakLine: true } },
    { text: "• Emerging technologies (AI, RAGT, wearables) further optimise outcomes", options: { color: "B0CCE0", fontSize: 10.5, fontFace: "Calibri" } },
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  s.addText("Key References", {
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    fontSize: 18, bold: true, color: C.gold, fontFace: "Calibri",
  });
  s.addShape(pres.ShapeType.line, { x: 5.2, y: 0.68, w: 4.5, h: 0, line: { color: C.gold, width: 1.2 } });

  const refs = [
    "1. Campbell's Operative Orthopaedics, 15th Ed (2026). Gait Analysis in Cerebral Palsy.",
    "2. Chen S et al. (2024). Robot-assisted gait training post-stroke. Eur J Phys Rehabil Med. PMID: 38647534",
    "3. Mehrholz J et al. (2025). Electromechanical-assisted training for walking after stroke. Cochrane Database Syst Rev. PMID: 40365867",
    "4. Choi JY et al. (2024). Overground gait training with wearable robot in CP. JAMA Netw Open. PMID: 39037815",
    "5. Bavan L et al. (2026). Wearable inertial sensors for paediatric gait assessment. Gait Posture. PMID: 42105725",
    "6. Gu B et al. (2026). Wearable sensors for health monitoring. JMIR mHealth uHealth. PMID: 41511829",
    "7. Khant M et al. (2025). Deep learning for stride-to-stride muscle activity estimation. Sci Rep.",
    "8. O'Sullivan & Schmitz. Physical Rehabilitation, 7th Ed. JBLearning. Ch. 14.",
    "9. Norkin CC & White DJ. Measurement of Joint Motion, 5th Ed.",
  ];
  refs.forEach((ref, i) => {
    s.addText(ref, {
      x: 5.2, y: 0.85 + i * 0.48, w: 4.5, h: 0.44,
      fontSize: 9, color: "8AACBE", fontFace: "Calibri", wrap: true, margin: 0,
    });
  });

  s.addShape(pres.ShapeType.rect, { x: 0, y: 5.24, w: 10, h: 0.385, fill: { color: C.gold } });
  s.addText("Thank You  |  Questions Welcome  |  MPT – Neurological Physiotherapy", {
    x: 0, y: 5.24, w: 10, h: 0.385,
    fontSize: 13, bold: true, color: C.navy, fontFace: "Calibri", align: "center", valign: "middle", margin: 0,
  });
}

// ── Write file ─────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/gait-stroke-ppt/Gait_Analysis_Stroke_Rehab_Case_Study.pptx" })
  .then(() => console.log("DONE"))
  .catch(e => { console.error(e); process.exit(1); });