Two-dimensional analysis of gait asymmetry in spastic hemiplegia

Abstract

Objective: Simple measures of gait for routine clinical use could be useful when the complex gait analysis systems are not available. The aim of this study was to quantify asymmetry in children with spastic hemiplegia using a two-dimensional gait analysis by videography and to relate the asymmetry to motor function. Methods: Twenty-four children with spastic hemiplegia (19 males, 5 females; mean age 49 months [SD 5 months], range from 39 to 60 months) were assessed with a two-dimensional gait analysis by videography and the analyzed parameters were compared with normal values and with clinical and functional data. results: There were significant differences in swing time (p = 0.002), stance time (p = 0.01) and stance/swing time ratio (p < 0.001). The comparison with the normal values described by Sutherland also demonstrated gait asymmetry. There was no direct relationship between the motor function and asymmetry but a score analysis for specific Gross Motor Function Measure items could quantify it in terms of age of gait acquisition. Children with more adequate muscle tone presented longer stance time in the involved limb than those with more spasticity (p = 0.03). conclusions: These results suggest that the best performance is associated with the smallest asymmetry in this sample. Although two-dimensional gait analysis does not provide as much data as three dimensional gait analyses, we believe it can contribute significantly to the gait assessment of children with cerebral palsy.Keywords: Gait; Cerebral palsy; Hemiplegia; Child reSUMO Objetivo: Medidas simples para mensuração da marcha na rotina clínica podem ser úteis quando os sistemas complexos para a análise da marcha não estão disponíveis. O objetivo deste estudo foi quantificar a assimetria na marcha de crianças com hemiplegia espástica por meio de uma análise bidimensional por videografia e relacionar a assimetria à função motora. Métodos: Vinte e quatro crianças com paralisia cerebral do tipo hemiplégica espástica (19 do sexo masculino, 5 feminino; média de idade de 49 meses [± 5 meses], variando de 39 a 60 m) foram avaliadas por meio da análise bidimensional por videografia, e os parâmetros analisados foram comparados a valores normais e com dados clínicos e funcionais. resultados: Foram observadas diferenças estatisticamente significantes entre as médias do tempo de balanço (p = 0,002), tempo de apoio (p = 0,01) e da relação apoio/balanço (p < 0,001). A comparação aos valores normais de Sutherland também demonstrou a assimetria na marcha. Não foi observada relação direta entre a função motora avaliada pela escala GMFM e a assimetria. Já a análise do escore para itens específicos dessa escala pôde relacionar a assimetria à idade de aquisição da marcha independente. Crianças com tônus muscular mais adequado apresentaram maior tempo de apoio no lado envolvido do que aqueles com maior espasticidade (p = 0,03). conclusões: Esses resultados sugerem que a melhor performance está associada à menor assimetria nesta amostra. Mesmo que a análise bidime...

Side-to-side growth discrepancies in children with hemiplegic cerebral palsy: association with function, activity and social participation

“…This arises from muscle contractures, poor body segment balance and/or positioning, poor selective motor control, and abnormal or short bone lever arms. In a previous study by our group, which analyzed gait in the same cohort that participated in the present study 22 , we found an association between the lowest percentage of double support time in the involved limb with decreased muscle strength. We observed that these two variables were related to greater discrepancy in the involved limb, reinforcing the involvement of several factors in both the genesis and adaptation to disability.…”

“…Gait pattern was assessed using the Physician's Rating Scale (PRS) 21 , a recognized scale that scores various components of gait movement, yielding scores for each leg that range from zero to 14. We also considered a Two-Dimensional Gait Analysis using data retrieved from another study using the same cohort 22 .…”

Preliminary analysis of linear and angular kinetic parameters of the gait of individuals with cerebral palsy

“…and T37, according to IPC classification manual. IPC is pioneer in using functional assessment in sports, since clinical assessments as Gross Motor Function Classification System were more commonly used in the past (Dini & David, 2009;Kwon et al, 2011;Matsuno et al, 2010;Prosser et al, 2010;Zonta et al, 2010) .…”

Correlation between movement of the feet and motor function of children with chronic encephalopathy

“…Children with major joint deformities have severe motor dysfunction and less independence to perform functional skills (27,28,29). This relationship is extremely important for evidencing that a greater joint mobility of the ankle and toes, associated with a lower level of neuromotor impairment, enables greater functional performance (30,31). Therefore, as one of the major goals of physical therapy is functional gain, the in luence of comorbidities should not be underestimated, such as foot deformities associated with functional loss in children with CNPE and its impact on daily activities (32,33).…”