Development of a core set of gait features and their potential underlying impairments to assist gait data interpretation in children with cerebral palsy

Abstract

BackgroundThe interpretation of clinical gait data in children with cerebral palsy (CP) is time-consuming, requires extensive expertise and often lacks transparency. Here we aimed to develop a set of look-up tables to support this process, linking typical gait features as present in CP to their potential underlying impairments.MethodsWe developed an initial core set of gait features and their potential underlying impairments based on biomechanical reasoning, literature and clinical experience. This core set was further specified through a Delphi process in a multidisciplinary group of experts in gait analysis of children with CP and evaluated on 20 patient cases. The likelihood of the listed gait feature–impairment relationships was scored by the expert panel on a five-point scale.ResultsThe final core set included 120 relevant gait feature–impairment relations including likelihood scores. This set was presented in the form of look-up tables in both directions, i.e., sorted by gait features with potential underlying impairment, and sorted by impairments with potential related gait features. The average likelihood score for the relations was 3.5 ± 0.6 (range 2.1–4.6).ConclusionThe developed set of look-up tables linking gait features and impairments, can assist gait analysts and clinicians in standardized biomechanical reasoning, to support treatment decision-making for gait impairments in children with CP.

The applicability of markerless motion capture for clinical gait analysis in children with cerebral palsy

“…However, since the markerless system hardly measured any rotation in the hip over the gait cycle for any of the subjects, and a high individual subject-level difference was present between systems, it can be questioned whether the markerless system is capable of capturing transverse hip rotation any more accurately than the marker-based system. In children with CP, increased hip endorotation is a common gait feature 8,27 , and therefore accurate tracking of transverse hip rotation is highly relevant in clinical practice. The marker-based system seems to better reflect those clinical observations (Fig.…”

“…It is known that children in CP often walk with increased plantar flexion in the ankle, and more dorsal flexion in the forefoot (i.e. a midfoot break) 8,27,34 . Hence, the larger variation measured by the markerless system might indicate that it is better capable of tracking the hindfoot than a marker-based mono-segment foot model, resulting in better tracking of the ankle joint itself instead of the whole foot.…”

“…Clinical gait analysis (CGA) is often performed to provide guidance on which impairments to target with medical and rehabilitation interventions 5,6 . For CGA joint kinematics and kinetics, either with or without electromyography, are measured and compared to normative reference data to determine underlying motor impairments and guide treatment planning 7,8 .3D marker-based motion capture has long been considered the standard in CGA 9 . However, it has several practical limitations that impact its application in clinical use [10][11][12] .…”

“…Clinical gait analysis (CGA) is often performed to provide guidance on which impairments to target with medical and rehabilitation interventions 5,6 . For CGA joint kinematics and kinetics, either with or without electromyography, are measured and compared to normative reference data to determine underlying motor impairments and guide treatment planning 7,8 .…”

Predicting Gait Patterns of Children With Spasticity by Simulating Hyperreflexia

“…Such relations are used in clinical practice to guide treatment selection. [54][55][56] As a next step, spasticity should be combined with other impairments, such as weakness and contracture, to elucidate the interaction of these impairments. This may assist in the clinical reasoning process of gait analysis interpretation in children with CP and other neuromuscular disorders, which could improve treatment selection.…”