Explaining the variability improvements in gait quality as a result of single event multi-level surgery in cerebral palsy

The relationship between the Edinburgh Visual Gait Score, the Gait Profile Score and GMFCS levels I–III

“…When observing the GMFCS subgroups in Fig. 1, it is noted that level 1 patients appear to cluster at lower gait score values, with subsequent GMFCS levels clustering at higher gait score values; a finding that has been demonstrated by Rutz et al [9]. This further supports the findings in Table. There is, however, some overlap in the GPS and EVGS scores between levels of the GMFCS.…”

Abnormality of standing posture improves in patients with bilateral spastic cerebral palsy following lower limb surgery

“…Thomason et al [14,15] reported improvements in gait and gross motor function at 1, 2 and 5 years post-operatively using a range of gait indices. Rutz et al [17] found that patients with greater preoperative gait abnormality had the most significant improvements in GPS, with a mean improvement of 4.3°. In a retrospective study of 40 children with BSCP and an equinus gait, Firth et al [11] showed GPS improved by an average of 6.6 degrees 7.5 years after multi-level surgery.…”

“…Interventions may include lengthening of musculo-tendinous units, tendon transfers, rotational and displacement osteotomies and stabilization of the hip and foot [6]. A recent systematic review [7] identified numerous retrospective [8][9][10][11][12][13] and prospective studies [14][15][16][17][18][19] demonstrating improvements in gait, gross motor function and quality of life following orthopaedic intervention. 3D gait analysis is commonly used to inform surgical decision making [20][21][22].…”

“…A number of indices have been proposed in the literature to measure gait abnormality, including the Gillette Gait Index (GGI) [23], Gait Deviation Index (GDI) [24] and Gait Profile Score (GPS) [25]. The Gait Profile Score (GPS) [25][26][27] is a well-validated index commonlyadopted as an outcome measure for orthopaedic intervention [11,[14][15][16][17]28]. Thomason et al [14,15] reported improvements in gait and gross motor function at 1, 2 and 5 years post-operatively using a range of gait indices.…”

A systematic review of interventions for children with cerebral palsy: the state of the evidence

“…The failure by Novak et al to apply the GRADE guidelines consistently invalidates their conclusions. 6 The authors have given strong +/green light status to hip surveillance and a weak +/yellow light status to hip surgery. This is the most obvious example of many internal inconsistencies in their review.…”