Follow-up of walking quality after end of growth in 28 children with bilateral cerebral palsy

Abstract

Purpose Assessment of surgical treatments on gait in patients with bilateral cerebral palsy (CP) is often performed in short-term studies. The purpose of this study was to analyze the influence of single-event multilevel surgery (SEMLS) on long-term evolution of gait using gait deviation index (GDI) and walking speed. Methods In all, 28 patients with bilateral CP (Gross Motor Function Classification System I to III) with two clinical gait analyses (CGA) were included (mean age: 9.0 years (sd 2.9) at the first CGA, 19.6 years (sd 4.1) at the last, all of them at skeletal maturity). GDI, walking speed and their changes were calculated. Statistical analysis was performed to observe differences between baseline and follow-up CGA. Pearson’s correlations were conducted to evaluate the associations between GDI and walking speed changes with: GDI at baseline and walking speed at baseline. GDI and walking speed evolution have been analyzed for two groups of patients: with and without SEMLS. Results Regardless of the treatment, GDI was significantly higher at follow-up CGA (baseline: 73.1 (sd 13.1) versus follow-up: 80.1 (sd 13.2); p = 0.014). Significant negative correlations were found between GDI change and GDI at baseline (r = -0.52; p = 0.004) and between walking speed change and walking speed at the baseline (r = -0.70; p < 0.001). Regarding the group of patients with or without SEMLS, only significant improvement of GDI was found for patients with SEMLS (at baseline: 69.0 (sd 12.1) versus follow-up: 77.8 (sd 11.2); p < 0.05). Conclusion Analysis at skeletal maturity showed a gait quality maintained for patients without SEMLS and an improvement for patients with SEMLS. Level of evidence Level III

A 10.5-year follow-up of walking with unilateral spastic cerebral palsy

“…This revealed that patients who did not undergo surgery and had good gait function at baseline (10 patients at GMFCS level I) maintained their gait quality, whereas patients who underwent SEMLS (18 patients at GMFCS levels I and II) showed-in the majority of cases-improved gait quality at follow-up. 14 Thus, for both USCP and bilateral CP patients, the long-term beneficial impacts of surgery on gait quality are noteworthy, as measured using mGPS and GVS.…”

“…Similar results were observed in previous publications. 14,31 Examining this study cohort in more detail, only 18 patients had not undergone surgery after their initial CGA. We observed improvement or stabilization in the "no surgery" treatment group's mGPS on both their affected and unaffected sides but with no significant overall difference (Table 2).…”

“…11 These scores are relevant indicators of overall gait pathology (expressed in degrees) for assessing pathological gait characteristics and detecting changes, such as before and after treatment. 12 Several studies in the literature have observed the longterm gait evolution of children with CP, mostly focusing on patients with bilateral CP [13][14][15][16][17][18][19] and showing improved gait scores thanks to surgery. However, to the best of our knowledge, few published articles have examined the long-term gait evolution of USCP patients.…”

“…Several studies in the literature have observed the long-term gait evolution of children with CP, mostly focusing on patients with bilateral CP 13–19 and showing improved gait scores thanks to surgery. However, to the best of our knowledge, few published articles have examined the long-term gait evolution of USCP patients.…”

Gait Indices for Characterization of Patients with Unilateral Cerebral Palsy

“…The GDI and the GPS were developed for gait assessment of patients in general and not exclusively for CP patients [19,21,23,31,32]. Furthermore, the GGI and the GDI were suggested as an adequate parameter for follow-up evaluation of gait and correction procedures [33][34][35].…”