Gait analysis in children with cerebral palsy

Abstract

Cerebral palsy (CP) children present complex and heterogeneous motor disorders that cause gait deviations.Clinical gait analysis (CGA) is needed to identify, understand and support the management of gait deviations in CP. CGA assesses a large amount of quantitative data concerning patients’ gait characteristics, such as video, kinematics, kinetics, electromyography and plantar pressure data.Common gait deviations in CP can be grouped into the gait patterns of spastic hemiplegia (drop foot, equinus with different knee positions) and spastic diplegia (true equinus, jump, apparent equinus and crouch) to facilitate communication. However, gait deviations in CP tend to be a continuum of deviations rather than well delineated groups. To interpret CGA, it is necessary to link gait deviations to clinical impairments and to distinguish primary gait deviations from compensatory strategies.CGA does not tell us how to treat a CP patient, but can provide objective identification of gait deviations and further the understanding of gait deviations. Numerous treatment options are available to manage gait deviations in CP. Generally, treatments strive to limit secondary deformations, re-establish the lever arm function and preserve muscle strength.Additional roles of CGA are to better understand the effects of treatments on gait deviations.Cite this article: Armand S, Decoulon G, Bonnefoy-Mazure A. Gait analysis in children with cerebral palsy. EFORT Open Rev 2016;1:448-460. DOI: 10.1302/2058-5241.1.000052.

Gait parameters in children with bilateral spastic cerebral palsy: a systematic review of randomized controlled trials

“…This makes sense since the widest movements involved in gait are ankle plantarflexion/dorsiflexion, and knee and hip flexion‐extension. Most of the gait pattern classifications are based on sagittal plane kinematics and many gait deviations observed and treated in children with CP occur in the sagittal plane . However, deviations in the transverse and frontal planes are also considered important in clinical decision‐making and intervention planning, and analyses in these planes could improve content validity of gait classifications …”

“…The instrumented gait analysis (IGA) allows a precise quantification of gait characteristics, through objective data that cannot be appreciated visually or measured on a static physical examination . The IGA provides detailed information on four main types of data recorded simultaneously: spatiotemporal, kinematic, kinetic, and surface electromyography (sEMG) parameters . The IGA is often used in the assessment of ambulatory children with CP, for multiple purposes including the identification and understanding of gait deviations, the refinement of clinical decision‐making, and the evaluation and understanding of the effects of treatments on gait deviations .…”

“…The IGA provides detailed information on four main types of data recorded simultaneously: spatiotemporal, kinematic, kinetic, and surface electromyography (sEMG) parameters . The IGA is often used in the assessment of ambulatory children with CP, for multiple purposes including the identification and understanding of gait deviations, the refinement of clinical decision‐making, and the evaluation and understanding of the effects of treatments on gait deviations . However, the reliability, validity, and clinical utility of the IGA have not been well established, and its clinical use remains variable and controversial …”

Automatic versus manual tuning of robot-assisted gait training in people with neurological disorders

“…Another possible reason for the differences between the AT and MT approach is that tuning all subtasks separately could be too complicated and time-consuming for clinical practice. The subtasks were related to common problems after neurological disorders [36][37][38][39][40]. They were chosen based on input from physical therapists and rehabilitation physicians who indicated that they would like to have more possibilities to tune the assistance than in other (commercially available) robotic gait trainers, which often only allow to change the general assistance for the whole gait cycle and multiple joints simultaneously [4,32].…”

The role of neurogenic feet deformities in the lower limb dysfunction structure in patients with cerebral palsy. Management of surgical treatment. Literature data review

“…По данным многочисленных источников, утверждают, что методы апоневротомии икроножной мышцы с рассечением межмышечной перегородки или частичной чрескожной тенотомии являются наиболее малотравматичными, функциональными и достаточно физиологичными методами коррекции эквинусной деформации при спастических формах ДЦП. Показанием к выполнению подобных вмешательств является изолированное контрагирование икроножной мышцы [19].…”