Gait Indices for Characterization of Patients with Unilateral Cerebral Palsy

Abstract

As cerebral palsy (CP) is a complex disorder, classification of gait pathologies is difficult. It is assumed that unclassified patients show less functional impairment and less gait deviation. The aim of this study was to assess the different subgroups and the unclassified patients with unilateral CP using different gait indices. The Gillette Gait Index (GGI), Gait Deviation Index (GDI), Gait Profile Score (GPS) and spatiotemporal parameters derived from instrumented 3D-Gait Analysis (IGA) were assessed. Subgroups were defined using morphological and functional classification systems. Regarding the different gait indices, a ranking of the different gait patterns is evident. Significant differences were found between GMFCS level I and II, Winters et al. (Winters, Gage, Hicks; WGH) type IV and type I and the WGH-unclassified. Concerning the spatiotemporal parameters significant differences were found between GMFCS level I and II concerning velocity. The unclassified patients showed mean values for the different gait indices that were comparable to those of established subgroups. Established gait patterns cause different degrees of gait deviation and functional impairment. The unclassified patients do not differ from established gait patterns but from the unimpaired gait. Further evaluation using 3D-IGA is necessary to identify the underlying gait pathologies of the unclassified patients.

Estimation of Gross Motor Functions in Children with Cerebral Palsy Using Zebris FDM-T Treadmill

“…Because CP is a complex disorder, different morphological and functional Gait Classification Systems (GCSs) have been developed, many of whom express either gait pathology or functional impairment [23,24]. GCSs help categorize gait pathologies, allow for the assessment of patient health over time, provide a standardized way to compare gaits between different patients, simplify treatment recommendations and planning, and improve data exchange between clinicians and researchers [23,24].…”

“…Because CP is a complex disorder, different morphological and functional Gait Classification Systems (GCSs) have been developed, many of whom express either gait pathology or functional impairment [23,24]. GCSs help categorize gait pathologies, allow for the assessment of patient health over time, provide a standardized way to compare gaits between different patients, simplify treatment recommendations and planning, and improve data exchange between clinicians and researchers [23,24]. To increase the efficiency of gait classification and quantify gait compared to the unimpaired gait of typically developing individuals (TD), data obtained with the use of three-dimensional Instrumented Gait Analysis (3DIGA) have been used to introduce gait indices such as the Gillette Gait Index (GGI), the Gait Deviation Index (GDI), and the Gait Profile Score (GPS) [24][25][26].…”

“…GCSs help categorize gait pathologies, allow for the assessment of patient health over time, provide a standardized way to compare gaits between different patients, simplify treatment recommendations and planning, and improve data exchange between clinicians and researchers [23,24]. To increase the efficiency of gait classification and quantify gait compared to the unimpaired gait of typically developing individuals (TD), data obtained with the use of three-dimensional Instrumented Gait Analysis (3DIGA) have been used to introduce gait indices such as the Gillette Gait Index (GGI), the Gait Deviation Index (GDI), and the Gait Profile Score (GPS) [24][25][26]. GGI has been proven to show an excellent correlation with Gross Motor Function Measure (GMFM), and GDI is strongly correlated with Gross Motor Function Classification System (GMFCS) [24].…”

“…To increase the efficiency of gait classification and quantify gait compared to the unimpaired gait of typically developing individuals (TD), data obtained with the use of three-dimensional Instrumented Gait Analysis (3DIGA) have been used to introduce gait indices such as the Gillette Gait Index (GGI), the Gait Deviation Index (GDI), and the Gait Profile Score (GPS) [24][25][26]. GGI has been proven to show an excellent correlation with Gross Motor Function Measure (GMFM), and GDI is strongly correlated with Gross Motor Function Classification System (GMFCS) [24]. Also, it should be noted that GDI and GPS were not developed exclusively for gait assessment in patients with CP, but as a more general measure of gait pathology [24,26].…”

“…GGI has been proven to show an excellent correlation with Gross Motor Function Measure (GMFM), and GDI is strongly correlated with Gross Motor Function Classification System (GMFCS) [24]. Also, it should be noted that GDI and GPS were not developed exclusively for gait assessment in patients with CP, but as a more general measure of gait pathology [24,26]. Another test that is frequently used to evaluate functional exercise capacity of children with CP and is inexpensive to administer is the 6-minute Walk Test (6MWT) [27,28].…”