Preoperative gait analysis has a substantial effect on orthopedic decision making in children with cerebral palsy: Comparison between clinical evaluation and gait analysis in 60 patients

Abstract

Background There is still some debate regarding the role of 3-dimensional gait analysis in routine preoperative evaluation of children with cerebral palsy. The aim of this prospective study was to evaluate to what extent introduction of 3-D gait analysis changes preoperative surgical planning.Method Before gait analysis, 60 ambulatory children aged 10 (4-18) years with spastic cerebral palsy had a specific surgical plan outlined, based on clinical examination by orthopedic surgeons. After gait analysis, the proposed surgical procedures were reviewed to determine the frequency with which the treatment plans changed. A multidisciplinary team assessed the gait analysis.Results Treatment plans for 42 of the 60 patients were altered after gait analysis. Surgical treatment was recommended for 49 patients whereas 11 were recommended non-surgical treatment. Of the 253 specific surgical procedures proposed, 97 procedures were not recommended after gait analysis and 65 additional procedures were recommended after the analysis. Thus, the number of procedures proposed was reduced by 13%. A total of 318 specific surgical procedures were proposed either clinically, by gait analysis, or both. There was overall agreement between the referring orthopedic surgeons and gait analysis in 156 of these 318 procedures (49%). Gait analysis proposed more surgery for psoas tenotomy and rectus femoris transfer, whereas less surgery was proposed for other soft tissue and bony procedures. There was good accordance between gait analysis recommendations and the surgery performed subsequently (92%).

Effects of Preoperative Gait Analysis on Costs and Amount of Surgery

“…5 It has been clearly documented that CGA alters surgical decision making and changes the treatment that patients receive. [6][7][8][9][10] However, the implications of these changes in terms of cost and the amount of surgery performed have not been documented. Therefore, the purpose of this large retrospective study was to determine the effects of CGA on the costs of care in ambulatory children with cerebral palsy (CP) and the amount of surgery that these children undergo.…”

Investigating the Use of Visualisations of Biomechanics in Physical Rehabilitation

“…Motion analysis systems and supporting software enable the collection of accurate, repeatable and objective data on the complex dynamic movements patients perform. This type of analysis has shown a demonstrable positive effect on clinical decision-making in the context of gait analysis [5,6]. The ability to provide this data in other rehabilitation settings could enable clinicians to make more informed decisions.…”

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

“…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].…”