Retrospective Evaluation of Changes in Gait Patterns in Children and Adolescents With Cerebral Palsy After Multilevel Surgery

Steppacher, Ramona; North, David; Künzle, Christoph; Lengnick, Harald; Klima, Harry; Mündermann, Annegret; Wegener, Regina

doi:10.1177/0883073818766681

Cited by 2 publications

(1 citation statement)

References 27 publications

(51 reference statements)

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“…To identify patterns of correlated deviations from average kinematic angle waveforms, the principal component analysis (PCA) was facilitated. The PCA has already been successfully used in different contexts in CP, for example, to identify CP-related gait pathologies (Carriero et al, 2009a,b), to study multi segmental gait deviations (Zago et al, 2017) or to evaluate post-operative changes after multilevel surgery (Steppacher et al, 2018).…”

Section: Methodsmentioning

confidence: 99%

Excessive Lateral Trunk Lean in Patients With Cerebral Palsy: Is It Based on a Kinematic Compensatory Mechanism?

Rethwilm

Böhm

Dussa

et al. 2019

Front. Bioeng. Biotechnol.

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Introduction: Excessive lateral trunk lean is a commonly observed gait deviation in children with cerebral palsy (CP), with implications for energy expenditure and the development of back pain. While the trunk lean toward the stance leg is widely interpreted as a compensatory strategy to unload the hip, in CP the relation to hip abductor muscle strength is only weak. Therefore, other mechanisms may play a role in the prevalence of excessive trunk lean in CP, or it could be a primary motor function deficit.Research Question: Is the excessive lateral trunk lean in patients with CP part of an underlying biomechanical mechanism?Materials and Methods: Patients with bilateral CP (N = 255; age 13.6 ± 6.6 years) were retrospectively included and divided into a group with (n = 174) and without (n = 81) excessive lateral trunk lean. Ten lower-extremity joint angle waveforms were analyzed using a principal component analysis (PCA) to identify patterns of correlated deviations from average angle waveforms. Binary logistic regressions were performed to determine the discriminative capacity of the identified patterns.Results: The PCA identified correlated kinematic patterns, with lower-order patterns showing more common gait pathologies, such as torsional malalignments and crouch gait pattern. Within five patterns, significant (p < 0.0025) group differences were identified. Interestingly, the trunk lean was not always distinctive in these patterns and despite the significant differences their effect sizes were small. The logistic regression was unable to reliably classify patients based on their trunk lean patterns.Discussion: The current study identified multiple trunk lean-related patterns, however, excessive trunk lean was not attributable to a distinctive CP related gait pathology or to a specific compensatory strategy. Overall, the results do not support the hypothesis that excessive trunk lean is part of a biomechanical mechanism. Therefore, it seems more likely that excessive lateral trunk lean is based on other disease specific dysfunctions, influenced by the severity of the disease.

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Section: Methodsmentioning

confidence: 99%

Excessive Lateral Trunk Lean in Patients With Cerebral Palsy: Is It Based on a Kinematic Compensatory Mechanism?

Rethwilm

Böhm

Dussa

et al. 2019

Front. Bioeng. Biotechnol.

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Outcome domains and measures after lower limb orthopaedic surgery for ambulant children with cerebral palsy: an updated scoping review

Almoajil

Wilson

Theologis

et al. 2020

Develop Med Child Neuro

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Aim To determine the reported outcome domains and measures used to assess lower limb orthopaedic surgery of ambulant children and young people with cerebral palsy (CP) and map these outcomes to the International Classification of Functioning, Disability and Health – Children and Youth (ICF‐CY) framework. Method This updated scoping review included studies published between January 2016 and July 2019 in five databases: MEDLINE, PubMed, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials. Studies were included if participants were ambulant individuals with CP aged between 0 and 20 years who had undergone lower limb orthopaedic surgery. Health outcome domains and measures were identified and classified using the ICF‐CY framework. Results Forty‐four eligible studies were identified with a total of 40 different outcome domains recorded. Among eligible studies, 44 (100%) measured body function and structural impairment and seven (16%) measured activity limitation and participation restriction. The most frequently reported outcome was gait pattern (n=37, 84%). Few studies reported adverse effects of surgery (n=13, 30%). Twenty‐nine different outcome measures were identified. Patient‐reported outcomes measures were used in 10 studies (23%). Interpretation The review highlights a heterogeneity in the reported outcome domains and measures used in CP studies. The majority of the reported outcomes focus on the ICF‐CY domain of body function and structure. The review also highlights a notable shift towards patient‐reported outcomes in recent years. Development of a core outcome set for lower limb orthopaedic surgery would guide researchers to use more consistent and complete measurement sets.

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Retrospective Evaluation of Changes in Gait Patterns in Children and Adolescents With Cerebral Palsy After Multilevel Surgery

Cited by 2 publications

References 27 publications

Excessive Lateral Trunk Lean in Patients With Cerebral Palsy: Is It Based on a Kinematic Compensatory Mechanism?

Excessive Lateral Trunk Lean in Patients With Cerebral Palsy: Is It Based on a Kinematic Compensatory Mechanism?

Outcome domains and measures after lower limb orthopaedic surgery for ambulant children with cerebral palsy: an updated scoping review

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