The paediatric version of Wisconsin gait scale, adaptation for children with hemiplegic cerebral palsy: a prospective observational study

Abstract

BackgroundIn clinical practice there is a need for a specific scale enabling detailed and multifactorial assessment of gait in children with spastic hemiplegic cerebral palsy. The practical value of the present study is linked with the attempts to find a new, affordable, easy-to-use tool for gait assessment in children with spastic hemiplegic cerebral palsy. The objective of the study is to evaluate the Wisconsin Gait Scale (WGS) in terms of its inter- and intra-rater reliability in observational assessment of walking in children with hemiplegic cerebral palsy.MethodsThe study was conducted in a group of 34 patients with hemiplegic cerebral palsy. At the first stage, the original version of the ordinal WGS was used. The WGS, consisting of four subscales, evaluates fourteen gait parameters which can be observed during consecutive gait phases. At the second stage, a modification was introduced in the kinematics description of the knee and weight shift, in relation to the original scale. The same video recordings were rescored using the new, paediatric version of the WGS. Three independent examiners performed the assessment twice. Inter and intra-observer reliability of the modified WGS were determined.ResultsThe findings show very high inter- and intra-observer reliability of the modified WGS. This was reflected by a lack of systematically oriented differences between the repeated measurements, very high value of Spearman’s rank correlation coefficient 0.9 ≤ |R| < 1, very high value of ICC > 0.9, and low value of CV < 2.5% for the specific physical therapists.ConclusionsThe new, ordinal, paediatric version of WGS, proposed by the authors, seems to be useful as an additional tool that can be used in qualitative observational gait assessment of children with spastic hemiplegic cerebral palsy. Practical dimension of the study lies in the fact that it proposes a simple, easy-to-use tool for a global gait assessment in children with spastic hemiplegic cerebral palsy. However, further research is needed to validate the modified WGS by comparing it to other observational scales and objective 3-dimensional spatiotemporal and kinematic gait parameters.Trial registrationanzctr.org.au, ID: ACTRN12617000436370. Registered 24 March 2017.

The Telemedicine-Based Pediatric Examination of the Back and Lower Limbs: A Narrative Review

“…The WGS is a valuable observational tool originally destined for adult stroke patients which has been modified for children with hemiplegic cerebral palsy given that both gaits are very similar. 78 The authors have reported very high inter- and intra-observer reliability.…”

Pediatric telerehabilitation medicine: Making your virtual visits efficient, effective and fun

“…Other possible telerehabilitation medicine friendly gait assessments include the Edinburgh Visual Gait Analysis [31], the Modified Wisconsin Gait Scale [32,33] and modified versions of the PRS [25,26,[28][29][30]34]. These tests, as with the proposed PRS, have variable intra and inter-observer reliability.…”

The Utility of Gait Deviation Index (GDI) and Gait Variability Index (GVI) in Detecting Gait Changes in Spastic Hemiplegic Cerebral Palsy Children Using Ankle–Foot Orthoses (AFO)

“…Gait pattern can be impaired due to motor coordination, balance, and stability problems during walking. Additionally, there are significant differences in kinematic parameters of the hip, knee, and ankle joints, compared to healthy children [ 14 ]. For the purpose of the improvement of the dynamic gait efficiency, different types of AFO are recommended for patients with spastic hemiplegic CP [ 15 ].…”