Gait Analysis in Cerebral Palsy

Original Editor - Kim Jackson as part of ICRC Cerebral Palsy Content Development Project

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Gait Deviations in Children with Cerebral Palsy[edit | edit source]

Children with cerebral palsy (CP) often exhibit several gait deviations, largely due to motor control abnormalities, muscle weakness, contractures, and spasticity. Common deviations can be seen across various stages of the gait cycle:

  1. Initial Contact and Loading Response: Children with cerebral palsy often demonstrate a flat foot or an equinus foot (heel does not touch the ground) during initial contact, with ensuing knee hyperextension or flexion during the loading response.[1] This could lead to instability and increased energy expenditure during walking.
  2. Mid-Stance and Terminal Stance: In these stages, the child may exhibit excessive hip internal rotation due to muscle imbalances, contractures, or overactivity of certain muscle groups (e.g., hip adductors or internal rotators).
  3. Pre-Swing and Swing Phase: There may be problems with foot clearance, mainly due to decreased hip and knee flexion and ankle dorsiflexion. This might lead to an altered swing phase, often manifesting as a circumduction gait, where the child swings their leg in a semi-circle due to the inability to flex their knee or hip adequately.[2]

Importance of Gait Analysis[edit | edit source]

Gait analysis plays an essential role in the assessment, planning, and evaluation of treatment strategies for children with cerebral palsy. Research indicates that gait analysis can provide essential insights into motor disorders in cerebral palsy, leading to improved treatment planning and prognosis.[3] Quantitative gait analysis, which involves the use of advanced technology such as motion capture systems and force plates, offers detailed insights into spatiotemporal parameters, kinematics, kinetics, and muscle activity during gait.[4]Gait analysis aids clinicians in:

  1. Identifying Specific Deviations: Gait analysis can help identify specific gait deviations and the phase of the gait cycle where they occur. This information can guide targeted therapeutic interventions.
  2. Quantifying Abnormalities: Gait analysis tools offer quantitative data about the child's walking pattern, providing an objective measure of the severity of gait abnormalities.
  3. Monitoring Progress: Gait analysis can track changes over time, allowing the healthcare provider to monitor the effectiveness of interventions and adjust the treatment plan as necessary.
  4. Informing Surgical Planning: In some cases, gait analysis can provide valuable information that informs the planning of orthopaedic surgery, such as selective dorsal rhizotomy or muscle-tendon lengthening.

Gait Analysis Tools and Assessment Aids[edit | edit source]

In addition to the tools already mentioned (PRS, EVGS, VGAS, 3DGA), several other instruments are frequently used in clinical practice:

  1. Gait Deviation Index (GDI): This is a summary measure of overall gait 'abnormality'. It takes multiple variables from 3DGA and reduces them to a single score, with lower scores indicating greater deviation from typical gait.[5]
  2. Gait Profile Score (GPS): Similar to the GDI, the GPS provides a single score that summarises the overall deviation of an individual's gait from a reference normal. It specifically focuses on nine key kinematic variables.[6]
  3. Temporal-Spatial Parameters: These include variables such as walking speed, step length, stride length, cadence, and the proportion of the gait cycle spent in different phases (stance, swing, double support). These parameters can be measured relatively simply and can provide important information about gait function.
  4. Functional Mobility Scale (FMS): The FMS assesses a child's usual performance in walking different distances (5, 50, and 500 metres), focusing on real-world functional mobility. This can help clinicians understand how gait deviations impact the child's everyday life.[7]

References[edit | edit source]

  1. ↑ Wren TA, Rethlefsen S, Kay RM. Prevalence of specific gait abnormalities in children with cerebral palsy: influence of cerebral palsy subtype, age, and previous surgery. Journal of Pediatric Orthopaedics. 2005 Jan 1;25(1):79-83.
  2. ↑ Schwartz MH, Rozumalski A, Trost JP. The effect of walking speed on the gait of typically developing children. Journal of biomechanics. 2008 Jan 1;41(8):1639-50.
  3. ↑ Schwartz MH, Trost JP, Wervey RA. Measurement and management of errors in quantitative gait data. Gait & posture. 2004 Oct 1;20(2):196-203.
  4. ↑ Wren TA, Gorton III GE, Ounpuu S, Tucker CA. Efficacy of clinical gait analysis: A systematic review. Gait & posture. 2011 Jun 1;34(2):149-53.
  5. ↑ Schwartz MH, Rozumalski A. The Gait Deviation Index: a new comprehensive index of gait pathology. Gait & posture. 2008 Oct 1;28(3):351-7.
  6. ↑ Baker R, McGinley JL, Schwartz MH, Beynon S, Rozumalski A, Graham HK, Tirosh O. The gait profile score and movement analysis profile. Gait & posture. 2009 Oct 1;30(3):265-9.
  7. ↑ Graham HK, Harvey A, Rodda J, Nattrass GR, Pirpiris M. The functional mobility scale (FMS). Journal of Pediatric Orthopaedics. 2004 Sep 1;24(5):514-20.
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