Gait Analysis in Cerebral Palsy

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]

For effective management and treatment planning, it's essential to accurately identify and quantify these gait deviations, a process significantly facilitated by gait analysis tools and assessment aids. Tools allow precision and objectivity, eliminating the subjectivity associated with simple observational methods. They provide quantifiable and standardised measurements of various aspects of gait, thus permitting the accurate identification of specific deviations, be it in foot contact, knee motion, or trunk sway.

Aside from identifying specific abnormalities, these tools serve as invaluable resources in monitoring the evolution of a child's gait over time, capturing changes attributable to natural progression or in response to therapeutic interventions. This longitudinal tracking of gait patterns facilitates evidence-based evaluation of treatment efficacy and allows for necessary adjustments in the treatment plan.

Certain tools, notably the GDI and GPS, offer a comprehensive understanding of a child's gait 'abnormality' by consolidating multiple variables into a single score. On the other hand, tools that measure temporal-spatial parameters provide rich insights into various functional aspects of a child's walking ability.

Tools such as the FMS explore life scenarios, assessing how gait deviations impact daily life and independence. This perspective aids clinicians in goal setting and prioritising interventions that significantly enhance the child's participation and overall quality of life. Some tools commonly used when assessing gait in children with cp include:

  1. Physicians Rating Scale (PRS): This widely-used clinical tool provides a qualitative assessment of gait abnormalities in children with cerebral palsy. By evaluating various parameters like foot contact, knee motion, symmetry, and trunk sway, PRS helps clinicians identify specific areas for therapeutic intervention.
  2. Edinburgh Visual Gait Scale (EVGS): The EVGS is an observational tool designed for subjective assessment of gait in children with cerebral palsy. With a total of 17 items, it provides a comprehensive view of a child's gait, focusing on aspects such as foot strike, knee flexion, and trunk movement.
  3. Visual Gait Assessment Scale (VGAS): The VGAS offers an objective way to rate gait pathologies in children with cerebral palsy. Comprising 18 items related to common gait abnormalities, it helps healthcare professionals to pinpoint specific issues and monitor changes over time.
  4. Three-Dimensional Gait Analysis (3DGA): Considered the gold standard for gait analysis, 3DGA uses advanced technology to provide in-depth insights into the kinematics, kinetics, and electromyographic activity during walking. Although resource-intensive, its precision and accuracy make it invaluable for personalized treatment planning.
  5. 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]
  6. 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]
  7. 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.
  8. 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]

Conclusion[edit | edit source]

Gait analysis, is an important aspect of the assessment process. By accurately identifying and quantifying gait deviations, these tools provide clinicians with invaluable insights into the unique gait patterns observed in these children. This understanding enables targeted interventions, precise monitoring of progress over time, and assessment of treatment effectiveness. By leveraging these comprehensive and objective measures, clinicians can optimise therapeutic strategies, improve gait function, and enhance the overall quality of life for children with cerebral palsy.

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.