Relationship between the Gait Profile Score and caregiver-reported mobility in cerebral palsy

Background: Different types of ankle-foot orthoses are commonly used following lower limb surgery in children with bilateral spastic cerebral palsy. After three-dimensional gait analysis 1 year postoperatively, many children are recommended continued use of ankle-foot orthoses. Objectives: Our aims were to quantify the impact of ankle-foot orthoses on gait 1 year postoperatively and evaluate predictors for clinically important improvement. Study design: Prospective cohort study. Methods: A total of 34 ambulating children with bilateral cerebral palsy, with mean age 11 years (range 6–17), comprising 12 girls and 22 boys, were measured with three-dimensional gait analysis preoperatively (barefoot) and 1 year postoperatively (barefoot and with ankle-foot orthoses). Outcome was evaluated using gait profile score, key kinematic, kinetic and temporal–spatial variables in paired sample comparisons. Logistic regression was used to evaluate predictors for clinically important improvement with orthoses (⩾1.6° change in gait profile score). Results: Walking barefoot 1 year postoperatively, major improvements were seen in gait profile score and key variables. With ankle-foot orthoses, there were significantly improved step length and velocity, additional moderate reduction/improvement in gait profile score and knee moments and decreased stance ankle dorsiflexion compared to barefoot. Children using ground reaction ankle-foot orthoses ( n = 14) decreased stance knee flexion from 13.9° walking barefoot to 8.2° with orthoses. High gait profile score and more gait dysfunction preoperatively were significant predictors of clinically important improvement walking with orthoses. Conclusion: The results indicate improved gait function walking with ankle-foot orthoses versus barefoot 1 year after lower limb surgery. Stronger impact of ankle-foot orthoses was found in children with more pronounced gait dysfunction preoperatively. Clinical relevance The 1-year postoperative three-dimensional gait analysis is a useful method to assess treatment outcome after lower limb surgery in children with bilateral cerebral palsy and could also guide clinicians whether further treatment with ankle-foot orthoses is indicated, using clinically important differences as thresholds to evaluate their impact on gait.

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An Unsupervised Data-Driven Model to Classify Gait Patterns in Children with Cerebral Palsy

Journal of Clinical Medicine ◽

10.3390/jcm9051432 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1432

Author(s):

Julie Choisne ◽

Nicolas Fourrier ◽

Geoffrey Handsfield ◽

Nada Signal ◽

Denise Taylor ◽

...

Keyword(s):

Cerebral Palsy ◽

Gait Pattern ◽

Data Driven ◽

Self Organizing Map ◽

Gait Patterns ◽

Gait Biomechanics ◽

Children With Cerebral Palsy ◽

Profile Score ◽

Data Driven Modeling ◽

Gait Variable

Ankle and foot orthoses are commonly prescribed to children with cerebral palsy (CP). It is unclear whether 3D gait analysis (3DGA) provides sufficient and reliable information for clinicians to be consistent when prescribing orthoses. Data-driven modeling can probe such questions by revealing non-intuitive relationships between variables such as 3DGA parameters and gait outcomes of orthoses use. The purpose of this study was to (1) develop a data-driven model to classify children with CP according to their gait biomechanics and (2) identify relationships between orthotics types and gait patterns. 3DGA data were acquired from walking trials of 25 typically developed children and 98 children with CP with additional prescribed orthoses. An unsupervised self-organizing map followed by k-means clustering was developed to group different gait patterns based on children’s 3DGA. Model inputs were gait variable scores (GVSs) extracted from the gait profile score, measuring root mean square differences from TD children’s gait cycle. The model identified five pathological gait patterns with statistical differences in GVSs. Only 43% of children improved their gait pattern when wearing an orthosis. Orthotics prescriptions were variable even in children with similar gait patterns. This study suggests that quantitative data-driven approaches may provide more clarity and specificity to support orthotics prescription.

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Quantitative Evaluation of the Effects of Ankle Foot Orthosis on Gait in Children with Cerebral Palsy Using the Gait Profile Score and Gait Variable Scores

Journal of Developmental and Physical Disabilities ◽

10.1007/s10882-016-9472-6 ◽

2016 ◽

Vol 28 (3) ◽

pp. 367-379 ◽

Cited By ~ 9

Author(s):

Manuela Galli ◽

Veronica Cimolin ◽

Chiara Rigoldi ◽

Giorgio Albertini

Keyword(s):

Cerebral Palsy ◽

Quantitative Evaluation ◽

Ankle Foot Orthosis ◽

Children With Cerebral Palsy ◽

Profile Score ◽

Foot Orthosis ◽

Gait Variable

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P 082 – Effect of bilateral tDCS on functional balance and the Gait Profile score in a child with hemiparetic spastic cerebral palsy

Gait & Posture ◽

10.1016/j.gaitpost.2018.07.017 ◽

2018 ◽

Vol 65 ◽

pp. 365-366 ◽

Cited By ~ 1

Author(s):

N. Duarte ◽

L. Grecco ◽

R. Lazzari ◽

M. Galli ◽

C. Oliveira

Keyword(s):

Cerebral Palsy ◽

Spastic Cerebral Palsy ◽

Functional Balance ◽

Profile Score

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Gait Deviation Index, Gait Profile Score and Gait Variable Score in children with spastic cerebral palsy: Intra-rater reliability and agreement across two repeated sessions

Gait & Posture ◽

10.1016/j.gaitpost.2015.04.019 ◽

2015 ◽

Vol 42 (2) ◽

pp. 133-137 ◽

Cited By ~ 30

Author(s):

Helle Mätzke Rasmussen ◽

Dennis Brandborg Nielsen ◽

Niels Wisbech Pedersen ◽

Søren Overgaard ◽

Anders Holsgaard-Larsen

Keyword(s):

Cerebral Palsy ◽

Spastic Cerebral Palsy ◽

Rater Reliability ◽

Deviation Index ◽

Gait Deviation Index ◽

Profile Score ◽

Gait Variable

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A comparison of conventional and minimally invasive multilevel surgery for children with diplegic cerebral palsy

The Bone & Joint Journal ◽

10.1302/0301-620x.103b1.bjj-2020-0714.r1 ◽

2021 ◽

Vol 103-B (1) ◽

pp. 192-197

Author(s):

Tomos A. Edwards ◽

Nicky Thompson ◽

Robin J. Prescott ◽

Julie Stebbins ◽

James G. Wright ◽

...

Keyword(s):

Cerebral Palsy ◽

Adverse Events ◽

Minimally Invasive ◽

Walking Speed ◽

Gait Kinematics ◽

Multilevel Surgery ◽

Age At Surgery ◽

Profile Score ◽

Surgical Adverse Events ◽

Over Time

Aims To compare changes in gait kinematics and walking speed 24 months after conventional (C-MLS) and minimally invasive (MI-MLS) multilevel surgery for children with diplegic cerebral palsy (CP). Methods A retrospective analysis of 19 children following C-MLS, with mean age at surgery of 12 years five months (seven years ten months to 15 years 11 months), and 36 children following MI-MLS, with mean age at surgery of ten years seven months (seven years one month to 14 years ten months), was performed. The Gait Profile Score (GPS) and walking speed were collected preoperatively and six, 12 and 24 months postoperatively. Type and frequency of procedures as part of MLS, surgical adverse events, and subsequent surgery were recorded. Results In both groups, GPS improved from the preoperative gait analysis to the six-month assessment with maintenance at 12 and 24 months postoperatively. While reduced at six months in both groups, walking speed returned to preoperative speed by 12 months. The overall pattern of change in GPS and walking speed was similar over time following C-MLS and MI-MLS. There was a median of ten procedures per child as part of both C-MLS (interquartile range (IQR) 8.0 to 11.0) and MI-MLS (IQR 7.8 to 11.0). Surgical adverse events occurred in seven (37%) and 13 (36%) children, with four (21%) and 13 (36%) patients requiring subsequent surgery following C-MLS and MI-MLS, respectively. Conclusion This study indicates similar improvements in gait kinematics and walking speed 24 months after C-MLS and MI-MLS for children with diplegic CP. Cite this article: Bone Joint J 2021;103-B(1):192–197.

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Effectiveness of Global Optimisation and Direct Kinematics in Predicting Surgical Outcome in Children with Cerebral Palsy

Life ◽

10.3390/life11121306 ◽

2021 ◽

Vol 11 (12) ◽

pp. 1306

Author(s):

Claude Fiifi Hayford ◽

Emma Pratt ◽

John P. Cashman ◽

Owain G. Evans ◽

Claudia Mazzà

Keyword(s):

Cerebral Palsy ◽

Clinical Decision Making ◽

Three Dimensional ◽

Clinical Decision ◽

Contact Forces ◽

Gait Quality ◽

Children With Cerebral Palsy ◽

Profile Score ◽

Joint Contact ◽

Direct Kinematics

Multibody optimisation approaches have not seen much use in routine clinical applications despite evidence of improvements in modelling through a reduction in soft tissue artifacts compared to the standard gait analysis technique of direct kinematics. To inform clinical use, this study investigated the consistency with which both approaches predicted post-surgical outcomes, using changes in Gait Profile Score (GPS) when compared to a clinical assessment of outcome that did not include the 3D gait data. Retrospective three-dimensional motion capture data were utilised from 34 typically developing children and 26 children with cerebral palsy who underwent femoral derotation osteotomies as part of Single Event Multi-Level Surgeries. Results indicated that while, as expected, the GPS estimated from the two methods were numerically different, they were strongly correlated (Spearman’s ρ = 0.93), and no significant differences were observed between their estimations of change in GPS after surgery. The two scores equivalently classified a worsening or improvement in the gait quality in 93% of the cases. When compared with the clinical classification of responders versus non-responders to the intervention, an equivalent performance was found for the two approaches, with 27/41 and 28/41 cases in agreement with the clinical judgement for multibody optimisation and direct kinematics, respectively. With this equivalent performance to the direct kinematics approach and the benefit of being less sensitive to skin artefact and allowing additional analysis such as estimation of musculotendon lengths and joint contact forces, multibody optimisation has the potential to improve the clinical decision-making process in children with cerebral palsy.

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