Effects of Robot-Assisted Therapy on Gait Parameters in Pediatric Patients With Spastic Cerebral Palsy

Background: Gait dysfunction is a crucial factor that restricts independence and quality of life in children with cerebral palsy (CP). Gait training based on robotic-assisted therapy (RAT) is widely used, but information about effectiveness and ideal patient profile is not sufficient. Aim of this study was to assess the effect of RAT on gait parameters in spastic children with CP, and to determine whether changes in gait parameters are different among patients on different ambulatory levels.Method: A total of 26 children with bilateral spastic CP were divided into two groups based on their functional ability: non-assisted ambulator (NAS) or assisted ambulator (AS); and underwent a RAT program (30 training sessions of RAT during 10 weeks). Gait analysis was performed: before the therapy (t1), right after (t2), and 6 weeks later (t3).Results: No significant changes in spatiotemporal parameters or gait deviation index at t2 or t3. Double support symmetry significantly improved (t1 vs. t3, p = 0.03) for the whole group (NAS + AS). Walking speed symmetry significantly improved (t2 vs. t3, p = 0.02) for group AS.Conclusion: RAT based on our protocol did not change spatiotemporal parameters and kinematics of walking except limited improvement in some aspects of gait symmetry. We did not find differences in changes in selected objective gait parameters among children with CP in different ambulatory levels.

Identifying Running Deviations in Long Distance Runners Utilizing Gait Profile Analysis: A Case Control Study

Objective: The goal of this study was to utilize Gait Profile Score (GPS) and Gait Deviation Index (GDI), to assess its capability of differentiating between injured and non-injured runners. Design: In total, 45 long-distance runners (15 non-injured, 30 injured), diagnosed with one of the following running related injuries, patella femoral pain syndrome, iliotibial pain syndrome, and medial tibial stress syndrome, were recruited. Methods: Data were obtained from a running analysis gait laboratory equipped with eight infrared motion-capturing cameras and a conventional treadmill. Running kinematics were recorded according to the Plug-In Gait model, measuring running deviations of the pelvis and lower extremities at a sampling rate of 200 Hz. GPS and GDI were calculated integrating pelvis and lower limb kinematics. Movement Analysis Profile results were compared between injured and non-injured runners. The non-parametric two-sample Wilcoxson test determined whether significant kinematic differences were observed. Results: Total GPS score significantly differed between the injured and non-injured runners. Not all running kinematics expressed by GDI differed between groups. Conclusions: GPS score was capable of discriminating between the injured and non-injured runners’ groups. This new running assessment method makes it possible to identify running injuries using a single numerical value and evaluate movements in individual joints.

Effect of the COVID-19 Emergency on Physical Function among School-Aged Children

In April 2020, the Japanese government declared a state of emergency due to the novel coronavirus disease (COVID-19). Schools were closed and a stay-at-home order was issued in April and May 2020. This before-and-after study aimed to measure the effects of these COVID-19-related restrictions on physical function among Japanese children. The study included children aged 6–7 years, enrolled before and after the emergency declaration. Their body fat percentage, single-leg standing time, Gait Deviation Index score, and history of falls were compared. There were 56 and 54 children in the before and after groups, respectively. Children in the after group had a higher body fat percentage (p = 0.037), shorter single-leg standing time (p = 0.003), and a larger number of falls per month (p < 0.001) than those in the before group. In the logistic regression analysis, children in the after group had a significantly shorter single-leg standing time (odds ratio (OR): 0.985, 95% confidence interval (CI): 0.972−0.997, p = 0.013), a greater number of falls per month (OR: 1.899, 95% CI: 1.123−3.210, p = 0.017), and a higher body fat percentage (OR: 1.111, 95% CI: 1.016−1.215, p = 0.020) than those in the before group. The COVID-19 emergency restrictions had a negative effect on children’s physical function, especially on balance.

Gait Characteristics in Youth With Transverse Myelitis

Background: Transverse myelitis (TM) in childhood is a rare disorder characterized by the presence of spinal cord inflammation. Gait difficulty in children with TM is common; however, there is a paucity of literature regarding quantitative assessment of gait in children and adolescents with TM. Objectives: To characterize gait patterns in a cohort of ambulatory children with TM and age-matched, typically developing peers in order to better understand the functional mobility of patients diagnosed with childhood TM. Methods: This was a retrospective study of 26 ambulatory pediatric patients with a confirmed diagnosis of TM who had undergone three-dimensional, instrumented gait analysis (3D-IGA) at 3 years of age or older. A group of 38 typically developing children served as a control group. Results: Gait in children with TM was characterized by moderate kinematic deviations as measured by the Gait Deviation Index (GDI) and a crouched gait pattern (p &lt; .001), increased anterior pelvic tilt (p &lt; .001), decreased motion at the knees (p &lt; .001), and a wider base of support (foot progression angle, p &lt; .001). The TM group had a slower walking speed (p &lt; .001), shorter strides (p &lt; .001), and an increased stance phase compared to controls. Conclusion: Our study results showed moderate kinematic deviations quantified by the GDI. Overall, the gait pattern in the TM population tested had greater hip and knee flexion with wider foot progression angle. Identification of gait characteristics in children with TM is the first step in predicting changes in gait pattern as they mature over time, which may ultimately allow for targeted intervention to maintain their ambulatory function.

Outcomes of Corrective Surgery in Children with Foot Deformities Using Quantitative Gait Analysis

Objective. This study aimed to quantitatively define outcomes of corrective surgery in children with various foot deformities. Methods. We used a retrospective, nonrandomized design. All pediatric patients who underwent pre and post-operative gait analysis and corrective surgery were included. Outcome measures included quantitative gait analysis with temporospatial and kinematic parameters, the Gait Deviation Index, Gillette FAQ, and Hoffer’s criteria. Results. Five patients with neurogenic and idiopathic deformities underwent corrective surgery at the Philippine General Hospital from 2015 to 2017. Comparison of gait pre and postoperatively show promising outcomes, with improvement in GDI and FAQ levels, despite some of the patients’ need for braces. Conclusions. Quantitative gait analysis is a suitable method for evaluating surgical outcomes for foot deformity correction. It can be used in combination with functional outcome measures and clinical examination to give an overall picture of a patient’s walking ability.

Identifying gait quality metrics sensitive to changes in lower limb constraint

Background Manual tuning of robotic lower limb prostheses can be time consuming for both the patient and the clinician and requires in-person visits to a clinic. An automated process for the tuning parameters of a robotic lower limb prosthesis could result in a substantial savings in healthcare resources. A critical challenge to an automated parameter tuning algorithm is the quantification of a person’s gait quality. There is not good agreement in the literature of an objective outcome measure that can rapidly assess gait quality in lower limb amputees. As a first step, we investigated the ability of four common gait quality metrics to detect differences in gait quality: Prosthetic Observational Gait Score (POGS), Gait Deviation Index (GDI), Lateral Sway, and Impulse Asymmetry. Methods We systematically applied four unilateral lower limb joint constraint conditions (baseline/no constraint, ankle constraint, knee constraint, and knee + ankle constraint) to nine able-bodied participants walking at three different speeds (0.7, 0.85 and 1.0 m/s). We calculated and compared the resulting GDI, POGS, Lateral Sway and Impulse Asymmetry scores across all conditions. We performed a 2-way ANOVA statistical analysis to compare sensitivity of the metrics to the various conditions with significance defined by an alpha-level = 0.05. Results The Lateral Sway metric distinguished three joint constraint conditions and two of the speed conditions. Both GDI and POGS were able to distinguish four out of six possible constraint-speed conditions, while Impulse Asymmetry was only able to detect differences between three of the six constraint-speed conditions. Conclusions No single gait quality metric could distinguish every condition. Accordingly, a single metric of gait quality may be inadequate for tuning a prosthesis and therefore multiple metrics and sensors may provide the best results for tuning a prosthesis to the most natural gait pattern for an individual. Compared to the more complex gait measures, Lateral Sway performed well as a simple metric that might easily be operationalized into a real-time parameter tuning controller.

Three dimensional gait analysesin dizygotic twin athletes

Gait analysis and gait indices are frequently used to evaluate gait pathologies and outcomes. The aim of this study is to investigate the differences in gait parameters of dizygotic twin athletes according to each other and athletes group who are similar age but non-twin. Eighty-four athletes without any disease that could cause gait pathology were included the study. Time-distance measurements, kinematic – kinetic variables, and gait deviation index (GDI) of the gait functions of twin athletes (17 boys and 25 girls, height: 153.9 ± 15 cm, weight: 45.9 ± 12 kg, leg length 80.5 ± 11 cm) were compared with each other and with 42 sex and age matched non-twins athletes (height: 155 ± 15 cm, weight: 47 ± 14 kg, leg length 80.6 ± 9.8 cm, mean age 11.8 ± 2.29, range 6–15 years). No statistically significant difference was found about the time, distance parameters and GDIs in comparison of twin athletes with each other and the non-twin group. Additionally, kinetic and kinematic variables were similar in between twins. We measured lower adduction angles and higher abduction angles in non-twin athletes in comparison to the twin athletes ( p = 0.01, 0.04). Additionally, the angle of knee flexion at the first contact was higher in non-twins ( p = 0.003). Being dizygotic twin seems to have no clinical effect on gait function in athletes.

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)

Background: Cerebral palsy (CP) children present complex and heterogeneous motor disorders that cause gait deviations. Clinical gait analysis (CGA) is used to identify, understand and support the management of gait deviations in CP. Children with CP often use ankle–foot orthosis (AFO) to facilitate and optimize their walking ability. The aim of this study was to assess whether the gait deviation index (GDI) and the gait variability index (GVI) results can reflect the changes of spatio-temporal and kinematic gait parameters in spastic hemiplegic CP children wearing AFO. Method: The study group consisted of 37 CP children with hemiparesis. All had undergone a comprehensive, instrumented gait analysis while walking, both barefoot and with their AFO, during the same CGA session. Kinematic and spatio-temporal data were collected and GVI and GDI gait indexes were calculated. Results: Significant differences were found between the barefoot condition and the AFO conditions for selected spatio-temporal and kinematic gait parameters. Changes in GVI and GDI were also statistically significant. Conclusions: The use of AFO in hemiplegic CP children caused a statistically significant improvement in spatio-temporal and kinematic gait parameters. It was found that these changes were also reflected by GVI and GDI. These findings might suggest that gait indices, such as GDI and GVI, as clinical outcome measures, may reflect the effects of specific therapeutic interventions in CP children.