Abstract
ObjectiveTo evaluate the correlation between physical examination data concerning hip rotation and tibial torsion with transverse plane kinematics in children with cerebral palsy; and to determine which time points and events of the gait cycle present higher correlation with physical examination findings.MethodsA total of 195 children with cerebral palsy seen at two gait laboratories from 2008 and 2016 were included in this study. Physical examination measurements included internal hip rotation, external hip rotation, mid-point hip rotation and the transmalleolar axis angle. Six kinematic parameters were selected for each segment to assess hip rotation and shank-based foot rotation. Correlations between physical examination and kinematic measures were analyzed by Spearman correlation coefficients, and a significance level of 5% was considered.ResultsComparing physical examination measurements of hip rotation and hip kinematics, we found moderate to strong correlations for all variables (p<0.001). The highest coefficients were seen between the mid-point hip rotation on physical examination and hip rotation kinematics (rho range: 0.48-0.61). Moderate correlations were also found between the transmalleolar axis angle measurement on physical examination and foot rotation kinematics (rho range 0.44-0.56; p<0.001).ConclusionThese findings may have clinical implications in the assessment and management of transverse plane gait deviations in children with cerebral palsy.
Highlights
Outpatients with cerebral palsy (CP) classified as levels I-III according to the Gross Motor Function Classification System (GMFCS)(1) often present with rotational gait abnormalities, which may lead to lever arm dysfunction and increased energy expenditure.[2,3] Among the most common rotational problems in CP are increased femoral anteversion and external tibial torsion.[2,3,4,5]
Previous studies explored the correlation between physical examination findings and 3DGA, with conflicting results depending on the analyzed parameters.[13,14,15,16] Eventual disagreements between clinical and kinematic data may be related to dynamic factors that do not alter static physical examination measures, such as: joint instability, muscle imbalance and involuntary movement.[14]. The impact of these dynamic factors may vary according to the phase of the gait cycle, depending on the external and internal forces acting on each limb, potentially reflecting in the kinematic angular measures
Regarding the correlations between physical examination measurements of hip rotation and hip kinematics, we found moderate to strong correlations for all variables p
Summary
Outpatients with cerebral palsy (CP) classified as levels I-III according to the Gross Motor Function Classification System (GMFCS)(1) often present with rotational gait abnormalities, which may lead to lever arm dysfunction and increased energy expenditure.[2,3] Among the most common rotational problems in CP are increased femoral anteversion and external tibial torsion.[2,3,4,5]Quantitative assessment of these changes through physical examination is often subjective and inaccurate, which may directly impact treatment.[6,7,8] Likewise, measurements of femoral anteversion and tibial torsion using computed tomography can present high inter- and intra-rater variability and may not correlate with physical examination and the actual gait pattern.[8,9,10,11]Many treatment strategies aim to improve gait of children with CP, and correction of rotational problems is a key point in the planning of orthopedic interventions for this group of patients.[3]. Outpatients with cerebral palsy (CP) classified as levels I-III according to the Gross Motor Function Classification System (GMFCS)(1) often present with rotational gait abnormalities, which may lead to lever arm dysfunction and increased energy expenditure.[2,3] Among the most common rotational problems in CP are increased femoral anteversion and external tibial torsion.[2,3,4,5] Quantitative assessment of these changes through physical examination is often subjective and inaccurate, which may directly impact treatment.[6,7,8] Likewise, measurements of femoral anteversion and tibial torsion using computed tomography can present high inter- and intra-rater variability and may not correlate with physical examination and the actual gait pattern.[8,9,10,11]. Determining which measurement best correlates with the clinical assessment may be relevant for the planning of surgical corrections in these patients
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
