Gait Indices for Characterization of Patients with Unilateral Cerebral Palsy.

Stefanos Tsitlakidis,Martin Schwarze,Sébastien Hagmann,Axel Horsch,Marco Götze,Sebastian I Wolf,Fabian Westhauser,Korbinian Heubisch

doi:10.3390/jcm9123888

Stefanos Tsitlakidis, Martin Schwarze + Show 6 more

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https://doi.org/10.3390/jcm9123888

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Abstract

As cerebral palsy (CP) is a complex disorder, classification of gait pathologies is difficult. It is assumed that unclassified patients show less functional impairment and less gait deviation. The aim of this study was to assess the different subgroups and the unclassified patients with unilateral CP using different gait indices. The Gillette Gait Index (GGI), Gait Deviation Index (GDI), Gait Profile Score (GPS) and spatiotemporal parameters derived from instrumented 3D-Gait Analysis (IGA) were assessed. Subgroups were defined using morphological and functional classification systems. Regarding the different gait indices, a ranking of the different gait patterns is evident. Significant differences were found between GMFCS level I and II, Winters et al. (Winters, Gage, Hicks; WGH) type IV and type I and the WGH-unclassified. Concerning the spatiotemporal parameters significant differences were found between GMFCS level I and II concerning velocity. The unclassified patients showed mean values for the different gait indices that were comparable to those of established subgroups. Established gait patterns cause different degrees of gait deviation and functional impairment. The unclassified patients do not differ from established gait patterns but from the unimpaired gait. Further evaluation using 3D-IGA is necessary to identify the underlying gait pathologies of the unclassified patients.

Highlights

Cerebral Palsy (CP) is a complex and heterogeneous disorder, leading to a variety of secondary musculoskeletal symptoms and deformities [1,2,3,4]
The Gillette Gait Index (GGI) and the Gait Deviation Index (GDI) were suggested as an adequate parameter for follow-up evaluation of gait and correction procedures [33,34,35]. The objective of this current study was the collection, assessment and correlation of the different gait indices in a cohort of patients with unilateral CP in order to compare the different subgroups according to the Gross Motor Function Classification System (GMFCS) and the WGH classification system against each other and to characterize the unclassified patients
Our results indicate that the unclassified patients do not represent a subgroup that shows no or negligible gait abnormalities, as they show comparable values for the different gait indices as other established gait patterns

Summary

Introduction

Cerebral Palsy (CP) is a complex and heterogeneous disorder, leading to a variety of secondary musculoskeletal symptoms and deformities [1,2,3,4]. Different classification systems (morphological and functional) have been developed in the past, in order to simplify treatment recommendations and decision-making [7,8,9,10]. Many of these classification systems are depicting either the gait pathology or the functional impairment mainly on a qualitative level without taking the degree of the impairment and the actual quantitative deviation [compared to the unimpaired gait of typically developing individuals (TD)] into account [11]. Many classification systems are lacking reliability [8]. Considering that clinical/observational classification is difficult, there is a considerable number of patients that remain unclassified [12,13,14]

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