Most frequent gait patterns in diplegic spastic cerebral palsy.

Mauro César De Morais Filho,José Augusto Fernandes Lopes,Cátia Miyuki Kawamura,Michelle De Oliveira Cardoso,Jordana Brandão Caiafa,Daniella Lins Neves

doi:10.1590/1413-78522014220400942

Mauro César De Morais Filho, José Augusto Fernandes Lopes + Show 4 more

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https://doi.org/10.1590/1413-78522014220400942

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Abstract

OBJECTIVE: To identify gait patterns in a large group of children with diplegic cerebral palsy and to characterize each group according to age, Gross Motor Function Classification System (GMFCS) level, Gait Deviation Index (GDI) and previous surgical procedures. METHODS: One thousand eight hundred and five patients were divided in seven groups regarding observed gait patterns: jump knee, crouch knee, recurvatum knee, stiff knee, asymmetric, mixed and non-classified. RESULTS: The asymmetric group was the most prevalent (48.8%). The jump knee (9.6 years old) and recurvatum (9.4 years old) groups had mean age lower than the other groups. The lowest GDI (43.58) was found in the crouch group. There were more children classified within GMFCS level III in the crouch and mixed groups. Previous surgical procedures on the triceps surae were more frequent in stiff knee and mixed groups. The jump knee group received less and the stiff-knee group more surgical procedures at hamstrings than others. CONCLUSIONS: The asymmetrical cases were the most frequent within a group of diplegic patients. Individuals with crouch gait pattern were characterized by the lowest GDI and the highest prevalence of GMFCS III, while patients with stiff knee exhibited a higher percentage of previous hamstring lengthening in comparison to the other groups. Level of Evidence III, Retrospective Comparative Study.

Highlights

The term cerebral palsy (CP) is frequently used to designate a large number of clinical conditions which have in common a specific and non-progressive lesion in the immature brain.[1]
The analysis of 1,805 patients resulted in the following distribution among groups: crouch knee gait with 395 patients (21.88%); jump knee gait with 168 patients (9.30%); stiff knee gait with 32 patients (1.77%); recurvatum knee gait with 70 patients (3.87%); asymmetrical pattern with 881 patients (48.80%); mixed pattern with 31 patients (1.70%) and non-classified group with 228 patients (12.68%)
There was no significant difference between these two groups as well as among the other groups. (Table 1) Patients of the crouch knee group had the lowest Gait Deviation Index (GDI) values (43.58), while the non-classified group exhibited the highest values (64.12). (Table 2) The patients of jump knee (58.91), asymmetrical pattern (56.65), recurvatum knee (56.86) and stiff knee (56.64) groups were not significantly different

Summary

INTRODUCTION

The term cerebral palsy (CP) is frequently used to designate a large number of clinical conditions which have in common a specific and non-progressive lesion in the immature brain.[1]. Rodda et al.[6] classified the gait patterns in spastic diplegic CP into five groups, based on the kinematic analysis in the sagittal plane of the ankle, knee, hip and pelvis. These two classifications systems have similar characteristics, but the classification of Sutherland and Davids[5] is simpler and easier to apply in a large group of patients. The purpose of this study was to test the use of Sutherland and Davids classification[5] in a large group of children with spastic diplegic CP, identifying the prevalence of the four patterns described (jump, recurvatum, crouch and stiff knee). Tukey’s multiple comparison test was applied as well, and the level of significance for all tests was settled on 0.05 (5%)

RESULTS

DISCUSSION

CONCLUSION