Abstract
Experts recently identified 49 joint motion patterns in children with cerebral palsy during a Delphi consensus study. Pattern definitions were therefore the result of subjective expert opinion. The present study aims to provide objective, quantitative data supporting the identification of these consensus-based patterns. To do so, statistical parametric mapping was used to compare the mean kinematic waveforms of 154 trials of typically developing children (n = 56) to the mean kinematic waveforms of 1719 trials of children with cerebral palsy (n = 356), which were classified following the classification rules of the Delphi study. Three hypotheses stated that: (a) joint motion patterns with ‘no or minor gait deviations’ (n = 11 patterns) do not differ significantly from the gait pattern of typically developing children; (b) all other pathological joint motion patterns (n = 38 patterns) differ from typically developing gait and the locations of difference within the gait cycle, highlighted by statistical parametric mapping, concur with the consensus-based classification rules. (c) all joint motion patterns at the level of each joint (n = 49 patterns) differ from each other during at least one phase of the gait cycle. Results showed that: (a) ten patterns with ‘no or minor gait deviations’ differed somewhat unexpectedly from typically developing gait, but these differences were generally small (≤3°); (b) all other joint motion patterns (n = 38) differed from typically developing gait and the significant locations within the gait cycle that were indicated by the statistical analyses, coincided well with the classification rules; (c) joint motion patterns at the level of each joint significantly differed from each other, apart from two sagittal plane pelvic patterns. In addition to these results, for several joints, statistical analyses indicated other significant areas during the gait cycle that were not included in the pattern definitions of the consensus study. Based on these findings, suggestions to improve pattern definitions were made.
Highlights
Three-dimensional gait analysis (3DGA) serves as a golden standard to objectively evaluate pathological gait in children with cerebral palsy (CP) and it has been shown to alter clinical decision making and improve treatment outcome [1,2,3,4]
In an attempt to overcome some of these methodological challenges, gait patterns for the different lower limb joints have recently been proposed for children with CP following an international consensus study [11]
It was found that most patterns with ‘no or minor gait deviations’ differed somewhat unexpectedly from typically developing (TD) gait, but differences were generally small (
Summary
Three-dimensional gait analysis (3DGA) serves as a golden standard to objectively evaluate pathological gait in children with cerebral palsy (CP) and it has been shown to alter clinical decision making and improve treatment outcome [1,2,3,4]. To support the clinical understanding of gait data, many attempts have been made to recognize different gait patterns from kinematic and kinetic reports, using either qualitative or quantitative approaches [6,7,8,9,10,11,12,13]. In an attempt to overcome some of these methodological challenges, gait patterns for the different lower limb joints have recently been proposed for children with CP following an international consensus study [11]. Precise pattern definitions are available in the supplementary material (S1 Table)
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