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).

Majewska Joanna,Bazarnik-Mucha Katarzyna,Szymczyk Daniel,Lenart-Domka Ewa,Szczepanik Magdalena

doi:10.3390/children7100149

Majewska Joanna, Bazarnik-Mucha Katarzyna + Show 3 more

Open Access

https://doi.org/10.3390/children7100149

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Journal: Children (Basel, Switzerland)	Publication Date: Sep 25, 2020
Citations: 7	License type: CC BY 4.0

Affiliation: Rzeszów University

Abstract

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.

Highlights

Cerebral palsy (CP) with a prevalence of about 2.2/1000 live births is the most common cause of motor disability in childhood [1]
There are a wide variety of ankle–foot orthosis (AFO) used in clinical practice, which are differentiated depending on their design, the material used and the stiffness of that material
There were no significant differences between the percentage of the stance phase in the gait cycle, comparing walking with orthoses and without them

Summary

Introduction

Cerebral palsy (CP) with a prevalence of about 2.2/1000 live births is the most common cause of motor disability in childhood [1]. Changes in gait of children with spastic cerebral palsy are often affected by symptoms of spasticity and lower extremity muscle weakness, which limit the patient’s ability to walk [2]. There are a wide variety of AFOs used in clinical practice, which are differentiated depending on their design, the material used and the stiffness of that material. Changing any of these three elements will alter the AFO control and this may have influence on the patient’s gait [4]. Cerebral palsy (CP) children present complex and heterogeneous motor disorders that cause gait deviations. 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

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