Deviation In Children Research Articles

Does septoplasty improve the quality of life in children?

ObjectivesThe aim of this study is to evaluate the outcomes of septoplasty and the effects of septoplasty on the quality of life and to determine postoperative patient satisfaction in children using nose obstruction symptom evaluation (NOSE) and visual analog scale (VAS). MethodsOnly pediatric patients who underwent septoplasty were included in the study. Patients who underwent adenoidectomy, endoscopic sinus surgery, or turbinate surgery in addition to septoplasty and total septal reconstruction with open technique septorhinoplasty were excluded from the study. Patients and their parents were inquired about their nasal obstruction symptoms using the NOSE scale before and 3 and 12 months following the surgery. VAS was used to analyze overall satisfaction of the patients and their parents on the outcomes of surgery, at the last follow-up examination 12 months after the surgery. ResultsThirty-five patients with a mean age of 13.4±2.8 (8–16) were included in the study. There was a very significant improvement in NOSE score at 3 months after septoplasty. The mean subjective satisfaction score measured with VAS at the 12th month postoperatively was 7.9±2.1. Improvement in NOSE score was correlated with patient satisfaction. ConclusionSeptoplasty is a very effective and satisfactory treatment for nasal obstruction caused by nasal septal deviation in children. The NOSE scale can be used for the evaluation of nasal obstruction symptoms.

Epidemiological investigation of physique situation for birth high-risk children aged 9-15 years in Chengdu, Southwest China

Background: As the intrauterine environment can effect children's growth and development, this study aimed to explore the relationship between birth high-risk and physique situation of 9 to 15-year-old children by cross-sectional investigation, and to provide clues for the monitoring, prevention, and treatment of growth deviation in children. Materials and Methods: This study recruited 7,194 students aged 9 to 15 years in primary and junior schools. Their parents were asked to complete the birth situation questionnaire. Measurements included height, weight, and body mass index (BMI). Birth high-risk infant was defined according to the gestational age and birth weight. Growth deviation was classified as underweight, short stature, overweight, and obesity. Results: The prevalence of all kinds of growth deviations in preterm, full-term, and post-term birth groups were similar, the same as the physique situation at school age among both sexes. The incidence of small for gestational age (SGA) was 6.23%, when at school age, part of SGA had catch-up growth. However, the prevalence of underweight and short stature for SGA was highest in three groups. The weight and height at school age in SGA group was less than that in appropriate for gestational age (AGA) and large for gestational age (LGA) groups. The prevalence of overweight and obesity for LGA and macrosomia were highest in three groups. At school age, the weight in macrosomia and LGA groups was higher than that in the other groups. Conclusions: Longitudinal height and weight development and growth of children with birth high-risk are different from normal children. In order to improve healthy situation, more attention should be paid to height and weight development of those children with birth high-risk at school age, even in pre-school age. Prevention may already begin during pregnancy.

Postural alignment in children with Duchenne muscular dystrophy and its relationship with balance.

BackgroundIn Duchenne muscular dystrophy, functional deficits seem to arise from body misalignment, deconditioning, and obesity secondary to weakness and immobility. The question remains about the effects of postural deviations on the functional balance of these children. ObjectivesTo identify and quantify postural deviations in children with DMD in comparison to non-affected children (eutrophic and overweight/obese), exploring relationships between posture and function.MethodThis case-control study evaluated 29 participants aged 6 to 11 years: 10 DMD (DG), 10 eutrophic (EG), and 9 overweight/obese (OG). Digital photogrammetry and SAPo program were used to measure postural alignment and the Pediatric Balance Scale (PBS) was used to measure balance. The Kruskall-Wallis and Dunn post-hoc tests were used for inter-group comparison of posture and balance. Spearman's coefficient tested the correlation between postural and balance variables. ResultsThe horizontal pelvic alignment data indicated that the anteversion of the DG was similar to that of the OG and twice that of the EG (p<0.05). Compared to the EG, the DG and OG showed an increased forward position of the center of mass (p<0.05). There was a moderate and weak correlation between the PBS score and horizontal pelvic alignment (0.58 and 0.47-left/right). The PBS showed a weak correlation with asymmetries in the sagittal plane (-0.39). The PBS scores for the OG and EG suggest that obesity did not have a deleterious effect on balance. ConclusionsThe balance deficit in children with DMD was accompanied by an increased forward position of the center of mass and significant pelvic anteversion that constitutes a compensatory strategy to guarantee similar performance to the children not affected by the disease.

Demystifying septoplasty in children.

Introduction Septum deviation in children may alter the early physiologic process of breathing, causing obligatory oral breathing and consequently changing craniofacial development and even intellect. Because of these consequences, septoplasty should be performed as early as possible. Materials and Methods The retrospective study reviewed the results of septoplasty in 40 children under 12 years old who had follow-up after surgery for a maximum period of 7 years. The research was submitted to the ethics committee and approved with protocol number 10331912.0.0000.0058. Results Forty patients underwent septoplasty, 39 (97.5%) had cauterization of inferior turbinate and associated procedure, 20 (50%) had adenotonsillectomy, and 17 (42.5%) had adenoidectomy. Conclusion Nasal septum deviation should be corrected early to provide the harmonious growth of the face and to enable normal development of the child, without the occurrence of nasal deformity.

Plantar pressures in children with congenital talipes equino varus—A comparison between surgical management and the Ponseti technique

The Ponseti technique for treatment for Congenital Talipes Equinovarus (CTEV) was introduced in the authors’ institution in 2001, substituting a more traditional orthopaedic approach which involved surgery. There is currently limited published information regarding the differences in clinical outcomes between these two techniques, particularly in relation to plantar pressure analysis. This study aims to determine differences in pedobarographic outcome in children with CTEV, treated with either a surgical or Ponseti approach.A high resolution pedobarograph was used to record plantar pressure distribution in 52 children with CTEV and 26 children with typical development. Data were imported into Matlab where a custom programme was developed for processing and analysing pedobarographic recordings.There were significant differences in both treatment groups compared to the typically developed group (p<0.05) for most measurements. The most salient differences between treatment groups were (i) at the hind-foot where the Ponseti group had significantly lower maximum peak pressures (p<0.05); (ii) at the lateral mid-foot where children treated by the Ponseti approach showed significantly larger peak force (p<0.001), average peak pressure (p<0.001) and maximum peak pressure (p<0.01); (iii) at the lateral fore-foot where the surgical group showed lower average peak pressure (p<0.05); and (iv) in the medial/lateral fore-foot ratio where the Ponseti group showed significantly lower values (p<0.05).Plantar pressure analysis is a complementary measurement for the assessment of gait in children with CTEV. Data presented in this study showed that while there were deviations in children with CTEV, the differences observed between treatment groups suggest children in the Ponseti group have some level of under correction or recurrence.

Transverse Plane Gait Problems in Children With Cerebral Palsy

Transverse plane deviations are significant contributors to pathologic gait in children with cerebral palsy (CP). Due to limitations in neuromuscular control, balance, strength and coordination, transverse plane gait deviations are poorly tolerated in these children. Transverse plane malalignment results in lever arm dysfunction and can be seen with either intoeing or out-toeing. Frequent causes of transverse plane problems and lever arm dysfunction include long bone (femoral and/or tibial) torsion, pelvic rotation, and pes varus or valgus. Computerized motion analysis facilitates accurate identification of transverse plane abnormalities. This article addresses appropriate identification and treatment of transverse plane gait deviations in children with CP.

The use of postoperative botulinum toxin injection in large angle childhood esotropia

IntroductionThis study aimed to assess the influence of preoperative botulinum toxin (BT) injection upon the surgical correction of large angle esotropia (ET) in children and the stability of alignment following subsequent strabismus surgery.MethodsA retrospective review of children younger than 14 who had received BT prior to surgery for large angle ET (>50Δ) from January 2002 to April 2012 was undertaken. 27 patients who met inclusion criteria and had been treated with BT to both medial recti were identified. The angles for near and distance fixation, preBT, 3 months post BT, at last follow-up prior to surgery and at last postoperative follow-up were analyzed.Results3 months post BT the mean angle of deviation had reduced from 60Δ to 38Δ. This stayed stable (42Δ) after a mean follow-up of 11.8 months. 20 of the 27 patients (74%) had undergone or were awaiting 2-muscle surgery. Of those operated (n = 15), 11 were satisfactorily aligned but 4 exhibited a residual postoperative esotropia of 20Δ or more at final follow-up (range, 3 months to 3 years).DiscussionThe use of preoperative BT reduced the angle of deviation in children with large angle ET and enabled the use of less aggressive 2-muscle (instead of 3 or 4 muscle) strabismus surgery.ConclusionsBT injection prior to planned surgery in large-angle ET is an effective strategy for reducing the angle of esotropia to be surgically managed. We believe this is beneficial for the long term management of these patients who may require further strabismus procedures in their lifetime IntroductionThis study aimed to assess the influence of preoperative botulinum toxin (BT) injection upon the surgical correction of large angle esotropia (ET) in children and the stability of alignment following subsequent strabismus surgery. This study aimed to assess the influence of preoperative botulinum toxin (BT) injection upon the surgical correction of large angle esotropia (ET) in children and the stability of alignment following subsequent strabismus surgery. MethodsA retrospective review of children younger than 14 who had received BT prior to surgery for large angle ET (>50Δ) from January 2002 to April 2012 was undertaken. 27 patients who met inclusion criteria and had been treated with BT to both medial recti were identified. The angles for near and distance fixation, preBT, 3 months post BT, at last follow-up prior to surgery and at last postoperative follow-up were analyzed. A retrospective review of children younger than 14 who had received BT prior to surgery for large angle ET (>50Δ) from January 2002 to April 2012 was undertaken. 27 patients who met inclusion criteria and had been treated with BT to both medial recti were identified. The angles for near and distance fixation, preBT, 3 months post BT, at last follow-up prior to surgery and at last postoperative follow-up were analyzed. Results3 months post BT the mean angle of deviation had reduced from 60Δ to 38Δ. This stayed stable (42Δ) after a mean follow-up of 11.8 months. 20 of the 27 patients (74%) had undergone or were awaiting 2-muscle surgery. Of those operated (n = 15), 11 were satisfactorily aligned but 4 exhibited a residual postoperative esotropia of 20Δ or more at final follow-up (range, 3 months to 3 years). 3 months post BT the mean angle of deviation had reduced from 60Δ to 38Δ. This stayed stable (42Δ) after a mean follow-up of 11.8 months. 20 of the 27 patients (74%) had undergone or were awaiting 2-muscle surgery. Of those operated (n = 15), 11 were satisfactorily aligned but 4 exhibited a residual postoperative esotropia of 20Δ or more at final follow-up (range, 3 months to 3 years). DiscussionThe use of preoperative BT reduced the angle of deviation in children with large angle ET and enabled the use of less aggressive 2-muscle (instead of 3 or 4 muscle) strabismus surgery. The use of preoperative BT reduced the angle of deviation in children with large angle ET and enabled the use of less aggressive 2-muscle (instead of 3 or 4 muscle) strabismus surgery. ConclusionsBT injection prior to planned surgery in large-angle ET is an effective strategy for reducing the angle of esotropia to be surgically managed. We believe this is beneficial for the long term management of these patients who may require further strabismus procedures in their lifetime BT injection prior to planned surgery in large-angle ET is an effective strategy for reducing the angle of esotropia to be surgically managed. We believe this is beneficial for the long term management of these patients who may require further strabismus procedures in their lifetime

Responsiveness of Edinburgh Visual Gait Score to Orthopedic Surgical Intervention of the Lower Limbs in Children with Cerebral Palsy

The aim of this study was to report the responsiveness and minimal clinically important difference of the Edinburgh Visual Gait Score (EVGS), used to measure gait deviations in children with cerebral palsy. Fifty ambulant children with spastic diplegia (Gross Motor Function Classification System levels II and III) aged between 6 and 19 yrs were recruited for this longitudinal study. The participants were evaluated before surgery and at 6 and 12 mos after surgery. The change in EVGS at these time points was used to calculate effect sizes and minimal clinically important differences. Friedman analysis of variance showed a significant difference (χ2 = 60.69, P = 0.000) in the EVGS scores at 6 and 12 mos when compared with baseline. Effect sizes at 6 and 12 mos were large (1.19 and 1.22, respectively), indicating a visible difference in gait .The minimal clinically important differences of EVGS at 6 and 12 mos were 11 and 15, respectively. The EVGS is an outcome measure that can be used to evaluate the effect of orthopedic surgical intervention in children with cerebral palsy. Differences of 11 and 15 points on the EVGS are required to suggest that changes in gait are attributable to intervention when group means are considered.

Is pneumatization of middle turbinates compensatory or congenital?

To determine the frequency of concha bullosa (CB) and the association between the degree of pneumatization and the severity of septum deviation in both paediatric and adult groups by CT evaluation and to investigate whether the pneumatization of middle turbinates is compensatory or congenital. We retrospectively reviewed digitally stored paranasal sinus CT images of 86 paediatric and 204 adult patients. The severity of the deviation and cross-sectional area of the pneumatized area of the CB were determined using tomography images. The septums were divided into three groups according to the severity of deviation. The cross-sectional area of the contralateral side divided by the cross-sectional area of the deviation was calculated and described as the interturbinate ratio. When bilateral CB was found, the pneumatization of the CB was more prominent on the contralateral side than on the deviation side in both the paediatric and the adult groups. However, we found that the interturbinate ratios were not statistically different between the paediatric and adult groups. Also, the interturbinate ratios were independent degrees of deviation in children and adults. The frequency of CB was low in the adult group compared with the paediatric group. Interturbinate ratios were not statistically different between paediatric and adult groups and were independent of the severity of deviation. These findings suggest that the pneumatization process is not compensatory.

Dosimétrie des mesures de torsion et d’antéversion des membres inférieurs utilisant l’EOS et le scanner

Torsional deformities of the femur and tibia are associated with gait impairments and joint pain. Several studies have investigated these gait deviations in children with cerebral palsy. However, relatively little is known about gait deviations in children with idiopathic torsion and debate ensues about the management of these patients.What are the effects of idiopathic increased femoral neck anteversion and external tibial torsion on lower-limb kinematics, kinetics and joint loading during gait in children and adolescents.Patient-specific musculoskeletal models were created for 12 children/adolescents (mean age of 14 years) with torsional deformities using low-dose biplane radiographic imaging and 3D gait analysis. Comparisons of joint motion and net joint torques during gait were made to an age-matched control group with no torsional deformities. The effects of torsional deformities on muscle and joint contact forces were investigated using two personalised musculoskeletal models: one with normal torsion and another with patient-specific torsion.Femoral neck anteversion and external tibial torsion for the patients were (mean ± SD) 38° ± 9° and 40° ± 10°, respectively. Patients had increased internal hip rotation and external knee rotation as well as increased pelvic tilt during gait. Additionally, the efficacy of the plantarflexor-knee extension mechanism was diminished. Hip joint contact force was higher in the model with patient-specific torsion. The mediolateral component of the patellofemoral joint contact force was also increased despite the magnitude of the resultant patellofemoral contact force being unchanged.It has been previously established that idiopathic lower-limb torsional deformities alter gait kinematics. However, this study also showed that loading of the hip and patellofemoral joints are increased. This is an important insight for the clinical management of these patients and highlights that idiopathic lower-limb torsional deformities are not a purely cosmetic issue.

Scoliosis and dental occlusion: a review of the literature.

BackgroundIdiopathic scoliosis is a deformity without clear etiology. It is unclear wether there is an association between malocclusion and scoliosis. Several types of occlusion were described in subjects with scoliosis, mostly case-reports.ObjectivesThe aim of this review was to evaluate the type of occluslins more prevalent in subjects with scoliosisSearch strategyAll randomised and controlled clinical trials identified from the Cochrane Oral Health Group Trials Register, a MEDLINE search using the Mesh term scoliosis, malocclusion, and relevant free text words, and the bibliographies of papers and review articles which reported the outcome of orthodontic treatment in subjects with scoliosis that were published as abstracts or papers between 1970 and 2010.Selection criteriaAll randomised and controlled clinical trials published as full papers or abstracts which reported quantitative data on the outcomes malocclusion in subjects with scoliosis.Data collection and analysisData were extracted without blinding to the authors, age of patients or type of occlusion.Main resultsUsing the search strategy eleven observational longitudinal studies were identified. No randomized clinical trials were recorded. Twenty-three cross-sectional studies were recorderd, and the others studies were reviews, editorials, case-reports, or opinions. The clinical trials were often not controlled and were about the cephalometric evaluation after treatment with the modified Milwuakee brace, followed by the orthodontic treatment of the class II relationship with a functional appliance. Clinical trials also included the study of the associations between scoliosis and unilateral crossbite, in children with asymmetry of the upper cervical spine. This association was also investigated in rats, pigs and rabbits in clinical trials. The other associations between scoliosis and occlusion seems to be based only on cross-sectional studies, case-reports, opinions.Authors' conclusionsBased on selected studies, this review concludes that there is plausible evidence for an increased prevalence of unilateral Angle Class II malocclusions associated with scoliosis, and an increased risk of lateral crossbite, midline deviation in children affected by scoliosis. Also, documentation of associations between reduced range of lateral movements and scoliosis seem convincing. Data are also mentioned about the association between plagiocephaly and scoliosis.

Surgical treatment of nasal septal deviation (septoplasty) in children

The aim of this study was to indicate the importance of surgical treatment of nasal septal deviation in children as early correction of functional and cosmetic nose deformities. In this study, we presented 76 children, from age of 7 to 15, who were surgical treated for the reason of nasal septal deviation starting from January 2001. to December 2009. There were 48 (63%) male and 28 (37%) female patients. The lowest number of patients were between 7 and 9 years old--5 (6.5%), between 10 and 12 years--28 (37%) and 43--(56.5%) between 13 and 15 years. Only 7 (9%) patients indicated genetics inheritance, and 11 of them (14%) could not determine the exact cause of deviation origin. References taken from the parents showed that nasal septal deviation developed like consequence of injury in 58 (76%) cases. We used closed technique of septoplasty with hemitransfictional incision and sub mucosal resection. Deviated portion of septum was completely removed. Patients felt improvement in nose breathing in 65 (85%) cases. The most often complication was nasal obstruction in 6 (8%) cases which occurred due to the insufficient removal of deviated portion. We also had a septal perforation in one and abscess of nasal septum in another case. There were no esthetic deformities.Surgical treatment of nasal septal deviation in children must to be conservative and limited on injured part of septum. After the operation nose breathing significantly improved, without consequences on esthetic appearance or the growth of central part of a face.

Relação entre consciência fonológica e desvio fonológico em crianças da 1ª série do ensino fundamental

OBJETIVO: verificar a relação entre a consciência fonológica e os desvios fonológicos. MÉTODOS: o estudo foi realizado com 34 crianças de ambos os sexos, sendo que 17 apresentavam alteração no aspecto fonológico e 17 não, com idades entre 6 e 8 anos, estudantes da 1ª série de uma escola estadual e outra municipal, no Rio Grande do Sul. As crianças foram avaliadas para verificação do desvio fonológico pela Fonologia do Teste ABFW e para avaliar a consciência fonológica pelo Teste CONFIAS. RESULTADOS: a média de idade foi de 7,18 ± 0,52, sendo predominante o sexo feminino 18 (52,9%). Não houve diferença estatística quando comparada a variável desvio fonológico com o desempenho das crianças no Teste CONFIAS, tanto na soma dos níveis de sílaba quanto de fonema (P=0,81 e P=0,53, respectivamente). Num único subteste, o de segmentação silábica (P=0,03), a diferença se mostrou presente. Quando estratificados em relação ao gênero, os grupos não diferiram, porém na comparação por tipo de escola (estadual x municipal) foram encontradas diferenças significantes no Teste CONFIAS na produção de palavra com a sílaba dada (P=0,002) e na produção de rima (P=0,031). CONCLUSÃO: a ocorrência de desvio fonológico em crianças da 1ª série não interferiu no desempenho dos itens relacionados com a consciência fonológica.

Mismatch negativity (MMN) elicited by duration deviations in children with reading disorder, attention deficit or both

According to several studies auditory discrimination as measured by mismatch negativity (MMN) is compromised in participants with reading disorder. However, studies on duration discrimination have produced conflicting findings [Baldeweg, T., Richardson, A., Watkins, S., Foale, C., & Gruzelier, J., 1999. Impaired auditory frequency discrimination in dyslexia detected with mismatch evoked potentials. Annals of Neurology, 4, 1–9; Corbera, S., Escera, C., & Artigas, J., 2006. Impaired duration mismatch negativity in developmental dyslexia. Neuroreport, 17, 1051–1055]. Auditory sensitivity has not been as actively investigated among children with attention deficit, although attention problems often co-occur with dyslexia. The present study is a reanalysis of MMN data gathered from control children and children with reading disorder (RD) and/or attention deficit (AD). In our previous analysis [Huttunen, T., Halonen, A., Kaartinen, J. & Lyytinen, H., 2007. Does mismatch negativity show differences in reading disabled children as compared to normal children and children with attention deficit? Developmental Neuropsychology, 31, 453–470.], the only significant difference between the groups was in the lateralization of the MMNs in the RD and the control group: the MMNs of the RD group were more pronounced over the left hemisphere, while those of the control group appeared larger over the right hemisphere. A reanalysis was conducted to study whether the group definition criteria and/or overlap of the attention and reading deficits in the AD group might have affected the results. For this purpose participants were divided to four groups: control children, children with RD, children with AD, and children with both RD and AD. MMN was elicited by duration deviations in a continuous sound. Significant differences were observed in the MMN peaks between the control group and all clinical groups: the MMNs were diminished in the right hemisphere in the RD group, in all frontal and central channels in the RD + AD group, and the MMN peaks appeared earlier in frontal channels in the AD group.

Developmental Assessment

Developmental Assessment

Developmental Assessment

Developmental Assessment

Sistema de vigilância alimentar e nutricional no Estado de São Paulo, Brasil: experiência da implementação e avaliação do estado nutricional de crianças

OBJETIVOS: descrever a estratégia de implantação do aplicativo "SISVAN-SP" no Estado de São Paulo e analisar as informações geradas pelo Sistema quanto à distribuição e magnitude dos desvios nutricionais em crianças menores de cinco anos de idade. MÉTODOS: as Unidades Básicas de Saúde dos municípios foram responsáveis pela coleta, digitação e processamento de dados, utilizando um sistema de informações denominado "SISVAN-SP", aplicativo desenvolvido no Instituto de Saúde da Secretaria de Estado da Saúde de São Paulo (SES/SP). Os dados disponíveis mensalmente no sistema são: Direção Regional de Saúde, município, unidade básica de saúde, número do prontuário, data de nascimento, data do atendimento, sexo e classificação do estado nutricional das crianças. Foram consideradas desnutridas as crianças com peso/idade &lt; percentil 3 e em risco de sobrepeso com peso/idade &gt; percentil 97 da curva de referência do National Center of Health Statisics. RESULTADOS: a prevalência de desnutrição variou de 3,1% a 4,2% e a de risco de sobrepeso 4,0 a 4,8% nos diferentes municípios; a qualidade das informações e a cobertura do Sistema, ainda que variáveis, mostraram-se consistentes com informações epidemiológicas. CONCLUSÕES: o aplicativo "SISVAN-SP", desenvolvido pela SES/SP e utilizado para o monitoramento nutricional de crianças até cinco anos de idade, atendidas nas Unidades Básicas de Saúde, mostrou-se útil para avaliar e discutir aspectos do Sistema de Vigilância Alimentar e Nutricional (SISVAN), tais como cobertura e qualidade dos dados. Os resultados apontam para a definição de ações que visem a prevenção e controle de peso dessas crianças.

Cartilaginous septum deviation in children with cleft lip, alveolus and palate – an MRI analysis

This study aimed to investigate by MRI examination the degree of deviation of the cartilaginous septum in relation to cleft size in patients with cleft lip, alveolus and palate. Six children with cleft lip, alveolus and palate at age 5-20 days were examined with a 1.0 Tesla scanner using a head coil. The following parameters were evaluated: maximal cleft size (millimeter) and degree of the nasal septum deviation from the median-sagittal plane (degrees). Two children with bilateral clefts had no deviation; 3 children with unilateral (left-sided) cleft had a deviation to the right and 1 patient with a unilateral right-sided cleft a deviation to the left side. In all 4 patients, the degree of the nasal septum deviation increased with cleft size. Cartilaginous nasal septum deviation was noticed only in patients with unilateral cleft lip and palate toward the non-cleft side and was greater with increasing cleft sizes.

Gait classification in children with cerebral palsy: A systematic review

This systematic review of the literature evaluates the validity of existing classifications of gait deviations in children with cerebral palsy (CP). Numerous efforts have been made to develop classification systems for gait in CP to assist in diagnosis, clinical decision-making and communication. The internal and external validity of gait classifications in 18 studies were examined, including their sampling methods, content validity, construct validity, reliability and clinical utility. Half of the studies used qualitative pattern recognition to construct the gait classification and the remainder used statistical techniques such as cluster analysis. Few adequately defined their samples or sampling methods. Most classifications were constructed using only sagittal plane gait data. Many did not provide adequate guidelines or evidence of reliability and validity of the classification system. No single classification addressed the full magnitude or range of gait deviations in children with CP. Although gait classification in CP can be useful in clinical and research settings, the methodological limitations of many classifications restrict their clinical and research applicability.

The Reliability and Validity of Assessment of Sagittal Plane Deviations in Children Who Have Spastic Diplegia

Stott NS, Atherton WG, Mackey AH, Galley IJ, Nicol RO, Walsh SJ. The reliability and validity of assessment of sagittal plane deviations in children who have spastic diplegia. Objective To assess the reliability and validity of a newly described classification of sagittal plane alignment in spastic diplegic gait. Design Twenty split-screen videos of children with spastic diplegia, Gross Motor Function Classification System levels I to III, were viewed on 2 occasions, 6 weeks apart, by 5 raters. The sagittal plane alignments of the right and left lower limbs in gait were classified separately as true equinus, jump knee, apparent equinus, or crouch, based on the published classification. A fifth category, nonclassifiable, was used if classification was not possible. We then used sagittal plane kinematic data to confirm the classification for each subject and these were compared with rater classification scores, which used the video information only. Setting Tertiary-level children’s hospital. Participants Three pediatric orthopedic surgeons and 2 pediatric orthopedic residents. Interventions Not applicable. Main Outcome Measures Gait classification scores derived from visual observation were compared among and within raters. The gait classification scores derived from visual observation were compared with the scores derived from sagittal plane kinematic data to assess validity. Results A moderate correlation was found among the 5 raters within each session, with an interrater weighted κ score of .45 in session 1 and .49 in session 2. The intrarater, weighted κ scores showed a moderate to substantial level of agreement between sessions, ranging from .50 to .68. The classification scores of individual raters had moderate validity when compared with classifications derived from the sagittal plane kinematic data. However, there was a substantial level of agreement between the consensus opinion and the classification obtained using the kinematic data as well as the video recordings (weighted κ=0.8). Conclusions This classification has only moderate reliability and validity when a single experienced rater views the 2-dimensional gait videos. However, the consensus opinion derived from the scores of 5 raters considerably improves the validity of the assessment.