Edinburgh Visual Gait Score Research Articles

A cohort study of tibialis anterior tendon shortening in combination with calf muscle lengthening in spastic equinus in cerebral palsy

The aim of this study was to evaluate the outcome of combined tibialis anterior tendon shortening (TATS) and calf muscle-tendon lengthening (CMTL) in spastic equinus.Prospectively collected data was analysed in 26 patients with hemiplegic (n=13) and diplegic (n=13) cerebral palsy (CP) (GMFCS level I or II, 14 males, 12 females, age range 10–35 years; mean 16.8 years). All patients had pre-operative 3D gait analysis and a further analysis at a mean of 17.1 months (±5.6months) after surgery. None was lost to follow-up. Twenty-eight combined TATS and CMTL were undertaken and 19 patients had additional synchronous multilevel surgery. At follow-up 79% of patients had improved foot positioning at initial contact, whilst 68% reported improved fitting or reduced requirement of orthotic support. Statistically significant improvements were seen in the Movement Analysis Profile for ankle dorsi-/plantarflexion (4.15°, p=0.032), maximum ankle dorsiflexion during swing phase (11.68°, p<0.001), and Edinburgh Visual Gait Score (EVGS) (4.85, p=0.014). Diplegic patients had a greater improvement in the EVGS than hemiplegics (6.27 -vs- 2.21, p=0.024).The originators of combined TATS and CMTL showed that it improved foot positioning during gait. The present study has independently confirmed favourable outcomes in a similar patient population and added additional outcome measures, the EVGS, foot positioning at initial contact, and maximum ankle dorsiflexion during swing phase. Study limitations include short term follow-up in a heterogeneous population and that 19 patients had additional surgery. TATS combined with CMTL is a recommended option for spastic equinus in ambulatory patients with CP.

Reliability and validity of Edinburgh visual gait score as an evaluation tool for children with cerebral palsy

Assessment of gait abnormalities in cerebral palsy (CP) is challenging, and access to instrumented gait analysis is not always feasible. Therefore, many observational gait analysis scales have been devised. This study aimed to evaluate the interobserver reliability, intraobserver reliability, and validity of Edinburgh visual gait score (EVGS). Video of 30 children with spastic CP were reviewed by 7 raters (10 children each in GMFCS levels I, II, and III, age 6–12 years). Three observers had high level of experience in gait analysis (10+ years), two had medium level (2–5 years) and two had no previous experience (orthopedic fellows). Interobserver reliability was evaluated using percentage of complete agreement and kappa values. Criterion validity was evaluated by comparing EVGS scores with 3DGA data taken from the same video visit. Interobserver agreement was 60–90% and Kappa values were 0.18–0.85 for the 17 items in EVGS. Reliability was higher for distal segments (foot/ankle/knee 63–90%; trunk/pelvis/hip 60–76%), with greater experience (high 66–91%, medium 62–90%, no-experience 41–87%), with more EVGS practice (1st 10 videos 52–88%, last 10 videos 64–97%) and when used with higher functioning children (GMFCS I 65–96%, II 58-90%, III 35–65%). Intraobserver agreement was 64–92%. Agreement between EVGS and 3DGA was 52–73%. We believe that having EVGS as part of the standardized gait evaluation is helpful in optimizing the visual scoring. EVGS can be a supportive tool that adds quantitative data instead of only qualitative assessment to a video only gait evaluation.

Evaluation of group versus individual physiotherapy following lower limb intra-muscular Botulinum Toxin-Type A injections for ambulant children with cerebral palsy: A single-blind randomized comparison trial

This study aimed to evaluate efficacy of group (GRP) versus individual (IND) physiotherapy rehabilitation following lower limb intramuscular injections of Botulinum Toxin-Type A (BoNT-A) for ambulant children with cerebral palsy (CP). Following lower limb BoNT-A injections, 34 children were randomly allocated to GRP (n=17; mean age 7y8m SD 2.0; 13 males; Gross Motor Function Classification System (GMFCS) I=5, II=8, III=4) or IND physiotherapy (n=17; mean age 8y7m SD 2.0; 11 males; GMFCS I=9, II=5, III=3). Primary outcomes were the Canadian Occupational Performance Measure (COPM) and Edinburgh Visual Gait Score (EVGS) assessed at baseline, 10 and 26 weeks post intervention. There were no baseline differences between groups. GRP intervention had greater, but not clinically meaningful, improvement in COPM satisfaction (estimated mean difference EMD 1.7, 95% CI 0.4–3.1; p<0.01) at 26 weeks. Both groups demonstrated clinically significant improvements in COPM performance and satisfaction, but minimal change in quality of gait (EVGS). Six hours of direct physiotherapy (either GRP or IND) with an additional indirect dose (median 16 episodes) of individualized home programme activities following lower limb BoNT-A injections, however, was inadequate to drive clinically meaningful changes in lower limb motor outcomes.

Resultados tras cirugía multinivel en pacientes afectados de parálisis cerebral

ObjectiveSingle-event multilevel surgery (SEMLS) of the lower limbs is a procedure for children with cerebral palsy (CP). Its aim is to improve gait pattern and/or facilitate transfers, according to the patient's walking ability. The aim of our study was to quantify the improvement in gait pattern in patients treated with this procedure. DesignProspective study of patients with cerebral palsy who underwent SEMLS between March 2011 and March 2013. Material and methodWe evaluated 11 patients who underwent SEMLS by quantifying gait changes after surgery, using the Edinburgh Visual Gait Score (EVGS). We determined changes in gait speed (steps per second) and in the Gross Motor Function Classification System (GMFCS). Patients were assessed at one and two years after surgery. ResultsWe observed an average improvement of 9 points when applying the EVGS. The GMFCS was unchanged in 8 patients, and gait speed improved in 5 patients. All patients who used to practice some kind of adapted sport are still doing so in the same conditions. ConclusionsDespite finding a global improvement in the EVGS and gait speed, no change was observed in the GMFCS. Nevertheless, family satisfaction was satisfactory. Future long-term studies with a larger number of patients are needed to check whether the improvement remains at the end of growth.

The relationship between the Edinburgh Visual Gait Score, the Gait Profile Score and GMFCS levels I–III

ObjectiveTo determine the relationship between the Edinburgh Visual Gait Score (EVGS) and the Gait Profile Score (GPS). MethodThree dimensional gait data and EVGS scores from 151 diplegic children (Gross Motor Function Classification System (GMFCS) levels I–III) were used for analysis. ResultsThe EVGS correlated strongly with GPS (r=0.816). There was a significant difference in both gait scores between each level of the GMFCS. ConclusionsThe strong correlation of GPS with EVGS implies that any advantages of using GPS can also be applied to centres without 3-dimensional gait analysis facilities if the EVGS is used.

Classification of trunk movements during gait in cerebral palsy

Des programmes de vaccination contre le papillomavirus humain (HPV) en milieu scolaire ont été implantés dans la plupart des pays occidentaux. Seules de rares études ont pour l’instant étudié les facteurs socioéconomiques en lien avec une vaccination en milieu scolaire.Une étude transversale a été effectuée en étudiant 1158 carnets de vaccination de jeunes filles de 13 à 14 ans scolarisées dans les écoles publiques du canton de Genève tirées au sort de façon aléatoire. Plusieurs autres variables de type socioéconomique (nationalité, catégorie socioprofessionnelle et statut marital des parents) ont été recueillies.Le taux de couverture vaccinale pour trois doses de vaccin HPV était de 56 %. Après avoir contrôlé pour les différentes co-variables, les adolescentes de nationalité portugaise (OR ajusté [IC 95 %] : 4,18 [1,76–9,92]), ou celles dont la catégorie socioprofessionnelle de la mère était ouvrière (OR ajusté [IC 95 %] : 1,91 [1,38–2,65]) ou dont le statut marital de la mère était mariée (OR ajusté [IC 95 %] : 1,44 [1,06–1,98]) étaient significativement plus vaccinées que les adolescentes de nationalité suisse, ou celles dont la catégorie socioprofessionnelle de la mère était cadre supérieur ou dirigeante.Cette étude montre que le taux de couverture vaccinale HPV n’est pas encore optimal à Genève et varie significativement selon le statut économique. Une meilleure promotion de cette vaccination parmi certains groupes cibles doit être menée.School vaccination programs against human papilloma virus (HPV) have been implemented in most Western countries. Only a few studies have investigated socio-economic factors related to school-based vaccination.A cross-sectional study was conducted using the vaccination cards of 1158 randomized girls aged 13 to 14 years enrolled in the public schools of the canton of Geneva. Several other socio-economic variables (nationality, socio-professional category and marital status of the parents) were collected.Immunization coverage for three doses of HPV vaccine was 56%. After having controlled the covariates, Portuguese adolescents (adjusted OR [95% CI]: 4.18 [1.76–9.92]), adolescents whose mothers were workers (adjusted OR [95% CI]: 1.91 [1.38–2.65]) or married (adjusted OR [95% CI]: 1.44 [1.06–1.98]) showed significantly higher immunization rates than Swiss adolescents or those whose mothers’ socio-professional category was senior manager or executive.This study shows that the HPV vaccine coverage is not yet optimal in Geneva and varies significantly according to the socio-economic status, thus better promotion of HPV vaccination for certain target groups must be implemented.

KER-EGI, a new index of gait quantification based on electromyography

Purpose: To define a new index of gait pathology in adults based on electromyographic data: the Ker-EGI for Kerpape-Rennes EMG-based Gait Index. The principle is similar to the one of Gait Deviation Index but using EMG profiles instead of joint angles. It first needs to build a database of healthy subjects gait to be able then to quantify the deviation of one peculiar patient’s gait from this typical behavior. Methods: Ninety adults (59 healthy and 31 pathological) participated to this study. All pathological subjects had a diagnosis of central nervous system disorder. On each subject we collected the joint angles and the activation profile of seven muscles of each lower limb. Moreover, we recorded two videos (face and profile) of each patient to compute his/her Edinburgh Visual Gait Score (EVGS). Then for each patient, we computed the GGI (Gillette Gait Index), the GDI (Gait Deviation Index) and the Ker-EGI. Results: Correlation Ker-EGI and each of the three kinematical indices (GGI, GDI, EVGS) is fair to good (respectively R 2 = 0.62, 0.42, and 0.69).

GRIN: “GRoup versus INdividual physiotherapy following lower limb intra-muscular Botulinum Toxin-A injections for ambulant children with cerebral palsy: an assessor-masked randomised comparison trial”: study protocol

BackgroundCerebral palsy is the most common cause of physical disability in childhood. Spasticity is a significant contributor to the secondary impairments impacting functional performance and participation. The most common lower limb spasticity management is focal intramuscular injections of Botulinum Toxin-Type A accompanied by individually-delivered (one on one) physiotherapy rehabilitation. With increasing emphasis on improving goal-directed functional activity and participation within a family-centred framework, it is timely to explore whether physiotherapy provided in a group could achieve comparable outcomes, encouraging providers to offer flexible models of physiotherapy delivery. This study aims to compare individual to group-based physiotherapy following intramuscular Botulinum Toxin-A injections to the lower limbs for ambulant children with cerebral palsy aged four to fourteen years.Methods/DesignAn assessor-masked, block randomised comparison trial will be conducted with random allocation to either group-based or individual physiotherapy. A sample size of 30 (15 in each study arm) will be recruited. Both groups will receive six hours of direct therapy following Botulinum Toxin-A injections in either an individual or group format with additional home programme activities (three exercises to be performed three times a week). Study groups will be compared at baseline (T1), then at 10 weeks (T2, efficacy) and 26 weeks (T3, retention) post Botulinum Toxin-A injections. Primary outcomes will be caregiver/s perception of and satisfaction with their child’s occupational performance goals (Canadian Occupational Performance Measure) and quality of gait (Edinburgh Visual Gait Score) with a range of secondary outcomes across domains of the International Classification of Disability, Functioning and Health.DiscussionThis paper outlines the study protocol including theoretical basis, study hypotheses and outcome measures for this assessor-masked, randomised comparison trial comparing group versus individual models of physiotherapy following intramuscular injections of Botulinum Toxin-A to the lower limbs for ambulant children with cerebral palsy.Trial registrationACTRN12611000454976

KeR-EGI, a new index of gait quantification based on electromyography

PurposeTo define a new index of gait pathology in adults based on electromyographic data: the Ker-EGI for Kerpape-Rennes EMG-based Gait Index. The principle is similar to the one of Gait Deviation Index but using EMG profiles instead of joint angles. It first needs to build a database of healthy subjects gait to be able then to quantify the deviation of one peculiar patient’s gait from this typical behavior. MethodsNinety adults (59 healthy and 31 pathological) participated to this study. All pathological subjects had a diagnosis of central nervous system disorder. On each subject we collected the joint angles and the activation profile of seven muscles of each lower limb. Moreover, we recorded two videos (face and profile) of each patient to compute his/her Edinburgh Visual Gait Score (EVGS). Then for each patient, we computed the GGI (Gillette Gait Index), the GDI (Gait Deviation Index) and the Ker-EGI. ResultsCorrelation Ker-EGI and each of the three kinematical indices (GGI, GDI, EVGS) is fair to good (respectively R2=0.62, 0.42, and 0.69). ConclusionKeR-EGI is a valid index to evaluate gait and is complementary to one of these three kinematical indices providing synthetic vision on patients’ motor control abilities.

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.

Reliabilität und Validität von Ganganalyse-Skalen

BACKGROUND: Visual gait analysis is a commonly used tool to evaluate kinematic parameters in physical therapy. OBJECTIVE: The aim of this study was to review the reliability of the EDINBURGH VISUAL GAIT SCORE and the PHYSICIAN RATING SCALE as well as their modifications. In addition, their validity is portrayed. METHOD: The Literature research was carried out in the databases Medline, Cinahl and PEDro. The reported studies were included according to defined criteria and allocated to thematic groups. The results were extracted subject to reliability and validity. RESULTS: In average the scales showed moderate results (k = 0,26 – 0,77; level of agreement = 60,23 – 66,09 %). The EDINBURGH VISUAL GAIT SCORE attained values from fair to good agreement and the modified PHYSICIAN RATING SCALE produced slight to substantial accordance. The OBSERVATIONAL GAIT SCALE showed substantial agreement and the VISUAL GAIT ASSESSMENT SCALE achieved moderate reliability. Compared to the goldstandard the scales’ results also revealed moderate correlation (k = 0,21 – 0,61; level of agreement = 47,3 – 64 %). CONCLUSIONS: Visual assessment of kinematic parameters on the basis of gait scales is subjective. Clinical practice findings must be compared and critically analysed.

Gillette Gait Index in adults

Gillette Gait Index (GGI) is a very useful tool to assess gait abnormalities. However, it seems that it has only been validated in children with cerebral palsy. Nevertheless, the parameters used to compute GGI are not specific to children population. Our aim is to demonstrate that GGI could also be used to evaluate adults gait abnormalities. 44 adults (25 healthy and 19 pathological) participated to this study. Pathological subjects had a diagnosis of central nervous system pathology (6 with spinal cord injury and 13 with brain injury). We first, compared the kinematic parameter values of our healthy adult group to healthy children group in previous studies. It appears that those parameters’ variability is a bit lower in adults, which makes the GGI more sensitive. Moreover, the GGI in adults is too much dependent on one parameter among the 16 proposed by Schutte et al. (2000), the “Time of Peak Flexion”. Finally, the Edinburgh Visual Gait Score (EVGS) is correlated to GGI in children. To emphasize the relevance of GGI in adults, we have evaluated the correlation between EVGS and GGI in our pathological group. Those two parameters are indeed highly correlated. All these results allow us to conclude that the GGI computed with the 15 remaining parameters is a useful tool to assess gait abnormalities in adults.

Reliability and validity of the Edinburgh Visual Gait Score for cerebral palsy when used by inexperienced observers

The Edinburgh Visual Gait Score (EVGS) for cerebral palsy has been validated for observer reliability and validity for observers experienced in gait analysis. This study investigated the reliability and validity of the EVGS for observers inexperienced in gait analysis. Six medical students used the score to analyse videotapes from the original study by Read et al. [Read HS, Hazlewood ME, Hillman SJ, Prescott RJ, Robb JE. Edinburgh visual gait score for use in cerebral palsy. J Pediatr Orthop 2003;23:296–301]. These were viewed on two separate occasions to provide inter- and intra-observer reliability, and the results of the numerical items were compared to those from three-dimensional (3D) gait analyses for validity. Observer agreement was tested using Coefficient of Repeatability (CoR), percentage of complete agreement and the kappa statistic. The CoR for inter-observer agreement for inexperienced observers was 5.99/5.07 (Session 1/Session 2) compared to 4.60/3.95 (Session 1/Session 2) for experienced observers. The CoR for intra-observer agreement for inexperienced observers was 5.15 compared to 4.21 for experienced observers. There was complete agreement for 52% of the 10 numerical items with 3D-gait analysis data for inexperienced observers compared to 64% for experienced observers. Ranking of reliability of individual items was similar between the two groups and was generally best for events occurring at the foot and ankle. Observations of gait events by the inexperienced observers using the EVGS were reasonably reliable but not very accurate when compared to experienced observers and 3D-gait analysis.

Selective dorsal rhizotomy in cerebral palsy to improve functional abilities: evaluation of criteria for selection

The aim of this study is to evaluate the effect of selective dorsal rhizotomy (SDR) on functional abilities in a well-defined group of ambulatory children with spastic diplegia. Nine children were selected for SDR (mean age 65 months, range 43-82 months). Gross motor function was measured with the Gross Motor Function Measure (GMFM-88). Self-care was assessed with the Pediatric Evaluation of Disability Inventory (PEDI) and gait pattern was measured with the Edinburgh Visual Gait Score (EGS). There were nine single-case research designs with a 12-month follow-up after surgery. After 12 months the mean improvement in the total GMFM-88 scores was 8.8%. On an individual level, all patients improved significantly in comparison with baseline. Functional skills and care-giver assistance measured with the PEDI showed significant improvement. Improvement in gait was also found; in particular, better initial contact and heel-lift resulted in an increased EGS. In this well-defined group of ambulatory children SDR had a small but significant positive effect on gross motor function, self-care and gait pattern.

Comparison of overground and treadmill vertical ground reaction forces

In the process of 3D-gait analysis interpretation, gait deviations in children with cerebral palsy are identified through comparison with reference data of typically developing children (TD). Generally, TD-data are presented based on averaged normalized curves of numerous strides for different ages and walking velocities. In patients however, often only a limited number of strides are available which are compared to group-averaged reference curves.To investigate the consequences of ignoring stride-to-stride variation when averaged normalized curves are used as a reference paediatric dataset. To illustrate implications for clinical practice, we investigated how many individual strides of TD-children would be classified as abnormal, when compared to averaged normalized curves from the reference group, and how this is affected by age and treadmill versus overground walking.Ninety TD-datasets were collected. Children (4-18y) walked on a 10 m-walkway (n = 49) or instrumented treadmill (n = 41). Joint kinematic and kinetic curves and clinically relevant outcome parameters were established. Individual strides were considered abnormal if they exceeded the group average more than 2SD. In addition, the Edinburgh Visual Gait Score, Gait Profile Score (GPS) and stride-to-stride variability were calculated. Generalized estimation equation analyses were used to investigate effects of age, overground/treadmill and their interaction.Of all 2532 analysed strides, on average 28% were classified as abnormal for joint kinematic curves, 50% for moments, and 51% for powers. Younger children showed a greater percentage of abnormal strides, greater GPS and more variability (p < 0.001). The effect of age was similar between treadmill and overground, but variability was lower on the treadmill.Our findings indicate that due to stride-to-stride variability, even in TD-children a substantial number of strides can be classified as abnormal, when compared to group averaged normalized curves. Consequently, in patients, comparing a single stride to such a reference curve may lead to potential overestimation of gait deviations.