Gait Deviation Index Research Articles

Assessment of dynamic balance during walking in patients with adult spinal deformity

To assess dynamic postural alignment in ASD during walking using a subject-specific 3D approach. 69 ASD (51 ± 20years, 77%F) and 62 controls (34 ± 13years, 62%F) underwent gait analysis along with full-body biplanar Xrays and filled HRQoL questionnaires. Spinopelvic and postural parameters were computed from 3D skeletal reconstructions, including radiographic odontoid to hip axis angle (ODHA) that evaluates the head's position over the pelvis (rODHA), in addition to rSVA and rPT. The 3D bones were then registered on each gait frame to compute the dynamic ODHA (dODHA), dSVA, and dPT. Patients with high dODHA (> mean + 1SD in controls) were classified as ASD-DU (dynamically unbalanced), otherwise as ASD-DB (dynamically balanced). Between-group comparisons and relationship between parameters were investigated. 26 patients were classified as ASD-DU having an average dODHA of 10.4° (ASD-DB: 1.2°, controls: 1.7°), dSVA of 112mm (ASD-DB: 57mm, controls: 43mm), and dPT of 21° (ASD-DB: 18°, controls: 14°; all p < 0.001). On static radiographs, ASD-DU group showed more severe sagittal malalignment than ASD-DB, with more altered HRQoL outcomes. The ASD-DU group had an overall abnormal walking compared to ASD-DB & controls (gait deviation index: 81 versus 93 & 97 resp., p < 0.001) showing a reduced flexion/extension range of motion at the hips and knees with a slower gait speed and shorter step length. Dynamic ODHA was correlated to HRQoL scores. Dynamically unbalanced ASD had postural malalignment that persist during walking, associated with kinematic alterations in the trunk, pelvis, and lower limbs, making them more prone to falls. Dynamic-ODHA correlates better with HRQoL outcomes than dSVA and dPT.

Are Clinical Impairments Related to Kinematic Gait Variability in Children and Young Adults With Cerebral Palsy?

Intrinsic gait variability (GV), i.e., fluctuations in the regularity of gait patterns between repetitive cycles, is inherent to the sensorimotor system and influenced by factors such as age and pathology. Increased GV is associated with gait impairments in individuals with cerebral palsy (CP) and has been mainly studied based on spatiotemporal parameters. The present study aimed to describe kinematic GV in young people with CP and its associations with clinical impairments [i.e., passive range of motion (pROM), muscle weakness, reduced selective motor control (selectivity), and spasticity]. This retrospective study included 177 participants with CP (age range 5–25 years; Gross Motor Function Classification System I-III) representing 289 clinical gait analyses [n = 172 for unilateral CP (uCP) vs. 117 for bilateral CP (bCP)]. As variability metrics, Root Mean Square Deviation (RMSD) for nine lower-limb kinematic parameters and Gait Standard Deviation (GaitSD) – as composite score of the kinematic parameters – were computed for the affected (unilateral = uCP) and most affected side (bilateral = bCP), respectively, as defined by clinical scores. GaitSD was then computed for the non/less-affected side for between leg comparisons. Uni- and multivariate linear regressions were subsequently performed on GaitSD of the affected/most affected side with all clinical impairments (composite scores) as independent variables. Highest RMSD were found in the transverse plane (hip, pelvis), for distal joints in the sagittal plane (knee, ankle) and for foot progression. GaitSD was not different between uCP and bCP (affected/most affected side) but higher in the non-affected vs. affected side in uCP. GaitSD was associated with age (p < 0.001), gait deviation index (GDI) (p < 0.05), muscle weakness (p < 0.001), selectivity (p < 0.05), and pROM (p < 0.001). After adjustment for age and GDI, GaitSD remained associated with muscle weakness (uCP: p = 0.003, bCP: p < 0.001) and selectivity (bCP: p = 0.024). Kinematic GV can be expressed as global indicator of variability (GaitSD) in young people with CP given the strong correlation of RMSD for lower-limb kinematic parameters. In terms of asymmetry, increased variability of the non-affected vs. affected side may indicate contralateral compensation mechanisms in uCP. Notably muscle weakness (uCP, bCP) and selectivity (bCP) – but not spasticity – were associated with GaitSD. Further studies need to explore the clinical relevance of kinematic GV in CP to support the interpretation of clinical gait analyses and therapeutic decision-making.

Gender Differences in Functional Outcomes from the Cerebral Palsy Adult Transition Study Cohort (CPAT)

<h3>Research Objectives</h3> To evaluate gender differences in cognitive function and physiological outcomes associated with physical function on the Cerebral Palsy Adult Transition Study (CPAT) cohort. <h3>Design</h3> Cross-sectional, cohort, study. <h3>Setting</h3> Accredited clinical motion analysis laboratory at a regional Children's Hospital. <h3>Participants</h3> 72 ambulatory adults with CP [mean ± SD of age=20± 5.3] representing a balanced gender sample (38 females and 34 males). <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Physiological outcomes included BMI, waist-to-hip ratio, grip strength and rate of force development (RFD). An instrumented gait analysis was utilized to assess walking ability, in which Gait Deviation Index and walking speed adjusted for height were collected. Cognitive function was evaluated using the WMS-IV and the WAIS- IV subtests. Blood biomarkers consisted of glucose, insulin, lipids (CHOL, HDL, Non-HDL, LDL) and BDNF. Simple T-tests were performed to determine differences between females and males. <h3>Results</h3> Grip strength (p-value = 0.006) showed differences between females and males, in which males showing higher scores. For cognitive function, differences were observed within the WMS-IV subtests; Visual Reproduction delayed recall (p-value = 0.0252) and delayed recognition (p-value = 0.0498), in which females had higher scores compared to males. For the blood biomarkers, only BDNF (p-value =0.02) and HDL (p-value =0.0003) showed differences, in which females showing the highest levels. There were no differences in walking performance between females and males. <h3>Conclusions</h3> The analysis showed that there is gender-specific health outcome differences in adults with CP. Physiological and biological markers are important to guide precision medicine models. Biomarkers can generate diagnosis and treatments accordingly to patient unique health needs. As such, it could assist clinicians to accurately differentiate those at risk for disease as well as to design disease-modifying interventions. <h3>Author(s) Disclosures</h3> There is no conflict of interest.

Anomalous Gait Feature Classification From 3-D Motion Capture Data.

The gait kinematics of an individual is affected by various factors, including age, anthropometry, gender, and disease. Detecting anomalous gait features aids in the diagnosis and treatment of gait-related diseases. The objective of this study was to develop a machine learning method for automatically classifying five anomalous gait features, i.e., toe-out, genu varum, pes planus, hindfoot valgus, and forward head posture features, from three-dimensional data on gait kinematics. Gait data and gait feature labels of 488 subjects were acquired. The orientations of the human body segments during a gait cycle were mapped to a low-dimensional latent gait vector using a variational autoencoder. A two-layer neural network was trained to classify five gait features using logistic regression and calculate an anomalous gait feature vector (AGFV). The proposed network showed balanced accuracies of 82.8% for a toe-out, 85.9% for hindfoot valgus, 80.2% for pes planus, 73.2% for genu varum, and 92.9% for forward head posture when the AGFV was rounded to the nearest zero or 1. Multiple anomalous gait features were detectable using the proposed method, which has a practical advantage over current gait indices, including the gait deviation index with a single value. The overall results confirmed the feasibility of using the proposed method for screening subjects with anomalous gait features using three-dimensional motion capture data.

Residual Deformity and Outcome of Ambulatory Adults With Cerebral Palsy: A Long-term Longitudinal Assessment.

Advances in pediatric orthopaedic care have improved mobility and function for children with cerebral palsy (CP) as mobility declines from adolescence into adulthood. The long-term effectiveness of modern orthopaedic care is not widely reported. This study aimed to report the pediatric orthopaedic surgical burden, residual deformities, and outcomes using objective evidence of mobility in ambulatory adults with CP. An institutional review board-approved prospective cohort study was performed in ambulatory adults with CP between 25 and 45 years, who had an adolescent gait analysis. Orthopaedic interventions were reviewed, and adolescent and adult gait analyses were compared using paired 2-tailed t tests. Adults were categorized by the presence of no, mild, or severe residual deformities in rotation, crouch, stiff knee, equinus, and foot deformity. Of 106 adults with CP, Gross Motor Function Classification System (GMFCS) distribution was grade I (22%), II (50%), III (23%), and IV (5%). Sixty-one males and 45 females were tested. The average age was 30±4 years with follow-up of 13±4 years since previous analysis; 279 surgical events (1165 procedures) were performed with a mean per patient of 2.6 events and 11 procedures. Comm on procedures were gastrocsoleus complex (88%) and hamstring lengthening (79%). The mean gait deviation index at adolescent and adult visit were 72.7±13 and 72.3±13 (P=0.78). Mean gait velocity at the adolescent visit was 85±27 and 79±31 cm/s at adult visit (P=0.02). Both gait deviation index and gait velocity change were clinically insignificant. Fifty-seven adults (81 limbs, 54%) had mild residual deformities. Residual hip internal rotation, pes planovalgus, and crouch gait were common. Severe deformities impacting function or causing pain were present in 11 participants (14 limbs, 10%). Seven of the 11 adults with severe deformities were worse compared with their adolescent evaluation; 4 were unchanged. Correcting deformities before adulthood has lasting stability with little functional loss in most ambulatory young adults with CP. Increasing deformity after adolescence can occur in young adults but is uncommon. Level III.

Validity of the Gait Deviation Index in children and adolescents with juvenile idiopathic arthritis

Purpose: Effectiveness of the Gait Deviation Index (GDI) in patients with juvenile idiopathic arthritis (JIA) is unknown. The aim of this study was to investigate the validity of the GDI as an outcome measure of gait disturbance children with JIA. Methods: Fifty children and adolescents with JIA were included into the study. The control group included 50 healthy children without gait disorders, matched for age and gender. The kinematic gait parameters were measured using a 3D movement analysis system. Walking speed, walking distance, cadence, step length and single support time were also evaluated. Results: The findings show a statistically significant difference between the values of GDI for the right leg in the study group and the controls (p = 0.036). The individuals included in the study group achieved significantly lower values in this parameter (mean 94.92 ± 8.38 vs. mean 100.00 ± 10.00). The GDI value for right and left leg and the mean GDI value showed low (0.3 ≤ |R| &lt; 0.5, p &lt; 0.005) to moderate (0.5 ≤ |R| &lt; 0.7, p &lt; 0.001) correlations with the other gait parameters and measures. Conclusions: The GDI scores were lower in individuals with JIA compared to controls. This difference in the GDI values was only significant for the right leg. The GDI values showed low to moderate correlations with other gait parameters.

Effects of Robot-Assisted Therapy on Gait Parameters in Pediatric Patients With Spastic Cerebral Palsy.

Background: Gait dysfunction is a crucial factor that restricts independence and quality of life in children with cerebral palsy (CP). Gait training based on robotic-assisted therapy (RAT) is widely used, but information about effectiveness and ideal patient profile is not sufficient. Aim of this study was to assess the effect of RAT on gait parameters in spastic children with CP, and to determine whether changes in gait parameters are different among patients on different ambulatory levels.Method: A total of 26 children with bilateral spastic CP were divided into two groups based on their functional ability: non-assisted ambulator (NAS) or assisted ambulator (AS); and underwent a RAT program (30 training sessions of RAT during 10 weeks). Gait analysis was performed: before the therapy (t1), right after (t2), and 6 weeks later (t3).Results: No significant changes in spatiotemporal parameters or gait deviation index at t2 or t3. Double support symmetry significantly improved (t1 vs. t3, p = 0.03) for the whole group (NAS + AS). Walking speed symmetry significantly improved (t2 vs. t3, p = 0.02) for group AS.Conclusion: RAT based on our protocol did not change spatiotemporal parameters and kinematics of walking except limited improvement in some aspects of gait symmetry. We did not find differences in changes in selected objective gait parameters among children with CP in different ambulatory levels.

Three-dimensional gait analysis in children with recurrent idiopathic clubfoot undergoing complete tibialis anterior tendon transfer.

This study was aimed to evaluate the kinetics and kinematics of the foot and ankle using three-dimensional gait analysis in children with recurrent clubfoot treated with tibialis anterior tendon transfer (TATT). Three-dimensional gait analysis of 17 children with dynamic supination (24 feet; 12 males; mean age: 6.34 years) was performed pre- and post-TATT. Spatial, temporal and kinematic parameters, as well as the gait deviation index (GDI), were recorded for all patients. Moreover, to evaluate the severity of dynamic supination during walking, we also measured the angle between the plane of the foot and the X-axis during the swing phase (V-angle-S). The postoperative step length (38.95 ± 8.36 cm) and stride length (76.73 ± 15.92 cm) were significantly smaller than their preoperative values (40.68 ± 9.35 cm and 80.57 ± 17.51 cm; P = 0.0316 and P = 0.0028, respectively). The postoperative peak internal ankle rotation angle in the frontal plane (20.45° ± 14.44) was significantly lower than the preoperative value (25.93° ± 9.84; P = 0.029). The postoperative peak internal foot progression angle in the transverse plane (0.96° ± 5.83) was significantly lower than the preoperative value (4.34° ± 8.88; P = 0.026). However, both the peak ankle varus moment and GDI were not significantly different between the pre- and postoperative data. Postoperative V-angle-S values (28.55° ± 7.56) were reduced compared to their preoperative values (32.52° ± 6.53; P = 0.0094). TATT to the lateral cuneiform can correct dynamic supination in patients with a recurrent clubfoot; however, it has limited or no effects on hindfoot varus deformity. Level of evidence: Level III.

Parental subjective assessment of gait limitations: Comparison with objective gait variables

BackgroundSubjective assessment is an important part of clinical examination providing quality insights into impairments of body structure and functions. Research into the associations between parental perceptions of gait in children with cerebral palsy (CP) and objective clinical gait measures is limited. Research questionWhat are the parental perceived gait limitations in children with CP and are these perceptions associated with objective clinical gait analysis? MethodsParent questionnaires were retrospectively analysed for children with CP who attended our gait analysis laboratory over a 24-month period. Perceived walking limitations caused by pain, weakness, lack of endurance, mental ability, safety concerns, and balance were recorded on a 5-point Likert scale. Normalised gait speed, normalised step length and the Gait Deviation Index (GDI) were calculated. Differences between responses were assessed using Chi-squared tests with Dunn’s post hoc test with Bonferroni adjustment. Spearman’s rank correlations were performed to determine the relationship between responses and gait parameters. ResultsData from 251 participants were included, mean age 9 ± 3.4 years, Gross Motor Function Classification System (GMFCS) level I = 158, II = 64 and III = 29. Balance was perceived to limit walking to the greatest extent, followed by weakness, lack of endurance, safety concerns, pain and mental ability. This rank was consistent across GMFCS levels I, II and III. Perceived balance limitations showed the strongest correlations with objective gait variables, GDI (r = −0.31 p = 0.000), normalised step length (r = −0.30 p = 0.0000) and normalised gait speed (r = −0.24 p = 0.0001). SignificanceSubjective gait perceptions provide a valuable indication of gait function but are weakly associated with objective clinical gait analysis. Outcome measures that are sensitive to changes in balance may be more responsive to parental concerns and help to satisfy their goals and expectations.

Identifying Running Deviations in Long Distance Runners Utilizing Gait Profile Analysis: A Case Control Study

Objective: The goal of this study was to utilize Gait Profile Score (GPS) and Gait Deviation Index (GDI), to assess its capability of differentiating between injured and non-injured runners. Design: In total, 45 long-distance runners (15 non-injured, 30 injured), diagnosed with one of the following running related injuries, patella femoral pain syndrome, iliotibial pain syndrome, and medial tibial stress syndrome, were recruited. Methods: Data were obtained from a running analysis gait laboratory equipped with eight infrared motion-capturing cameras and a conventional treadmill. Running kinematics were recorded according to the Plug-In Gait model, measuring running deviations of the pelvis and lower extremities at a sampling rate of 200 Hz. GPS and GDI were calculated integrating pelvis and lower limb kinematics. Movement Analysis Profile results were compared between injured and non-injured runners. The non-parametric two-sample Wilcoxson test determined whether significant kinematic differences were observed. Results: Total GPS score significantly differed between the injured and non-injured runners. Not all running kinematics expressed by GDI differed between groups. Conclusions: GPS score was capable of discriminating between the injured and non-injured runners’ groups. This new running assessment method makes it possible to identify running injuries using a single numerical value and evaluate movements in individual joints.

Relationship between 3D lower limb bone morphology and 3D gait variables in children with uni and bilateral Cerebral Palsy

BackgroundMedical and surgical interventions to prevent or reduce bone deformities and improve gait in children with cerebral palsy (CP) are based on empirical evidence that there is a relationship between bone deformities and gait deviations. Research questionWhat is the relationship between tibial-femoral bone morphology and kinematic gait variables in ambulant children with CP? MethodsA retrospective analysis was conducted on data from 121 children with uni- (n = 64, mean age 9.9 (SD 3.4) years) and bi- lateral (n = 57, mean age 10.4 (SD 3.6) years) CP who had undergone 3D gait analysis and biplanar X-rays (EOS® system). The limbs were split as DIP (the more impaired limb of children with bilateral CP), HEMI (the impaired limb of unilateral CP) and REF (the unimpaired limb of unilateral CP). Multi-variable Linear Regressions were performed between 23 kinematic variables, the Gait Deviation Index (GDI) and a model composed of nine 3D bone variables for each limb type. ResultsWhen the whole sample was pooled, 72% of R2 values were poor, 16% were fair, and 12% were moderate. Lower limb bone morphology models explained less than 1% of GDI variability. Correlations between tibial-femoral rotational parameters and hip rotation were mostly poor. Mean foot progression angle was the only kinematic parameter that was fairly to moderately correlated with bone variables in the 3 limb types. A tibial-femoral bone model explained 48% of the variability of mean foot progression angle in the REF limbs, 31% in the HEMI limbs and 25% in the DIP limbs. SignificanceTibial-femoral bone morphology was only weakly related to kinematic gait variables, in contrast with common clinical assumptions. These results suggest that factors other than bone morphology influence gait quality and thus a thorough clinical examination and gait analysis is required prior to making treatment decisions.

Long-term effects of spasticity treatment, including selective dorsal rhizotomy, for individuals with cerebral palsy.

To understand the long-term effects of comprehensive spasticity treatment, including selective dorsal rhizotomy (SDR), on individuals with spastic cerebral palsy. This was a pre-registered, multicenter, retrospectively matched cohort study. Children were matched on age range and spasticity at baseline. Children at one center underwent spasticity treatment including SDR (Yes-SDR, n=35) and antispastic injections. Children at two other centers had no SDR (No-SDR, n=40 total) and limited antispastic injections. All underwent subsequent orthopedic treatment. Participants returned for comprehensive long-term assessment (age ≥21y, follow-up ≥10y). Assessment included spasticity, contracture, bony alignment, strength, gait, walking energy, function, pain, stiffness, participation, and quality of life. Spasticity was effectively reduced at long-term assessment in the Yes-SDR group and was unchanged in the No-SDR group. There were no meaningful differences between the groups in any measure except the Gait Deviation Index (Yes-SDR + 11 vs No-SDR + 5) and walking speed (Yes-SDR unchanged, No-SDR declined 25%). The Yes-SDR group underwent more subsequent orthopedic surgery (11.9 vs 9.7 per individual) and antispastic injections to the lower limbs (14.4 vs <3, by design). Untreated spasticity does not cause meaningful impairments in young adulthood at the level of pathophysiology, function, or quality of life.

Gait status 26–35 years after selective dorsal rhizotomy: A 9 year follow up study

BackgroundAlthough the short-term outcomes of selective dorsal rhizotomy (SDR) in children with cerebral palsy (CP) have been well documented, less is known about the long-term benefits of SDR, especially while aging. Research questionDoes the gait of adults with CP, who underwent SDR in childhood, change during a nine-year aging follow-up period? Do associations exists between the gait deviation index (GDI) and contextual factors at follow-up? MethodsThree-dimensional motion data was captured (Vicon system) of 26 adults (10 female) with CP and spastic diplegia at baseline (17-to-26 years post-SDR) and at nine-year follow-up (26-to-35 years post-SDR), as well as 41 matched typically developed (TD) adults used for reference data. Kinematic, non-dimensional temporal distance and GDI parameters were determined, and associations with contextual factors were studied. ResultsAt follow-up the adults with CP had a (median [interquartile ranges]) age of 35.8 [34.2–41.2] years and classified as Gross Motor Function Classification System (GMFCS) level I (n = 13), level II (n = 10) and level III (n = 3). Overall no clinically relevant change in gait quality (GDI) was detected over the nine-year follow-up period. However, small changes were found in hip and knee range of motion, peak knee flexion and walking speed. In line with the baseline study, a number of gait parameters were different to TD adults. The only association found was between GDI and GMFCS at follow-up (r = 0.64, p < 0.01). SignificanceThe overall walking pattern of the adults with CP who underwent SDR in childhood was characterised by mild crouch gait with minimal signs of spasticity, confirming former physical examination findings. Some small changes in certain gait parameters were determined, though clinically the gait quality remained stable during the nine-year aging period. This finding supports the stability of the gait pattern during mid-life in adults with CP, who met the strict SDR selection criteria.

The Effects of Specific Omega-3 and Omega-6 Polyunsaturated Fatty Acids and Antioxidant Vitamins on Gait and Functional Capacity Parameters in Patients with Relapsing-Remitting Multiple Sclerosis.

Patients with multiple sclerosis (MS) are characterized by, among other symptoms, impaired functional capacity and walking difficulties. Polyunsaturated fatty acids (PUFAs) have been found to improve MS patients’ clinical outcomes; however, their effect on other parameters associated with daily living activities need further investigation. The current study aimed to examine the effect of a 24-month supplementation with a cocktail dietary supplement formula, the NeuroaspisTM PLP10, containing specific omega-3 and omega-6 PUFAs and specific antioxidant vitamins on gait and functional capacity parameters of patients with MS. Fifty-one relapsing-remitting MS (RRMS) patients with low disability scores (age: 38.4 ± 7.1 years; 30 female) were randomized 1:1 to receive either a 20 mL daily dose of the dietary formula containing a mixture of omega-3 and omega-6 PUFAs (12,150 mg), vitamin A (0.6 mg), vitamin E (22 mg), and γ-tocopherol (760 mg), the OMEGA group (n = 27; age: 39 ± 8.3 years), or 20 mL placebo containing virgin olive oil, the placebo group (n = 24; age: 37.8 ± 5.3 years). The mean ± SD (standard deviation) Expanded Disability Status Scale (EDSS) score for the placebo group was 2.36 and for the OMEGA group 2.22. All enrolled patients in the study were on Interferon-β treatment. Spatiotemporal gait parameters and gait deviation index (GDI) were assessed using a motion capture system. Functional capacity was examined using various functional tests such as the six-minute walk test (6MWT), two sit-to-stand tests (STS-5 and STS-60), and the Timed Up and Go test (TUG). Isometric handgrip strength was assessed by a dynamometer. Leg strength was assessed using an isokinetic dynamometer. All assessments were performed at baseline and at 12 and 24 months of supplementation. A total of 36 patients completed the study (18 from each group). Six patients from the placebo group and 9 patients from the OMEGA group dropped out from the study or were lost to follow-up. The dietary supplement significantly improved the single support time and the step and stride time (p < 0.05), both spatiotemporal gait parameters. In addition, while GDI of the placebo group decreased by about 10% at 24 months, it increased by about 4% in the OMEGA group (p < 0.05). Moreover, performance in the STS-60 test improved in the OMEGA group (p < 0.05) and there was a tendency for improvement in the 6MWT and TUG tests. Long-term supplementation with high dosages of omega-3 and omega-6 PUFAs (compared to previous published clinical studies using PUFAs) and specific antioxidant vitamins improved some functional capacity and gait parameters in RRMS patients.

Factors associated with walking activity in adults with cerebral palsy.

This prospective study used instrumented gait analysis, patient-reported outcomes, and portable accelerometers to examine walking activity in adults with cerebral palsy (CP). This study aimed to provide objective data and evaluate factors associated with walking activity in adults with CP. Participants with CP (ages 25-45 years) completed instrumented gait analysis and patient-reported outcomes, including the Patient Reported Outcome Measurement Information System (PROMIS) and Satisfaction with Life Score (SWLS), and wore a StepWatch for 8 days. Average strides per day, stratified by Gross Motor Function Classification System (GMFCS), were compared with nondisabled adults ages 30-39 years utilizing Welch's t-tests with Bonferroni corrections. Correlation coefficients and stepwise multiple linear regression analyses examined relationships between walking activity and GMFCS, gait deviation index (GDI), gait velocity, PROMIS physical function, SWLS, body mass index (BMI), and employment. Participants included 109 adults with CP, ages 29 ± 4 years, classified at GMFCS levels I/II (73 %) and III/IV (27 %). Compared with nondisabled adults, daily stride count was significantly lower in both groups of adults with CP (p < 0.00025), with a progressive decline according to GMFCS level. Walking activity correlated with PROMIS physical function (r = .42), GDI (r = .48), and gait velocity (r = .58). Association for employment was lower (r = 0.27) but significant, while age, SWLS, and BMI were not individually correlated with walking activity. Stepwise, multiple linear regression modeled with Akaike information criterion explained 40.9 % of the observed variability in walking activity in this cohort of adults with CP. Physical function, as classified by GMFCS or measured by PROMIS and self-selected walking velocity, has the strongest association with and is the most significant predictor of walking activity in adults with CP. After accounting for physical function, a small amount of the variation in walking activity can be explained by GDI, employment, and age.

Gait Alterations in Knee Osteoarthritis

Objective: People with knee osteoarthritis suffer from many different symptoms and signs, including gait deviations. Studying in deep these alterations through precise instruments like optoelectronic systems allows clinicians to identify alterations on the different body planes during gait. Methods: This study highlights the different alterations found by literature, analyzing them according to the single gait phase. Results: The spatiotemporal parameters are among the most altered parameters; with stride length and speed reduction, on the kinetic and kinematic level, the knee range of motion is reduced while the moments affecting the knee, hip, and ankle joint are altered in the different phases of stance. Conclusions: Preliminary studies have been developed on the possible quantification of these alterations through scoring systems like the Gait Deviation Index. Further studies should use this scoring system also to solve the issue between the possible correlation of pain and gait deviation that literature is still trying to solve.

An automated deep learning-based gait event detection algorithm for various pathologies

It is unknown how a femoral derotation osteotomy (FDO) during childhood affects functional outcomes in adulthood among individuals with bilateral cerebral palsy (CP).How do long-term functional outcomes after an FDO compare to matched individuals who did not have an FDO? How do outcomes change over time?We queried the gait laboratory database for individuals who underwent an external FDO in childhood and were currently ≥25 years old. Participants returned for a long-term analysis (gait, physical examination, functional tests, imaging, questionnaires). The matched non-FDO group included only individuals in Gross Motor Function Classification System levels I-II, yielding three groups (non-FDO I-II, FDO I-II, FDO III-IV).Sixty-one adults (11 non-FDO, 34 FDO I-II, 16 FDO III-IV) returned 13–25 years after baseline (non-FDO) or surgery (FDO). The non-FDO and FDO I-II groups were matched at baseline on most variables, except the FDO group had weaker hip abductors. At long-term, groups were similar on gait variables (median long-term hip rotation [primary outcome], non-FDO: −4°, FDO I-II: −4°, FDO III-IV: −5°), hip abduction test, fear of falling, and most pain measures despite anteversion being 29° greater in the non-FDO group. The FDO I-II group reported more falls than the non-FDO group. All groups improved on hip rotation, foot progression, and hip abductor strength. Speed and step length decreased/tended to decrease for all three groups. Hip abduction moment and gait deviation index did not change. Improvements in the FDO groups were maintained from short- to long-term.These results challenge the notion that an FDO is necessary to correct mean stance hip rotation for higher functioning individuals since nearly identical results were achieved by adulthood in the non-FDO I-II group. However, an FDO provides improvement earlier and maintenance from short- to long-term. This should factor into the shared decision-making process.

Mobility and gait in adults with cerebral palsy: Evaluating change from adolescence.

Previous studies have looked at the short-term effectiveness of conservative and surgical treatment of children with cerebral palsy (CP), but few have explored the long-term outcomes into adulthood using gait analysis and patient-reported outcome measures. How do gait, mobility, and patient-reported outcomes in adults with CP who received specialized pediatric orthopedic care change from adolescence? We identified 645 adults with 1) CP, 2) age 25-45 years, and 3) an adolescent instrumented gait analysis (IGA) at our center. Measurement outcomes included physical examination, IGA, and select domains of the Patient-Reported Outcomes Measurement Information System (PROMIS). Participants included 136 adults with CP; Gross Motor Function Classification System levels I (21 %), II (51 %), III (22 %), and IV (7%); 57 % males; and average age 16 ± 3/29 ± 3 years (adolescent/adult visits). There was no significant difference in gait deviation index, stride length, or gross motor function between adolescent and adult visits. There were statistically significant but not clinically meaningful declines in gait velocity. At adulthood, PROMIS results revealed limitations in physical function compared with a normative sample but no differences in depression, participation, or pain interference. In this relatively homogeneous group of adults with CP who received orthopedic care from one center, gait and gross motor function showed no clinically meaningful change from adolescence, which differs from recent reports of declining mobility in adulthood. Expert orthopedic care, guided by IGA, may prevent losses in functional mobility for adults with CP.

Lower Limb Deformity and Gait Deviations Among Adolescents and Adults With X-Linked Hypophosphatemia.

BackgroundX-linked hypophosphatemia (XLH) is a rare genetic disorder characterized by lower limb deformity, gait and joint problems, and pain. Hence, quality of life is substantially impaired. This study aimed to assess lower limb deformity, specific radiographic changes, and gait deviations among adolescents and adults with XLH.DesignData on laboratory examination and gait analysis results were analyzed retrospectively. Deformities, osteoarthritis, pseudofractures, and enthesopathies on lower limb radiographs were investigated. Gait analysis findings were compared between the XLH group and the control group comprising healthy adults.Patients and ControlsRadiographic outcomes were assessed retrospectively in 43 patients with XLH (28 female, 15 male). Gait analysis data was available in 29 patients with confirmed XLH and compared to a healthy reference cohort (n=76).ResultsPatients with XLH had a lower gait quality compared to healthy controls (Gait deviation index GDI 65.9% +/- 16.2). About 48.3% of the study population presented with a greater lateral trunk lean, commonly referred to as waddling gait. A higher BMI and mechanical axis deviation of the lower limbs were associated with lower gait scores and greater lateral trunk lean. Patients with radiologic signs of enthesopathies had a lower GDI.ConclusionsThis study showed for the first time that lower limb deformity, BMI, and typical features of XLH such as enthesopathies negatively affected gait quality among adolescents and adults with XLH.

Effect of the COVID-19 Emergency on Physical Function among School-Aged Children

In April 2020, the Japanese government declared a state of emergency due to the novel coronavirus disease (COVID-19). Schools were closed and a stay-at-home order was issued in April and May 2020. This before-and-after study aimed to measure the effects of these COVID-19-related restrictions on physical function among Japanese children. The study included children aged 6–7 years, enrolled before and after the emergency declaration. Their body fat percentage, single-leg standing time, Gait Deviation Index score, and history of falls were compared. There were 56 and 54 children in the before and after groups, respectively. Children in the after group had a higher body fat percentage (p = 0.037), shorter single-leg standing time (p = 0.003), and a larger number of falls per month (p < 0.001) than those in the before group. In the logistic regression analysis, children in the after group had a significantly shorter single-leg standing time (odds ratio (OR): 0.985, 95% confidence interval (CI): 0.972−0.997, p = 0.013), a greater number of falls per month (OR: 1.899, 95% CI: 1.123−3.210, p = 0.017), and a higher body fat percentage (OR: 1.111, 95% CI: 1.016−1.215, p = 0.020) than those in the before group. The COVID-19 emergency restrictions had a negative effect on children’s physical function, especially on balance.