Gait Variable Scores Research Articles

Correlation of radiological outcome and gait function of SCFE patients after growth arrest

Introduction: Slipped upper femoral epiphysis (SUFE) results in hip deformity and femoro-acetabular impingement (FAI). FAI affects hip motion and impacts on gait. The purpose of this study was to quantify the effects of moderate to severe SUFE on 3D gait kinematics and to determine if there were correlations between gait deviations and slip severity. Patients/materials andmethods: Patients referred to the Royal Children’s Hospital for a 3D gait analysis (3DGA) between 2000 and 2009 after pinning in situ of a stable SUFE were studied retrospectively. Inclusion criteria were unilateral SUFE, Southwick Lateral Slip Angle (LSA)≥30◦, [1], no surgical complications, appropriate hip and pelvis radiology and 3DGA. 3DGA was performed with a Vicon motion system (OMG, UK) and followed the Plug in Gait (VICON, UK) protocol. Gait variable score (GVS) and Gait profile score (GPS) [2], were calculated on the study cohort for both the sound and slipped side, compared to 38 paediatric subjects with no gait pathology (NGP), using t-test with unequal variances ( =0.05) in Minitab (Minitab, Inc., USA). Results:30Patients (17Male, 13 Female),with an average age at pinning of 13.3 years (±1.9 years) were included. The average LSA, Klein’s line offset and alpha angle of Noztli were 45.3◦ (±13.0◦), −6.4mm (±8.0mm) and 113.6◦(±13.1◦) respectively. The GPS and all GVS, except pelvic tilt (sound and slip side) and foot progression (sound side), were significantly different compared to the NGP group. Hip rotation and foot progression GVSs as well as GPS were significantly different between the slipped and sound sides. However, no significant correlations were found between GVSs and the radiological measurements.

Use of the Gait Profile Score for the evaluation of patients with joint hypermobility syndrome/Ehlers–Danlos syndrome hypermobility type

Gait analysis (GA) is widely used for clinical evaluations in various pathological states, both in children and in adults, such as in patients with joint hypermobility syndrome/Ehlers-Danlos syndrome hypermobility type (JHS/EDS-HT). Otherwise, GA produces a large volume of data and there is the clinical need to provide also a quantitative measure of the patient's overall gait. Starting from this aim some global indexes were proposed by literature as a summary measure of the patient's gait, such as the Gait Profile Score (GPS). While validity of the GPS was demonstrated for the evaluation of the functional limitation of children with Cerebral Palsy, no studies have been conducted in patients JHS/EDS-HT. The aim of our study was therefore to investigate the effectiveness of the GPS in the quantification of functional limitation of patients with JHS/EDS-HT. Twenty-one adult (age: 36.1 ± 12.7 years) individuals with JHS/EDS-HT were evaluated using GA and from GA data the GPS was computed. The results evidenced that the GPS value of patients was 8.9 ± 2.6, statistically different from 4.6 ± 0.9 displayed by the control group. In particular, all values of Gait Variable Scores (GVS) which compose the GPS were higher if compared to controls, with the exception of Pelvic Tilt and Foot Progression. The correlations between GPS/GVS and Lower Extremity Functional Scale (LEFS) showed significant relationship between GPS and the item 11 ("Walking 2 blocks") (ρ=-0.56; p<0.05) and 12 ("Walking a mile") of LEFS (ρ=-0.76; p<0.05). Our results showed that GPS and GVS seem to be appropriate outcome measures for the evaluation of the functional limitation during gait of patients with JHS/EDS-HT.

One side or two?

One side or two?

Functional decline in children undergoing selective dorsal rhizotomy after age 10

To compare function and gait in a group of children older than most children who received selective dorsal rhizotomy (SDR) with age- and function-matched peers who received either orthopedic surgery or no surgical intervention. A retrospective study examined ambulatory children with diplegic cerebral palsy, aged between 10 years and 20 years and categorized in Gross Motor Function Classification System (GMFCS) levels I or II. Three groups were considered: (1) children who had selective dorsal rhizotomy (n=8; two females, six males; mean age 15y 4mo at SDR, 16y 8mo at follow-up); (2) children who had orthopedic surgery (n=9; three females, six males; mean age 14y 6mo at SDR, 15y 1mo at follow-up), and (3) children who had no surgical intervention (n=9; two females, seven males; mean age 15y 6mo at follow-up). Longitudinal measures of gait analysis (velocity, gait deviation index, and gait variable scores) and gross motor function (GMFCS level, Gross Motor Function Measure scores, and centiles) were examined. No significant differences were found between changes in gait comparing rhizotomy with orthopedic surgery; however, the group who received orthopedic surgery demonstrated improved gait compared with the group without surgical intervention. Longitudinal comparisons of gross motor function demonstrated a decrease in the group who received SDR. Between-group analysis of outcomes also demonstrated worse outcomes of the SDR group compared with the orthopedic surgery group and with the no surgical intervention group. Rhizotomy in older children was associated with functional declines compared with similar children who had no surgery and with those who underwent orthopedic surgery. This suggests that age greater than 10 years might be a contraindication for SDR if the goal is to improve motor skills.

Correlations of the Gait Profile Score and the Movement Analysis Profile relative to clinical judgments

The Gait Profile Score (GPS) is a single index measure that summarises the overall deviation of kinematic gait data relative to normative data. The GPS can be decomposed to provide Gait Variable Scores (GVS) of nine key component kinematic gait variables, which are presented as a Movement Analysis Profile (MAP). The purpose of this study was to investigate the validity of the GPS and MAP relative to clinician judgments. Kinematic data were selected from 60 children and inspected by 17 experienced clinicians. The degree of abnormality of the overall unilateral gait pattern and the nine kinematic variables was rated according to a 0–10 point scale. Strong, significant, positive correlations were found between the GPS and MAP component scores, and clinicians’ ratings of kinematic gait deviation, with Spearman correlations ranging from 0.84 to 0.97. These high correlations provide evidence that the GPS and the MAP have criterion-related validity relative to clinician judgments. We propose that the GPS and particularly its MAP decomposition may be useful in clinical practice and education as an adjunct to the traditional presentation of complex kinematic data.