Pediatric Gait Research Articles

Is age or speed the predominant factor in the development of trunk movement in normally developing children?

BackgroundGait analysis is an increasingly used tool in the evaluation of neurological or orthopaedic problems in children. A good insight into age-related changes in normal paediatric gait is necessary to evaluate gait inefficiency caused by pathological walking patterns in children. However, no systematic evaluation of the normal development of trunk movement has yet been made. MethodsData of n=85 healthy children were available. They were asked to walk at self selected speed. The gait data were measured with the Vicon Plug-In-Gait model, including the trunk. We assessed gait cycles of thorax, spine and pelvis in the sagittal, frontal and transverse plane, respectively, stratified by age (categories: <4, 4–6, 7–9, 10–12 and 13–16 years) as well as by normalized speed (≤0.40, 0.41–0.49, ≥0.50). ResultsThe sagittal thorax and spine movement was found to be gradually and significantly associated with age, but less so with speed, indicating that, with increasing age, children tend to lean their trunk forward relative to both the global co-ordinate system and the pelvis. In contrast, the frontal and transverse parameters of spine and pelvic movement seemed to depend mainly on speed, not age. ConclusionOur study shows that age dependency has to be considered with respect to sagittal thorax and spine movements. This finding might be of great importance with respect to the identification of pathological patterns in trunk movement.

Pediatric gait and motion analysis: Current limitations and emerging opportunities for quantitative assessment

Studies of human locomotion have historically paralleled developments in photographic technology. Early works of the late 19th century by Muybridge and Marey employed sequential photography. Later works by Braun and Fischer introduced illuminated tubes on limb segments, and multiple cameras. With these early contributions began the maturation of gait a nalysis from a research-based activity to a more clinically relevant assessment tool. Significant clinical advances began in th e 1960's and have continued to the current time. Recognized clinical contributors include David Sutherland, Jacqueline Perry, Sheldon Simon, Freeman Miller, and James Gage. Today, the majority of pediatric clinical applications focus on the lower extremities ( LE) with segmental motions distal to the ankle seldom considered. Methods for expanding current LE analysis methods are presented. These include functional means of assessing hip joint center location and refinement of a biomechanical foot model to inc lude segmental (heel, forefoot, hallux) motion. Emerging opportunities for clinically relevant pediatric assessment, pr e-treatment decision making, and post-treatment rehabilitative follow-up are included.

The role of augmented feedback in pediatric robotic-assisted gait training: A case series

The role of augmented feedback in pediatric robotic-assisted gait training: A case series

Temporal and spatial gait parameters analysis in non-pathological Mexican children

Objective To examine temporal and spatial gait parameters in Mexican healthy pediatric subjects to describe normal values which could serve as reference data to eventually compare pathological patterns of the Mexican infant gait. Materials and methods Descriptive study that analyzed the gait of 120 children (61 boys and 59 girls) between the ages of 6 and 13 years old. Modifying factors (age, gender, and footwear) were recorded and its impact over temporal and spatial gait parameters was assessed. The data was stratified according to the modifying factors. A GAITRite ® System was used for recording the gait data. Results Significant differences were noted for the following factors: age and the use of footwear. As the individual advances in age, a decrease in number of steps, normalized velocity, velocity, cadence, normalized cadence, normalized step and stride length was observed. In contrast, step and stride length increased. Use of footwear increased velocity (normalized and non-normalized), normalized cadence, step and stride length (normalized and non-normalized), and percentage of stance GC phase; cadence and swing GC percentage diminished. Gender stratification showed no significant differences in any temporal and spatial gait parameters. There were also found significant differences with those reported for normal adult and pediatric gait in the literature. Conclusion Age and footwear modified gait pattern in the studied sample, while gender apparently did not exert any influence on it.

Acceptability and Practicality of Musculoskeletal Examination in Acute General Pediatric Assessment

To evaluate the practicality and the acceptability of pGALS (pediatric Gait, Arms, Legs and Spine) screening, a simple pediatric musculoskeletal screening examination, when performed as part of an acute pediatric assessment. Consecutive school-aged children attending an acute pediatric assessment unit were assessed with the addition of pGALS to the routine clinical examination. Practicality (ie, time taken, degree of completion) and patients/parent-assessed acceptability (ie, time taken, discomfort caused) were recorded. Fifty consecutive school-aged children (median age 8 years) were evaluated by pGALS. Median time taken was 3 minutes (range 1.2-5.3), and examination was completed in 47/50 (96%) children. Acceptability of pGALS was deemed high: time taken was "about right" (98% children, 94% parents) and caused no or little discomfort (72% of children, 92% of parents). Abnormalities on pGALS examination were common, with most (17/50, 34%) explained by confirmed musculoskeletal disease, and 6 of 50 (12%) had non- musculoskeletal disease. PGALS is practical and acceptable to perform in acute pediatric assessment performed by a non expert in musculoskeletal medicine. Abnormal musculoskeletal findings are common as part of the pGALS examination but need to be interpreted in the global clinical context and assessment.

Using Waveform Analyses to Develop Pediatric Gait Indices

Most studies examining the development of pediatric gait patterns have relied on parameterization or sampling techniques, which involve extracting instantaneous points from curves of data. Although such methods are useful and easy to understand, we hypothesize that waveform techniques can lead to a more complete account of the development of gait and, in turn, lead to more effective indices of impairments.

The Gait Profile Score and Movement Analysis Profile

The Gait Deviation Index (GDI) has been proposed as an index of overall gait pathology. This study proposes an interpretation of the difference measure upon which the GDI is based, which naturally leads to the definition of a similar index, the Gait Profile Score (GPS). The GPS can be calculated independently of the feature analysis upon which the GDI is based. Understanding what the underlying difference measure represents also suggests that reporting a raw score, as the GPS does, may have advantages over the logarithmic transformation and z-scaling incorporated in the GDI. It also leads to the concept of a Movement Analysis Profile (MAP) to summarise much of the information contained within kinematic data. A validation study on all children attending a paediatric gait analysis service over 3 years (407 children) provides evidence to support the use of the GPS through analysis of its frequency distribution across different Gross Motor Function Classification System (GMFCS) and Gillette Functional Assessment Questionnaire (FAQ) categories, investigation of intra-session variability, and correlation with the square root of GGI. Correlation with GDI confirms the strong relationship between the two measures. The study concludes that GDI and GPS are alternative and closely related measures. The GDI has prior art and is particularly useful in applications arising out of feature analysis such as cluster analysis or subject matching. The GPS will be easier to calculate for new models where a large reference dataset is not available and in association with applications using the MAP.

Use of the Teager-Kaiser Energy Operator for Muscle Activity Detection in Children

The purpose of this study was to demonstrate the usefulness of the Teager-Kaiser Energy (TKE) operator to assess surface electromyographic (sEMG) activity from the hip and trunk muscles during pediatric gait in children with and without cerebral palsy (CP). Muscle activity was recorded from the trapezius, erector spinae, rectus abdominus, external oblique, gluteus maximus and medius, rectus femoris, and semitendinosus bilaterally in ten children with typical development (TD) and five children with CP ages 44.4 +/- 18.6 months. Duration of muscle activity was calculated as a percentage of the gait cycle, and compared to two common onset detection methods, a standard deviation (SD) amplitude threshold method, and the visual inspection from two raters (R1, R2). Relative and absolute agreement was determined using intraclass correlation coefficients (ICCs) and Bland-Altman plots. Of the two automated methods, the TKE method demonstrated better agreement with visual inspection (0.45-0.89) than the SD (0.11-0.76) method. The Bland-Altman plots indicated a smaller bias and 95% confidence interval for the TKE method in comparison to the raters (TKE to R1: -5, 113%; TKE to R2: 4, 95%; SD to R1: -24, 170%; SD to R2: -15, 151%). The use of the TKE operator may better detect sEMG activity in children than the standard amplitude method.

Comparison of two normative paediatric gait databases

The availability of age-matched normative data is an essential component of clinical gait analyses. Comparison of normative gait databases is difficult due to the high-dimensionality and temporal nature of the various gait waveforms. The purpose of this study was to provide a method of comparing the sagittal joint angle data between two normative databases. We compared a modern gait database to the historical San Diego database using statistical classifiers developed by Tingley et al. (2002). Gait data were recorded from 60 children aged 1–13 years. A six-camera Vicon 512 motion analysis system and two force plates were utilized to obtain temporal-spatial, kinematic, and kinetic parameters during walking. Differences between the two normative data sets were explored using the classifier index scores, and the mean and covariance structure of the joint angle data from each lab. Significant differences in sagittal angle data between the two databases were identified and attributed to technological advances and data processing techniques (data smoothing, sampling, and joint angle approximations). This work provides a simple method of database comparison using trainable statistical classifiers.

Pediatric Gait Development and the Biomechanics of Movement Disorders

Pediatric Gait Development and the Biomechanics of Movement Disorders

Infantile Arachnoid Cyst Compressing the Sacral Nerve Root Associated with Spina Bifida and Lipoma. Case Report.

A 2-year-old boy presented with a rare sacral arachnoid cyst manifesting as gait disturbance. Neuroimaging revealed an intradural cyst in the sacral nerve root sheath associated with spina bifida occulta and a lipoma at the same level. At surgery, the conus medullaris was situated at the L-1 level and not tethered. The highly pressurized arachnoid cyst had exposed the dural sheath of the left S-2 nerve root and compressed the adjacent nerves. An S-2 nerve root pierced through the cyst. There was no communication between the cyst and spinal arachnoid space. We thought the one-way valve mechanism had contributed to the cyst enlargement and the nerve compression. Radical resection of the cyst was not attempted. A cyst-subarachnoid shunt was placed to release the intracystic pressure. Postoperatively, his gait disturbance improved and no deterioration occurred during the 4-year follow up. Both tethered cord syndrome and sacral arachnoid cyst in the nerve root sheath should be considered in pediatric progressive gait disturbance. Cyst-subarachnoid shunt is an alternative method to cyst resection or fenestration to achieve neurological improvement.

Gait of Normal Hong Kong Chinese Children: the Bootstrap Approach

This paper describes a study on the gait of normal Hong Kong Chinese children using a representative sample to create a normal paediatric gait database. The database will serve as a local reference norm for the comparisons of pathological gait patterns. The 11 males and nine females aged from seven to 12 years were recruited through stratified random sampling. Free walking gait cycles were collected using the ELITE Motion Analysis System. Bootstrap analysis was used to generate the prediction regions of kinematic curves in sagittal, coronal, and transverse planes for two age groups; seven to nine years and 10 to 12 years. The study demonstrates unique characteristics of the gait pattern of Hong Kong Chinese children. The key differences are in the pattern of hip rotation and the magnitude of pelvic rotation, that may be linked to differences in the static rotational profile of Chinese children. The higher cadence, shorter stance, and stride time for a given age in Hong Kong Chinese children is possibly explained by lower leg-to-height ratios. The study suggests that leg length, height, and age may be associated with cadence, stance time, and stride time only through the leg-to-height ratio. The marked similarities in the Hong Kong and US findings support the use of this normal paediatric gait database using the bootstrap approach as a reliable means for assessing pathological gait in children.

A multilevel approach to botulinum toxin type A treatment of the (ilio)psoas in spasticity in cerebral palsy

In spasticity, flexion deformity of the hip is frequently associated with contracture or hyper‐reflexia of the psoas muscle. Botulinum toxin type A (BTX‐A) has been used for some considerable time in the management of paediatric gait disorders. We have been using a multilevel approach to manage spasticity in cerebral palsy for several years, the combination of gait analysis and clinical evaluation being important for the selection of target muscles for BTX‐A injections. Twenty cerebral palsy children (12 female) with spasticity were treated with BTX‐A injections (BOTOX® mean dose, 2 U/kg body weight) into the psoas muscle. Patients were monitored using range of motion measurements of maximal hip extension, clinical estimates of hypertonia in the hip flexors, gait analysis (three‐dimensional kinematics and kinetics) and surface electromyography of major lower limb muscles. Full gait analysis was carried out on 12 of the patients. Significant clinical improvements were observed following 15 of the 21 psoas treatments. Furthermore, the kinematics results of gait analysis showed improvement in one or more parameters in nine of the 12 patients. In conclusion, we have demonstrated the value of a multilevel approach to BTX‐A treatment in the management of spasticity in children with cerebral palsy.

Baroreceptor responsiveness of sympathetic efferents of various destinations during and after cushing reaction in anesthetized cats

The clinical objective of the gait analysis laboratory, developed by United Technologies Corporation (Hartford, CT, USA) in 1980, at the Newington Children's Hospital is to provide quantified assessments of human locomotion which assist in the orthopaedic management of various pediatric gait pathologies. The motion measurement system utilizes a video-based data collection strategy similar to commercially available systems for motion data collection. Anatomically aligned, passive, retroreflective markers placed on the subject are illuminated, detected, and stored in dedicated camera hardware while data are acquired from force platforms and EMG transducers. Three-dimensional marker position information is used to determine: (i) the orientation of segmentally-embedded coordinate systems, (ii) instantaneous joint center locations, and (iii) joint angles. Joint kinetics, i.e., moments and powers, may also be computed if valid force plate data are collected.

Limits to passive range of joint motion and the effect on crouch gait in children with cerebral palsy

Children with cerebral palsy are at risk of developing muscle contractures, often contributing to pain, structural deformities and mobility limitations. With the increasing use of gait indices to summarise the findings of three dimensional gait analysis (3DGA), the purpose of this study is to determine whether there is a relationship between multilevel joint contractures and the Gait Profile Score in children with cerebral palsy.The Gait Profile Score, calculated from 3D gait analysis, and passive range of motion, strength and spasticity of the hips, knees and ankles in the sagittal plane were measured in 145 children with cerebral palsy (mean age:11 years,4 months; SD:2 years,10 months) (83 males) enrolled in the NSW Paediatric Gait Analysis Service Research Registry from 2011 to 2016. The relationships between these physical measures and the Gait Profile Score were explored using bivariate and multivariate correlations.Reduced hip extension, knee extension and ankle dorsiflexion (knee extended) range of motion were correlated with a higher (worse) Gait Profile Score (r = −0.348 to −0.466, p < .001). Children with all joints contracted had a significantly higher Gait Profile Score (mean 17.5°, SD 6.2°) than those with no contractures (mean 11.0°, SD 2.3°) or ankle contractures only (mean 12.8°, SD 5.1°) (p < .05). Knee flexion weakness, reduced hip extension and ankle dorsiflexion (knee extended) range of motion predicted 47% of the Gait Profile Score.The Gait Profile Score is a sensitive measure for demonstrating the relationship between multilevel sagittal plane joint contractures and kinematic gait. Clinically, this supports the use of the Gait Profile Score as a simplified measure to understand the contribution of contractures to functional gait limitations. Monitoring knee flexion strength, and hip extension and ankle dorsiflexion (knee extended) range of motion may assist clinicians in prioritising interventions to improve gait in this population.

Normalization of temporal-distance parameters in pediatric gait

Several techniques for the normalization of temporal-distance parameters in pediatric gait are given. The resulting normalized data can be used to compare (or discriminate) individuals or groups of individuals without the effect of variables such as age and height. The normalization with respect to a reference data set or with respect to the data set itself can be accommodated. Three novel techniques for normalization of gait data have been given: offset, decorrelation and detrending. For normalization of stride length with respect to height, all three are superior to the commonly accepted technique of dividing by the height. The offset technique has obscure units and will have a residual correlation. The decorrelation technique also has obscure units but will have zero correlation provided it is being normalized using a linear model (or piecewise linear model) fitted to the data in a least-squares sense. The detrending technique will also result in a zero correlation if piecewise linear or polynomial models, fitted to the data in a least-squares sense, are used. The detrending technique is the most useful of the three techniques proposed as it will also generate the same units as the original data set and can be easily scaled so that its magnitude is also comparable with the original data. Both the decorrelation and detrending techniques can be used simultaneously to normalize data with respect to two or more variables.

Change in temporal and distance parameters of gait following stroke

Several techniques for the normalization of temporal-distance parameters in pediatric gait are given. The resulting normalized data can be used to compare (or discriminate) individuals or groups of individuals without the effect of variables such as age and height. The normalization with respect to a reference data set or with respect to the data set itself can be accommodated. Three novel techniques for normalization of gait data have been given: offset, decorrelation and detrending. For normalization of stride length with respect to height, all three are superior to the commonly accepted technique of dividing by the height. The offset technique has obscure units and will have a residual correlation. The decorrelation technique also has obscure units but will have zero correlation provided it is being normalized using a linear model (or piecewise linear model) fitted to the data in a least-squares sense. The detrending technique will also result in a zero correlation if piecewise linear or polynomial models, fitted to the data in a least-squares sense, are used. The detrending technique is the most useful of the three techniques proposed as it will also generate the same units as the original data set and can be easily scaled so that its magnitude is also comparable with the original data. Both the decorrelation and detrending techniques can be used simultaneously to normalize data with respect to two or more variables.

Joint powers of the lower extremity in ankle-foot orthotic-assisted spastic pediatric gait

Joint powers of the lower extremity in ankle-foot orthotic-assisted spastic pediatric gait

Joint powers of the lower extremity in ankle-foot orthotic-assisted spastic pediatric gait

Joint powers of the lower extremity in ankle-foot orthotic-assisted spastic pediatric gait

Strategies for the Assessment of Pediatric Gait in the Clinical Setting

Clinical gait analysis is a term that can be applied to numerous methods of evaluating a subject's walking pattern. These methods may include observation, videotaping, electromyography, kinematics, kinetics, and energetics. Modern gait analysis is based on the integration of these component methods of measurement to derive a complete analysis of gait. The data may then be used to help determine the treatment course of a patient with ambulatory problems or to document the effects of treatment. The purpose of this article is to provide an overview of the individual components of gait analysis. Emphasis will be placed on the type of information that can be derived from each component and how the information may be used clinically. Normal pediatric kinematics and kinetics are provided with literature references for phasic electromyography and temporal and stride variables. Two case examples illustrate the clinical utility of gait analysis information applied to cerebral palsy in surgical decision making and orthotic assessment. Guidelines are also provided for the referral of patients to a gait analysis laboratory.