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Yared F, Massaad A, Bakouny Z, Otayek J, Bizdikian AJ, Ghanimeh J, Labaki C, Ghanem D, Ghanem I, Skalli W, Assi A. Differences in Kinematic Changes From Self-Selected to Fast Speed Gait in Asymptomatic Adults With Radiological Signs of Femoro-Acetabular Impingement. Cureus 2023; 15:e43733. [PMID: 37727201 PMCID: PMC10505836 DOI: 10.7759/cureus.43733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/21/2023] Open
Abstract
Femoro-acetabular impingement (FAI) may present as alterations in the skeletal morphology of the hip. Repercussions of FAI can be witnessed in self-selected speed walking as well as physical exercise such as running or fast speed walking. The aim of this study was to investigate changes in kinematics at different gait speeds in subjects presenting with radiological findings invoking FAI. One hundred thirty asymptomatic adults underwent biplanar X-rays with a calculation of 3D hip parameters: acetabular anteversion, abduction and tilt, vertical center edge angle (VCE), femoral anteversion, neck-shaft angle, acetabular coverage of the femoral head, femoral head diameter and neck length. Parameters were classified according to FAI clinical thresholds. Two groups were created: Control group (63 subjects having up to one subnormal hip parameter in favour of FAI) and Radiographic FAI group (67 subjects having ≥2 subnormal hip parameters that might cause FAI). All subjects underwent 3D gait analysis at self-selected and fast speed, from which kinematic parameters were generated. Arithmetic differences between fast and self-selected speed gait were considered as gait changes. Subjects in the Radiographic FAI group had decreased acetabular tilt (24 vs. 19˚), anteversion (19 vs. 16˚), abduction (55 vs. 53˚), femoral anteversion (18 vs. 14˚) and increased VCE (29 vs. 33˚, all p<0.05), compared to controls. Changes from self-selected to fast speed showed that subjects in the Radiographic FAI group had lower range of motion (ROM) pelvic rotation (7 vs. 4˚) and ROM hip flexion/extension (10 vs. 7˚), reduced hip extension (-4 vs. -2˚) and step length (16 vs. 13 cm; all p<0.05). The Radiographic FAI group had decreased acetabular abduction, anteversion and femoral anteversion in favour of FAI. When adapting from self-selected to fast speed gait, the Radiographic FAI group seemed to limit pelvic rotation and hip flexion/extension resulting in a decrease in step length. These kinematic limitations were previously reported in subjects with symptomatic FAI. Gait analysis could be considered as a functional diagnostic tool to assess FAI along with radiological assessment.
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Affiliation(s)
- Fares Yared
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Abir Massaad
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Ziad Bakouny
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Joeffroy Otayek
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Aren-Joe Bizdikian
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Joe Ghanimeh
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Chris Labaki
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Diane Ghanem
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Ismat Ghanem
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, FRA
| | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
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Li H, Huang H, Ren S, Rong Q. Leveraging Multivariable Linear Regression Analysis to Identify Patients with Anterior Cruciate Ligament Deficiency Using a Composite Index of the Knee Flexion and Muscle Force. Bioengineering (Basel) 2023; 10:bioengineering10030284. [PMID: 36978675 PMCID: PMC10045096 DOI: 10.3390/bioengineering10030284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/10/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
Patients with anterior cruciate ligament (ACL) deficiency (ACLD) tend to have altered lower extremity kinematics and dynamics. Clinical diagnosis of ACLD requires more objective and convenient evaluation criteria. Twenty-five patients with ACLD before ACL reconstruction and nine healthy volunteers were recruited. Five experimental jogging data sets of each participant were collected and calculated using a musculoskeletal model. The resulting knee flexion and muscle force data were analyzed using a t-test for characteristic points, which were the time points in the gait cycle when the most significant difference between the two groups was observed. The data of the characteristic points were processed with principal component analysis to generate a composite index for multivariable linear regression. The accuracy rate of the regression model in diagnosing patients with ACLD was 81.4%. This study demonstrates that the multivariable linear regression model and composite index can be used to diagnose patients with ACLD. The composite index and characteristic points can be clinically objective and can be used to extract effective information quickly and conveniently.
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Affiliation(s)
- Haoran Li
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing 100871, China
| | - Hongshi Huang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100871, China
| | - Shuang Ren
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100871, China
- Correspondence: (S.R.); (Q.R.)
| | - Qiguo Rong
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing 100871, China
- Correspondence: (S.R.); (Q.R.)
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Three decades of gait index development: A comparative review of clinical and research gait indices. Clin Biomech (Bristol, Avon) 2022; 96:105682. [PMID: 35640522 DOI: 10.1016/j.clinbiomech.2022.105682] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 03/14/2022] [Accepted: 05/17/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND A wide variety of indices have been developed to quantify gait performance markers and associate them with their respective pathologies. Indices scores have enabled better decisions regarding patient treatments and allowed for optimized monitoring of the evolution of their condition. The extensive range of human gait indices presented over the last 30 years is evaluated and summarized in this narrative literature review exploring their application in clinical and research environments. METHODS The analysis will explore historical and modern gait indices, focusing on the clinical efficacy with respect to their proposed pathology, age range, and associated parameter limits. Features, methods, and clinically acceptable errors are discussed while simultaneously assessing indices advantages and disadvantages. This review analyses all indices published between 1994 and February 2021 identified using the Medline, PubMed, ScienceDirect, CINAHL, EMBASE, and Google Scholar databases. FINDINGS A total of 30 indices were identified as noteworthy for clinical and research purposes and another 137 works were included for discussion. The indices were divided in three major groups: observational (13), instrumented (16) and hybrid (1). The instrumented indices were further sub-divided in six groups, namely kinematic- (4), spatiotemporal- (5), kinetic- (2), kinematic- and kinetic- (2), electromyographic- (1) and Inertial Measurement Unit-based indices (2). INTERPRETATION This work is one of the first reviews to summarize observational and instrumented gait indices, exploring their applicability in research and clinical contexts. The aim of this review is to assist members of these communities with the selection of the proper index for the group in analysis.
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Objective assessment of the functional status of stroke patients: Can comprehensive rehabilitation treatment improve their functional efficiency? BIOMEDICAL HUMAN KINETICS 2022. [DOI: 10.2478/bhk-2022-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Study aim: To check if the short rehabilitation treatment (3 weeks) complemented by complex rehabilitation on advanced equipment improves the functional status of chronic stroke patients; and which clinical and objective parameters can be used to assess the efficacy of such treatment.
Material and methods: 28 patients 3 to 6 months after the stroke. They participated in 3 weeks rehabilitation program in Rehabilitation Hospital. This program was supplemented by rehabilitation on: Zebris treadmill, ALFA and GAMMA platform, Biodex Balance System SD, the Balance Tutor treadmill. Their functional status was assessed by: Scandinavian Stroke Scale (SSS), Timed-Up-And-Go test (TUG), balance tests on Zebris, instrumented gait analysis on BTS system.
Results: The positive changes of the patients’ functional status were found in time of TUG test, in case of balance test for 95% of the ellipsoid area, lengths of major and minor axes of the ellipsoid, average sway speed, sway path length, total ground reaction force for left and right leg, and Gillette Gait Index in case of the gait analysis.
Conclusions: The improvement of the functional status of chronic stroke patients after relatively short rehabilitation treatment was achieved, due to the addition to the standard rehabilitation treatment the program on the advanced technologically equipment.
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Composite Score of Readiness (CSR) as Holistic Profiling of Functional Deficits in Footballers Following ACL Reconstruction. J Clin Med 2021; 10:jcm10163570. [PMID: 34441865 PMCID: PMC8397164 DOI: 10.3390/jcm10163570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 12/13/2022] Open
Abstract
Background: The decision to return to sport (RTS) after anterior cruciate ligament (ACL) reconstruction is difficult; thus, coaching staff require a readable, easy-to-use, and holistic indication of an athlete’s readiness to play. Purpose: To present the Composite Score of Readiness (CSR) as a method providing a single score for RTS tests after ACL reconstruction. Methods: The study comprised 65 male football players (age 18–25 years), divided into three groups: ACL group—subjects after ACL rupture and reconstruction, Mild Injury (MI) group—subjects after mild lower limb injuries, and Control (C) group—subjects without injuries. The CSR was calculated based on three performed tests (Y-balance test, Functional Movement Screen, and Tuck Jump Assessment) and expressed as the sum of z-scores. The CSR index allows highlighting an athlete’s functional deficits across tests relative to the evaluated group. Results: The CSR indicated that relative to the group of athletes under the study, similar functional deficits were present. Comparing athletes following ACL reconstruction to both the MI and C groups, in the majority of subjects, the CSR index was below zero. The correlation between CSR and raw tests results indicated that the CSR is most strongly determined by YBT. Conclusion: The CSR is a simple way to differentiate people after serious injuries (with large functional deficits) from people without injuries or with only small deficits. Because the CSR is a single number, it allows us to more easily interpret the value of functional deficits in athletes, compared to rating those deficits based on raw tests results.
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Piccinini L, Cimolin V, Storm F, Di Girolamo G, Biffi E, Galli M, Condoluci C. Quantification of the effects of robotic-assisted gait training on upper and lower body strategy during gait in diplegic children with Cerebral Palsy using summary parameters. Comput Methods Biomech Biomed Engin 2021; 25:140-147. [PMID: 34121521 DOI: 10.1080/10255842.2021.1938009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The effects of robotic-assisted gait training on upper and lower body strategy during gait in diplegic children with Cerebral Palsy (CP) were quantified using summary parameters (Upper Body Profile Score (UBPS) and Gait Profile Score (GPS)). Firstly, the upper body strategy during gait was assessed in 73 children with CP and 15 healthy children (Control Group: CG): patients with CP exhibited higher values of most of the summary parameters of the upper body position than the CG. Then, the effects of a robotic-assisted gait training in a sub-group of 35 children by means of UBPS were evaluated. After robotic-assisted gait training program, no significant differences as for the summary parameters (UBPS and GPS). However, considering the specific variables scores, significant improvements are displayed as for the upper body parameter on the sagittal plane (Upper Body Ant/Pst index) and the lower limbs, in particular pelvis (Pelvic Ant/Pst and Pelvic Int/Ext indices) and as for walking velocity. A sort of reorganization of full-body kinematics, especially at upper body and proximal level (pelvis) seems to appear, with a new gait approach, characterised by a better strategy of the upper body associated with a significant improvement of the pelvis movement.
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Affiliation(s)
- Luigi Piccinini
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Veronica Cimolin
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Fabio Storm
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | | | - Emilia Biffi
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Manuela Galli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
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Syczewska M, Święcicka A, Szczerbik E, Kalinowska M, Dunin-Wąsowicz D, Łukowicz M. Types of gait deviations in children and adolescents with Guillain-Barre syndrome identified using cluster analysis. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Liu X, Huang H, Ren S, Rong Q, Ao Y. Use of the normalcy index for the assessment of abnormal gait in the anterior cruciate ligament deficiency combined with meniscus injury. Comput Methods Biomech Biomed Engin 2020; 23:1102-1108. [PMID: 32648770 DOI: 10.1080/10255842.2020.1789119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The normalcy index (NI) has been implemented by several studies as a simple index for quantitatively analyzing diffident gait abnormalities, such as children with cerebral palsy and idiopathic toe-walkers. However, whether the NI can be used in anterior cruciate ligament (ACL) deficiency with different types of meniscus injuries or not, has not been reported yet. In this study, 25 patients who combined different types of ACL and meniscus injuries were evaluated by the NI analysis. 12 healthy subjects were used to define the normal range of NI. The result showed that NI values of patients were significantly larger than the control group (P < 0.05). Meanwhile, the tendency of increasing NI values associated with increasing pathology were significant with only 5 subjects in the smallest group (Jonkheere-Terpsta test: P < 0.001). These results indicated that the NI was a concise yet effective tool to evaluate combined ACL and meniscus injury patients. Increasing severity degree of meniscus tears in ACL rupture patients is corresponded to increasing NI values. It also demonstrates that the proposed NI can be applied as a robustness factor to detect the discrepancy between healthy and patient subjects clinically, and has the potential in the quantitative evaluation of pre- or post-surgery and rehabilitation.
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Affiliation(s)
- Xiaode Liu
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
| | - Hongshi Huang
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Shuang Ren
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Qiguo Rong
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
| | - Yingfang Ao
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
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9
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Syczewska M, Kocel K, Święcicka A, Graff K, Krawczyk M, Wąsiewicz P, Kalinowska M, Szczerbik E. Selection of gait parameters for modified Gillette Gait Index using Hellwig Correlation Based Filter method, random forest method, and correlation methods. Biocybern Biomed Eng 2020. [DOI: 10.1016/j.bbe.2020.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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Szopa A, Domagalska-Szopa M, Siwiec A, Kwiecień-Czerwieniec I. Canonical correlation between body-posture deviations and gait disorders in children with cerebral palsy. PLoS One 2020; 15:e0234654. [PMID: 32544177 PMCID: PMC7297316 DOI: 10.1371/journal.pone.0234654] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 05/30/2020] [Indexed: 11/18/2022] Open
Abstract
Children with Cerebral Palsy (CP) show the postural constraints while standing, and gait disorders, resulting from both primary and secondary impairments of brain injury. In our previous studies, several characteristic postural and gait patterns in children with unilateral as well as with bilateral CP were defined, and the relationship between these patterns was demonstrated. The purpose of present study was to identify which features of body posture deviation during standing were strongly related to gait deviations in independently ambulatory children with CP. For this aim we explored the cross-relationship between features of body posture while standing examined by surface topography and the selected gait parameters from three-dimensional instrumented gait analysis in one hundred twenty children with cerebral palsy, aged between 7 and 13 years, who were able to walk independently. First, our study documented that that sagittal misalignment of the spine curvature was significantly related to kinematic deviations such as deviations of pelvic tilt, inadequate swing phase and knee flexion, and peak dorsiflexion in stance. Second, the study shows that the static asymmetry of pelvis and trunk was significantly associated with kinematic deviations during gait cycle such as pelvic rotation, hip abduction in swing, ROM of knee flexion, peak dorsiflexion in stance. Based on obtained results and referring to our previous findings it can be assumed that the first model of the relationship between postural deviation and gait disturbances, called 'postural and gait complex of disorders in sagittal plane', is related to children with bilateral CP, whereas the second model 'postural and gait complex of disorders in coronal plane' to children with unilateral CP. The clinical applications of this study relate to the early recognition of particular features of postural deviation using surface topography, instead of more difficult and demanding expensive tools 3-D gait analysis.
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Affiliation(s)
- Andrzej Szopa
- Department of Physiotherapy, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Małgorzata Domagalska-Szopa
- Department of Medical Rehabilitation, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Andrzej Siwiec
- Pediatrics Center John Paul II in Sosnowiec, Sosnowiec, Poland
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Domagalska–Szopa M, Szopa A. Gait Pattern Differences Among Children With Bilateral Cerebral Palsy. Front Neurol 2019; 10:183. [PMID: 30930827 PMCID: PMC6423305 DOI: 10.3389/fneur.2019.00183] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 02/13/2019] [Indexed: 11/13/2022] Open
Abstract
Background: The positive findings from our previous studies, which revealed the link between postural and gait patterns in children with unilateral cerebral palsy (CP) were very encouraging for recognition this relationship in children with bilateral cerebral palsy (CP). Therefore, the objective of this study was to evaluate whether different gait patterns corresponding to postural patterns in children with bilateral CP could be statistically significant according to a cluster analysis. Methods: Fifty-eight participants with bilateral CP and 45 matched children with typical growth and development. The participants walked barefoot along a treadmill at their own pace. Three-dimensional kinematic data were collected using the Measuring System for Motion Analysis. To characterize gait patterns, the Gillette Gait Index (GGI) and its 16 distinct gait parameters were used. The participants were divided into four subgroups according to their postural patterns. Results: A cluster analysis revealed 4 gait patterns corresponding to postural patterns: (1) normal gait pattern corresponded to neutral posture; (2) balanced gait pattern corresponded to balanced posture; (3) lordotic gait pattern corresponded to lordotic postural pattern; (4) swayback gait pattern corresponded to backward-leaning posture. There were significant differences in mean GGI and various clusters in the 8 GGI gait parameters: cadence, mean pelvic tilt; mean pelvic rotation, minimum hip flexion, peak hip abduction in swing; knee flexion at initial contact, and peak dorsiflexion in stance. Conclusion: Our results showed that gait discrepancies among children with bilateral CP were not simply a result of lower limb kinematic deviations in the sagittal plane. Information on different gait patterns could improve early therapy in children with bilateral CP before abnormal gait patterns are fully established.
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Affiliation(s)
- Małgorzata Domagalska–Szopa
- Department of Medical Rehabilitation, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Andrzej Szopa
- Department of Physiotherapy, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
- Medical Rehabilitation Center Neuromed SC, Katowice, Poland
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12
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Schreiber C, Armand S, Moissenet F. Influence of normative data's walking speed on the computation of conventional gait indices. J Biomech 2018; 76:68-73. [PMID: 29853318 DOI: 10.1016/j.jbiomech.2018.05.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 03/26/2018] [Accepted: 05/13/2018] [Indexed: 11/25/2022]
Abstract
The pathology's impact on gait pattern may be overestimated by conventional gait indices (Gillette Gait Index - GGI, Gait Deviation Index - GDI, Gait Profile Score - GPS), since impairments' consequences on kinematics may be amplified by a change in walking speed. The objectives of this study were to evaluate the influence of walking speed on the computation of gait indices and to propose a corrective method to cancel the effects of walking speed. Spatiotemporal parameters and kinematics of fifty-four asymptomatic participants (30 M/24 W, 37.9 ± 13.7 years, 72.8 ± 13.3 kg, 1.74 ± 0.10 m) were collected at four speed conditions (C1:[0,0.4] m s-1, C2:[0.4,0.8] m s-1, C3:[0.8,1.2] m s-1, C4:spontaneous). Four values of each index were computed for each trial using successively the four conditions as normative data repository. Mean values over all participants were statistically compared (paired t-tests, 95% confidence level). Indices values computed with normative at equivalent walking speed were not statistically different from reference values. Meanwhile, deviations appeared when the walking speed discrepancy between conditions and normative increased. These drifts related to walking speed mismatch have been quantified and fitting functions proposed. A correction was applied to indices. GGI was efficiently adjusted while GDI and GPS remain different from their reference values for C1 and C2. Gait indices must be interpreted cautiously in function of the normative data repository's walking speed used for computation. Furthermore, a coupled use of conventional and corrected gait indices could lead to a better comprehension of the contribution of impairments and walking speed on gait deviations and overall gait quality.
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Affiliation(s)
- Céline Schreiber
- Centre National de Rééducation Fonctionnelle et de Réadaptation - Rehazenter, Laboratoire d'Analyse du Mouvement et de la Posture (LAMP), Luxembourg, Luxembourg
| | - Stéphane Armand
- Willy Taillard Laboratory of Kinesiology, University Geneva Hospitals and Geneva University, Geneva, Switzerland
| | - Florent Moissenet
- Centre National de Rééducation Fonctionnelle et de Réadaptation - Rehazenter, Laboratoire d'Analyse du Mouvement et de la Posture (LAMP), Luxembourg, Luxembourg.
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Abstract
Beyond the classic clinical description, recent studies have quantitatively evaluated gait and balance dysfunction in cerebellar ataxias by means of modern motion analysis systems. These systems have the aim of clearly and quantitatively describing the differences, with respect to healthy subjects, in kinematic, kinetic, and surface electromyography variables, establishing the basis for a rehabilitation strategy and assessing its efficacy. The main findings which characterize the gait pattern of cerebellar patients are: increased step width, reduced ankle joint range of motion with increased coactivation of the antagonist muscles, and increased stride-to-stride variability. Whereas the former is a compensatory strategy adopted by patients to keep the center of mass within the base of support, the latter indicates the inability of patients to maintain dynamic balance through a regular walking pattern and may reflect the primary deficit directly related to cerebellar dysfunction and the consequent lack of muscle coordination during walking. Moreover, during the course of the disease, with the progressive loss of walking autonomy, step length, and lower-limb joint range of motion are drastically reduced. As to the joint coordination defect, abnormal intralimb joint coordination during walking, in terms of both joint kinematics and interaction torques, has been reported in several studies. Furthermore, patients with cerebellar ataxia show a poor intersegmental coordination, with a chaotic coordinative behavior between trunk and hip, leading to increased upper-body oscillations that affect gait performance and stability, sustaining a vicious circle that transforms the upper body into a generator of perturbations. The use of motion analysis laboratories allows a deeper segmental and global characterization of walking impairment in these patients and can shed light on the nature of both the primary specific gait disorder and compensatory mechanisms. Such deeper understanding might reasonably represent a valid prerequisite for establishing better-targeted rehabilitation strategies.
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Affiliation(s)
- Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy.
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Istituto Nazionale per l'Assicurazione contro gli Infortuni sul Lavoro, Rome, Italy
| | - Carlo Casali
- Department of Medical and Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
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Ramakrishnan T, Muratagic H, Reed KB. Combined gait asymmetry metric. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:2165-2168. [PMID: 28268761 DOI: 10.1109/embc.2016.7591158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
People with physical impairments often have asymmetric gait. To evaluate if their overall symmetry is improving during intervention, there needs to be a simple metric that can help classify gait patterns that includes multiple measures of gait asymmetry. The Combined Gait Asymmetry Metric presented here is based on the Mahalanobis distance of multiple step parameters. We tested able-bodied subjects with perturbations that involve a change in leg length, the addition of ankle weights, and a combination of both perturbations. The Mahalanobis distances are calculated from perfect symmetry to all points in the data to analyze the effects of the different perturbations. The metric demonstrates how an overall view of symmetry can give a better perspective of asymmetry than only looking at a few individual parameters. This metric is straightforward and can be extended to include large numbers of spatiotemporal, kinematic, and kinetic parameters that more completely evaluate a change in gait symmetry.
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Dependence of Gait Deviation on Weight-Bearing Asymmetry and Postural Instability in Children with Unilateral Cerebral Palsy. PLoS One 2016; 11:e0165583. [PMID: 27788247 PMCID: PMC5082807 DOI: 10.1371/journal.pone.0165583] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 10/16/2016] [Indexed: 11/22/2022] Open
Abstract
Postural control deficits have been suggested to be a major component of gait disorders in children with cerebral palsy. The purpose of this study was to investigate the relationship between postural stability and treadmill walking, in children with unilateral cerebral palsy, by defining dependence between the posturographic weight-bearing distribution and center of pressure (CoP) sway during quiet standing with Gillette Gait Index and the 16 distinct gait parameters that composed the Gillette Gait Index. Forty-five children with unilateral cerebral palsy from 7–12 years of age were included in this study. A posturographic procedure and 3-dimensional instrumented gait analysis was developed. In general, across the entire tested group, the significant correlations concerned only the asymmetry of the weight bearing and a few of the distinct gait parameters that compose the Gillette Gait Index; moreover, correlation coefficients were low. The division of subjects into two clinical subgroups: children that exhibited a tendency to overload (1) and to underload (2) the affected body side, modified the results of the explored relationships. Our findings revealed that the difficulties experienced by children with hemiplegia while controlled in a standing position result from tendency to excessively or insufficiently load the affected lower limbs, and thus establishes a direct relationship with inadequate affected peak ankle DF in both stance and swing gait phases. Given the presented relationship between postural instability and deviation of the particular gait parameters in children with unilateral cerebral palsy, a follow-up study will be needed to determine the therapeutic approaches that will be most effective in promoting increased improvement in gait pattern, as well as the static and dynamic balance in standing.
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Helwig NE, Shorter KA, Ma P, Hsiao-Wecksler ET. Smoothing spline analysis of variance models: A new tool for the analysis of cyclic biomechanical data. J Biomech 2016; 49:3216-3222. [DOI: 10.1016/j.jbiomech.2016.07.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 06/09/2016] [Accepted: 07/31/2016] [Indexed: 11/26/2022]
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Szopa A, Domagalska-Szopa M, Gallert-Kopyto W, Kiebzak W, Plinta R. Effect of a nonsurgical treatment program on the gait pattern of idiopathic toe walking: a case report. Ther Clin Risk Manag 2016; 12:139-46. [PMID: 26937193 PMCID: PMC4762432 DOI: 10.2147/tcrm.s95052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Recent studies have reported many possibilities for the treatment of idiopathic toe walking (ITW); however, none of them have been sufficiently documented. The purpose of this case study was to document the evolution of the gait pattern of a child with severe ITW using the Gillette Gait Index before and after the third and sixth weeks, a nonsurgical treatment program and then every 3 months to 1 year from the start of the treatment. This is significant because the case study shows that a nonsurgical treatment program can be an alternative treatment method for children with severe ITW. CASE DESCRIPTION The case study involved a 5-year-old boy diagnosed with severe ITW. An orthopedist recommended a surgical treatment, but his parents refused to provide consent. INTERVENTION The subject participated in a 12-week nonsurgical treatment program that used tone-inhibiting casts (TICs) combined with physiotherapy based on neurodevelopmental treatment principles. The treatment protocol included the following: 1) precast preparation; 2) TICs with treatment; and 3) post-cast treatment to improve the gait pattern. OUTCOMES After treatment with TICs, the range of motion of ankle dorsiflexion during stance had increased, resulting in an almost normalized gait. The patient stopped toe walking for at least 1 year. DISCUSSION This study demonstrates that nonsurgical treatment should be considered first, with surgical options reserved for resistant cases; however, further research is required given the current lack of knowledge about treatment outcomes using TICs and the wide use of this treatment modality in children with ITW.
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Affiliation(s)
- Andrzej Szopa
- Department of Physiotherapy, Medical University of Silesia, Katowice, Kielce, Poland
| | - Małgorzata Domagalska-Szopa
- Department of Medical Rehabilitation, School of Health Sciences, Medical University of Silesia, Katowice, Kielce, Poland
| | | | - Wojciech Kiebzak
- Faculty of Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Ryszard Plinta
- Department of Adapted Physical Activity and Sport, School of Health Sciences, Medical University of Silesia, Katowice, Poland
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Tao W, Zhang X, Chen X, Wu D, Zhou P. Multi-scale complexity analysis of muscle coactivation during gait in children with cerebral palsy. Front Hum Neurosci 2015; 9:367. [PMID: 26257622 PMCID: PMC4510417 DOI: 10.3389/fnhum.2015.00367] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 06/09/2015] [Indexed: 11/13/2022] Open
Abstract
The objective of this study is to characterize complexity of lower-extremity muscle coactivation and coordination during gait in children with cerebral palsy (CP), children with typical development (TD) and healthy adults, by applying recently developed multivariate multi-scale entropy (MMSE) analysis to surface electromyographic (EMG) signals. Eleven CP children (CP group), eight TD children and seven healthy adults (considered as an entire control group) were asked to walk while surface EMG signals were collected from five thigh muscles and three lower leg muscles on each leg (16 EMG channels in total). The 16-channel surface EMG data, recorded during a series of consecutive gait cycles, were simultaneously processed by multivariate empirical mode decomposition (MEMD), to generate fully aligned data scales for subsequent MMSE analysis. In order to conduct extensive examination of muscle coactivation complexity using the MEMD-enhanced MMSE, 14 data analysis schemes were designed by varying partial muscle combinations and time durations of data segments. Both TD children and healthy adults showed almost consistent MMSE curves over multiple scales for all the 14 schemes, without any significant difference (p > 0.09). However, distinct diversity in MMSE curve was observed in the CP group when compared with the control group. There appears to be diverse neuropathological processes in CP that may affect dynamical complexity of muscle coactivation and coordination during gait. The abnormal complexity patterns emerging in the CP group can be attributed to different factors such as motor control impairments, loss of muscle couplings, and spasticity or paralysis in individual muscles. This study expands our knowledge of neuropathology of CP from a novel point of view of muscle co-activation complexity, which might be useful to derive a quantitative index for assessing muscle activation characteristics as well as motor function in CP.
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Affiliation(s)
- Wen Tao
- Neuromuscular Control Laboratory, Department of Electronic Science and Technology, University of Science and Technology of ChinaHefei, China
| | - Xu Zhang
- Neuromuscular Control Laboratory, Department of Electronic Science and Technology, University of Science and Technology of ChinaHefei, China
| | - Xiang Chen
- Neuromuscular Control Laboratory, Department of Electronic Science and Technology, University of Science and Technology of ChinaHefei, China
| | - De Wu
- Department of pediatrics, First Affiliated Hospital of Anhui Medical UniversityHefei, China
| | - Ping Zhou
- Neuromuscular Control Laboratory, Department of Electronic Science and Technology, University of Science and Technology of ChinaHefei, China
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, TIRR Memorial Hermann Research CenterHouston, TX, USA
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The use of the Gait Deviation Index for the evaluation of participants following total hip arthroplasty: An explorative randomized trial. Gait Posture 2015; 42:36-41. [PMID: 25957650 DOI: 10.1016/j.gaitpost.2015.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 01/23/2015] [Accepted: 02/21/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In this paper, the Gait Deviation Index (GDI) was used as a convenient method to evaluate pre-to-postoperative gait pattern changes after total hip arthroplasty and identify factors which might be predictive of outcome. DESIGN Three-dimensional gait data from a randomized clinical trial was used to determine changes in gait quality in participants walking at self-selected speed. Upon completion of the first assessment, the participants were randomly assigned to either resurfacing hip arthroplasty or conventional hip arthroplasty. The outcome was changes in overall gait 'quality' measured with GDI during the 6-month post-surgery follow-up period. RESULTS 38 participants with severe unilateral primary hip osteoarthritis took part in the trial. We found no difference in change scores between the two treatment groups; 1.9 [95%CI: -0.3 to 4.0] or between change scores for the non-operated and the operated limbs; 0.3 [95%CI: -2.3 to 1.7]. However, the score for the two groups (pooled data) improved after surgery by 4.4 [95%CI: 1.8-7.0]. The single level regression analysis identified the preoperative GDI score as a strong predictor of outcome (p<0.001). CONCLUSION Six months after surgery, there was no additional effect of resurfacing hip arthroplasty on GDI scores compared with conventional hip arthroplasty. Participants with the most pathological preoperative gait pattern improved the most. The GDI increased, which indicates an overall improvement in gait pathology after surgery. TRIAL REGISTRATION NCT01229293.
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Szopa A, Domagalska–Szopa M, Kidoń Z, Syczewska M. Quadriceps femoris spasticity in children with cerebral palsy: measurement with the pendulum test and relationship with gait abnormalities. J Neuroeng Rehabil 2014; 11:166. [PMID: 25516151 PMCID: PMC4277843 DOI: 10.1186/1743-0003-11-166] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 12/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Development of a reliable and objective test of spasticity is important for assessment and treatment of children with cerebral palsy. The pendulum test has been reported to yield reliable measurements of spasticity and to be sensitive to variations in spasticity in these children. However, the relationship between the pendulum test scores and other objective measures of spasticity has not been studied. The present study aimed to assess the effectiveness of an accelerometer-based pendulum test as a measurement of spasticity in CP, and to explore the correlation between the measurements of this test and the global index of deviation from normal gait in in children with cerebral palsy. METHODS We studied thirty-six children with cerebral palsy, including 18 with spastic hemiplegia and 18 with spastic diplegia, and a group of 18 typically-developing children. Knee extensor spasticity was assessed bilaterally using the accelerometer-based pendulum test and three-dimensional gait analysis. The Gillette Gait Index was calculated from the results of the gait analysis. RESULTS The data from the accelerometer-based pendulum test could be used to distinguish between able-bodied children and children with cerebral palsy. Additionally, two of the measurements, first swing excursion and relaxation index, could be used to differentiate the degree of knee extensor spasticity in the children with cerebral palsy. Only a few moderate correlations were found between the Gillette Gait Index and the pendulum test data. CONCLUSIONS This study demonstrates that the pendulum test can be used to discriminate between typically developing children and children with CP, as well as between various degrees of spasticity, such as spastic hemiplegia and spastic diplegia, in the knee extensor muscle of children with CP. Deviations from normal gait in children with CP were not correlated with the results of the pendulum test.
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Affiliation(s)
- Andrzej Szopa
- />School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | | | - Zenon Kidoń
- />Institute of Electronics, Silesian University of Technology, Gliwice, Poland
| | - Małgorzata Syczewska
- />Paediatric Rehabilitation Department, The Children’s Memorial Health Institute, Warszawa, Poland
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Szopa A, Domagalska-Szopa M, Czamara A. Gait pattern differences in children with unilateral cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:2261-2266. [PMID: 24946266 DOI: 10.1016/j.ridd.2014.05.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 05/12/2014] [Accepted: 05/29/2014] [Indexed: 06/03/2023]
Abstract
Children with cerebral palsy (CP) often have atypical body posture patterns and abnormal gait patterns resulting from functional strategies to compensate for primary anomalies that are directly attributable to damage to the central nervous system. Our previous study revealed two different postural patterns in children with unilateral CP: (1) a pattern with overloading of the affected body side and (2) a pattern with under-loading of the affected side. The purpose of present study was to test whether different gait patterns dependent on weight distribution between the affected and unaffected body sides could be detected in these children. The study included 45 outpatients with unilateral CP and 51 children with mild scoliosis (reference group). The examination consisted of two inter-related parts: paedobarographic measurements of the body mass distribution between the body sides and three-dimensional instrumented gait analysis. Using cluster analysis based on the Gillette Gait Index (GGI) values, three gait patterns were described: a scoliotic gait pattern and two hemiplegic gait patterns, corresponding to overloading/under-loading of the hemi-side, which are the pro-gravitational gait pattern (PGP) and the anti-gravitational gait pattern (AGP), respectively. The results of this study showed that subjects with AGP presented a higher degree of deviation from the normal gait than children with PGP. This proof that there are differences in the GGI between the AGP and PGP could be a starting point to identify kinematic differences between these gaits in a follow-up study.
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Affiliation(s)
- Andrzej Szopa
- School of Health Sciences, Medical University of Silesia, Medyków 12, Katowice 40-752, Poland.
| | | | - Andrzej Czamara
- College of Physiotherapy, Kościuszki 4, Wrocław 50-038, Poland.
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Assessment of waveform similarity in clinical gait data: the linear fit method. BIOMED RESEARCH INTERNATIONAL 2014; 2014:214156. [PMID: 25126548 PMCID: PMC4122015 DOI: 10.1155/2014/214156] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 06/19/2014] [Indexed: 12/02/2022]
Abstract
The assessment of waveform similarity is a crucial issue in gait analysis for the comparison of kinematic or kinetic patterns with reference data. A typical scenario is in fact the comparison of a patient's gait pattern with a relevant physiological pattern. This study aims to propose and validate a simple method for the assessment of waveform similarity in terms of shape, amplitude, and offset. The method relies on the interpretation of these three parameters, obtained through a linear fit applied to the two data sets under comparison plotted one against the other after time normalization. The validity of this linear fit method was tested in terms of appropriateness (comparing real gait data of 34 patients with cerebrovascular accident with those of 15 healthy subjects), reliability, sensitivity, and specificity (applying a cluster analysis on the real data). Results showed for this method good appropriateness, 94.1% of sensitivity, 93.3% of specificity, and good reliability. The LFM resulted in a simple method suitable for analysing the waveform similarity in clinical gait analysis.
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Dhahbi W, Zouita A, Ben Salah F, Chaouachi A, Chamari K, Chèze L. Reference database of the gait cycle for young healthy Tunisian adults. Ing Rech Biomed 2014. [DOI: 10.1016/j.irbm.2013.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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van Drongelen S, Dreher T, Heitzmann DWW, Wolf SI. Gait patterns in twins with cerebral palsy: similarities and development over time after multilevel surgery. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:1595-1601. [PMID: 23475009 DOI: 10.1016/j.ridd.2013.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 02/04/2013] [Accepted: 02/05/2013] [Indexed: 06/01/2023]
Abstract
To examine gait patterns and gait quality, 7 twins with cerebral palsy were measured preoperatively and after surgical intervention. The aim was to study differences and/or similarities in gait between twins, the influence of personal characteristics and birth conditions, and to describe the development of gait over time after single event multilevel surgery. A standardized clinical exam and a three-dimensional gait analysis were performed. Gait patterns were classified according to Sutherland and Davids, and the Gillette Gait Index was calculated as a global measure of the gait impairment. Next to subject characteristics at time of first measurement, and at time of birth, birth conditions were collected. Gait patterns were determined as crouch gait in 13 legs, as stiff gait in 6 legs and as jump gait in 8 legs. One leg showed a normal gait pattern. The knee flexion-extension angle correlated most constant with the knee flexion-extension angle of the contralateral leg (range 0.91-0.99). Correlations with the legs of the sibling showed variable correlations (range 0.44-0.99); with all other legs medium to high correlations of 0.73-0.91 were found. The Gillette Gait Index was found to initially decrease after surgical intervention. Similar correlations were found between twins or between legs for the gait pattern expressed by the knee flexion-extension angle, and the Gillette Gait Index improved after surgery. It seems that gait quality in twins with cerebral palsy is characterized predominantly by the traumatic disorder: genetic dispositions and personal characteristics only play a negligible role.
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Affiliation(s)
- Stefan van Drongelen
- Department of Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
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Gait parameters in a reference sample of healthy Spanish schoolchildren: Multivariate descriptive statistics and asymmetries observed in left and right cycles. NEUROLOGÍA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.nrleng.2012.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Does gender influence the long-term outcome of single-event multilevel surgery in spastic cerebral palsy? J Pediatr Orthop B 2012; 21:448-51. [PMID: 22027704 DOI: 10.1097/bpb.0b013e32834d4daa] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study compared the long-term outcome of single-event multilevel surgery in spastic diplegic cerebral palsy (CP) on the basis of sex. We hypothesized that boys would have a worse outcome than girls. Thirty-four children (19 boys and 15 girls) with diplegic spastic CP and a minimal follow-up of 10 years were included. The Gillette Gait Index was the main outcome measure. We found no differences in surgical treatment, and both groups initially benefited from the surgery. However, although girls maintained the enhanced level of walking, walking ability in boys deteriorated constantly. Such a finding suggests that sex might have an important influence on treatment outcomes in children with CP.
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Pulido-Valdeolivas I, Gómez-Andrés D, Martín-Gonzalo JA, López-López J, Gómez-Barrena E, Sánchez Hernández JJ, Rausell E. Gait parameters in a reference sample of healthy Spanish schoolchildren: multivariate descriptive statistics and asymmetries observed in left and right cycles. Neurologia 2012; 28:145-52. [PMID: 22703633 DOI: 10.1016/j.nrl.2012.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 03/17/2012] [Accepted: 04/01/2012] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Instrumental gait analysis is an emerging technology used increasingly to evaluate motor disorders in children. Normal reference data is necessary in order to evaluate patients, but there are few reference resources for the Spanish paediatric population. OBJECTIVE We aim to describe the values of 16 clinically relevant gait variables in healthy Spanish schoolchildren, and identify any linear associations or left-right asymmetries. SUBJECTS AND METHODS The values of 16 gait variables were determined in schoolchildren (n=27, aged 5-13 years) using instrumental gait analysis. We analysed asymmetries for each variable (Student's t-test for dependent samples) and calculated their confidence intervals (95% of the standardised difference in right and left means [SMD]). Values and associations between variables were represented using a heat map. RESULTS Our project presents normal values tables for 16 variables in the gait cycle. Significant asymmetries were detected in the mean values for minimum hip flexion (SMD: 0.25 95% CI, 0.11-0.39) and peak hip abduction in swing (SMD: -1.05 95% CI: -1.71--0.27). Functional associations among gait variables are present. CONCLUSIONS We present a reference dataset for Spanish school-aged children in which left-right asymmetries and functional associations may be observed for different variables.
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Affiliation(s)
- I Pulido-Valdeolivas
- TRADESMA, Instituto de investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
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Galli M, Cimolin V, De Pandis MF, Schwartz MH, Albertini G. Use of the Gait Deviation Index for the Evaluation of Patients With Parkinson's Disease. J Mot Behav 2012; 44:161-7. [DOI: 10.1080/00222895.2012.664180] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kark L, Vickers D, McIntosh A, Simmons A. Use of gait summary measures with lower limb amputees. Gait Posture 2012; 35:238-43. [PMID: 22000790 DOI: 10.1016/j.gaitpost.2011.09.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Revised: 09/06/2011] [Accepted: 09/13/2011] [Indexed: 02/02/2023]
Abstract
Gait summary measures have been developed as a convenient method to communicate overall gait pathology. These measures are primarily used in the context of paediatric cerebral palsy and their use remains largely untested in other disability groups. This study assessed the suitability of gait summary measures for use with lower limb amputees. Modified (m) versions of three published gait summary measures were investigated - the Gillette Gait Index (mGGI), the Gait Deviation Index (mGDI) and the Gait Profile Score (mGPS) in conjunction with the Movement Analysis Profile (MAP). Twenty unilateral lower limb amputees underwent three-dimensional gait analysis. All measures reported significant differences between levels of amputation on the prosthetic limb. The mGGI and mGPS detected significant differences between the levels of amputation on the intact side, but the mGDI did not. All gait summary measures were moderately to strongly correlated with leg-length normalised self-selected walking speed and strong correlations were reported between all measures. The MAP exposed common strategies in amputee gait and showed that sagittal hip and knee kinematics contributed predominantly to overall gait deviation in this population group. The mGGI, mGDI and mGPS identified, quantified and stratified gait pathology, indicating that any of the gait measures investigated in this study can be applied as outcome measures in research and case management in lower limb amputees.
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Affiliation(s)
- Lauren Kark
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, NSW 2052, Australia.
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Influence of the structural deformity of the spine on the gait pathology in scoliotic patients. Gait Posture 2012; 35:209-13. [PMID: 21978792 DOI: 10.1016/j.gaitpost.2011.09.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 08/22/2011] [Accepted: 09/04/2011] [Indexed: 02/02/2023]
Abstract
Scoliosis is not only a spinal deformity, but also leads to the development of a pathological gait pattern. Nearly all studies examining walking in scoliotic patients report some degree of gait abnormality, however the results are somewhat contradictory. Therefore the aim of this study is to explore the relationship between gait pathology and degree of scoliotic deformity in a group of patients with idiopathic scoliosis. Sixty three females with idiopathic scoliosis, aged between 12 and 17 participated in the study. They were not treated previously, neither surgically, nor conservatively. They underwent objective gait analysis with a VICON 460 system. Data for the following parameters were analysed: gait velocity, cadence, step length, pelvic tilt, pelvic retraction, pelvic range of motion in the transverse plane, pelvic obliquity, hip and knee range of motion in the sagittal plane, knee flexion at initial contact, ankle dorsiflexion in swing, foot progression angle. Additionally a Gillette Gait Index (GGI) was calculated. Prior to the gait analysis all patients underwent a clinical examination, an X-ray, clinical tests and anthropometric measurements. In conclusion our results indicate that the gait pathology of the patients with idiopathic thoraco-lumbar (i.e. double curve) scoliosis depends on the severity of the spinal deformity and the type of pelvic deformity.
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Gouelle A, Megrot F, Presedo A, Pennecot GF, Yelnik A. Validity of Functional Ambulation Performance Score for the evaluation of spatiotemporal parameters of children's gait. J Mot Behav 2011; 43:95-100. [PMID: 21298587 DOI: 10.1080/00222895.2010.538768] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Gait characteristics of a healthy adult population have been used to develop the Functional Ambulation Profile (FAP) score to evaluate gait in patients with neuromuscular or musculoskeletal involvement (A. J. Nelson, 1974). Further technological progress allowed a more precise recording of walk parameters and propitiated the development of the Functional Ambulation Performance Score (FAPS). The authors aimed to explore the evolution of the FAPS in healthy children to determine what the lower limit of age would be to ensure reliability of this score. Participants were 32 children with normal development. A GAITRite® walkway was used to log the spatiotemporal parameters. Compared with values obtained in adults, the average FAPS was significantly lower for children under 12 years old. The interparticipant variability was particularly high for the younger children and decreased with age. Similar trends were observed regarding the intraparticipant variability. In conclusion, the authors observed that the FAPS is not suitable to compare the gait of different children younger than 12 years old. At least, the adult standards used to calculate FAPS would need to be modified if the score has to be applied to a pediatric population.
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Affiliation(s)
- Arnaud Gouelle
- Plateforme d'Analyse du Mouvement, Hopital Robert Debre, Paris, France.
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Barthélémy I, Barrey E, Aguilar P, Uriarte A, Le Chevoir M, Thibaud JL, Voit T, Blot S, Hogrel JY. Longitudinal ambulatory measurements of gait abnormality in dystrophin-deficient dogs. BMC Musculoskelet Disord 2011; 12:75. [PMID: 21489295 PMCID: PMC3103492 DOI: 10.1186/1471-2474-12-75] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 04/13/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to measure the gait abnormalities in GRMD (Golden retriever muscular dystrophy) dogs during growth and disease progression using an ambulatory gait analyzer (3D-accelerometers) as a possible tool to assess the effects of a therapeutic intervention. METHODS Six healthy and twelve GRMD dogs were evaluated twice monthly, from the age of two to nine months. The evolution of each gait variable previously shown to be modified in control and dystrophin-deficient adults was assessed using two-ways variance analysis (age, clinical status) with repeated measurements. A principal component analysis (PCA) was applied to perfect multivariate data interpretation. RESULTS Speed, stride length, total power and force significantly already decreased (p<0.01) at the age of 2 months. The other gait variables (stride frequency, relative power distributions along the three axes) became modified at later stages. Using the PCA analysis, a global gait index taking into account the main gait variables was calculated, and was also consistent to detect the early changes in the GRMD gait patterns, as well as the progressive degradation of gait quality. CONCLUSION The gait variables measured by the accelerometers were sensitive to early detect and follow the gait disorders and mirrored the heterogeneity of clinical presentations, giving sense to monitor gait in GRMD dogs during progression of the disease and pre-clinical therapeutic trials.
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Affiliation(s)
- Inès Barthélémy
- UPR de Neurobiologie, Ecole Nationale Vétérinaire d’Alfort, 94704 Maisons-Alfort, France
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Quantitative effects of repeated muscle vibrations on gait pattern in a 5-year-old child with cerebral palsy. Case Rep Med 2011; 2011:359126. [PMID: 21826147 PMCID: PMC3150156 DOI: 10.1155/2011/359126] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 12/26/2010] [Accepted: 02/10/2011] [Indexed: 11/18/2022] Open
Abstract
Objective. To investigate quantitatively and objectively the effects of repeated muscle vibration (rMV) of triceps surae on the gait pattern in a 5-year-old patient with Cerebral Palsy with equinus foot deformity due to calf spasticity. Methods. The patient was assessed before and one month after the rMV treatment using Gait Analysis. Results. rMV had positive effects on the patient's gait pattern, as for spatio-temporal parameters (the stance duration and the step length increased their values after the treatment) and kinematics. The pelvic tilt reduced its anteversion and the hip reduced the high flexion evidenced at baseline; the knee and the ankle gained a more physiological pattern bilaterally. The Gillette Gait Index showed a significant reduction of its value bilaterally, representing a global improvement of the child's gait pattern. Conclusions. The rMV technique seems to be an effective option for the gait pattern improvement in CP, which can be used also in very young patient. Significant improvements were displayed in terms of kinematics at all lower limb joints, not only at the joint directly involved by the treatment (i.e., ankle and knee joints) but also at proximal joints (i.e., pelvis and hip joint).
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Muniz AMS, Liu H, Lyons KE, Pahwa R, Liu W, Nadal J. Quantitative evaluation of the effects of subthalamic stimulation on gait in Parkinson's disease patients using principal component analysis. Int J Neurosci 2010; 120:609-16. [PMID: 20707636 DOI: 10.3109/00207454.2010.504904] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Principal component analysis (PCA) was applied to the ground reaction force (GRF) for evaluating the deep brain stimulation of the subthalamic nucleus (DBS-STN) effects in Parkinson's disease (PD) subjects with and without medication. METHODS Ten subjects who underwent DBS-STN were evaluated under the following four conditions: without treatment (mof-sof), with stimulation (mof-son), with medication (mon-sof), and with both treatments (mon-son). A control group of 30 subjects was also evaluated. PCA was applied separately on each GRF component. Broken stick criterion selected eight principal components (PC) from vertical GRF and one from each horizontal GRF. A standard distance was calculated using these 10 PCs and the gait speed to measure how far the PD group's gait was from the normal pattern. RESULTS The standard distance allowed classifying normal and PD subjects in the mof-sof condition with 100% accuracy, sensitivity, and specificity. The same distance was calculated for mon-sof, mof-son, and mon-son conditions. The smallest mean standard distance was found in the mon-son condition, which was significantly different from mof-sof (Friedman test with Dunn post-hoc, p < .05). CONCLUSION PCA allowed the quantitative evaluation of treatment effects, indicating that DBS-STN improves the GRF pattern in PD subjects, primarily in the medication on state.
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Affiliation(s)
- A M S Muniz
- Department of Postgraduation, Physical Education College of Brazilian Army, Rio de Janeiro, Brazil
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Barton GJ, Hawken MB, Scott MA, Schwartz MH. Movement deviation profile: a measure of distance from normality using a self-organizing neural network. Hum Mov Sci 2010; 31:284-94. [PMID: 20728953 DOI: 10.1016/j.humov.2010.06.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Revised: 06/11/2010] [Accepted: 06/15/2010] [Indexed: 11/28/2022]
Abstract
We introduce the Movement Deviation Profile (MDP), which is a single curve showing the deviation of an individual's movement from normality. Joint angles, recorded from typically developing children over one gait cycle, were used to train a self-organizing map (SOM) which then generated MDP curves for patients with gait problems. The mean MDP over the gait cycle showed a high correlation (r(2) = .927) with the Gait Deviation Index (GDI), a statistically significant difference between groups of patients with a range of functional levels (Gillette Functional Assessment Questionnaire Walking Scale 7-10) and a trend of increasing values for patients with cerebral palsy through hemiplegia I-IV, diplegia, triplegia, and quadriplegia. The small difference between the MDP and GDI can be explained by the SOM's method of operation comparing biomechanical patterns to the nearest abstract reference pattern, and its flexibility to compensate for temporal shifts in movement data. The MDP is an alternative method of processing complex biomechanical data, potentially supporting clinical interpretation. The electronic addendum accompanying this article is a standalone program, which can be used to calculate the MDP from gait data, and can also be used in other applications where the deviation of multi-channel temporal data from a reference is required.
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Affiliation(s)
- Gabor J Barton
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom.
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Tedroff K, Löwing K, Haglund-Akerlind Y, Gutierrez-Farewik E, Forssberg H. Botulinum toxin A treatment in toddlers with cerebral palsy. Acta Paediatr 2010; 99:1156-62. [PMID: 20222884 DOI: 10.1111/j.1651-2227.2010.01767.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS In this study the aim was to evaluate the effect of botulinum toxin A (BoNT-A) treatment on muscle tone, contracture development and gait pattern in young children with cerebral palsy (CP). METHOD Fifteen children with spastic CP (mean age = 16 months) were included in a randomized control study. All received a daily stretching programme and children in the BoNT-A group additionally received two injections, 6 months apart in the gastrocnemius muscle. Outcomes were assessed at baseline, and after 1 and 3.5 years. A 3D gait-analysis was performed at 5 years of age. RESULTS Plantarflexor muscle tone in the BoNT-A group was significantly reduced after 3.5 years, while the muscle tone at the ankle and knee in the control group remained unchanged. The change-score in knee-flexion muscle tone between the groups was significantly different after 3.5 years. The knee joint ROM was significantly increased at 1 year in the BoNT-A group but reduced at the knee and ankle joints in the control group after 3.5 years. No group differences were found for gait analysis, GMFM-66 or PEDI. CONCLUSION Early treatment of BoNT-A in children with spastic CP may decrease muscle tone and decelerate contracture development after 3.5 years. The effect on gait development remains inconclusive.
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Affiliation(s)
- K Tedroff
- Neuropediatric Unit, Astrid Lindgren Children's Hospital, Department of Woman and Child Health, Karolinska Institutet, Stockholm, Sweden.
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Syczewska M, Dembowska-Bagińska B, Perek-Polnik M, Kalinowska M, Perek D. Gait pathology assessed with Gillette Gait Index in patients after CNS tumour treatment. Gait Posture 2010; 32:358-62. [PMID: 20630761 DOI: 10.1016/j.gaitpost.2010.06.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 06/07/2010] [Accepted: 06/13/2010] [Indexed: 02/02/2023]
Abstract
Brain tumour is the third leading cause of death in children and adolescents younger than 16 years of age. The increasing survival rate of these patients makes their follow-up and quality of life assessment an important task. This study evaluated the gait pathology of the patients after the combined treatment for central nervous system (CNS) tumours. It assessed if the severity of gait deviation depended on the tumour site or age of illness onset. Gait analysis was performed on patients who completed the treatment (neurosurgery, chemo- and radiotherapy) and were disease-free at the time of the study. One hundred and five patients, 42 girls and 63 boys, aged 5-24 years of age, participated in the study. Depending on the location of the tumour, patients were divided into six groups. The Gillette Gait Index (GGI) was used to quantify gait deviation of patients compared to healthy subjects. Gait analysis was undertaken using VICON 460 movement analysis system. The Helen Hayes marker set was used, together with the Vicon Plug-in-Gait model. For each child the GGI was calculated separately for the left and right legs using data extracted from the subjects' averaged data. The results from left and right legs were then pooled together. To determine the effect of the tumour site and the onset of illness the ANOVA Kruskal-Wallis and correlation tests were used. The GGI did not depend on the tumour site, but demonstrated significant gait pathology in all patients. The age of illness onset appeared to influence the severity of gait deviation.
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Affiliation(s)
- Małgorzata Syczewska
- Department of Paediatric Rehabilitation, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, Warsaw, Poland.
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Abstract
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.
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Assi A, Ghanem I, Lavaste F, Skalli W. Gait analysis in children and uncertainty assessment for Davis protocol and Gillette Gait Index. Gait Posture 2009; 30:22-6. [PMID: 19321345 DOI: 10.1016/j.gaitpost.2009.02.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Revised: 01/28/2009] [Accepted: 02/16/2009] [Indexed: 02/02/2023]
Abstract
The protocol of Davis is widely used in children's gait analysis, especially in cerebral palsy studies and its repeatability was evaluated primarily for adults. The aim of this research was to evaluate the uncertainty and repeatability of this protocol for children. 56 asymptomatic children aged 5-15 years performed the gait exam. Kinematics parameters and Gillette Gait Index (GGI) were calculated. 17 subjects performed the exam twice with markers replacement. Uncertainties on gait parameters were evaluated using repeatability study and Monte Carlo simulations. Uncertainty (2SD of test-retest differences) obtained on angles calculated by the protocol varied between +/-2 degrees and +/-3 degrees (for pelvis and hip in sagittal and frontal planes) and +/-14 degrees (for mean hip rotation). Uncertainty on GGI was +/-12 for healthy subjects. Monte Carlo simulations on 30 cerebral palsy children showed that the error on GGI could reach +/-100 and was correlated to GGI value (R2=0.92): 2SD=24+0.09xGGI.
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Affiliation(s)
- Ayman Assi
- Laboratoire de Biomécanique, CNRS UMR 8005, Arts et Métiers ParisTech, 151, Boulevard de l'Hôpital, 75013 Paris, France.
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Tulchin K, Campbell S, Browne R, Orendurff M. Effect of sample size and reduced number of principle components on the Gillette Gait Index. Gait Posture 2009; 29:526-9. [PMID: 19233654 DOI: 10.1016/j.gaitpost.2009.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Revised: 12/23/2008] [Accepted: 01/06/2009] [Indexed: 02/02/2023]
Abstract
The Gillette Gait Index uses principle components analysis of 16 variables to determine the deviation of an individual's gait compared to a normal control set. Previous literature has not reported on the effects of altering the size of the control set used to create the principle components, or described the effects of using less than the maximum number of principle components, 16, to calculate the Gillette Gait Index (GGI). Calculations of the GGI were determined for a group of 24 able-bodied normal subjects and 24 cerebral palsy subjects using 128 control subjects allotted into 15 subsets of varying sizes, from N=16-128. A minimum of 40 controls were needed for GGI estimates to achieve less than approximately 20% error, and 96 controls were needed for less than 10% error, if all 16 principle components were used. With smaller control sets, an alternative method to increase the accuracy would be to use only those principle components that represent 95% of the variance. Caution must still be used when describing differences in GGI among groups, or changes in an individual's GGI over time. In addition, absolute changes in GGI should always be reported, as differences as great as 150 were seen in cerebral palsy patients across control groups, even when greater than 40 controls are used to create the principle components.
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Affiliation(s)
- Kirsten Tulchin
- Texas Scottish Rite Hospital for Children, Movement Science Laboratory, 2222 Welborn Street, Dallas, TX 75219, USA.
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Mao Y, Saito M, Kanno T, Wei D, Muroi H. Walking pattern analysis and SVM classification based on simulated gaits. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2009; 2008:5069-72. [PMID: 19163856 DOI: 10.1109/iembs.2008.4650353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Three classes of walking patterns, normal, caution and danger, were simulated by tying elastic bands to joints of lower body. In order to distinguish one class from another, four local motions suggested by doctors were investigated stepwise, and differences between levels were evaluated using t-tests. The human adaptability in the tests was also evaluated. We improved average classification accuracy to 84.50% using multiclass support vector machine classifier and concluded that human adaptability is a factor that can cause obvious bias in contiguous data collections.
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Affiliation(s)
- Yuxiang Mao
- Graduate School of Computer Science and Engineering, University of Aizu, Aizu-Wakamatsu City, Fukushima 965-8580, Japan
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Muniz AMS, Nadal J. Application of principal component analysis in vertical ground reaction force to discriminate normal and abnormal gait. Gait Posture 2009; 29:31-5. [PMID: 18640040 DOI: 10.1016/j.gaitpost.2008.05.015] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2007] [Revised: 05/19/2008] [Accepted: 05/27/2008] [Indexed: 02/02/2023]
Abstract
Discrete parameters from ground reaction force (GRF) are been considered in gait analysis studies. However, principal component analysis (PCA) may provide additional insight into gait analysis for considering the complete pattern of GRF. This study aimed at testing the application of PCA to discriminate the vertical GRF pattern between control group (CG) and patients with lower limb fractures (FG), as well as proposing a score to quantify the abnormality of gait. Thirty-eight healthy subjects participated of CG and 13 subjects in FG, five subjects from FG were also evaluated after physiotherapeutic treatment (FGA). The GRF was measured by an instrumented treadmill. Principal component coefficients (PCCs) were obtained by singular value decomposition using GRF of complete stride. Two, four and six PCCs were used to obtain the standard distance (D). The classification between groups was mainly given by the first PC, which indicated higher loading factors during push off of affected side and heel strike of unaffected side. The classification performance achieved 92.2% accuracy with two PCCs, 94.1% with four PCCs and 96.1% with six PCCs. Four subjects reached normal boundary after treatment, with all FGA subjects presenting decreased D. This study demonstrates that PCA is an adequate method for discriminating normal and abnormal gait and D allows an objective evaluation of the progress and effectiveness of rehabilitation treatment.
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Affiliation(s)
- A M S Muniz
- Federal University of Rio de Janeiro, Biomedical Engineering Program, COPPE, Rio de Janeiro, Brazil
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Viehweger E, Haumont T, de Lattre C, Presedo A, Filipetti P, Ilharreborde B, Lebarbier P, Loundou A, Simeoni MC. Multidimensional outcome assessment in cerebral palsy: is it feasible and relevant? J Pediatr Orthop 2008; 28:576-83. [PMID: 18580376 DOI: 10.1097/bpo.0b013e31817bd7ef] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND To examine feasibility and relevance of a multidimensional outcome assessment approach using instrumented 3-dimensional gait analysis, via the Gillette Gait Index (GGI), and a set of validated functional and health-related quality of life tools in diplegic cerebral palsy children, before introduction as a nationwide evaluation set. METHODS A 3-year prospective government-funded multicenter study was conducted, recruiting patients during a 9-month period classified using the Gross Motor Function Classification System and the Rodda et al sagittal walking patterns. The Gross Motor Classification System Dimensions D and E, the 10-level Gillette Functional Assessment Questionnaire, the Energy Expenditure Index (EEI), the GGI out of 3D gait analysis, and health-related quality of life, assessed by self or proxy with the questionnaire "Vècu et Santè Perçu de l'Adolescent," were selected for the study. RESULTS Cross-sectional data subset at inclusion of 160 spastic diplegic cerebral palsy patients, the largest series in our country, 6 to 18 years old (mean age, 11.0 years), are reported. The GGI correlated significantly (P < 0.001) with the Gross Motor Classification System, the Functional Assessment Questionnaire, and the EEI for all the patients, and all but one (EEI) correlated if grouped according to Gross Motor Function Classification System or Rodda. No systematic correlation was found between the quality of life scores and the other outcome tools. CONCLUSIONS The outcome evaluation instrument set tested in our study helps to adopt common tools, to be integrated in an evidence-based practice and to compare health status and treatment outcome between countries, specifically in different linguistic environments like in European countries.
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Affiliation(s)
- Elke Viehweger
- Department of Pediatric Orthopaedics, Children's Hospital Timone, 264 Rue Saint Pierre, Marseille Cedex 05, France.
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Stout JL, Gage JR, Schwartz MH, Novacheck TF. Distal femoral extension osteotomy and patellar tendon advancement to treat persistent crouch gait in cerebral palsy. J Bone Joint Surg Am 2008; 90:2470-84. [PMID: 18978417 DOI: 10.2106/jbjs.g.00327] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hallmarks of a persistent crouched walking pattern exhibited by individuals with cerebral palsy usually include loss of an adequate plantar flexion/knee extension couple, hamstring and/or psoas tightness, or contracture in conjunction with quadriceps insufficiency. Traditional treatment addresses the muscle-tightness component, but not the contracture or the muscle insufficiency. This study was performed to evaluate the effectiveness of distal femoral extension osteotomy and/or patellar tendon advancement in the treatment of crouch gait in patients with cerebral palsy. METHODS A retrospective, nonrandomized, repeated-measures design was used. Individuals with a diagnosis of cerebral palsy were included if they had had (1) a distal femoral extension osteotomy in combination with a distal patellar tendon advancement (thirty-three patients), (2) a distal femoral extension osteotomy without patellar tendon advancement (sixteen), or (3) a distal patellar tendon advancement only (twenty-four). All subjects were evaluated with preoperative and postoperative gait analysis. Gait, radiographic, strength, and functional measures were included in the analysis to assess changes in knee function. RESULTS Seventy-three individuals met the criteria for inclusion. A single side was chosen for the analysis of each subject. Ninety percent of the subjects had additional, concurrent surgery. Improvements were noted in the index assessing the level of gait pathology and in functional variables across all groups, and pain was consistently decreased. All preoperative stress fractures healed. Strength levels were maintained across all groups. The Koshino index of patellar height improved from 1.4 to -2.3 in the group treated with patellar tendon advancement only and from 1.5 to -2.9 in the group treated with both osteotomy and tendon advancement. The range of knee flexion improved an average of 15 degrees to 20 degrees, and stance-phase knee flexion was restored to the typical range (9 degrees to 10 degrees) in the groups that had advancement of the patellar tendon as part of the procedure. Individuals who underwent a distal femoral osteotomy only were still in a crouch (a mean of 31 degrees of knee flexion in midstance) at the final assessment. CONCLUSIONS Inclusion of patellar tendon advancement is necessary to achieve optimal results in the surgical management of a persistent crouch gait exhibited by adolescents and young adults with cerebral palsy. When this procedure is done alone or in combination with a distal femoral extension osteotomy (for the treatment of a knee flexion contracture), knee function in gait can be restored to values within typical limits, with gains in community function.
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Affiliation(s)
- Jean L Stout
- Center for Gait and Motion Analysis, Gillette Children's Specialty Healthcare, 200 East University Avenue, St. Paul, MN 55101, USA.
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Intersite variations of the Gillette Gait Index. Gait Posture 2008; 28:483-7. [PMID: 18439828 DOI: 10.1016/j.gaitpost.2008.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Revised: 02/12/2008] [Accepted: 03/05/2008] [Indexed: 02/02/2023]
Abstract
The Gillette Gait Index (GGI) is a tool used to measure pathologic gait severity and assess outcomes. The purpose of this study is to assess the variation in calculated GGI values with different sets of control data. Five able bodied control sets from four labs were used to establish the basis of the GGI. Gait data from three pediatric patients seen pre- and post-operatively at one lab and one adult control subject that visited each lab were input to calculate GGI values. Differences in underlying control data created large differences in computed GGI values for both pathologic and able bodied subjects. Initial pre-operative GGI values calculated for the three patients with cerebral palsy using different control data sets varied widely with differences as large as 1129 and had magnitudes of improvement differing by as much as 800 (or 21%). GGI value differences greater than 250 were determined from an able bodied control subject seen at each lab, both when examining a single trial with different control sets, and when examining different trials of the same individual collected from different labs using a single control set. These results highlight the importance of the underlying control set for establishing mean values and variance in the GGI and suggest that if GGI values are compared longitudinally or between sites these comparisons should be based on a single control dataset.
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Trost JP, Schwartz MH, Krach LE, Dunn ME, Novacheck TF. Comprehensive short-term outcome assessment of selective dorsal rhizotomy. Dev Med Child Neurol 2008; 50:765-71. [PMID: 18834390 DOI: 10.1111/j.1469-8749.2008.03031.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study retrospectively evaluated the safety and efficacy of selective dorsal rhizotomy (SDR) in participants who underwent a rigorous selection process, uniform surgical procedure, and a standardized postoperative rehabilitation process. Outcome measures assessed were the Ashworth scale for spasticity, the Gillette Gait Index (GGI) for overall gait pathology, oxygen cost for gait efficiency, and the Gillette Functional Assessment Questionnaire (functional walking ability scale; [FAQ]) for functional mobility. Outcomes were evaluated for 136 children (81 males, 55 females; mean age 7y 3mo [SD 2y 1mo], range 3y 5mo-18y 9mo) for an average of 18.3 months (SD 4.4mo) postoperatively. All participants had a diagnosis of cerebral palsy (CP): 10 quadriplegia, 19 triplegia, and 107 diplegia. Preoperative Gross Motor Function Classification System levels were: Level I n=6; Level II n=64; Level III n=59, and Level IV n=7. All outcome measures improved for the group as a whole. Spasticity improved with 66 to 92% of possible gain in Ashworth scores; GGI was 7.5 times more likely to have a good as opposed to a poor outcome; energy efficiency improved in over half of the participants, and the FAQ demonstrated a statistically significant improvement of 0.9 levels (p<0.001). The rate of complications was low, with peri- and postoperative complications resolved by time of discharge.
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Affiliation(s)
- Joyce P Trost
- Centre for Gait and Motion Analysis, Gillette Children's Specialty Healthcare, St Paul, MN, USA.
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Schwartz MH, Rozumalski A. The Gait Deviation Index: a new comprehensive index of gait pathology. Gait Posture 2008; 28:351-7. [PMID: 18565753 DOI: 10.1016/j.gaitpost.2008.05.001] [Citation(s) in RCA: 405] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Accepted: 05/03/2008] [Indexed: 02/06/2023]
Abstract
This article describes a new multivariate measure of overall gait pathology called the Gait Deviation Index (GDI). The first step in developing the GDI was to use kinematic data from a large number of walking strides to derive a set of mutually independent joint rotation patterns that efficiently describe gait. These patterns are called gait features. Linear combinations of the first 15 gait features produced a 98% faithful reconstruction of both the data from which they were derived and 1000 validation strides not used in the derivation. The GDI was then defined as a scaled distance between the 15 gait feature scores for a subject and the average of the same 15 gait feature scores for a control group of typically developing (TD) children. Concurrent and face validity data for the GDI are presented through comparisons with the Gillette Gait Index (GGI), Gillette Functional Assessment Questionnaire Walking Scale (FAQ), and topographic classifications within the diagnosis of Cerebral Palsy (CP). The GDI and GGI are strongly correlated (r(2)=0.56). The GDI scales with FAQ level, distinguishes levels from one another, and is normally distributed across FAQ levels six to ten and among TD children. The GDI also scales with respect to clinical involvement based on topographic CP classification in Hemiplegia Types I-IV, Diplegia, Triplegia and Quadriplegia. The GDI offers an alternative to the GGI as a comprehensive quantitative gait pathology index, and can be readily computed using the electronic addendum provided with this article.
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Gough M, Shafafy R, Shortland AP. Does sex influence outcome in ambulant children with bilateral spastic cerebral palsy? Dev Med Child Neurol 2008; 50:702-5. [PMID: 18754921 DOI: 10.1111/j.1469-8749.2008.03038.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To investigate the effect of sex on the phenotype of bilateral spastic cerebral palsy (CP) we reviewed the gait analysis data of 116 children (78 males, mean age 8 y 1 mo [SD 3 y 1 mo] and 38 females, mean age 8 y 9 mo [3 y 1 mo]) with bilateral spastic CP (Gross Motor Function Classification System [GMFCS] Levels I [four males, six females]; II [41 males, 19 females]; III [26 males, 12 females]; and IV [7 males, 1 female]) who had been referred for gait analysis to inform treatment. Although there were no differences between males and females in terms of gestational age, chronological age, or GMFCS level, males were more likely to have had nonoperative intervention before the referral (p=0.024), had a greater degree of knee flexion in stance phase when walking (p=0.003), and had a higher Gillette Gait Index (p<0.001) when compared with females. Males were also more likely to have surgery recommended on the basis of gait analysis (p<0.001). Sex seems to influence the development of the musculoskeletal system and mobility in ambulant children with bilateral spastic CP, and this may need to be considered when planning intervention or when assessing the outcome of intervention.
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Affiliation(s)
- M Gough
- One Small Step Gait Laboratory, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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Gough M, Schneider P, Shortland AP. The outcome of surgical intervention for early deformity in young ambulant children with bilateral spastic cerebral palsy. ACTA ACUST UNITED AC 2008; 90:946-51. [DOI: 10.1302/0301-620x.90b7.20577] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We reviewed the outcome in 24 children with bilateral spastic cerebral palsy aged seven years or younger for whom surgery was recommended between 1999 and 2005 following gait analysis. A total of 13 children (operative group) had surgery and the remaining 11 (control group) did not, for family or administrative reasons. The operative group had at least two post-operative gait analyses at yearly intervals, with eight children having a third and six children a fourth. The control group had a second analysis after a mean interval of 1.5 years (95% confidence interval 1.1 to 1.9). In the operative group, the Gillette gait index, the ranges of movement in the lower limb joint and knee extension in stance improved following surgery, and this was maintained overall at the second post-operative analysis. The minimum knee flexion in stance in the control group increased between analyses. These results suggest that surgical intervention in selected children can result in improvements in gait and function in the short to medium term compared with non-operative management.
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Affiliation(s)
- M. Gough
- Gait Laboratory, One Small Step Gait Laboratory Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, St Thomas’ Street, London SE1 9RT, UK
| | - P. Schneider
- Gait Laboratory, One Small Step Gait Laboratory Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, St Thomas’ Street, London SE1 9RT, UK
| | - A. P. Shortland
- Gait Laboratory, One Small Step Gait Laboratory Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, St Thomas’ Street, London SE1 9RT, UK
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Wren TAL, Do KP, Hara R, Dorey FJ, Kay RM, Otsuka NY. Gillette Gait Index as a gait analysis summary measure: comparison with qualitative visual assessments of overall gait. J Pediatr Orthop 2008; 27:765-8. [PMID: 17878782 DOI: 10.1097/bpo.0b013e3181558ade] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Gillette Gait Index (GGI) is a summary measure incorporating 16 clinically important kinematic and temporal parameters. The purpose of this study was to compare GGI scores from computerized gait analysis versus qualitative visual assessments of overall gait to assess the validity of the GGI as a summary score for gait analysis. METHODS The GGI was calculated for 25 children with cerebral palsy who underwent computerized gait analysis before and 1 year after lower extremity surgery to correct gait problems. Twelve observers reviewed video recordings from the gait analysis to assess the severity of each patient's gait impairment preoperatively and postoperatively and the amount of preoperative to postoperative change. Variability of the video ratings was assessed, and GGI scores were compared with the mean video ratings. RESULTS The individual ratings showed some variability, with moderate intrarater agreement (weighted kappa = 0.49-0.56) and slight to fair interrater agreement (kappa = 0.11-0.25). However, the mean scores from all raters were much more consistent, as demonstrated by a highly significant relationship in preoperative to postoperative change viewing the videos separately versus together (r2 = 0.62; P = 0.0001). GGI scores were correlated with these mean scores preoperatively (r2 = 0.34; P = 0.003), postoperatively (r2 = 0.30; P= 0.005), and in preoperative to postoperative change (r2 = 0.30, P = 0.006 for absolute change; r2 = 0.22, P = 0.02 for percentage change). CONCLUSIONS These results support the validity of GGI as a gait analysis summary score and suggest that GGI may be a useful outcome measure in patients undergoing gait analysis. CLINICAL RELEVANCE Clinicians and researchers should consider using the GGI as a quantitative outcome measure for assessing overall gait.
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Affiliation(s)
- Tishya A L Wren
- Childrens Orthopaedic Center, Childrens Hospital Los Angeles, CA 90027, USA.
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