Three-Dimensional Instrumented Gait Analysis for Children With Cerebral Palsy: An Evidence-Based Clinical Practice Guideline.

Background: Children with cerebral palsy (CP) who walk have complex gait patterns and deviations often requiring physical therapy (PT)/medical/surgical interventions. Walking in children with CP can be assessed with 3-dimensional instrumented gait analysis (3D-IGA) providing kinematics (joint angles), kinetics (joint moments/powers), and muscle activity.

Purpose: This clinical practice guideline provides PTs, physicians, and associated clinicians involved in the care of children with CP, with 7 action statements on when and how 3D-IGA can inform clinical assessments and potential interventions.

Is peak hamstrings muscle-tendon length criterion a sufficient indicator to recommend against surgical lengthening of hamstrings?

Background: Excessive knee flexion during stance in children with cerebral palsy is often treated by surgical hamstrings lengthening. Pre-operative hamstrings muscle-tendon length can be estimated from kinematics and often used for decision making to rule out surgical lengthening if peak hamstrings muscle-tendon length is 'Not Short'.

Research Question: If peak hamstrings muscle-tendon length is within two standard deviations of typical, is that a sufficient indicator to rule out surgical hamstrings lengthening?

Methods: Three motion analysis centers retrospectively identified children with cerebral palsy, age 6-17 years, who had consecutive gait analyses with knee flexion at initial contact > 20° and popliteal angle > 35° at initial study.

The long-term effects of aggressive spasticity reducing treatment, including selective dorsal rhizotomy, on joint kinematic outcomes of persons with cerebral palsy.

Background: Selective dorsal rhizotomy (SDR) creates a large and permanent reduction of spasticity for children with cerebral palsy (CP). Previous SDR outcomes studies have generally lacked appropriate control groups, had limited sample sizes, or reported short-term follow-up, limiting evidence for improvement in long-term gait function.

Research Question: Does aggressive spasticity management for individuals with CP improve long-term gait kinematics (discrete joint kinematics) compared to a control group of individuals with CP with minimal spasticity management?

Methods: This study was a secondary analysis - focused on joint-level kinematics - of a previous study evaluating the long-term outcomes of SDR.

Symmetry of Shoe Size and Calf Girth in Children With Treated Idiopathic Clubfoot: A Longitudinal Study.

Background: Treatments for idiopathic clubfoot focus on obtaining a functional foot, typical gait pattern, and activity participation. Patients and families are also concerned about practical considerations regarding shoe wear and the appearance of the calf. The purpose of this study was to quantify whether children treated for idiopathic clubfoot have symmetry differences in shoe size and calf girth when presenting with unilateral versus bilateral involvement.

Instrumented Gait Analysis (IGA) for Management of Children With Cerebral Palsy: A Needs Assessment Survey.

Purpose: This needs assessment survey identifies the priorities of the clinical and research communities involved with the use of instrumented gait analysis (IGA) for a clinical practice guideline on IGA use with children with cerebral palsy (CP).

Methods: Thirteen Likert scale questions asked about the importance of topics related to IGA. Other questions addressed respondents' demographics, experience with IGA, patient populations, and gait laboratory characteristics.

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

Aim: To understand the long-term effects of comprehensive spasticity treatment, including selective dorsal rhizotomy (SDR), on individuals with spastic cerebral palsy.

Method: This was a pre-registered, multicenter, retrospectively matched cohort study. Children were matched on age range and spasticity at baseline.

Instrumented gait analysis for management of gait disorders in children with cerebral palsy: A scoping review.

Background: The use of Instrumented Gait Analysis (IGA) for the clinical management of individuals with cerebral palsy (CP) has increased in recent years. Previous systematic reviews have been completed to evaluate and summarize the evidence related to the efficacy of IGA in general. However, a focused summary of research studies on IGA for children with CP related gait disorders is needed.

Children with Cerebral Palsy Have Similar Walking and Running Quality Assessed by an Overall Kinematic Index.

Running ability is critical to maintaining activity participation with peers. Children and adolescents with cerebral palsy (CP) are often stated to run better than they walk, but running is not often quantitatively measured. The purpose of this study was to utilize overall gait deviation indices to determine if children with diplegic CP run closer to typically developing children than they walk.

Synergies analysis produces consistent results between motion analysis laboratories.

Aim: The dynamic motor control index during walking (walk-DMC) is a scaled measure of motor control derived from electromyographic analysis of the lower extremity during gait. Walk-DMC has been shown to be related to patient outcomes and there has been an increasing interest from motion analysis centers regarding using this metric in their own practice. However, the methods for computing the index reported in the literature are not consistent.

Factors Influencing Outcomes of the Dysplastic Hip in Nonambulatory Children With Cerebral Palsy.

Background: Hip dysplasia in the nonambulatory child with spastic cerebral palsy (CP) is a common condition not always effectively treated with conservative measures even when recognized early. Optimal surgical intervention strategies and timing are not clear from previous studies. Contralateral hips with less severe subluxation in these patients also often undergo surgery and little is known of outcomes of these less severe hips.

Early Bony Hip Reconstructive Surgery for Hip Subluxation in Children With Severe Cerebral Palsy.

Hip subluxation occurs frequently in children with severe cerebral palsy. This retrospective study examined the effects of age and type of bony surgery on radiographic outcomes of children with severe cerebral palsy who were treated for hip subluxation. The study included nonambulatory children with cerebral palsy undergoing bony hip reconstructive surgery consisting of proximal femoral varus derotational osteotomy (VDRO) alone or combined with pelvic osteotomy.

The single portal percutaneous epiphysiodesis technique for treatment of leg length inequality stops growth as expected.

One technique for distal femur and proximal tibia epiphysiodesis to treat leg length inequality is a single-incision percutaneous technique using reamers and curettes. The purpose of this study is to demonstrate the efficacy and reliability of this technique by quantifying the growth arrest produced from this method. Patients who underwent distal femur and proximal tibia epiphysiodesis with a single-incision percutaneous technique were retrospectively reviewed.

Center of pressure metrics derived from spatially registered typically developing data.

Background: Pedobarography is a commonly used testing procedure in clinical gait analysis, yet has limited roles in quantification for treatment planning, outcome assessment, and classification. Spatial registration between plantar pressure and motion capture data allows for accurate quantitative assessment and metric development based on a typically developing cohort.

Research Question: This study assesses the validity of new center of pressure based metrics of anatomically registered pedobarography data by evaluating kinematic relationships over a broad spectrum of feet and by evaluating the sensitivity of these metrics to pathologies, interventions, and outcomes in two common clinical foot pathologies.

Comparing the effects of two spasticity management strategies on the long-term outcomes of individuals with bilateral spastic cerebral palsy: a multicentre cohort study protocol.

Introduction: Spasticity is one of the primary pathologies associated with cerebral palsy (CP), yet no definitive evidence exists to guide the appropriate level of spasticity management for an individual. Spasticity management strategies often differ by center. On one end of this strategy spectrum is a highly-interventional approach, characterized by treatments such as a selective dorsal rhizotomy (SDR), intrathecal baclofen pump (ITB), and anti-spasticity injections and medications.

Secondary Surgery Rates After Primary Fusion for Adolescent Idiopathic Scoliosis.

Instrumented spinal fusion is the gold standard treatment for surgical magnitude adolescent idiopathic scoliosis (AIS), with the goal being stable fusion without the need for additional procedures. The purpose of this study was to define the surgical return rates of AIS at a single center with respect to various instrumentation constructs used during initial spinal fusion. A retrospective chart review was performed of all patients with AIS who underwent instrumented fusion with a minimum of 2-year follow-up.

Quantitative coronal plane motion of hindfoot during clinical flexibility assessments.

Background: Common pediatric pathologic foot presentations include cavovarus and planovalgus feet. Flexibility of the hindfoot is established for these two clinical presentations through the Coleman block (eversion) and tiptoe tests (inversion).

Research Question: The purposes of this study are to establish typical quantitative eversion and inversion motion of the hindfoot during Coleman block and tiptoe tests using 3-D motion capture and demonstrate feasibility of using this data to assist in making treatment decisions.

Biomechanical changes associated with femoral derotational osteotomy.

Torsional deformities of the femur in children may occur as a result of either idiopathic or neuromuscular disorders and may be corrected with derotational osteotomies. Regardless of the underlying etiology, neither the effects of the torsional pathologies nor the alterations resulting from corrective osteotomies are well understood. A study of children with isolated femoral anteversion undergoing a single corrective procedure may assist in understanding the biomechanics of the pathology and the efficacy of surgical correction.

Long term gait outcomes of surgically treated idiopathic toe walkers.

Toe walking is a common gait deviation which in the absence of a known cause is termed idiopathic toe walking. Surgical treatment in the presence of a triceps surae contracture includes tendo-Achilles or gastrocnemius/soleus recession and has been shown to be effective in improving kinematic outcomes at a one year follow up. The purpose of this study was to assess longer term kinematic and kinetic outcomes of children with idiopathic toe walking treated surgically for gastrocnemius/soleus contractures.

Outcomes of Orthopaedic Surgery With and Without an External Femoral Derotational Osteotomy in Children With Cerebral Palsy.

Background: Ambulatory children with cerebral palsy (CP) often present with multiple deviations in all planes including increased internal hip rotation during gait. Excessive femoral anteversion is a common cause of deviation managed surgically with an external femoral derotational osteotomy (FDO). The purpose of this study was to evaluate the gait and functional outcomes of a group of subjects with CP who underwent surgical intervention that included an FDO compared with a match group with indications of internal hip rotation that did not receive an FDO.

Application of the Gillette Gait Index, Gait Deviation Index and Gait Profile Score to multiple clinical pediatric populations.

Gait indices are now commonly used to assess overall pathology and outcomes from studies with instrumented gait analyses. There are differences in how these indices are calculated and therefore inherent differences in their sensitivities to detect changes or differences between groups. The purpose of the current study was to examine the three most commonly used gait indices, Gillette Gait Index (GGI), Gait Deviation Index (GDI), and Gait Profile Score (GPS), comparing the statistical sensitivity and the ability to make meaningful interpretations of the clinical results.

Gait outcomes of patients with severe slipped capital femoral epiphysis after treatment by flexion-rotation osteotomy.

Background: Flexion-rotational osteotomy of the proximal femur is an accepted intervention in the management of severe deformity and femoral acetabular impingement secondary to slipped capital femoral epiphysis (SCFE). The impact of this surgical intervention on gait kinematics and kinetics, validated functional questionnaires, and patient outcomes has not been well studied. The purpose of this study was to analyze the changes in standard gait parameters of patients with moderate to severe SCFE who were treated with a flexion-rotational osteotomy.