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A Journal on Physical Medicine and Rehabilitation after Pathological Events

Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with International Society of Physical and Rehabilitation Medicine (ISPRM)
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Europa Medicophysica 2002 December;38(4):215-218

language: English

Gait patterns after traumatic brain injury

Gradenigo B.

Centro Car­dinal Fer­rari”, Fon­ta­nel­lato (­Parma)


Back­ground. ­Gait anal­ysis can be ­used to sub­di­vide a pop­u­la­tion of ­patients ­into dif­ferent ­groups, ­according to the pat­terns of move­ment. In ­this way it can be pos­sible to ­plan spe­cific ther­a­peutic inter­ven­tions for ­each pat­tern of move­ment. The clas­sifi­ca­tions of ­Knuttson, ­Winter, ­Muroy and ­Perry are exam­ined.
­Methods. The clas­sifi­ca­tion of ­gait pat­terns pro­posed by ­Knuttson is ­based on goni­o­metric ­data for the ­knee and the ­ankle and on emg. The clas­sifi­ca­tion of ­Winter is ­based on goni­o­metric ­data ­from the ­3 prin­cipal ­joints of the leg. The clas­sifi­ca­tion of ­Mulroy and ­Perry is ­based on ­velocity and goni­o­metric ­data ­from the ­knee at ter­minal ­stance ­phase and at preswing ­phase. ­These clas­sifi­ca­tions, orig­i­nally ­addressing ­patients ­with cereb­ro­vas­cular dis­ease, are ­used for a ­group of 14 sub­jects ­with trau­matic ­brain ­injury.
­Results. ­According to ­Knuttson’s clas­sifi­ca­tion ­patients are ­divided as fol­lows: ­type I (pre­ma­ture acti­va­tion of ­calf mus­cles) no. 7 (50%), ­type II (­marked low­ering of emg ­activity) 0 (0%), ­type III (co-acti­va­tion) no. 4 (29%), ­type IV (­more com­plex ­types) no. 3 (21%). There­fore ­with the clas­sifi­ca­tion of ­Knuttson is pos­sible to ­assign 79% of ­patients, ­while 21% of ­cases are ­labeled as ­type IV (­more com­plex ­types). ­According to the clas­sifi­ca­tion of ­Winter ­patients are ­divided as fol­lows: ­group I (insuf­fi­cient ­ankle con­trol) no. 6 (43%), ­group II (­same ­problem ­plus ­ankle ­plantar ­flexion in ­stance ­phase) no. 3 (21%), ­group III (reduc­tion of ­knee ­flexion ­motion in the ­swing ­phase due to quad­ri­ceps over­ac­tivity) no. 1 (7%), ­group IV (­same ­problem of ­group III, ­plus ­flexed posi­tion of the hip ­with ­reducted ­range of ­motion) no. 2 (14%), ­plus 2 unclas­si­fi­able sub­jects (14%). ­According to ­Mulroy and ­Perry’s clas­sifi­ca­tion ­patients are ­divided as fol­lows: ­group 1 (­fast) no. 5 (36%), ­group 2 (mod­erate) no. 6 (43%), ­group 3 (­flexed) no. 1 (7%), ­group 4 (­extended) no. 2 (14%).
Con­clu­sions. ­This ­study sug­gests ­that the ­gait clas­sifi­ca­tions ­born for the ­upper ­motor ­neuron ­lesion due to cereb­ro­vas­cular dis­ease can be use, yet ­with ­some lim­i­ta­tions, in sub­jects ­with trau­matic ­brain ­injury. Of the 3 clas­sifi­ca­tion exam­ined the clas­sifi­ca­tion of ­Mulroy and ­Perry ­seems to fit ­better ­with ­this ­type of ­patients as it is pos­sible to ­assign all ­patients, ­although ­some iso­lated goni­o­metric ­values are dif­ferent ­from the ­expected ­ones.

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