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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE

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)
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European Journal of Physical and Rehabilitation Medicine 2015 February;51(1):39-48

Copyright © 2015 EDIZIONI MINERVA MEDICA

language: English

Gait analysis contribution to problems identification and surgical planning in CP patients: an agreement study

Ferrari A. 1, 2, Brunner R. 3, Faccioli S. 1, Reverberi S. 1, Benedetti M. G. 4

1 Children Rehabilitation Unit, IRCCS S. Maria Nuova Hospital, Reggio Emilia, Italy; 2 Neuroscience Department, University of Modena and Reggio Emilia, Modena, Italy; 3 Neuro-orthopaedics Department, University Children’s Hospital, Basel, Switzerland; 4 Physical Medicine and Rehabilitation Unit, Istituto Ortopedico Rizzoli, Bologna, Italy


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BACKGROUND: Previous studies have demonstrated that the use of gait analysis (GA) modifies decision making and changes planned surgical treatment, confirming some clinical indications or defining alternative choices, excluding or delaying already planned surgery in children with cerebral palsy (CP).
AIM: To assess the difference in defining functional problems and treatment relevance using clinical assessment or gait analysis in CP children.
DESIGN: The study has been designed for assessing the rate of agreement on muscle-skeletal diagnosis, and on surgical recommendations in diplegic CP patients, when decided by two different blinded clinicians based on a) clinical assessment, and b) GA in addition to clinical assessment.
POPULATION: Twenty-five diplegic children who have been evaluated by GA before surgery and at a follow up of at least 6 months.
METHODS: Two separate lists of problems and consequent surgical interventions were outlined for all the patients by two blinded experts from clinical and GA assessment. The two sets of nominal-scale ratings for all patients of the two groups were statistically evaluated for agreement.
RESULTS: A fair and a slight agreement was found respectively between the two sets of problems and the two sets of surgical plans. Main differences in problems identified were relative to the presence of generalized spasticity and bony deformities as detected by means of GA instead of local problems and soft tissues spasticity/retraction clinically identified. As a consequence, by means of GA, surgery was indicated only in 65% of patients.
CONCLUSION: The availability of a GA laboratory helps in diagnostic reasoning in CP children indicated for surgery. Low agreement found appears to be a result of a different clinical approach of the surgeons.
CLINICAL REHABILITATION IMPACT: The use of GA in the analysis of motor problems in CP children provides a basis for an objective reasoning for clinical decision making and for assessing functional outcome. Further efforts are required to build a body of knowledge about a consensus on the identification of walking problems in CP children.

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Cite this article as

Ferrari A, Brunner R, Faccioli S, Reverberi S, Benedetti MG. Gait analysis contribution to problems identification and surgical planning in CP patients: an agreement study. Eur J Phys Rehabil Med 2015 February;51(1):39-48. 

Corresponding author e-mail

benedetti@ior.it