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Domagalska-Szopa M1, Szopa A2, Hagner-Derengowska M3, Czamara A4, Królikowska A4
1Medical University of Silesia in Katowice, Department of Medical Rehabilitation, School of Health Sciences in Katowice, Katowice, Poland, 2Medical University of Silesia in Katowice, Department of Physiotherapy, School of Health Sciences in Katowice, Katowice, Poland, 3University of Nicolaus Copernicus, Department of Neuropsychology, Faculty of Health Science, Collegium Medicum Bydgoszcz, Toruń, Poland, 4College of Physiotherapy in Wrocław, Department of Physiotherapy, Wrocław, Poland
Background: Children with bilateral Cerebral Palsy represent different gait patterns. The numerous schemes with classification of gait deviation published in literature are not useful in functional physiotherapy planning. Encouraged by the promising findings of our previous researches which revealed different gait patterns in children with unilateral Cerebral Palsy we tried develop novel strategies for determining clinically meaningful patient clusters among children with bilateral palsy.
Purpose: The objective was to evaluate whether the different gait patterns corresponding to postural pattern in children with bilateral Cerebral Palsy could be statistically recognized using cluster analysis. The specific aim of evaluation was to estimate the differences in the degree of deviation from a normal gait to particular gait patterns. We searched in data to determine the differences in gait biomechanics between them.
Methods: There wererecruited to the study 45 children with bilateral Cerebral Palsy, who were patients of local paediatric rehabilitation centres (20 females and 25 males) aged from 7 to 13 years (mean age =10.6 y (SD 2y). As reference values an age- and sex-matched sample of 45 typically developing children (18 girls and 27 boys; mean age 10.2 y; SD 2y) were included to the study. Three-dimensional kinematic data were collected using Measuring System for 3D Motion Analysis (Zebris Medizintechnik GmbH, Germany). The gait data were recorded as the participants walked barefoot on a treadmill (Alfa XL, Kettler, Germany). To characterize the gait, the Gillette Gait Index (GGI) as well as the 16 distinct gait parameters they composed were use. Based on the results of our previous study, which was performed on the same participants, they were divided into 4 subgroups according to the postural patterns: 1) children with neutral posture represented by typically developing children; 2) children with forward-leaning posture; 3) children with balanced posture; and 4) children with backward-leaning posture.
Results: A cluster analysis revealed 3 gait patterns clearly correspond to the postural patterns defined as follows:
1) balanced gait pattern, corresponding to neutral and balanced posture (Cluster 1);
2) lordotic gait pattern, corresponding to forward-leaning posture (Cluster 2) and
3) swayback gait pattern, corresponding to backward-leaning posture (Cluster 3).
There were significant differences among the means of GGI and the various clusters for 8 distinct gait parameters that composed the GGI: 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(s): Our results showed that the discrepancy in gait among children with bilateral Cerebral Palsy was not simply a lower limb kinematic deviation in the sagittal plane. Additional altered kinematics, such as pelvic misorientation in the coronal and horizontal plane and inadequate swing phase hip abduction, which resulted from postural pattern features, were distinguished between the gait patterns in children with bilateral Cerebral Palsy.
Implications: Information on differences in gait patterns may be used to improve the guidelines for early therapy for children with bilateral Cerebral Palsy before abnormal gait patterns are fully established.
Keywords: Postural patterns, Gillette Gait Index, Cluster analysis
Funding acknowledgements: The authors declare that the research was conducted in the absence of any commercial or financial relationships
Purpose: The objective was to evaluate whether the different gait patterns corresponding to postural pattern in children with bilateral Cerebral Palsy could be statistically recognized using cluster analysis. The specific aim of evaluation was to estimate the differences in the degree of deviation from a normal gait to particular gait patterns. We searched in data to determine the differences in gait biomechanics between them.
Methods: There wererecruited to the study 45 children with bilateral Cerebral Palsy, who were patients of local paediatric rehabilitation centres (20 females and 25 males) aged from 7 to 13 years (mean age =10.6 y (SD 2y). As reference values an age- and sex-matched sample of 45 typically developing children (18 girls and 27 boys; mean age 10.2 y; SD 2y) were included to the study. Three-dimensional kinematic data were collected using Measuring System for 3D Motion Analysis (Zebris Medizintechnik GmbH, Germany). The gait data were recorded as the participants walked barefoot on a treadmill (Alfa XL, Kettler, Germany). To characterize the gait, the Gillette Gait Index (GGI) as well as the 16 distinct gait parameters they composed were use. Based on the results of our previous study, which was performed on the same participants, they were divided into 4 subgroups according to the postural patterns: 1) children with neutral posture represented by typically developing children; 2) children with forward-leaning posture; 3) children with balanced posture; and 4) children with backward-leaning posture.
Results: A cluster analysis revealed 3 gait patterns clearly correspond to the postural patterns defined as follows:
1) balanced gait pattern, corresponding to neutral and balanced posture (Cluster 1);
2) lordotic gait pattern, corresponding to forward-leaning posture (Cluster 2) and
3) swayback gait pattern, corresponding to backward-leaning posture (Cluster 3).
There were significant differences among the means of GGI and the various clusters for 8 distinct gait parameters that composed the GGI: 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(s): Our results showed that the discrepancy in gait among children with bilateral Cerebral Palsy was not simply a lower limb kinematic deviation in the sagittal plane. Additional altered kinematics, such as pelvic misorientation in the coronal and horizontal plane and inadequate swing phase hip abduction, which resulted from postural pattern features, were distinguished between the gait patterns in children with bilateral Cerebral Palsy.
Implications: Information on differences in gait patterns may be used to improve the guidelines for early therapy for children with bilateral Cerebral Palsy before abnormal gait patterns are fully established.
Keywords: Postural patterns, Gillette Gait Index, Cluster analysis
Funding acknowledgements: The authors declare that the research was conducted in the absence of any commercial or financial relationships
Topic: Paediatrics: cerebral palsy; Paediatrics
Ethics approval required: Yes
Institution: Medical University of Silesia, Poland
Ethics committee: Bioethics Committee of the Medical University of Silesia
Ethics number: NN-013-350/I/03/09
All authors, affiliations and abstracts have been published as submitted.
