A study of deviation and asymmetry in a group of adolescents and young adults with unilateral cerebral palsy has led to the identification of four clinical groups that can be used to better diagnose and treat patients.
“The purpose [of the study] was to come up with a better classification system to help in diagnosing children with cerebral palsy and really, it could be applied to any population group with any kind of movement disorders,” Scott Coleman, a co-author of the study, told O&P Business News. “[The results] will help physicians to diagnose, plan treatment and [will] give them a better idea of the prognosis of that planning and treatment.”
3-D gait analysis and gait profile score
Coleman and colleagues studied 47 patients with spastic unilateral (hemiplegic) cerebral palsy ranging from age 13 years to 24 years. In 62% of the patients, the right side of the body was affected and for 38% the left side was affected. Criteria for exclusion from the group included any disease or injury previously affecting gait, substantial developmental delay or previous lower extremity surgery other than calf muscle lengthening surgery or spasticity treatment within the last year. Each patient was matched by age and gender to one of 15 individuals from a control group. Control group participants’ median age was 18.6 years.
A 3-D gait analysis was performed with an 8-camera motion capture system with data recorded at 100 Hz. The researchers calculated pelvic and hip angles in three planes; knee flexion/extension; angle doris/planar flexion; foot progression; shoulder flexion/extension; shoulder abduction/adduction; and wrist flexion/extension. Researchers recorded the gait variables, along with speed and distance parameters, as patients walked barefoot at a self-selected speed on a 10-meter walkway. A kinetic profile was developed for each patient using a minimum of five gaits per cycle.
The researchers calculated a gait profile score to describe lower extremity movement deviation during walking based on pelvis, hip, knee, ankle and foot in several dimensions. They also determined an arm posture score to describe the upper extremity movement deviation during walking, based on shoulder sagittal and frontal planes and elbow and wrist sagittal plane angles. Last, they measured asymmetry between extremities.
“We came out with four different groups, four classifications for this patient population,” Coleman said. Groups were identified as: close to normal; deviations mainly in the leg; deviations mainly in the arm; and those with deviations in the arm and leg. The exam also confirmed unilateral involvement. Coleman said the groups will aid in quantifying the extent of a patient’s disability.
Clinical use
“For patients with cerebral palsy, it is hard to identify the level of involvement and where that is happening. There are so many different things going on that it is hard to see just with the human eye. So this is a better way to quantify what exactly is happening and where it is happening,” Coleman said, adding, “Once they are in a group, then they will be able to better plan treatment. Maybe [they will plan] surgical intervention, bracing techniques [or] come up with a plan and then just know what to expect.”
The researchers recommended the use of the symmetry assessment in conjunction with the deviation scores in order to provide a more accurate and helpful diagnosis for each patient. Each child with cerebral palsy has different capabilities, and these categories will help physicians and practitioners make sure they reach their capabilities.
“The goal is to get them as functional as possible,” Coleman said. “This will help them know what potential is there.” — by Amanda Alexander
Lundh D. Clin Bio Mech. 2014;doi:10.1016/j.clinbiomech.2014.02.006.
Disclosure: Coleman has no relevant financial disclosures.
