The present study documents the correlation between gait analysis data and clinical measurements and evaluates the combined predictive value of static and dynamic clinical measurements on gait data of children with cerebral palsy. Two hundred patients were evaluated using a set of measurements of range of motion (ROM), alignment, spasticity, strength and selectivity, and by three-dimensional gait analysis. Fair to moderate correlations were found between clinical measurements and gait data, the overall highest correlation being 0.60. Clinical data of strength and selectivity had the highest degree of significant correlations with gait data, compared to the ROM and spasticity. ROM, spasticity and strength measurements for the hip in the coronal plane and spasticity of rectus femoris most frequently showed fair to moderate correlations to gait data. Time and distance and EMG parameters mainly correlated with strength and selectivity parameters. Unexpectedly, alignment parameters only fairly correlated with hip rotation in stance. Multiple regression analysis revealed that adding dynamic clinical measurements (spasticity, strength and selectivity) to a static model (ROM) enhanced the link between clinical measurements and gait data. The variance of gait parameters was better explained by a combined model of static and dynamic clinical measurements, compared to a purely static model. However, R 2 -values were low. Gait analysis data cannot be sufficiently predicted by a combination of clinical measurements. The independence of the measurements supports the notion that both, clinical examination and gait analysis data provide important information for delineating the problems of children with CP. #

Several studies indicated that walking with an ankle foot orthosis (AFO) impaired third rocker. The purpose of this study was to evaluate the effects of two types of orthoses, with similar goal settings, on gait, in a homogeneous group of children, using both barefoot and shoe walking as control conditions. Fifteen children with hemiplegia, aged between 4 and 10 years, received two types of individually tuned AFOs: common posterior leaf-spring (PLS) and Dual Carbon Fiber Spring AFO (CFO) (with carbon fibre at the dorsal part of the orthosis). Both orthoses were expected to prevent plantar flexion, thus improving first rocker, allowing dorsiflexion to improve second rocker, absorbing energy during second rocker, and returning it during the third rocker. The effect of the AFOs was studied using objective gait analysis, including 3D kinematics, and kinetics in four conditions: barefoot, shoes without AFO, and PLS and CFO combined with shoes. Several gait parameters significantly changed in shoe walking compared to barefoot walking (cadence, ankle ROM and velocity, knee shock absorption, and knee angle in swing). The CFO produced a significantly larger ankle ROM and ankle velocity during push-off, and an increased plantar flexion moment and power generation at pre-swing compared to the PLS (<0.01). The results of this study further support the findings of previous studies indicating that orthoses improve specific gait parameters compared to barefoot walking (velocity, step length, first and second ankle rocker, sagittal knee and hip ROM). However, compared to shoes, not all improvements were statistically significant.

Aim The aim of this study is to describe the course of motor development in children with Dravet syndrome. Method Forty‐three participants (21 males, 22 females; mean age at last assessment 53.89mo±42.50mo) met the inclusion criteria of having a confirmed diagnosis of Dravet syndrome and presence of data on motor development. All data between 1985 and 2018 were derived retrospectively from their medical records. Gross motor milestones and motor age equivalents were used to describe motor development. Standardized neurodevelopmental assessment and the Bayley Scales of Infant Development defined the overall motor development. Peabody Developmental Motor Scales, Bruininks‐Oseretsky Test of Motor Proficiency, and the Beery‐Buktenica Developmental Test of Visual‐Motor Integration were used to describe development in specific motor domains. Results Children with Dravet syndrome showed a delay in both sitting (seven out of 14) and walking independently (11 out of 25). Overall motor age equivalents revealed a delay in 29 out of 38 assessments (age 9–115mo). All assessments of children older than 2 years (16 out of 16) showed a delay. Gross motor delay was present in seven out of seven and fine motor delay in 10 out of 13 assessments (age 19–167mo). Interpretation Motor development is delayed in the majority of children with Dravet syndrome older than 2 years and increases with age. What this paper adds A delay in motor development is present in most children with Dravet syndrome older than 2 years. Large diversity in early gross motor milestones confirms heterogeneity in Dravet syndrome.

Objective: To quantify gait abnormalities in people with Dravet syndrome (DS).Methods: Individuals with a confirmed diagnosis of DS were enrolled. They were stratified according to knee flexion at initial contact (IC) and range of motion (ROM) during stance [crouch gait if knee flexion >20° at IC and knee range of motion (ROM) >15°; straight gait: knee flexion <20° at IC]. A 1D ANOVA (α = 0.05) was used to test statistical differences among the joint kinematics and spatio-temporal parameters of the cohort and an age-matched control group. Clinical (neurological and orthopedic evaluation) and anamnestic data (seizure type, drugs, genetic mutation) were collected; distribution between the two gait phenotypes was assessed with the Fisher exact test and, for mutation, with the chi-squared test (p-value < 0.05).Results: Seventy-one subjects were enrolled and evaluated with instrumented gait analysis. Fifty-two were included in the final analysis (mean age 13.8 ± 7.3; M 26). Two gait patterns were detected: an atypical crouch gait (34.6%) with increased ankle, knee and hip flexion during stance, and reduced walking speed and stride length without any muscle-tendon retraction; and a pattern resembling those of healthy age-matched controls, but still showing reduced walking speed and stride length. No difference in clinical or anamnestic data emerged between the two groups.Significance: Objectively quantified gait in DS shows two gait patterns with no clear-cut relation to clinical data. Kinematic parameters abnormalities are likely due to stabilization issues. These findings may guide rehabilitative and preventive measures.

Background: Dravet Syndrome is a rare developmental epileptic encephalopathy characterised by epileptic seizures, cognitive impairment and motor disorders. Gait is markedly impaired and could benefit from targeted intervention to improve quality of life for patient and caregivers.Objective: To establish the state of the art regarding gait deviations in patients with Dravet Syndrome.Methods: A systematic search was performed in Pubmed, Web of Science, Science Direct and Embase. Studies that assessed gait deviations in patients diagnosed with Dravet Syndrome using clinical observation, video gait analysis or three dimensional (3D) gait analysis and reported gait characteristics, spatiotemporal or kinematic outcomes were included. Screening, quality assessment and data extraction were performed by independent reviewers.Results: Out of a total of 478 citations, nine articles were included. The total study population had an age range from 2.5 to 47 years. Three studies used clinical observation, three studies video analysis and three studies 3D gait analysis. Crouch gait was observed in about half of the population next to a variety of other gait deviations such as parkinsonian and cerebellar gait. Other findings included abnormalities in spatiotemporal parameters and kinematics, passive knee extension deficits, skeletal malalignment and neurological signs. Conclusions:A variety of gait characteristics was observed with crouch gait being the most reported gait pattern. Inconsistency in methods and findings from clinical and instrumented evaluation impede thorough understanding of the causal mechanism and evolution behind these deviations.