Factors influencing post-surgical variability in StepWatch data in youth with cerebral palsy

Niiler, Tim; Nicholson, Kristen; Fischer, Lydia; Lennon, Nancy

doi:10.1016/j.gaitpost.2019.06.017

Cited by 11 publications

(18 citation statements)

References 12 publications

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“…16 Time since surgery, age, season, GMFCS level, and surgical burden are significant variables that may affect postoperative step counts for children with CP. 17 Surgical burden describes the challenges associated with the rehabilitation period for children with CP and their caregivers, which is correlated with the number of osteotomies completed in children. 17 Additionally, age, GMFCS level, and preoperative gait profile score are significant predictors of postoperative improvement in gait kinematics.…”

Section: Discussionmentioning

confidence: 99%

Walking activity after multilevel orthopedic surgery in children with cerebral palsy

Church¹,

Biermann²,

Lennon³

et al. 2022

Develop Med Child Neuro

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Cerebral palsy (CP) comprises a group of disorders with impairments of movement and posture due to non-progressive disturbances in the developing fetal or infant brain. 1 Children with CP develop gait deviations and functional impairment associated with muscle contractures and bony deformities, spasticity, limited motor control, decreased strength and balance, and delayed acquisition of gross motor skills. 2 Gait deviation can increase the energy cost of walking, 3 causing fatigue 4 and frequent joint pains, 5 resulting in a decrease in walking activity.Walking activity is quantified by counting the number of strides per day, which can be accomplished using a variety of activity monitors. Walking activity is an important outcome measure that aligns with the World Health Organization's International Classification of Function, Disability and Health: Children and Youth Version. 6 This classification system defines body structures, body function, activities and participation, and environmental factors as components of health and well-being. 6 Walking activity is associated with health-related physical fitness, 7 and children with CP have been reported to have decreased low-, medium-, and high-intensity walking activity (measured by strides per day) compared with typically developing adolescents. 8 Walking activity is associated with

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Section: Discussionmentioning

confidence: 99%

Walking activity after multilevel orthopedic surgery in children with cerebral palsy

Church¹,

Biermann²,

Lennon³

et al. 2022

Develop Med Child Neuro

Self Cite

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“…A previous study from our institution examining StepWatch data in children with CP created a practical method for quantifying the amount of surgery performed during SEMLS. [ 21 ] This system categorized patients from 1 (lowest surgical burden) to 5 (highest surgical burden) based on a number of factors including whether unilateral or bilateral surgery was performed, whether bony or soft-tissue procedures were performed, and the number of procedures performed. When applying this system to the patients in our cohort, all patients were rated at the highest surgical burden, which did not allow for patient stratification.…”

Section: Discussionmentioning

confidence: 99%

“…The challenge in studying SEMLS performed for lower extremity deformity in patients with CP is both the heterogeneity of procedures and the variance in the number of procedures included among patients [7] . Previous studies controlled for this either by examining 1 specific procedure performed in the context of SEMLS [18–20] or by quantifying the amount of surgery based on postoperative rehabilitation demands of each type of procedure [21] . However, these approaches do not reflect the operative time or resources required to complete SEMLS.…”

Section: Introductionmentioning

confidence: 99%

Single-event multilevel surgery in cerebral palsy

et al. 2021

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The aim of this study was to compare outcomes for single-event multilevel surgery (SEMLS) in cerebral palsy (CP) performed by 1 or 2 attending surgeons. A retrospective review of patients with CP undergoing SEMLS was performed. Patients undergoing SEMLS performed by a single senior surgeon were compared with patients undergoing SEMLS by the same senior surgeon and a consistent second attending surgeon. Due to heterogeneity of the type and quantity of SEMLS procedures included in this study, a scoring system was utilized to stratify patients to low and high surgical burden. The SEMLS events scoring less than 18 points were categorized as low burden surgery and SEMLS scoring 18 or more points were categorized as high burden surgery. Operative time, estimated blood loss, hospital length of stay, and operating room (OR) utilization costs were compared. In low burden SEMLS, 10 patients had SEMLS performed by a single surgeon and 8 patients had SEMLS performed by 2 surgeons. In high burden SEMLS, 10 patients had SEMLS performed by a single surgeon and 12 patients had SEMLS performed by 2 surgeons. For high burden SEMLS, operative time was decreased by a mean of 69 minutes in cases performed by 2 co-surgeons ( P = 0.03). Decreased operative time was associated with an estimated savings of $2484 per SEMLS case. In low burden SEMLS, a trend toward decreased operative time was associated for cases performed by 2 co-surgeons (182 vs 221 minutes, P = 0.11). Decreased operative time was associated with an estimated savings of $1404 per low burden SEMLS case. No difference was found for estimated blood loss or hospital length of stay between groups in high and low burden SEMLS. Employing 2 attending surgeons in SEMLS decreased operative time and OR utilization cost, particularly in patients with a high surgical burden. These findings support the practice of utilizing 2 attending surgeons for SEMLS in patients with CP. Level of Evidence: Level III

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“…174 Therefore, in the current study, the mean of two week-175 days and one weekend day was analysed to account for 176 this difference and to best capture overall activity lev-177 els. School term time versus school holidays as well as 178 seasonal variations in weather might also be expected 179 to impact on daily activity levels [30,31]. Therefore, 180 while the time of year of the assessment (school term 181 or summer) was not controlled in this study, the sea-182 son (spring, summer, fall, winter) was included in the 183 correlation analysis.…”

Section: Data Collection and Analysismentioning

confidence: 99%

“…Motor Function Classification System level (GMFCS) 196 were included in the overall correlation analysis as a 197 relationship between both PODCI scores and daily ac-198 tivity has previously been demonstrated in children with 199 CP [12,29]. Time of year (season) was included in the 200 correlation analysis of daily activity measures [30,31]. 201 Where both variables were continuous and normally 202 distributed, Pearson's correlation coefficients were cal-203 culated.…”

Section: Data Collection and Analysismentioning

confidence: 99%

The association between gait analysis measures associated with crouch gait, functional health status and daily activity levels in cerebral palsy

O’Sullivan

French

Rossom

et al. 2021

PRM

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PURPOSE: The aim of this study was to examine the relationship between gait analysis measures associated with crouch gait, functional health status and daily activity in ambulant cerebral palsy (CP). METHODS: Three-dimensional gait analysis was carried out on 35 ambulant participants with bilateral CP crouch gait (knee flexion at mid-stance (KFMS) ⩾ 190). KFMS, knee-flexion at initial contact, gait speed and step-lengths were extracted for analysis. Steps/day and sedentary time/day were assessed using an ActivPAL accelerometer. Functional health status was assessed using the five relevant domains of the Pediatric Outcomes Data Collection Instrument (PODCI) questionnaire. Associations between variables were assessed with correlation coefficients and multivariable linear regression. RESULTS: There were no significant correlations between KFMS and PODCI domains ρ=-0.008–0.110) or daily activity ρ=-0.297–0.237) variables. In contrast, multivariable analysis found that step-length was independently associated with the Sports and Physical Function (p= 0.030), Transfers and Basic Mobility (p= 0.041) and Global Function (< 0.001) domains of the PODCI assessment. Gait speed was independently associated with mean steps/day (p< 0.001). CONCLUSIONS: Step length and gait speed are more strongly associated with functional health status and daily activity than knee flexion during stance in children and adolescents with CP crouch gait.

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Factors influencing post-surgical variability in StepWatch data in youth with cerebral palsy

Cited by 11 publications

References 12 publications

Walking activity after multilevel orthopedic surgery in children with cerebral palsy

Walking activity after multilevel orthopedic surgery in children with cerebral palsy

Single-event multilevel surgery in cerebral palsy

The association between gait analysis measures associated with crouch gait, functional health status and daily activity levels in cerebral palsy

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