Measuring Outcomes for Children with Cerebral Palsy Who Use Gait Trainers

Abstract

Gait trainers are walking devices that provide additional trunk and pelvic support. The primary population of children using gait trainers includes children with cerebral palsy (CP) functioning at Gross Motor Function Classification System (GMFCS) levels IV and V. A recent systematic review found that evidence supporting the effectiveness of gait trainer interventions for children was primarily descriptive and insufficient to draw firm conclusions. A major limitation identified was the lack of valid, sensitive and reliable tools for measuring change in body structure and function, activity and participation outcomes. Twelve different clinical tools were identified in the systematic review and in this paper we review and discuss the evidence supporting their reliability, validity and clinical utility for use with children using gait trainers. We also describe seven additional clinical measurement tools that may be useful with this intervention and population. The Pediatric Evaluation of Disability Inventory (PEDI) rated highest across all areas at this time. Individualized outcome measures, such as the Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling and measuring user satisfaction with tools, such as the Quebec User Evaluation of Satisfaction with assistive Technology, show potential for gait trainer outcomes research. Spatiotemporal measures appear to be less useful than functional measures with this intervention and population. All tools would benefit from further development for use with children with CP functioning at GMFCS levels IV and V.

The Experience of Locomotor Training From the Perspectives of Therapists and Parents of Children With Cerebral Palsy

“…In children and youth with CP, controlled trials have largely focused on activity capacity motor outputs, such as improvements in walking speed ( 9 , 25 ) and endurance ( 29 ). However, reports in this study are consistent with previously reported uncontrolled trials and case series which provided early evidence of outcomes beyond walking speed and endurance which include improved confidence and mood ( 7 ), improved weight acceptance and transfers ( 30 ), reduced caregiver support, improved skills in gait trainers, and improved bowel function ( 31 ). In addition to this, parents provided the context of the perceived improvements that were meaningful to them.…”

Kindy Moves: the feasibility of an intensive interdisciplinary programme on goal and motor outcomes for preschool-aged children with neurodisabilities requiring daily equipment and physical assistance

“…The fPRC conceptualises a health condition and the interplay of various constructs based on the WHO’s International Classification of Functioning, Disability and Health (ICF) 50. The GAS is valid and reliable,51 and has detected change across a variety of paediatric populations 52. The GAS produces a t-score for analysis, with a t-score of 50 or more indicating clinical meaningfulness 53.…”

Locomotor and robotic assistive gait training for children with cerebral palsy

“…Individually specific goals -GAS The GAS was used to enable individualized goal setting for activity and participation outcome measures with excellent measurement properties across all GMFCS levels. 19 Goals on the GAS were set on the basis of goals identified by parents on the Canadian Occupational Performance Measure (COPM). 20 Each GAS was individualized enabling more detail from the COPM to be objectively assessed and scored by the assessor who was blinded to group allocation.…”

“…For children with CP that require gait trainers, there are limited motor-based outcome measures that have strong psychometric properties and this is an important area for future research. 19 The selection of the 10mWT is a limitation and though walking speed is associated with functional ability and quality of life in children with CP both with and without gait trainers, 25 there is inadequate data to support the psychometric properties of the 10mWT in children functioning in GMFCS levels IV and V. The 10mWT only provides an indication on walking speed leaving the descriptive aspects of the gait trainer unaccounted for. This includes changes in the degree of support, quality of steps, steering, and verbal prompting.…”