Multidimensional Outcome Assessment in Cerebral Palsy

Viehweger, Elke; Haumont, T.; Lattre, Capucine de; Presedo, Ana; Filipetti, Paul; Ilharreborde, Brice; Lebarbier, P; Loundou, Anderson; Siméoni, Marie-Claude

doi:10.1097/bpo.0b013e31817bd7ef

Cited by 10 publications

(6 citation statements)

References 59 publications

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“…These findings are consistent with the clinical recognition that those with greater gait impairment have more difficulty with activity and participation. This relationship has previously been reported by Viehweger et al, 37 who showed that Gillette Gait Index has a moderate inverse correlation to the GMFM and by Tervo et al 18 who reported moderate to strong inverse correlations with log Gillette Gait Index and several PODCI domains.…”

Section: Discussionsupporting

confidence: 85%

Variability explained by strength, body composition and gait impairment in activity and participation measures for children with cerebral palsy: a multicentre study

et al. 2014

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Objective: To determine the amount of variability in scores on activity and participation measures used to assess ambulatory individuals with cerebral palsy explained by strength, body composition, gait impairment and participant characteristics. Design: Multicentre prospective cross-sectional study. Setting: Seven paediatric–orthopaedic specialty hospitals. Participants: Three hundred and seventy-seven ambulatory individuals (241 males, 136 females) with cerebral palsy, Gross Motor Function Classification System (GMFCS) levels I–III (I = 148, II = 153, III = 76), ages 8–18 years (mean 12 years 9 months, SD 2 years 8 months). Methods: Participants completed assessments of GMFCS level, patient history, lower extremity muscle strength, Gross Motor Function Measure (GMFM-66), Pediatric Outcomes Data Collection Instrument (PODCI), instrumented gait analysis, 1 minute walk test, Timed Up-and-Go and body composition. Multiple linear regression and bootstrap analyses were performed for each outcome measure, stratified by GMFCS level. Results: The amount of variability in outcome measures explained by participant characteristics, strength, and gait impairment ranged from 11% to 50%. Gait impairment was the most common predictor variable and frequently explained the greatest variance across all outcome measures and GMFCS levels. As gait impairment increased, scores on outcome measures decreased. Strength findings were inconsistent and not a primary factor. Body composition contributed minimally (<4%) in explaining variability. Participant characteristics (cerebral palsy type, gestational age and age at walking onset), were significant predictor variables in several models. Conclusions: Variability in outcome measure scores is multifaceted and only partially explained by strength and gait impairment illustrating the challenges of attempting to explain variation within this heterogeneous population. Clinicians treating individuals with cerebral palsy should consider this when developing treatment paradigms.

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Section: Discussionsupporting

confidence: 85%

Variability explained by strength, body composition and gait impairment in activity and participation measures for children with cerebral palsy: a multicentre study

et al. 2014

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“…Clinical gait analysis (CGA) provides objective information about the gait of patients with CP and is a useful tool for evaluating long-term gait evolution in clinical practice. [4][5][6] Several scores summarizing patient gait quality have been proposed for children with CP, such as the gait deviation index (GDI) and the gait profile score (GPS). 7 GDI and GPS have been used quite extensively to evaluate the short-term (one year or less) and medium-term (less than five years) effects of treatments on CP gait.…”

Section: Introductionmentioning

confidence: 99%

Follow-up of walking quality after end of growth in 28 children with bilateral cerebral palsy

Bonnefoy‐Mazure¹,

Coulon²,

Lascombes³

et al. 2020

Journal of Children's Orthopaedics

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Purpose Assessment of surgical treatments on gait in patients with bilateral cerebral palsy (CP) is often performed in short-term studies. The purpose of this study was to analyze the influence of single-event multilevel surgery (SEMLS) on long-term evolution of gait using gait deviation index (GDI) and walking speed. Methods In all, 28 patients with bilateral CP (Gross Motor Function Classification System I to III) with two clinical gait analyses (CGA) were included (mean age: 9.0 years (sd 2.9) at the first CGA, 19.6 years (sd 4.1) at the last, all of them at skeletal maturity). GDI, walking speed and their changes were calculated. Statistical analysis was performed to observe differences between baseline and follow-up CGA. Pearson’s correlations were conducted to evaluate the associations between GDI and walking speed changes with: GDI at baseline and walking speed at baseline. GDI and walking speed evolution have been analyzed for two groups of patients: with and without SEMLS. Results Regardless of the treatment, GDI was significantly higher at follow-up CGA (baseline: 73.1 (sd 13.1) versus follow-up: 80.1 (sd 13.2); p = 0.014). Significant negative correlations were found between GDI change and GDI at baseline (r = -0.52; p = 0.004) and between walking speed change and walking speed at the baseline (r = -0.70; p < 0.001). Regarding the group of patients with or without SEMLS, only significant improvement of GDI was found for patients with SEMLS (at baseline: 69.0 (sd 12.1) versus follow-up: 77.8 (sd 11.2); p < 0.05). Conclusion Analysis at skeletal maturity showed a gait quality maintained for patients without SEMLS and an improvement for patients with SEMLS. Level of evidence Level III

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“…In the CP pathology, three dimensional (3D) gait analysis for ambulant children and clinical evaluations are commonly used as assessments and are part of the international standard of CP care [1]. Even with 3D gait analysis, which is becoming an essential tool to assess ambulant children with CP [2], it is sometimes difficult to define objectively the amount of abnormalities and the degree by which an abnormal gait deviates from normal patterns.…”

Section: Introductionmentioning

confidence: 99%

Repeatability and validation of Gait Deviation Index in children: Typically developing and cerebral palsy

Massaad¹,

Assi

Skalli

et al. 2014

Gait & Posture

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The Gait Deviation Index (GDI) is a dimensionless parameter that evaluates the deviation of kinematic gait from a control database. The GDI can be used to stratify gait pathology in children with cerebral palsy (CP). In this paper the repeatability and uncertainty of the GDI were evaluated. The Correlation between the GDI and the Gross Motor Function Classification System (GMFCS) was studied for different groups of children with CP (hemiplegia, diplegia, triplegia and quadriplegia). Forty-nine, typically developing children (TD) formed our database. A retrospective study was conducted on our 3D gait data and clinical exams and 134 spastic children were included. Sixteen TD children completed the gait analysis twice to evaluate the repeatability of the GDI (test-retest evaluation). Monte Carlo simulations were applied for all groups (TD and children with CP) in order to evaluate the propagation of errors stemming from kinematics. The repeatability coefficient (2SD of test-retest differences), obtained on the GDI for the 16 TD children (32 lower limbs) was ± 10. Monte Carlo simulations showed an uncertainty ranging between 0.8 and 1.3 for TD children and all groups with CP. The Spearman Rank correlation showed a moderate correlation between the GDI and the GMFCS (r=-0.44, p<0.0001).

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Multidimensional Outcome Assessment in Cerebral Palsy

Abstract: The outcome evaluation instrument set tested in our study helps to adopt common tools, to be integrated in an evidence-based practice and to compare health status and treatment outcome between countries, specifically in different linguistic environments like in European countries.

Cited by 10 publications

References 59 publications

Variability explained by strength, body composition and gait impairment in activity and participation measures for children with cerebral palsy: a multicentre study

Variability explained by strength, body composition and gait impairment in activity and participation measures for children with cerebral palsy: a multicentre study

Follow-up of walking quality after end of growth in 28 children with bilateral cerebral palsy

Repeatability and validation of Gait Deviation Index in children: Typically developing and cerebral palsy

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