Repetibilidade dos parâmetros espaço-temporais da marcha: comparação entre crianças normais e com paralisia cerebral do tipo hemiplegia espástica

Abstract

© Revista Brasileira de FisioterapiaRepeatability of spatiotemporal gait parameters: comparison between normal children and children with hemiplegic spastic cerebral palsyRepetibilidade dos parâmetros espaço-temporais da marcha: comparação entre crianças normais e com paralisia cerebral do tipo hemiplegia espástica AbstractObjective: To evaluate the repeatability of spatiotemporal gait parameters by means of a comparative study between normal children and children with cerebral palsy (CP). Methods: The sample consisted of 17 children divided into two groups: a group of nine children with spastic hemiplegia CP and a group of eight normal children. The children were evaluated by the same researcher in two different sessions, with a one-week interval between the sessions. The children walked at self-selected velocities, and six attempts were performed at each session to represent the average. To record the spatiotemporal parameters, the Peak Motus system was used with two SVHS video cameras with an acquisition rate of 60 Hz. The intra-class correlation coefficient (ICC) and Bland-Altman concordance limits were chosen for data analysis. Results: The results demonstrated that the children with CP presented lower velocity and shorter cycles than the normal children in sessions 1 and 2. For all the spatiotemporal parameters, the two groups presented moderate to excellent ICC values, i.e. greater than 0.70. Conclusion: It can be concluded that the two groups presented good levels of repeatability for all the parameters analyzed when six attempts were used to represent the average.Key words: gait; children; cerebral palsy; repeatability. ResumoObjetivo: Avaliar a repetibilidade das medidas dos parâmetros espaço-temporais da marcha por meio de um estudo comparativo entre crianças normais e crianças com paralisia cerebral (PC). Métodos: A amostra foi composta por 17 crianças divididas em dois grupos: um grupo de nove crianças com PC do tipo hemiplegia espástica e um grupo com oito crianças normais que foram avaliadas pelo mesmo pesquisador em duas sessões diferentes, com intervalo de uma semana entre as sessões. As crianças caminharam em velocidade autosselecionada e foram utilizadas seis tentativas nas sessões 1 e 2 para representar a média. Para registro dos parâmetros espaço-temporais, foi utilizado o sistema Peak Motus, com duas câmeras de vídeo SVHS com taxa de aquisição de 60 Hz.Coeficiente de correlação intraclasse (ICC) e limites de concordância de Bland-Altman foram escolhidos para análise dos dados.Resultados: Os resultados demonstraram que as crianças com PC apresentaram menor velocidade e comprimento do ciclo do que as crianças normais para as sessões 1 e 2. Para todos os parâmetros espaço-temporais, os dois grupos apresentaram valores de ICC de excelentes a moderados, ou seja, maior do que 0,70. Conclusão: Pode-se concluir que os dois grupos apresentaram níveis bons de repetibilidade para todos os parâmetros analisados quando seis tentativas foram utilizadas para representar a média.

Assessment of gait in toddlers with normal motor development and in hemiplegic children with mild motor impairment: a validity study

“…The duration of the swing phase is an indicator of stability. The lower stability of toddlers during the gait acquisition period is indicated by their irregular and shorter steps, indexed by a shorter and more variable duration of the swing phase of gait 2,20 . The digital camera video technology used in this study, which enables the delimitation of only 30 frames per second, most likely hindered the identification of gait event times required for calculating the relatively shorter and more variable swing phase of toddlers.…”

“…Gait is a key indicator of the functional capacity and independence of individuals [1][2][3] . Consequently, the acquisition and improvement of this locomotor ability of patients have been a central objective in the rehabilitation process 2 .…”

“…Consequently, the acquisition and improvement of this locomotor ability of patients have been a central objective in the rehabilitation process 2 . The implementation of interventions with such focus requires reliable and valid evaluation methods to enable the use of gait analysis to help establish a precise functional diagnosis, with the subsequent definition of therapeutic goals, and to document the effects of interventions 1,2,4 .…”

“…As gait pattern matures, swing phase speed and time increases while double stance time decreases 11,21,22 . Additionally, the use of temporal parameters enables the differentiation between gait patterns considered normal and those considered pathological, such as the gait patterns of children with cerebral palsy (CP) 2,23 . The gait performance of children with spastic hemiplegia-type CP, compared to that of normal children, is characterized by lower speed and lower single stance time in the most compromised limb, as well as reduced step length and limb asymmetry 2,24,25 .…”

“…Additionally, the use of temporal parameters enables the differentiation between gait patterns considered normal and those considered pathological, such as the gait patterns of children with cerebral palsy (CP) 2,23 . The gait performance of children with spastic hemiplegia-type CP, compared to that of normal children, is characterized by lower speed and lower single stance time in the most compromised limb, as well as reduced step length and limb asymmetry 2,24,25 . Such changes are most likely due to muscle weakness and impaired dexterity in the affected side of the body, which may hinder weight transfer to and weight bearing capacity of the affected limb during gait 2 .…”