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Integral method (IM) as a quantitative and objective method to supplement the GMFCS classification of gait in children with cerebral palsy (CP)

Dziuba A., Bober T., Kobel-Buys K., Stempień M.

Acta of Bioengineering and Biomechanics

2013

Vol. 15, no. 2

105--111

Gait analysis is an objective tool for the clinical assessment of locomotor activity in children with cerebral palsy (CP). Correct diagnosis and properly planned rehabilitation are necessary for enhanced motor functions in persons suffering from cerebral palsy. Orthoses, orthopedic operations, medications and physiotherapy are the most common treatments. However, there is still a lack of objective methods for assessing motor behavior and monitoring the progress of recovery. The aim of the study was to use the ground reaction force patterns generated during walking to create the Integral Method (IM), which could become an objective tool that could supplement the functional classification of CP children based on the Gross Motor Function Classification System (GMFCS). A total of 15 healthy children and 34 children with CP who walk independently participated in the study. A Kistler force plate and GRFintegral software were used. Of the 34 measurements based on the IM for CP children, 17 matched the level assigned by the GMFCS, 2 children were assigned a higher level, and 15 were assigned a lower level. Pearson’s correlation coefficient between the IM and the GMFCS was moderate (r = 0.61, p ≤ 0.01). Asymmetry was found in 11 cases. The IM supplements the GMFCS and is an objective and quantitative assessment of motor abilities. The method allows for the detection of asymmetry, diagnosis of the improvement of gait pattern and assessment of foot support technique. With the appropriate software, the IM provides pediatricians, neurologists, orthopedists, surgeons and physiotherapists with a simple and fast way to assess gait.

Gait characteristics following Achilles tendon elongation: the foot rocker perspective

Bober T., Dziuba A., Kobel-Buys K., Kulig K.

Acta of Bioengineering and Biomechanics

2008

Vol. 10, nr 1

37-42

The action of three functional rockers, namely the heel, ankle and forefoot rocker, assist the progression of the leg over the supporting foot. The purpose of this case series was to analyze the occurrence of foot rockers during gait in three children with cerebral palsy (CP) who had undergone the tendo-Achilles lengthening (TAL), procedure followed by a clinic- or home-based intervention and in one child with CP without history of surgery. Self-selected gait was video-recorded in a laboratory during six testing sessions at half-year intervals rendering a 3 year period of observation. One child had pre- and post-surgical gait data and the other two had post surgical data only. Sagittal plane knee angular velocity, as well as foot to ground positions, and foot rocker occurrence were analyzed. In a child with history of CP, and without history of surgery, mean angular velocities of the 1st, 2nd and 3rd foot rocker were 3.7, 0.57 and 6.67 rad/s, respectively, and the step length and cadence were normal. In children who underwent TAL the 1st and 2nd rocker was absent, as the initial contact of the foot with the ground was either with foot-flat or forefoot. The mean velocity of the 3rd rocker in children who underwent TAL was lower by approximately 50–80% than that of the nonsurgical case. Furthermore, the characteristic pattern of the knee joint to foot–floor position during gait was not observed in these cases. Foot rocker analysis identified children with abnormal gait characteristics. Following surgery these gait characteristics remained abnormal.