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Gait Treatment Outcome Assessments in Cerebral Palsy

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Abstract

Children with cerebral palsy (CP) who are able to ambulate almost all require treatment to improve their ambulatory abilities throughout growth and development. The treatment includes many modalities such as physical therapy, botulinum toxin, dorsal rhizotomy, orthopedic surgery, and the use of orthotics and assistive devices. In addition to all of these treatment modalities, the child’s gait is also strongly influenced by their normal motor development and the environment in which the child is living. To understand the individual impact of each of these influences requires good long-term outcome studies. And additional impact is the wide variety of motor ability for children with CP who are able to walk. The gross motor function classification system (GMFCS) is our current state-of-the-art method for classifying individual motor abilities. In addition to considering the individual’s level of impairment, it is important to consider the other domains as defined by the International Classification of Functioning, Disability and Health (ICF) which impact the individual’s function in society. This requires that we consider the person’s overall health condition as well as the local environmental factors which influence the person’s ability to be active. It is also important to consider the opportunity and personal interest in participation of specific activities and other personal factors which may influence their level of activity. In this context of multiple treatment modalities overlaying with multiple individual personal factors to assess makes outcome assessment a complicated and challenging problem. The goal of this chapter is to assess the individual areas which need to be evaluated.

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References

  • Akerstedt A, Risto O, Odman P, Oberg B (2010) Evaluation of single event multilevel surgery and rehabilitation in children and youth with cerebral palsy-a 2-year follow-up study. Disabil Rehabil 32(7):530–539

    Article  Google Scholar 

  • Baker R, McGinley JL, Schwartz MH, Beynon S, Rozumalski A, Graham HK, Tirosh O (2009) The gait profile score and movement analysis profile. Gait Posture 30(3):265–269

    Article  Google Scholar 

  • Baker R, McGinley JL, Schwartz M, Thomason P, Rodda J, Graham HK (2012) The minimal clinically important difference for the gait profile score. Gait Posture 35(4):612–615

    Article  Google Scholar 

  • Cuomo AV, Gamradt SC, Kim CO, Pirpiris M, Gates PE, McCarthy JJ, Otsuka NY (2007) Health-related quality of life outcomes improve after multilevel surgery in ambulatory children with cerebral palsy. J Pediatr Orthop 27(6):653–657

    Article  Google Scholar 

  • Dreher T, Gotze M, Wolf SI, Hagmann S, Heitzmann D, Gantz S, Braatz F (2012) Distal rectus femoris transfer as part of multilevel surgery in children with spastic diplegia-a randomized clinical trial. Gait Posture 36(2):212–218

    Article  Google Scholar 

  • Dumas HM, Fragala-Pinkham MA (2012) Concurrent validity and reliability of the pediatric evaluation of disability inventory-computer adaptive test mobility domain. Pediatr Phys Ther 24(2):171–176 discussion 176

    Article  Google Scholar 

  • Dumas HM, Fragala-Pinkham MA, Rosen EL, O'Brien JE (2017) Construct validity of the pediatric evaluation of disability inventory computer adaptive test (PEDI-CAT) in children with medical complexity. Disabil Rehabil 39(23):2446–2451

    Article  Google Scholar 

  • Fragala-Pinkham MA, Dumas HM, Lombard KA, O'Brien JE (2016) Responsiveness of the pediatric evaluation of disability inventory-computer adaptive test in measuring functional outcomes for inpatient pediatric rehabilitation. J Pediatr Rehabil Med 9(3):215–222

    Article  Google Scholar 

  • Franki I, De Cat J, Deschepper E, Molenaers G, Desloovere K, Himpens E, Vanderstraeten G, Van den Broeck C (2014) A clinical decision framework for the identification of main problems and treatment goals for ambulant children with bilateral spastic cerebral palsy. Res Dev Disabil 35(5):1160–1176

    Article  Google Scholar 

  • Gage JR (1983) Gait analysis for decision-making in cerebral palsy. Bull Hosp Jt Dis Orthop Inst 43(2):147–163

    CAS  PubMed  Google Scholar 

  • Gannotti ME, Gorton GE 3rd, Nahorniak MT, Masso PD (2013) Gait and participation outcomes in adults with cerebral palsy: a series of case studies using mixed methods. Disabil Health J 6(3):244–252

    Article  Google Scholar 

  • Gordon AB, McMulkin ML, Baird GO (2011) Modified goal attainment scale outcomes for ambulatory children: with and without orthopedic surgery. Gait Posture 33(1):77–82

    Article  Google Scholar 

  • Gough M, Eve LC, Robinson RO, Shortland AP (2004) Short-term outcome of multilevel surgical intervention in spastic diplegic cerebral palsy compared with the natural history. Dev Med Child Neurol 46(2):91–97

    Article  Google Scholar 

  • Graham HK, Harvey A, Rodda J, Nattrass GR, Pirpiris M (2004) The functional mobility scale (FMS). J Pediatr Orthop 24(5):514–520

    Article  Google Scholar 

  • Haley SM, Coster WJ, Dumas HM, Fragala-Pinkham MA, Kramer J, Ni P, Tian F, Kao YC, Moed R, Ludlow LH (2011) Accuracy and precision of the pediatric evaluation of disability inventory computer-adaptive tests (PEDI-CAT). Dev Med Child Neurol 53(12):1100–1106

    Article  Google Scholar 

  • Harvey A, Graham HK, Morris ME, Baker R, Wolfe R (2007) The functional mobility scale: ability to detect change following single event multilevel surgery. Dev Med Child Neurol 49(8):603–607

    Article  Google Scholar 

  • Haumont T, Church C, Hager S, Cornes MJ, Poljak D, Lennon N, Henley J, Taylor D, Niiler T, Miller F (2013) Flexed-knee gait in children with cerebral palsy: a 10-year follow-up study. J Child Orthop 7(5):435–443

    Article  Google Scholar 

  • Ishikawa S, Kang M, Bjornson KF, Song K (2013) Reliably measuring ambulatory activity levels of children and adolescents with cerebral palsy. Arch Phys Med Rehabil 94(1):132–137

    Article  Google Scholar 

  • Kamp FA, Lennon N, Holmes L, Dallmeijer AJ, Henley J, Miller F (2014) Energy cost of walking in children with spastic cerebral palsy: relationship with age, body composition and mobility capacity. Gait Posture 40(1):209–214

    Article  CAS  Google Scholar 

  • Kramer JM, Liljenquist K, Coster WJ (2016) Validity, reliability, and usability of the pediatric evaluation of disability inventory-computer adaptive test for autism spectrum disorders. Dev Med Child Neurol 58(3):255–261

    Article  Google Scholar 

  • Lee SY, Kwon SS, Chung CY, Lee KM, Choi Y, Kim TG, Shin WC, Choi IH, Cho TJ, Yoo WJ, Park MS (2014) Rectus femoris transfer in cerebral palsy patients with stiff knee gait. Gait Posture 40(1):76–81

    Article  Google Scholar 

  • McMorran D, Robinson LW, Henderson G, Herman J, Robb JE, Gaston MS (2016) Using a goal attainment scale in the evaluation of outcomes in patients with diplegic cerebral palsy. Gait Posture 44:168–171

    Article  CAS  Google Scholar 

  • McMulkin ML, Baird GO, Gordon AB, Caskey PM, Ferguson RL (2007) The pediatric outcomes data collection instrument detects improvements for children with ambulatory cerebral palsy after orthopaedic intervention. J Pediatr Orthop 27(1):1–6

    Article  Google Scholar 

  • Miller F, Cardoso Dias R, Lipton GE, Albarracin JP, Dabney KW, Castagno P (1997) The effect of rectus EMG patterns on the outcome of rectus femoris transfers. J Pediatr Orthop 17(5):603–607

    Article  CAS  Google Scholar 

  • Molloy M, McDowell BC, Kerr C, Cosgrove AP (2010) Further evidence of validity of the gait deviation index. Gait Posture 31(4):479–482

    Article  CAS  Google Scholar 

  • Niiler TA, Richards JG, Miller F (2007) Concurrent surgeries are a factor in predicting success of rectus transfer outcomes. Gait Posture 26(1):76–81

    Article  Google Scholar 

  • Novacheck TF, Stout JL, Tervo R (2000) Reliability and validity of the Gillette functional assessment questionnaire as an outcome measure in children with walking disabilities. J Pediatr Orthop 20(1):75–81

    CAS  PubMed  Google Scholar 

  • Rasmussen HM, Nielsen DB, Pedersen NW, Overgaard S, Holsgaard-Larsen A (2015) Gait deviation index, gait profile score and gait variable score in children with spastic cerebral palsy: intra-rater reliability and agreement across two repeated sessions. Gait Posture 42(2):133–137

    Article  Google Scholar 

  • Rozumalski A, Schwartz MH (2011) The GDI-kinetic: a new index for quantifying kinetic deviations from normal gait. Gait Posture 33(4):730–732

    Article  Google Scholar 

  • Saw A, Smith PA, Sirirungruangsarn Y, Chen S, Hassani S, Harris G, Kuo KN (2003) Rectus femoris transfer for children with cerebral palsy: long-term outcome. J Pediatr Orthop 23(5):672–678

    Article  Google Scholar 

  • Schwartz MH, Rozumalski A (2008) The gait deviation index: a new comprehensive index of gait pathology. Gait Posture 28(3):351–357

    Article  Google Scholar 

  • Shore BJ, Allar BG, Miller PE, Matheney TH, Snyder BD, Fragala-Pinkham MA (2017) Evaluating the discriminant validity of the pediatric evaluation of disability inventory: computer adaptive test in children with cerebral palsy. Phys Ther 97(6):669–676

    Article  Google Scholar 

  • Sullivan E, Barnes D, Linton JL, Calmes J, Damiano D, Oeffinger D, Abel M, Bagley A, Gorton G, Nicholson D, Rogers S, Tylkowski C (2007) Relationships among functional outcome measures used for assessing children with ambulatory CP. Dev Med Child Neurol 49(5):338–344

    Article  Google Scholar 

  • Thomason P, Baker R, Dodd K, Taylor N, Selber P, Wolfe R, Graham HK (2011) Single-event multilevel surgery in children with spastic diplegia: a pilot randomized controlled trial. J Bone Joint Surg Am 93(5):451–460

    Article  Google Scholar 

  • Wilson NC, Signal N, Naude Y, Taylor D, Stott NS (2015) Gait deviation index correlates with daily step activity in children with cerebral palsy. Arch Phys Med Rehabil 96(10):1924–1927

    Article  Google Scholar 

  • Wren TA, Do KP, Hara R, Dorey FJ, Kay RM, Otsuka NY (2007) Gillette gait index as a gait analysis summary measure: comparison with qualitative visual assessments of overall gait. J Pediatr Orthop 27(7):765–768

    Article  Google Scholar 

  • Wren TA, Otsuka NY, Bowen RE, Scaduto AA, Chan LS, Dennis SW, Rethlefsen SA, Healy BS, Hara R, Sheng M, Kay RM (2013) Outcomes of lower extremity orthopedic surgery in ambulatory children with cerebral palsy with and without gait analysis: results of a randomized controlled trial. Gait Posture 38(2):236–241

    Article  Google Scholar 

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Correspondence to Freeman Miller .

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Miller, F. (2018). Gait Treatment Outcome Assessments in Cerebral Palsy. In: Miller, F., Bachrach, S., Lennon, N., O'Neil, M. (eds) Cerebral Palsy. Springer, Cham. https://doi.org/10.1007/978-3-319-50592-3_100-1

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  • DOI: https://doi.org/10.1007/978-3-319-50592-3_100-1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-50592-3

  • Online ISBN: 978-3-319-50592-3

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