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PURPOSE: Hamstrings surgical lengthening (HSL) has been frequently used for the treatment of flexed knee gait in cerebral palsy; however, recurrence of knee flexion deformity (KFD) and increase of anterior pelvic tilt (APT) were reported in a long-term follow-up. RESEARCH QUESTION: The aim of this study was to compare semitendinosus transfer to distal femur (STTX) and semitendinosus surgical lengthening (STL) regarding the reduction of KFD and the increase of APT after flexed knee gait treatment. METHODS: One hundred and eleven patients were evaluated and they were divided into two groups according to surgical procedures at knees: group A (65 patients/130 knees), including patients who received medial HSL as part of multilevel approach; group B (46 patients/92 knees), represented by patients who underwent orthopedic surgery including an STTX instead of STL. RESULTS: Fixed knee flexion deformity (FKFD) decreased only in group B (from 6.79° to 2.96°, p < 0.001) after intervention. In kinematics, APT increased from 16.38° to 19.03° in group A (p = 0.003), while group B also increased from 15.26° to 20.59° (p < 0.001). The minimum knee flexion in stance phase (MKFS) reduced from 25.34° to 21.65° (p = 0.016) in group A and from 31° to 19.57° (p < 0.001) in group B. In the comparison between groups A and B, the increase of APT (p = 0.028) and reduction of FKFD (p < 0.001), popliteal angle (p = 0.001), bilateral popliteal angle (p = 0.003) and MKFS (p = 0.006) were higher after STTX than STL. CONCLUSION: In the present study, patients who received STTX exhibited more improvement of knee extension at clinical examination and during gait than those who underwent to STL; however, STTX was not effective to prevent the increase of APT after flexed knee gait treatment.
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Paralisia Cerebral/complicações , Contratura/cirurgia , Fêmur/cirurgia , Transtornos Neurológicos da Marcha/cirurgia , Músculos Isquiossurais/cirurgia , Transferência Tendinosa , Adolescente , Fenômenos Biomecânicos , Paralisia Cerebral/cirurgia , Criança , Pré-Escolar , Contratura/etiologia , Feminino , Transtornos Neurológicos da Marcha/etiologia , Humanos , Articulação do Joelho/cirurgia , Masculino , Postura , Recidiva , Estudos Retrospectivos , TenotomiaAssuntos
Paralisia Cerebral , Rotação , Marcha , Luxação do Quadril , Articulação do Quadril , Humanos , OsteotomiaRESUMO
Objective To evaluate the correlation between physical examination data concerning hip rotation and tibial torsion with transverse plane kinematics in children with cerebral palsy; and to determine which time points and events of the gait cycle present higher correlation with physical examination findings. Methods A total of 195 children with cerebral palsy seen at two gait laboratories from 2008 and 2016 were included in this study. Physical examination measurements included internal hip rotation, external hip rotation, mid-point hip rotation and the transmalleolar axis angle. Six kinematic parameters were selected for each segment to assess hip rotation and shank-based foot rotation. Correlations between physical examination and kinematic measures were analyzed by Spearman correlation coefficients, and a significance level of 5% was considered. Results Comparing physical examination measurements of hip rotation and hip kinematics, we found moderate to strong correlations for all variables (p<0.001). The highest coefficients were seen between the mid-point hip rotation on physical examination and hip rotation kinematics (rho range: 0.48-0.61). Moderate correlations were also found between the transmalleolar axis angle measurement on physical examination and foot rotation kinematics (rho range 0.44-0.56; p<0.001). Conclusion These findings may have clinical implications in the assessment and management of transverse plane gait deviations in children with cerebral palsy.
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Paralisia Cerebral/fisiopatologia , Marcha/fisiologia , Exame Físico , Amplitude de Movimento Articular/fisiologia , Adolescente , Fenômenos Biomecânicos , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estudos Retrospectivos , Rotação , Índice de Gravidade de DoençaRESUMO
Abstract Objective To evaluate the correlation between physical examination data concerning hip rotation and tibial torsion with transverse plane kinematics in children with cerebral palsy; and to determine which time points and events of the gait cycle present higher correlation with physical examination findings. Methods A total of 195 children with cerebral palsy seen at two gait laboratories from 2008 and 2016 were included in this study. Physical examination measurements included internal hip rotation, external hip rotation, mid-point hip rotation and the transmalleolar axis angle. Six kinematic parameters were selected for each segment to assess hip rotation and shank-based foot rotation. Correlations between physical examination and kinematic measures were analyzed by Spearman correlation coefficients, and a significance level of 5% was considered. Results Comparing physical examination measurements of hip rotation and hip kinematics, we found moderate to strong correlations for all variables (p<0.001). The highest coefficients were seen between the mid-point hip rotation on physical examination and hip rotation kinematics (rho range: 0.48-0.61). Moderate correlations were also found between the transmalleolar axis angle measurement on physical examination and foot rotation kinematics (rho range 0.44-0.56; p<0.001). Conclusion These findings may have clinical implications in the assessment and management of transverse plane gait deviations in children with cerebral palsy.
Resumo Objetivo Avaliar a correlação entre dados do exame físico relativos à rotação do quadril e torção tibial com a cinemática do plano transverso em crianças com paralisia cerebral; e determinar quais pontos no tempo e eventos do ciclo de marcha apresentam maior correlação com achados do exame físico. Métodos Um total de 195 crianças com paralisia cerebral vistas em dois laboratórios de marcha, de 2008 a 2016, foi incluído neste estudo. As medidas do exame físico incluíram rotação interna do quadril, rotação externa do quadril, ponto médio da rotação do quadril e ângulo do eixo transmaleolar. Foram selecionados seis parâmetros cinemáticos para cada segmento, para avaliar a rotação do quadril e a do pé em relação à perna durante a marcha. As correlações entre exame físico e medidas cinemáticas foram analisadas por coeficientes de correlação de Spearman, e considerou-se um nível de significância de 5%. Resultados Comparando as medidas da rotação do quadril e da cinemática do quadril, encontramos correlações moderadas a fortes para todas as variáveis (p<0,001). Os coeficientes mais altos foram observados entre o ponto médio da rotação do quadril no exame físico e a rotação do quadril na cinemática (rho range: 0,48-0,61). Correlações moderadas também foram encontradas entre a medição do ângulo do eixo transmaleolar no exame físico e a rotação do pé em relação à perna na cinemática (faixa rho: 0,44-0,56; p<0,001). Conclusão Estes achados podem ter implicações clínicas na avaliação e no tratamento de desvios da marcha do plano transverso em crianças com paralisia cerebral.
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Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Exame Físico , Paralisia Cerebral/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Marcha/fisiologia , Rotação , Fenômenos Biomecânicos , Índice de Gravidade de Doença , Estudos RetrospectivosRESUMO
ABSTRACT Objective: To evaluate whether distal rectus femoris transfer (DRFT) is related to postoperative increase of knee flexion during the stance phase in cerebral palsy (CP). Methods: The inclusion criteria were Gross Motor Function Classification System (GMFCS) levels I-III, kinematic criteria for stiff-knee gait at baseline, and individuals who underwent orthopaedic surgery and had gait analyses performed before and after intervention. The patients included were divided into the following two groups: NO-DRFT (133 patients), which included patients who underwent orthopaedic surgery without DRFT, and DRFT (83 patients), which included patients who underwent orthopaedic surgery that included DRFT. The primary outcome was to evaluate in each group if minimum knee flexion in stance phase (FMJFA) changed after treatment. Results: The mean FMJFA increased from 13.19° to 16.74° (p=0.003) and from 10.60° to 14.80° (p=0.001) in Groups NO-DRFT and DRFT, respectively. The post-operative FMJFA was similar between groups NO-DRFT and DRFT (p=0.534). The increase of FMJFA during the second exam (from 13.01° to 22.51°) was higher among the GMFCS III patients in the DRFT group (p<0.001). Conclusion: In this study, DRFT did not generate additional increase of knee flexion during stance phase when compared to the control group. Level of Evidence III, Retrospective Comparative Study.
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OBJECTIVE: To identify gait patterns in a large group of children with diplegic cerebral palsy and to characterize each group according to age, Gross Motor Function Classification System (GMFCS) level, Gait Deviation Index (GDI) and previous surgical procedures. METHODS: ONE THOUSAND EIGHT HUNDRED AND FIVE PATIENTS WERE DIVIDED IN SEVEN GROUPS REGARDING OBSERVED GAIT PATTERNS: jump knee, crouch knee, recurvatum knee, stiff knee, asymmetric, mixed and non-classified. RESULTS: The asymmetric group was the most prevalent (48.8%). The jump knee (9.6 years old) and recurvatum (9.4 years old) groups had mean age lower than the other groups. The lowest GDI (43.58) was found in the crouch group. There were more children classified within GMFCS level III in the crouch and mixed groups. Previous surgical procedures on the triceps surae were more frequent in stiff knee and mixed groups. The jump knee group received less and the stiff-knee group more surgical procedures at hamstrings than others. CONCLUSIONS: The asymmetrical cases were the most frequent within a group of diplegic patients. Individuals with crouch gait pattern were characterized by the lowest GDI and the highest prevalence of GMFCS III, while patients with stiff knee exhibited a higher percentage of previous hamstring lengthening in comparison to the other groups. Level of Evidence III, Retrospective Comparative Study.
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Identificar padrões de marcha em um grande grupo de crian-ças com paralisia cerebral (PC) tipo diplegia espástica e caracterizarcada grupo de acordo com a idade, nível do Gross Motor FunctionClassification System (GMFCS) e Gait Deviation Index (GDI) e cirurgiasprévias. Métodos: Foram divididos em sete grupos 1805 pacientescom base nos padrões de marcha observados: joelho saltitante, agachamento,recurvatum, joelho rígido, assimétrico, misto, e não classificável.Resultados: O grupo assimétrico foi o mais prevalente (48,8%).Os grupos joelho saltitante (9,6 anos) e recurvatum (9,4 anos) exibiramidade média menor que os demais grupos. O GDI mais baixo (43,58)foi observado no grupo agachamento. Notaram-se mais pacientesclassificados como nível III do GMFCS nos grupos agachamento emisto. Cirurgias prévias no tríceps sural foram mais frequentes nosgrupos joelho rígido e misto. O grupo joelho saltitante recebeu menornúmero de procedimentos cirúrgicos prévios nos isquiotibais, enquantoque o grupo com joelho rígido recebeu maior número, quandocomparado aos demais. Conclusões: Os casos assimétricos forammais frequentes, mesmo em grupo de pacientes diplégicos. Pacientescom padrão em agachamento foram caracterizados pelo GDI maisbaixo e prevalência do nível III no GMFCS, enquanto que o grupojoelho rígido exibiu uma porcentagem maior de alongamento préviodos isquiotibiais em comparação com os demais grupos. Nível deEvidência III, Estudo Retrospectivo Comparativo...
To identify gait patterns in a large group of childrenwith diplegic cerebral palsy and to characterize each groupaccording to age, Gross Motor Function Classification System(GMFCS) level, Gait Deviation Index (GDI) and previous surgicalprocedures. Methods: One thousand eight hundred and fivepatients were divided in seven groups regarding observed gaitpatterns: jump knee, crouch knee, recurvatum knee, stiff knee,asymmetric, mixed and non-classified. Results: The asymmetricgroup was the most prevalent (48.8%). The jump knee (9.6 yearsold) and recurvatum (9.4 years) groups had mean age lowerthan the other groups. The lowest GDI (43.58) was found in thecrouch group. There were more children classified within GMFCSlevel III in the crouch and mixed groups. Previous surgical procedureson the triceps surae were more frequent in stiff kneeand mixed groups. The jump knee group received less and thestiff-knee group more surgical procedures at hamstrings thanothers. Conclusions: The asymmetrical cases were the most frequentwithin a group of diplegic patients. Individuals with crouchgait pattern were characterized by the lowest GDI and the highestprevalence of GMFCS III, while patients with stiff knee exhibited ahigher percentage of previous hamstring lengthening in comparisonto the other groups. Level of Evidence III, RetrospectiveComparative Study...
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Humanos , Criança , Marcha , Paralisia Cerebral , Transtornos MotoresRESUMO
Proximal femur external rotation osteotomy is a common procedure used for the correction of increased femur anteversion and hip internal rotation in cerebral palsy (CP). Different levels of osteotomy have been used at the proximal femur, but there are no studies in the literature comparing the results in CP. Patients with spastic CP, Gross Motor Function Classification System (GMFCS) I-III, who had undergone a femoral rotational osteotomy from August 1998 to August 2007, and with complete documentation at gait laboratory were included in the study. Patients were divided into two groups according to the level of osteotomy at the proximal femur. Group A [Dynamic Compression Plate (DCP) group] included 24 patients (36 osteotomies), and the osteotomy in this group was performed below the lesser trochanter. In Group B (Blade Plate group), 29 patients (35 osteotomies) were included and the level of osteotomy was above the lesser trochanter. Age at surgery, sex distribution, follow-up time, previous surgical procedures, surgical procedures performed in the same session as femur osteotomy, GMFCS level, topographic classification, clinical findings (internal and external hip rotation, and femur anteversion), and hip rotation at kinematics were analyzed and the results were compared between groups. Groups A and B were matched in terms of the sex distribution, follow-up time, GMFCS levels, and severity of clinical findings and hip internal rotation at kinematics before surgery. The mean age of the patients at surgery was 9.24 years in group A and 12 years in group B, and this difference was significant on performing statistical analysis (P=0.004). The number of patients who had undergone previous hip adductors' tenotomy was higher in group B (P=0.036). Improvements in clinical and kinematics parameters were observed in both groups after femur osteotomy (P<0.001). The increase in hip external rotation at clinical examination and the reduction in hip internal rotation at kinematics did not show differences between groups A and B on performing statistical analysis. However, reduction of femoral anteversion (P=0.032) and hip internal rotation (P=0.002) were more remarkable in group B. In conclusion, reduction of hip internal rotation and femur anteversion at physical examination were more significant in patients with intertrochanteric osteotomies; however, improvement in kinematics was observed in both groups after surgical procedures.
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Paralisia Cerebral/complicações , Fêmur/cirurgia , Articulação do Quadril/cirurgia , Artropatias/etiologia , Artropatias/cirurgia , Osteotomia/métodos , Criança , Feminino , Humanos , Masculino , Estudos RetrospectivosRESUMO
Internal hip rotation (IHR) is the major cause of intoeing gait in patients with cerebral palsy (CP). Femoral derotation osteotomy (FDO) is the preferred treatment to correct excessive anteversion, however the condition may persist or recur postoperatively. Retrospective clinical and kinematic evaluation of 75 spastic diplegic CP patients was conducted for a mean duration of 22 months following proximal FDO. The patients were divided into two groups depending on the correction or persistence of IHR evident at kinematics after surgery. If corrected, mean patient follow-up was extended to 53 months. Outcomes were analyzed using Two Proportions Equality, Mann-Whitney and Wilcoxon tests. IHR persisted in 33.3% of cases at mean follow-up of 22 months and subtrochanteric femur osteotomy was more frequent in this group (p=0.033). Thirty-five of the fifty-four patients with first-round gait correction were monitored during the extended follow-up. Those for whom IHR recurred (9.5%) had undergone FDO at a comparatively younger age. Patient gender, operations prior to or at the time of femoral osteotomy, topographic classification, GMFCS level, or the extent of preoperative clinical and kinematic abnormalities had no apparent influence on persistence or recurrence of abnormal gait.
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Paralisia Cerebral/cirurgia , Fêmur/cirurgia , Transtornos Neurológicos da Marcha/fisiopatologia , Articulação do Quadril/fisiopatologia , Osteotomia , Fenômenos Biomecânicos , Paralisia Cerebral/complicações , Paralisia Cerebral/fisiopatologia , Criança , Feminino , Transtornos Neurológicos da Marcha/complicações , Humanos , Masculino , Procedimentos Ortopédicos , RecidivaRESUMO
Há poucos estudos sobre a reabilitação de pacientes com a doençade Charcot Marie. Estes pacientes apresentam sintomas da doença precocemente e têm sobrevida longa o que determina alterações biomecânicas que afetam a qualidade de vida dos mesmos e por esta razão o estudo de possíveis tratamentos para estes pacientes são de grande importância. A intervenção cirúrgica das extremidades inferiores é uma destas possibilidades. Apesar de não haver conclusões ainda sobre qual a técnica cirúrgica e se a mesma é omelhor tratamento, a mesma é realizada para melhorar a qualidade de marcha e qualidade de vida destes pacientes. O estudo tem então o objetivo de avaliar o impacto do procedimento cirúrgico na qualidade de vida dos pacientes com doença de Charcot MarieTooth. Foram avaliados 9 pacientes antes e após procedimento cirúrgico através de análise do laboratório de marcha, questionário MFM e SF 36. Houve diferença significativa nas avaliações pré e pós operatórias no MFM e SF36. Neste estudo, a cirurgia corretiva de membros inferiores mostrou ter um impacto positivo na qualidade de vida dos pacientes com a doença de CMT, principalmente através da melhora do desempenho motor e da dor.
Background: There are few studies regarding the rehabilitation of a CMT patient. Because patients present symptoms at an early age,have a long life expectancy, and have serious biomechanical complications that generate a great impact on a patients life, a careful study of possible treatments for this population seems to be important. Surgical interventions on the lower extremities are among these possible treatments. Although there are no conclusions about the most effective surgical techniques, this surgical treatment would be done to give the patient a better quality of life since it improves the gait quality.The aim of this study was to analyze the impact of lower limb surgical procedures on the quality of life of CMT patients. Nine patients with CMT disease were analyzed before and after surgery, and the participants underwent gait analysis, Motor Function Measure (MFM) andthe SF-36 questionnaires. There was a significant difference in the MFM and SF-36 evaluations. This study showed an improvement in the quality of life of Charcot-Marie-Tooth patients, especially related to motor performance and pain.
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Humanos , Masculino , Feminino , Criança , Adolescente , Pessoa de Meia-Idade , Adulto Jovem , Destreza Motora , Doença de Charcot-Marie-Tooth/cirurgia , Doença de Charcot-Marie-Tooth/reabilitação , Extremidade Inferior/cirurgia , Medição da Dor , Transtornos Neurológicos da Marcha/cirurgia , Estudos de Coortes , Período Pré-Operatório , Período Pós-Operatório , Qualidade de VidaRESUMO
To investigate the effect of earlier triceps surae (TS) surgical lengthening at knee kinematics in the stance phase in patients with cerebral palsy (CP). One thousand and thirty-nine participants from an eligible total of 1750 children with CP were referred to gait analysis laboratory from January 2000 to April 2007. Inclusion criteria were the diagnosis of diparetic spastic CP levels I to III (GMFCS) and complete kinematics documentation. Patients with an asymmetrical knee pattern at kinematics and with different types of TS management among sides were excluded. The patients were divided into two groups according to the mean minimum knee flexion (MMKF) in stance phase: group A (n=253) MMKF > or =30 degrees and group B (n=786) MMKF less than 30 degrees . For each group, the occurrence of following procedures for TS in the past: (i) earlier surgery, (ii) gastrocnemius lengthening (zone I), (iii) gastrocnemius and soleus lengthening (zone II), and (iv) calcaneous tendon lengthening (zone III), was investigated. A chi test was applied to check if the number of procedures performed was different between groups. The level of significance was defined as P value of less than 0.05. The number of patients with no earlier surgeries at TS was higher in group B (51.8%) than in group A (39.1%), and this difference was significant (P<0.01). In addition, the number of procedures at the calcaneous tendon was more elevated in group A (36.8%) than in group B (27%), and this finding was statistically significant as well (P<0.02). The percentage of surgical lengthening at zones I and II was very similar between the groups A and B. This study has shown that patients without earlier surgical procedures at TS are more susceptible to reach better extension of the knees in the stance phase. Patients in a crouch gait had a higher number of calcaneous tendon lengthening performed in the past than patients with a more normal knee extension in the stance phase.
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Paralisia Cerebral/cirurgia , Marcha , Articulação do Joelho/fisiopatologia , Músculo Esquelético/cirurgia , Adolescente , Paralisia Cerebral/fisiopatologia , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos , Adulto JovemRESUMO
OBJETIVO: Descrever o padrão de movimento dos joelhos e tornozelos na fase de apoio em grupos etários diferentes, com a proposta de identificar como estes parâmetros comportam-se durante a maturação da marcha normal. MÉTODOS: Foram considerados como critérios de inclusão a ausência de patologias osteo-musculares e neurológicas, e a realização de exame tridimensional da marcha de forma voluntária e consentida. Os dados cinemáticos foram coletados durante a velocidade auto selecionada no grupo de 34 crianças com idade média de 9.7 + 2.7 anos e no grupo de 17 adultos com idade média 25 + 3.8 anos. As variáveis analisadas foram: 1) Flexão de joelhos ao contato inicial, 2) Primeiro pico de flexão dos joelhos no apoio, 3) Flexão mínima dos joelhos no apoio e 4) Dorsiflexão máxima dos tornozelos no apoio. Os dados obtidos foram comparados entre os grupos e submetidos à análise estatística. RESULTADOS: Os resultados mostraram que o grupo de crianças apresentou um maior grau de flexão de joelhos na fase de apoio, porém a dorsiflexão dos tornozelos foi similar à apresentada pelos adultos. CONCLUSÃO: Na amostra estudada, o padrão de movimento dos joelhos na fase de apoio foi diferente entre crianças (9.7 anos em média) e adultos (25 anos em média), o que sugere que o processo de maturação da marcha normal pode se prolongar até a segunda década de vida.
OBJECTIVE: The purpose of this study was to evaluate the movement pattern of knee and ankle during stance phase in order to analyze the behavior of these parameters during gait maturation process. METHODS: Subjects without neuro-muscular diseases and with complete documentation at gait laboratory were included. Kinematics data were collected during self-selected speed in the children group (n =34) with mean age of 9.7 + 2.7 years and in the adult group (n =17) with mean age 25 + 3.8 years. The variables analyzed were 1) Knee flexion at initial contact 2) First peak knee flexion in stance 3) Minimum knee flexion in stance and 4) Peak of ankle dorsiflexion in stance. RESULTS: The results were compared and underwent statistical analysis. The children group showed higher knee flexion in stance than the adult group; however, dorsiflexion peak in stance did not present statically significant differences between groups. CONCLUSION: In the studied group, knee flexion during stance phase was different between children (mean age 9.7 years) and adults (mean age 25 years), which suggests that gait maturation process can last until the second decade of life.
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Humanos , Masculino , Feminino , Criança , Adulto , Tornozelo , Marcha/fisiologia , Movimento/fisiologia , Distribuição por Idade , Fenômenos Biomecânicos , Brasil , Joelho/fisiologia , Estudos RetrospectivosRESUMO
The purpose of this study was to describe the patterns of pelvic rotational asymmetry in the transverse plane and identify the possible factors related to this problem. One thousand and forty-five patients with cerebral palsy (CP) and complete documentation in the gait laboratory were reviewed in a retrospective study. Pelvic asymmetry in the transverse plane was observed in 52.7% of the patients; and to identify the possible causes of pelvic retraction, clinical (Thomas test, popliteal angle, and gastrocnemius tightness) and dynamic parameters (mean rotation of the hip in stance, minimum hip flexion, minimum knee flexion, and peak ankle dorsiflexion) were evaluated. The association between these parameters and pelvic retraction was assessed statistically. The results showed that 75.7% of patients with asymmetric pattern of the pelvis had clinical diagnosis of diplegic spastic CP. Among the patients with asymmetrical CP, the most common pattern was pelvic retraction on the affected side. The relationship between pelvic retraction and internal hip rotation was stronger in patients with asymmetrical diplegic CP than in those with hemiplegic (P<0.001) or symmetrical diplegic CP (P = 0.014). All of the patients exhibited a significant association among clinical parameters (Thomas test, popliteal angle, and gastrocnemius tightness) and pelvic retraction. In conclusion, pelvic retraction seems to be a multifactorial problem, and the etiology can change according to topographic classification, which must be taken into account during the decision-making process in patients with CP.
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Paralisia Cerebral/patologia , Transtornos Neurológicos da Marcha/patologia , Pelve/patologia , Adolescente , Fenômenos Biomecânicos , Paralisia Cerebral/complicações , Paralisia Cerebral/fisiopatologia , Criança , Pré-Escolar , Feminino , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Hemiplegia/etiologia , Hemiplegia/patologia , Hemiplegia/fisiopatologia , Articulação do Quadril/fisiopatologia , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pelve/fisiopatologia , Amplitude de Movimento Articular , Valores de Referência , Estudos RetrospectivosRESUMO
Fifty patients with spastic diplegic cerebral palsy were included in this retrospective study which compared visual assessment of gait to three-dimensional (3D) gait analysis. Inter-observer variability was evaluated as well. Inclusion criteria comprehended independent ambulation (i.e. without assistive devices or orthoses). All subjects went through 3D gait analysis at the Gait Analysis Laboratory of the AACD Hospital. Four observers, viewing videotaped gait cycles, evaluated 10 specific points of interest of the cycle: hip flexion at terminal stance; knee flexion at initial contact; knee extension at terminal stance; knee flexion at initial swing; ankle dorsiflexion at initial contact; pelvic obliquity at mid stance; hip adduction at loading response; pelvic rotation; hip rotation at mid stance and foot progression angle, in relation to the lower limb, at mid stance. Their evaluation was then compared to the 3D kinematics data. A statistical analysis of the results was performed using kappa and McNemar's test in order to determine inter-observer and visual/3D analysis agreement. Results showed that inter-observer agreement was high but on the other hand, only two points of the gait cycle (knee flexion at initial contact and pelvic obliquity) were shown to have been similarly evaluated visually and with the 3D analysis. In conclusion, this study indicates that only knee flexion at initial contact and pelvic obliquity appear to be reliably evaluated on a visual basis alone. Visual observation is therefore inadequate for the evaluation of the other eight selected points of the gait cycle which require some form of quantitative assessment.