1st Joint ESMAC-GCMAS Meeting - Análise de Marcha

O-18
3D HIP AND PELVIC GAIT PATTERN RECOGNITION IN CHILDREN WITH CP
Desloovere, Kaat 1,2 , PhD, Molenaers, Guy 2,3 , PhD-MD, Daniels, Kim 1 , PT MSc, Van Campenhout,
Anja 2,3 , MD, Corstjens, Hilde 1 , PT MSc
1 Department of rehabilitation sciences, 2 Clinical Motion Analysis Laboratory of the University
Hospital Pellenberg, 3 Department of Paediatric Orthopedics, KuLeuven, Belgium
Summary/conclusions
Cluster analysis was used to recognize typical patterns and to search for underlying
pathological mechanisms which might explain the large inter-subject variability in hip and
pelvic motion during gait in children with CP. Five typical gait patterns were clinically
described. Two groups of older children presented with continuous internal hip rotation (one
group with flexed hip and another with full hip extension at terminal stance), and two groups of
young children with gradually increasing hip rotation during stance (also one group with flexed
hip and another with full hip extension at terminal stance). A final group of mainly children
with hemiplegia only showed mild hip problems. The 5 clusters were characterised by
significant between-group differences for pelvic and hip gait parameters and for clinical
measures of muscle contractures and strength, but not for clinical alignment measures.
Introduction
Children with cerebral palsy (CP) present with a variety of gait patterns and in general, there is
a low correlation between clinical parameters (ROM, alignment, spasticity , strength and
selectivity) and gait deviations [1]. Therefore, the underlying mechanisms of the pathological
gait are still poorly understood. Gait classification systems have been developed to structure
and to create more insight into different gait patterns. However, most gait classifications only
describe sagittal gait patterns, thereby mainly focusing on ankle, knee and sagittal hip motion.
However, 3D hip and pelvic pathology is frequently observed in children with CP, and is
known to be complex, influenced by a combination of bony deformities, increased tone, muscle
contractures and weakness [2]. The purpose of the study was to evaluate whether different gait
patterns could be statistically recognized and clinically described for 3D hip and pelvic motion
for a large group of ambulant children with CP, by using cluster analysis. It was hypothesised
that the specific gait patterns would be related to diagnosis, age and clinical measurements
(alignment, ROM, tone, strength and selectivity).
Statement of clinical significance
More insight into the typical 3D hip and pelvic gait patterns can help to understand the
underlying mechanisms of pathological gait, and eventually improve communication between
clinicians and facilitate clinical decision-making.
Methods
342 ambulant patients (189 with diplegia and 153 with hemiplegia) were selected for this
retrospective study. The inclusion criteria were: (1) ambulation, without walking aids, (2) full
gait analysis, including 3D kinematics, kinetics and EMG (VICON, AMTI, K-lab) and full
clinical examination (ROM, spasticity, strength and selectivity) at 4 to 20 years of age. 40 gait
parameters (average of 3 trials per subject) and 32 clinical examination parameters were
defined for each subject. To avoid the influence of inter-correlation between limbs, only one
pathological side per subject was included for further analysis. Non-hierarchical k-means
clustering was used on the standardised data of a selection of 18 kinematic and kinetic
parameters of hip and pelvis, resulting in 5 clusters. The definition of the number of cluster
was based on the study of intra and inter cluster variability and the frequency distributions of
the clusters. The 5 clusters were clinically described by comparing the gait parameters with the
parameters of an age-related normal control group of 68 children. Mean and SD of all
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