Gait analysis contribution to problems identification and surgical planning in CP patients: An agreement study

Background. Previous studies have demonstrated that the use of gait analysis (GA) modifies decision making and changes planned surgical treatment, confirming some clinical indications or defining alternative choices, excluding or delaying already planned surgery in children with cerebral palsy (CP). Aim. To assess the difference in defining functional problems and treatment relevance using clinical assessment or gait analysis in CP children. Design. The study has been designed for assessing the rate of agreement on muscle-skeletal diagnosis, and on surgical recommendations in diplegic CP patients, when decided by two different blinded clinicians based on a) clinical assessment, and b) GA in addition to clinical assessment. Population. Twenty-five diplegic children who have been evaluated by GA before surgery and at a follow up of at least 6 months. Methods. Two separate lists of problems and consequent surgical interventions were outlined for all the patients by two blinded experts from clinical and GA assessment. The two sets of nominal-scale ratings for all patients of the two groups were statistically evaluated for agreement. Results. A fair and a slight agreement was found respectively between the two sets of problems and the two sets of surgical plans. Main differences in problems identified were relative to the presence of generalized spasticity and bony deformities as detected by means of GA instead of local problems and soft tissues spasticity/retraction clinically identified. As a consequence, by means of GA, surgery was indicated only in 65% of patients. Conclusion. The availability of a GA laboratory helps in diagnostic reasoning in CP children indicated for surgery. Low agreement found appears to be a result of a different clinical approach of the surgeons. Clinical Rehabilitation Impact. The use of GA in the analysis of motor problems in CP children provides a basis for an objective reasoning for clinical decision making and for assessing functional outcome. Further efforts are required to build a body of knowledge about a consensus on the identification of walking problems in CP children.