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Impact of gait analysis on correction of excessive hip internal rotation in ambulatory children with cerebral palsy: a randomized controlled trial
Author(s) -
Wren Tishya A L,
Lening Christopher,
Rethlefsen Susan A,
Kay Robert M
Publication year - 2013
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.12184
Subject(s) - cerebral palsy , ambulatory , medicine , internal rotation , gait , physical medicine and rehabilitation , randomized controlled trial , physical therapy , gait analysis , surgery , mechanical engineering , engineering
Aim The aim of this study was to determine if gait analysis improves correction of excessive hip internal rotation in ambulatory children with spastic cerebral palsy ( CP ). Method Children undergoing orthopedic surgery were randomized to receive or not receive a preoperative gait analysis report. This secondary analysis included all participants whose gait report recommended external femoral derotation osteotomy ( FDRO ). One‐year postoperative, and pre‐ to postoperative change in femoral anteversion, mean hip rotation in stance, and mean foot progression in stance were compared between groups and in subgroups based on whether the recommendation for FDRO was followed. Results Outcomes did not differ between the group which received a gait report ( n =39; 19 males, 20 females; mean age 10y 4mo [ SD 3y]; hemiplegia, 3; di/triplegia, 28; quadriplegia, 8; G ross M otor F unction C lassification S ystem [ GMFCS ]: level I, 5; level II , 12; level III 19; level IV , 3) and the control group ( n =26; 14 males, 12 females; mean age 9y 5mo [ SD 2y 10mo]; hemiplegia, 1; di/triplegia, 21; quadriplegia, 4; GMFCS : level I, 4; level II , 1; level III , 9; level IV , 2; all p values >0.29), but improved more in the gait report subgroup in which the FDRO recommendation was followed (seven limbs; change in anteversion −32.9°, hip rotation −25.5°, foot progression −36.2°) than in the control group (anteversion −12.2°, hip rotation −7.6°, foot progression −12.4°; all p values ≤0.02) and the gait report subgroup in which FDRO was not performed (32 limbs; anteversion −1.0°, hip rotation 0.5°, foot progression −8.0°; all p values ≤0.003). Postoperative measures became normal only in the gait report subgroup in which the recommended FDRO was performed. Interpretation Gait analysis can improve outcomes when its recommendations are incorporated in the treatment plan.