Gait analysis helps children with cerebral palsy keep pace

A person’s gait affects his or her entire body; movement that causes stress in too many places lead to pain, or injury. However, if a comprehensive motion and gait analysis is performed by a qualified professional, the nature of a person’s condition can be identified and corrected to improve mobility and avoid discomfort.

Gait Analysis Lab, Shriners Hospital for Children in Sacramento. Northern California photographer Julia Serat was selected for inclusion in the 2017 Children’s Hospitals Photo Exhibit, a national competition presented by HUGGIES® and the Children’s Hospital Association

Kenneth A. Stern, Cerebralpalsy.org

Gait analysis helps children with Cerebral Palsy keep pace

A child with Cerebral Palsy will undergo a battery of medical evaluations. One of the most telling of evaluations, when it comes to Cerebral Palsy’s effect on lower body mobility, is known as gait assessment. Gait assessment tells medical professionals why some individuals walk a certain way, and others don’t.

To most, walking does not require conscious effort, but to those with Cerebral Palsy the complex interactions between the brain and the spinal cord nerves, muscles, tendons, ligaments, bones and joints can be inherently complicated. Gait analysis is a tool that medical professionals use to measure and analyze how movement can be accomplished.

Gait analysis on individuals with Cerebral Palsy, which can be performed during any stage of human development from childhood to senior years, is an involved, comprehensive analysis that examines how the person’s brain injury affects his or her walking patterns. The test is performed on individuals with Cerebral Palsy or other conditions such as stroke or Parkinson’s Disease.

Although the brain injury or malformation that causes Cerebral Palsy is a permanent injury that does not progress throughout a person’s life, the patterns a child develops – those that may make it easier for them to move or compensate for lost mobility in the lower body – can change.

For this reason, gait analysis provides a useful snapshot of what physical conditions exist that can impede movements, why these conditions exist, and what treatments may help a person maximize their movement and comfort. It can also identify root causes for mobility issues and pain that vary from person to person.

Because no two children are affected in the same way by Cerebral Palsy, no two walking patterns will be the same. This is because brain injuries that occur in specific locations, combined with the severity of the brain injury, can impact the growth of muscles and bones differently. That means that the results of gait analysis will be varied; results will be based on a person’s unique way of moving. This analysis can be useful to physicians seeking solutions to address a patient’s specific condition(s).

Gait analysis is not a test that is available in every community, but where available it is performed by qualified and specially trained health professionals. Gait analysis can be expensive, but in the end may save time and money as it guides treatment and exercise programs and can prevent unneeded surgeries.

THE BIOMECHANIST. Photo credit Gjon Milli

A dependable predictor

Gait analysis was conceived in the early 1980s as a tool to help identify the causes and potential treatment for motor dysfunction. It takes a systematic approach to human motion and how it relates to a person’s bones, tendons and muscles.

The analysis, which typically takes place at a specially-designed laboratory, typically involves three steps – a physical exam, a video of gait, and a motion analysis. Typically, a gait analysis session will take anywhere from one to four hours of time. Two to four clinicians, including a physical therapist and a technician or engineer, will carry out the analysis and assist the child.

The physical therapist will conduct a comprehensive physical exam that includes assessment of the individual’s strength, range of motion, alignments and spasticity. Patients are often asked to complete a functional assessment questionnaire and an outcomes questionnaire.

Individuals undergoing gait analysis are urged to wear loose fitting shorts with elastic waist, t-shirts or tank tops, and walking shoes. They are also instructed to bring any braces or walking aids that are required for mobility.

A video will record the individual’s gait from two angles to provide a reference point to measure treatment outcomes.

During the actual motion analysis, the child will have several surface electrode sensors on his or her body at key locations, such as the ankle, knee, hip, and pelvis. The child then walks on a rail-supported catwalk or a treadmill while he or she is filmed by several video and infrared cameras.

Special cameras are hooked up to a computer, which tracks, records and calculates the trajectory of each marker in three dimensions. This allows the physician to understand the movement – or malfunction – of the underlying bones, muscles and tendons. It indicates when the muscles are active or at rest. Electromyography, or the electronic recording of muscle activity, is also used to measure muscle activity in legs while the individual moves.

Oxygen consumption, energy expenditure as measured when oxygen is inhaled and carbon dioxide is exhaled, is facilitated by a mask that covers the person’s nose and mouth. The mask is worn during rest before the motion analysis, and while walking during the procedure.

In most cases, clinicians will use special flooring, or force plates, on the path where a child’s feet touch the ground, a process called plantar pressure testing. This has a number of purposes: The electrodes take kinetic, or continuous readings of, measurements regarding the magnitude with which a child’s feet strike the ground, as well as the direction of a child’s feet and the center of pressure.

After all of the tests are performed, the technicians then process and analyze the data, to determine what factors are negatively influencing a child’s mobility. Within three to four weeks, the results are reviewed by physical therapists and orthopedic surgeons in an effort to guide the treatment plan. Treatments and interventions, such as orthopedic surgery (muscle, joint or tendon), drug therapy, rehabilitation therapies (physical therapy and occupational therapy), casting, exercise regimens, or braces may be recommended to rectify conditions, or lessen impact while improving gait and mobility.

Typically, the orthopedic surgeon will provide the individual’s primary care physician with the information to discuss with the patient. Benefits and risks of recommended procedures are reviewed, and alternative courses of treatment are also presented.

A gait analysis is considered pain-free and is not intrusive.

Walking Toward Endless Possibilities: The Story of Olivia Stamps – Shriners Hospitals for Children. Meet new patient ambassador Olivia Stamps through the video Walking Toward Endless Possibilities. Published on Youtube Jul 4, 2013
A whole host of benefits

In terms of people with Cerebral Palsy, gait analysis has provided physicians and physical therapists with additional knowledge about how Cerebral Palsy affects a child’s body.

It’s helped physicians devise ways to establish conventional gait patterns. Gait analysis also helped physicians establish the relationship between how a person’s musculoskeletal structure influences their movement.

Gait analysis can bring many benefits to a patient that will improve his or her mobility, and chances of living an independent life. One way the benefits can be divided is by looking at a child’s condition pre-operatively and post-operatively.

Prior to surgery or treatment, gait analysis can give physicians a specific picture of what is causing a child’s condition.

Once the factors that are impeding a child’s movement are better understood, various treatments can be implemented after a gait analysis is performed.

Based on the results of gait analysis, several surgical and non-surgical interventions may be recommended. A child’s physical therapy regimen can be adjusted and improved; new bracing or assistive equipment may be added to help a child move.

Or, orthopedic surgery may be recommended. Those surgeries can include interventions to reduce tension on tendons, or to lengthen tight muscles, or correct bone deformities. Surgery may also be performed to reduce spasticity. Successful surgery may help reduce a child’s dependence on devices like braces or walkers.

Post-operatively, gait analysis can provide valuable information to physicians regarding the success of surgery.

Additionally, information provided from the assessment allows physicians to determine if a treatment will yield the desired results; potentially saving a child from ill-advised medical interventions. When gait analysis is performed on a child, a parent learns more about the drivers affecting the child’s movement and the processes that can be employed to provide relief.

Parents have a few ways to confirm that the medical professional that is performing a child’s assessment is qualified. If the professional is a physician or a physical therapist, a parent should check with a state’s licensing board to make sure credentials and certifications are up to date.

Also, clinical settings and laboratories that provide gait analysis are voluntarily accredited by the Commission for Motion Laboratory Association, CMLA.

It’s important to note that in the hands of a qualified professional, gait analysis carries no health risks and is not painful for a child. It’s also not uncommon for a person to undergo analysis at more than one juncture in life, as secondary and related conditions change – a person’s needs at 10-years-old are likely to be different than they are when he or she turns 40. For these reasons, gait analysis can be useful in early childhood to frame a child’s medical treatment plan, but can be useful once the child is an adult if walking becomes difficult.

Gait analysis is one of several tests that can be performed to help physicians find ways to expand a child’s mobility. If it is not part of a child’s current medical plan, gait analysis is worth exploring because of its track record for success, especially among children with Cerebral Palsy.

Source Cerebralpalsy.org

Gait analysis in children with cerebral palsy, Stéphane Armand, Geraldo Decoulon, Alice Bonnefoy-Mazure. EFORT Open Reviews 2016;1:448-460. DOI: 10.1302/2058-5241.1.000052

Also see
Gait analysis influences care of children with CP in Lower Extremity Review
Kids with Cerebral Palsy Get Gait Help from Motion Analysis Engineers in AM Vans Inc.
Gait Analysis (Movement Lab at McMaster Children’s hospital) in Kate’s Blog

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