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The Pediatric Temporal-spatial Deviation Index: quantifying gait impairment for children with cerebral palsy
Joanne Y Zhou1,2, Kevin Zhang1,3, Katelyn Cahill-Rowley1,2
1Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA.
Insights
A new Pediatric Temporal-spatial Deviation Index (TDI) effectively quantifies gait impairment in children. This simple metric shows promise for diagnosing gait abnormalities in children with cerebral palsy (CP).
Area of Science:
- Biomedical Engineering
- Pediatric Orthopedics
- Movement Science
Background:
- Gait impairment is a significant challenge in children, particularly those with cerebral palsy (CP).
- Accurate and accessible quantification of gait abnormalities is crucial for timely diagnosis and intervention.
- Existing methods may be complex or time-consuming for routine clinical use.
Purpose of the Study:
- To develop and validate an easily administered metric for quantifying gait impairment in children.
- To assess the utility of this new metric in children diagnosed with cerebral palsy (CP).
Main Methods:
- Development of the Pediatric Temporal-spatial Deviation Index (TDI) using gait data from typically developing children and those with CP (GMFCS levels I-III).
- Data collection involved pressure-sensitive mats and 3D gait analysis for children with CP.
- Statistical methods, including Kaiser-Meyer-Olkin, were used for feature selection and principal component analysis to quantify gait deviation.
Main Results:
- The Pediatric TDI was significantly lower in children with CP compared to typically developing children (p<0.001).
- The Pediatric TDI showed a strong correlation with the 3D motion capture-based Gait Deviation Index (GDI) (r=0.610, p=0.009).
- The metric demonstrated good sensitivity (0.78) and specificity (0.88) in identifying gait abnormalities.
Conclusions:
- The Pediatric TDI is a simple, effective, and easily administered gait metric suitable for clinical and research settings.
- This index provides a comprehensive single-score quantification of gait deviation, outperforming individual temporal-spatial parameters.
- Early detection of gait abnormalities using the Pediatric TDI can facilitate prompt diagnosis and treatment for children with CP.
Aim:
To develop an easily-administered metric to quantify gait impairment in children and to assess its use in children with cerebral palsy (CP).
Method:
The Pediatric Temporal-spatial Deviation Index (TDI) was developed from gait data collected from 75 typically developing children (37 males, 38 females; mean age 9y 4mo; interquartile range [IQR] 8-10y) and 17 children diagnosed with spastic CP (nine males, eight females; mean age 9y 9mo; IQR 9-11y), in Gross Motor Function Classification System (GMFCS) levels I to III, aged 7 to 11 years. Children walked on a pressure-sensitive mat. Children with CP also completed 3D gait analysis. The Kaiser-Meyer-Olkin test of sampling adequacy was used for temporal-spatial feature selection. Principal components obtained from temporal-spatial gait parameters quantified deviation from typically developing gait. Deviation was normalized to a Pediatric TDI score mean (standard deviation [SD]) of 100 (10). The Pediatric TDI for children with CP was compared to 3D motion capture-based Gait Deviation Index (GDI).
Results:
The Pediatric TDI was significantly lower for children with CP compared to typically developing children (p<0.001), correlated with average GDI (r=0.610, p=0.009), and demonstrated sensitivity (0.78) and specificity (0.88) to gait function, assessed with GDI.
Interpretation:
The Pediatric TDI is an easily administered, revealing gait metric that can be used in children with CP in pediatric clinics and for research. Detection of gait abnormalities in the clinic can expedite diagnosis and treatment. What this paper adds The Pediatric Temporal-spatial Deviation Index (TDI) is a single-score index of gait deviation, based on nine parameters. The Pediatric TDI was more revealing than single temporal-spatial gait parameters. The Pediatric TDI is quick and simple to administer in the clinic.
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