Parental subjective assessment of gait limitations: Comparison with objective gait variables

Subjective assessment is an important part of clinical examination providing quality insights into impairments of body structure and functions. Research into the associations between parental perceptions of gait in children with cerebral palsy (CP) and objective clinical gait measures is limited.

What are the parental perceived gait limitations in children with CP and are these perceptions associated with objective clinical gait analysis?

Parent questionnaires were retrospectively analysed for children with CP who attended our gait analysis laboratory over a 24-month period. Perceived walking limitations caused by pain, weakness, lack of endurance, mental ability, safety concerns, and balance were recorded on a 5-point Likert scale. Normalised gait speed, normalised step length and the Gait Deviation Index (GDI) were calculated. Differences between responses were assessed using Chi-squared tests with Dunn's post hoc test with Bonferroni adjustment. Spearman's rank correlations were performed to determine the relationship between responses and gait parameters.

Data from 251 participants were included, mean age 9 ± 3.4 years, Gross Motor Function Classification System (GMFCS) level I = 158, II = 64 and III = 29. Balance was perceived to limit walking to the greatest extent, followed by weakness, lack of endurance, safety concerns, pain and mental ability. This rank was consistent across GMFCS levels I, II and III. Perceived balance limitations showed the strongest correlations with objective gait variables, GDI (r = -0.31 p = 0.000), normalised step length (r = -0.30 p = 0.0000) and normalised gait speed (r = -0.24 p = 0.0001).

Subjective gait perceptions provide a valuable indication of gait function but are weakly associated with objective clinical gait analysis. Outcome measures that are sensitive to changes in balance may be more responsive to parental concerns and help to satisfy their goals and expectations.