Related Experiment Video
Updated: Aug 23, 2025
Clinical-oriented Three-dimensional Gait Analysis Method for Evaluating Gait Disorder
Published on: March 4, 2018
Reliability and validity of the gait classification system in children with cerebral palsy (GCS-CP)
Alessandro G Melanda1, Jon R Davids2, Ana Carolina Pauleto3
1Department of Surgery, State University of Londrina, Paraná, Brazil; Master's and Doctoral degree program in Rehabilitation Sciences - State University of Londrina, Paraná, Brazil; Gait Analysis Laboratory, Ana Carolina Moura Xavier Hospital Rehabilitation Center, Curitiba, Brazil.
Insights
The Gait Classification System for Cerebral Palsy (GCS-CP) effectively categorizes gait deviations in children with cerebral palsy (CP). This system demonstrates good reliability and clinical utility for assessing gait patterns and aiding treatment decisions.
Area of Science:
- Biomechanical analysis of human locomotion.
- Clinical assessment tools for neurological disorders.
Background:
- Gait classification systems (GCS) aid clinical decision-making in assessing patient outcomes.
- Davids and Bagley developed a GCS for children with cerebral palsy (GCS-CP) in 2014.
Purpose of the Study:
- To apply the GCS-CP to a sample of patients with cerebral palsy (CP).
- To evaluate the reliability and clinical utility of the GCS-CP.
Main Methods:
- Retrospective review and classification of gait in 131 children with CP using 2D video and 3D lower limb kinematics/kinetics.
- Assessment of Gross Motor Function Classification System (GMFCS) levels and Gait Profile Scores (GPS).
- Statistical analysis using Kruskal-Wallis test and Kappa statistics for reliability (intrarater and interrater).
Main Results:
- The GCS-CP successfully classified 96.95% of cases for sagittal plane stance phase deviations.
- All patients were classifiable for sagittal plane swing phase and transverse plane deviations.
- Interrater reliability ranged from 0.485 to 0.596; intrarater reliability ranged from 0.714 to 0.776.
Conclusions:
- The GCS-CP demonstrates clinical utility by classifying nearly all CP subjects across two planes using kinematic and kinetic data.
- The system is valid with moderate interrater and moderate to substantial intrarater reliability.
Background:
Gait classification systems (GCS) may enable clinicians to differentiate gait patterns into clinically significant categories that assist in clinical decision-making and assessment of outcomes. Davids and Bagley in 2014 [1] described a GCS for children with cerebral palsy (GCS-CP). The purpose of our study was to use the GCS-CP for the first time on a sample of patients with CP and to evaluate the reliability and utility of the classification system.
Methods:
The gait of 131 children with CP was retrospectively reviewed and classified according to Davids and Bagley's classification using two-dimensional (2D) video and three-dimensional (3D) lower limb kinematics and kinetics. Gross Motor Function Classification System (GMFCS) levels were determined, and the Gait Profile Scores (GPS) calculated to characterize the sample concerning gait classification. The comparison between the groups was performed using the Kruskal-Wallis test with respect to the non-normal distribution of the data. The intrarater and interrater reliability was determined using the Kappa index (k) statistics with 95% CI.
Results:
All GCS-CP groups were represented within the evaluated sample. Of the 131 cases evaluated, 127 (96.95%) were able to be classified with respect to sagittal plane stance phase gait deviations. All patients in the sample were able to be classified with respect to sagittal plane swing phase and transverse plane gait deviations. The interrater reliability was 0.596 and 0.485 for the first and second levels of the classification, respectively, according to the Fleiss's Kappa statistics. Intrarater reliability was 0.776 and 0.714 for the raters one and two, respectively, according to the Cohen's Kappa statistics.
Significance:
The GCS-CP exhibited clinical utility, successfully classifying almost all subjects with CP in two planes, based upon kinematic and kinetic data. The classification is valid and has moderate interrater and moderate to substantial intrarater reliability.
