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Clinical Assessment of Spatiotemporal Gait Parameters in Patients and Older Adults
Published on: November 7, 2014
The Gait Pattern Classification System for Children with Spastic Cerebral Palsy (GaP-CP)-A Validity Study
Eirini Papageorgiou1, Laure Everaert1, Ines Vandekerckhove1
1Department of Rehabilitation Sciences, KU Leuven, 3001 Leuven, Belgium.
Insights
The gait pattern classification system for children with spastic cerebral palsy (sCP) shows good validity. Refined rules and clinical phenotypes support its use in practice for better decision-making.
Area of Science:
- Biomedical Engineering
- Clinical Biomechanics
- Pediatric Orthopedics
Background:
- The "gait pattern classification system for children with spastic cerebral palsy" (GaP-CP) was developed to classify gait deviations in children with spastic cerebral palsy (sCP).
- The system includes a novel "mild deviations" category, developed from a systematic review and expert consensus.
- Validation of the GaP-CP's content and construct validity is crucial for its clinical utility.
Purpose of the Study:
- To examine the content validity of the GaP-CP by comparing kinematic and kinetic data of children with sCP to typically developing children.
- To assess the construct validity of the GaP-CP by analyzing differences between neighboring gait patterns and exploring pattern-specific clinical phenotypes.
Main Methods:
- Non-parametric statistical comparisons were used to analyze kinematic (N=270) and kinetic (N=208) data from children with sCP and typically developing children (N=56).
- Kruskal-Wallis and Mann-Whitney U tests were employed to differentiate between gait patterns and explore patient- and impairment-specific characteristics.
- Analysis focused on identifying differences between adjacent gait patterns (construct validity) and all patterns (phenotype exploration).
Main Results:
- The GaP-CP demonstrated good content validity, with most classification rules confirmed by patient data; apparent equinus was most prevalent.
- Construct validity was supported by the system's ability to distinguish between neighboring gait deviations and identify pattern-specific phenotypes based on patient characteristics.
- Clear differentiation of pattern-specific phenotypes based solely on impairment characteristics was not achieved.
Conclusions:
- The findings support the validity of the GaP-CP for classifying gait patterns in children with sCP.
- Refined classification rules and precise terminology provide a clear path for clinical implementation.
- The identified pattern-specific clinical phenotypes enhance the system's utility in clinical practice and aid in decision-making.
Background:
In order to classify the gait of children with spastic cerebral palsy (sCP), the "gait pattern classification system for children with sCP" (GaP-CP) has been developed, based on a systematic review and complemented by an additional class of "mild deviations". The objective of the current study was to examine the content and construct validity of the GaP-CP.
Methods:
Statistical non-parametric comparisons identified the differences between the kinematics (N = 270) and kinetics (N = 208) of children with sCP and children with typically developing gait (N = 56) (content validity-aim 1), and between neighboring patterns (construct validity-aim 2a). Pattern-specific clinical phenotypes were explored based on the differences between all gait patterns (Kruskal-Wallis comparisons with post hoc Mann-Whitney U tests) in patient- and impairment-specific characteristics (construct validity-aim 2b).
Results:
The apparent and true equinus were the most and least prevalent patterns, respectively. The majority of the original classification rules were confirmed by the patient data, indicating good content validity of the GaP-CP. Its construct validity was strengthened by distinguishing between gait deviations of neighboring patterns and differentiating between gait patterns based on patient-specific characteristics, leading to pattern-specific phenotypes. Yet, pattern-specific phenotypes could not be clearly defined based on the impairment-specific comparisons.
Conclusions:
The current results support the validity of the GaP-CP. Refined classification rules, using more precise terminology, establish a roadmap for its clinical implementation. The pattern-specific clinical phenotypes enable its use in a clinical context and may aid clinical decision-making.
