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Gait patterns in hemiplegic cerebral palsy: Is it time for a new classification?
Mauro César de Morais Filho1, Marcelo H Fujino1, Cátia M Kawamura2
1Pediatric Orthopedic Surgeon, Gait Laboratory and Cerebral Palsy Clinic, AACD, São Paulo, Brazil.
Gait & Posture
|April 6, 2025
Summary
The Winters, Gage and Hicks classification (WGHC) for spastic hemiplegia is limited, failing to classify over half of cerebral palsy patients. This study identified new patterns, suggesting an update to the WGHC is needed for better classification.
Area of Science:
- Orthopedics
- Neurology
- Biomedical Engineering
Background:
- The Winters, Gage and Hicks classification (WGHC) is a widely used system for categorizing spastic hemiplegia.
- However, its limitations in accurately classifying all cases of cerebral palsy (CP) have been noted.
Purpose of the Study:
- To evaluate the reliability and comprehensiveness of the WGHC in a large cohort of patients with spastic hemiplegic cerebral palsy.
- To determine if all hemiplegic CP patients can be adequately classified using the existing WGHC framework.
Main Methods:
- A retrospective analysis of 983 spastic hemiplegic CP patients from a gait laboratory database was conducted.
- Exclusion criteria included mixed tone, co-existing pathologies, recent orthopedic surgeries, or botulinum toxin injections, leaving 532 subjects for classification using WGHC.
- Patients were classified into the 4 WGHC groups, with additional groups identified for unclassifiable individuals.
Main Results:
- The WGHC failed to classify 42.1% (224/532) of the spastic hemiplegic CP patients.
- Four new patterns were identified: Group V (no WGHC alterations), Group VI (WGHC III/IV with normal ankle dorsiflexion), Group VII (WGHC II-IV with normal swing phase dorsiflexion), and Group VIII (reduced dorsiflexion with increased hip flexion).
- Significant differences in age, Gross Developmental Index (GDI), pelvic asymmetry, hip rotation, and prevalence of perinatal anoxia were observed among the groups.
Conclusions:
- The WGHC classification system is insufficient for a significant portion (57.9%) of spastic hemiplegic cerebral palsy patients.
- The identification of four additional distinct patterns necessitates a revision and update of the WGHC to improve its clinical utility and reliability.
