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Assessing Gross Motor and Gait Function Using Hip-Knee Cyclograms in Ambulatory Children with Spastic Cerebral Palsy
Jehyun Yoo1,2, Juntaek Hong2, Jeuhee Lee2
1Department of Rehabilitation Medicine, Gachon University Gil Medical Center, College of Medicine, Gachon University, Incheon 21565, Republic of Korea.
Insights
Cyclogram analysis of hip and knee movement offers a new, accessible way to assess motor function in children with cerebral palsy (CP). This digital biomarker approach correlates well with traditional clinical measures, potentially simplifying evaluations.
Area of Science:
- Biomedical Engineering
- Rehabilitation Science
- Pediatric Neurology
Background:
- Children with cerebral palsy (CP) often experience motor impairments affecting gross motor, gait, and selective motor functions.
- Traditional assessments like the Gross Motor Function Measure (GMFM-66) and instrumented gait analysis are valuable but resource-intensive.
- There is a need for accessible, objective digital biomarkers to evaluate motor function in pediatric CP populations.
Purpose of the Study:
- To investigate the utility of cyclogram-based analysis of hip and knee kinematics as digital biomarkers for motor function in children with CP.
- To correlate cyclogram parameters with established clinical assessments including GMFM-66, gait speed, Gait Deviation Index (GDI), and Gait Profile Score (GPS).
Main Methods:
- Utilized cyclogram analysis of simple hip and knee joint kinematics in 144 ambulatory children with spastic CP.
- Employed Principal Component Analysis (PCA) to quantify cyclogram shape characteristics.
- Correlated cyclogram parameters with GMFM-66, gait speed, GDI, and GPS sagittal plane subscores.
Main Results:
- All cyclogram parameters showed significant correlations with GMFM-66, gait speed, GDI, and GPS hip/knee sagittal subscores.
- The swing phase area of the cyclogram demonstrated the strongest correlation with clinical measures.
- Regression models using swing phase area effectively estimated GMFM-66 (R²=0.301) and gait speed (R²=0.484); PC1/PC2 ratio correlated with selective motor control (R²=0.320).
Conclusions:
- Hip-knee cyclogram parameters show promise as accessible digital biomarkers for assessing motor control and gait in children with bilateral spastic CP.
- This approach offers a potential alternative to resource-intensive hospital-based evaluations.
- Further validation using wearable sensors like inertial measurement units is recommended.
Abstract:
Weakness, spasticity, and muscle shortening are common in children with cerebral palsy (CP), leading to deficits in gross motor, gait, and selective motor functions. While traditional assessments, such as the Gross Motor Function Measure (GMFM-66), instrumented gait analysis, and the Selective Control Assessment of the Lower Extremity (SCALE), are widely used, they are often limited by the resource-intensive nature of hospital-based evaluations. We employed cyclogram-based analysis, utilizing simple hip and knee joint kinematics to assess clinical measures, including GMFM-66, normalized gait speed, the gait deviation index (GDI), and the gait profile score (GPS). Principal component analysis was used to quantify the cyclogram shape characteristics. A total of 144 children with ambulatory spastic CP were included in the study. All the cyclogram parameters were significantly correlated with GMFM-66, gait speed, the GDI, and the sagittal plane subscore of the GPS for the hip and knee, with the swing phase area showing the strongest correlation. Regression models based on the swing phase area were used to estimate the GMFM-66 (R2 = 0.301) and gait speed (R2 = 0.484). The PC1/PC2 ratio showed a moderate correlation with selective motor control, as measured by the SCALE (R2 = 0.320). These findings highlight the potential of hip-knee cyclogram parameters to be used as accessible digital biomarkers for evaluating motor control and gait function in children with bilateral spastic CP. Further prospective studies using wearable sensors, such as inertial measurement units, are warranted to validate and build upon these results.
