gait analysis and interdisciplinary interventions for children with cerebral palsy

Conditions: Cerebral Palsy

Summary: the aim of this study is to test the hypothesis, that improvements in gait pattern following individually tailored interventions guided by instrumented 3-dimensional gait analysis are superior to those used in 'care as usual'.

children with cerebral palsy (cp) who walk independently often have an altered gait pattern. interdisciplinary interventions in terms of orthopaedic surgery, spasticity management, physical therapy and orthotics aim to improve the gait pattern. standardised measurements are used in the cerebral palsy follow-up program to assess walking. however, these measurements do not describe features in the gait pattern reflecting underlying neuro-musculoskeletal impairments. this can be done with instrumented 3-dimensional gait analysis (iga). it has never been investigated whether interdisciplinary interventions designed to address impairments identified by iga result in improved gait pattern compared with 'care as usual' without iga in children with cp. the aim of this study is to test the hypothesis, that improvements in gait pattern following individually tailored interventions guided by iga are superior to those used in 'care as usual'. a prospective, single blind, randomised, parallel group study will be conducted. participants will be recruited from the cerebral palsy follow-up program. children aged 5 to 9 years with spastic cp, classified at gross motor function classification system levels i or ii will be included. the interventions under investigation are 1) individually tailored interdisciplinary intervention addressing impairments identified by iga and 2) 'care as usual' (interdisciplinary interventions without iga). the primary outcome is gait pattern measured by the gait deviation index. secondary outcome measures are, walking performance and patient-reported outcomes of functional mobility, health-related quality of life and overall health, pain and participation. explorative outcome measures include walking performance, gait pattern, behavior of health care providers and the applied interventions. the primary endpoint for assessing the outcome of the two interventions will be 52 weeks after start of intervention. a follow up will also be performed at 26 weeks after start of intervention; however, exclusively for the patient-reported outcomes. to our knowledge, this is the first randomised controlled trial comparing the effects of an individually tailored interdisciplinary intervention designed to address impairments identified by iga versus 'care as usual' in children with cp. consequently, the study will provide novel evidence for the use of iga in interdisciplinary interventions.

Eligibility criteria:
inclusion criteria: * spastic cerebral palsy * gross motor function classification system levels i or ii. exclusion criteria: * earlier interventions in the form of orthopaedic surgery within the past 52 weeks, injection with botulinum toxin type a in the 12 weeks prior to baseline assessments * relocation to another region during the trial. * if the child not are able to demonstrate sufficient co-operation and cognitive understanding to participate in the iga.

Keywords: cerebral palsy instrumented gait analysis gait deviation index