Sagittal Gait Analysis in Children and Young Adults with Cerebral Palsy Before and After Single Event Multilevel Surgery: A Comparative Study

INTRODUCTION: Cerebral Palsy (CP) is the most common pediatric neurologic disorder, with an incidence of 3.6 per 1000 live births. It is defined as a motor disorder resulting from a non-progressive lesion or injury to the developing brain (1). CP being a syndrome with multiple disabilities has always been a challenge to treat. Of the various domains that may need addressing to ensure optimal function, mobility seems to play a key role in overall enhancement of quality of life in persons enduring CP. The best available evidence indicates that people with mobility impairment are among the least physically active groups in society (2). Physical and Occupational Therapies, Serial POP Casting, Medication, Orthosis and surgical procedures are in practice to work on posture, tone and mobility of persons with CP. Single Event Multilevel Surgery has replaced multi event multiple surgeries spread over a period of time. This ongoing evolution in the management of CP is primarily due to quantitative assessment tools of which Instrumented Gait Analysis is a major player. Our aim was to compare data from sagittal gait analysis of children with spastic diplegia, triplegia and hemiplegia who had undergone Single Event Multilevel Surgery, as a part of management of gait abnormalities, between 2001 and 2006 at The Christian Medical College Vellore, India. AIMS AND OBJECTIVES: Primary Aim: 1. To compare the sagittal gait parameters of Instrumented Gait Analysis, prior to and after Single Event Multilevel surgery in children and young adults with Cerebral Palsy. Secondary Aim: 1. To look for objective evidence for the efficacy of Single Event Multilevel Surgeries in the management of the progressive musculoskeletal disease in Cerebral Palsy. 2. To initiate the availability of a database of objective gait parameters for reference and future studies in the appropriate management of musculoskeletal issues in Cerebral Palsy. MATERIALS AND METHODS: The subjects for the study were children and young adults with cerebral palsy who had undergone Single Event multilevel Surgery for spasticity reduction and deformity correction between 2001 and 2003 at the Physical Medicine and Rehabilitation department of Christian Medical College Vellore. These children have been under the interdisciplinary care of the PMR department prior to surgery and had undergone observational and Instrumented gait analysis pre and post-operatively. Their clinical details and gait analyses were retrospectively analyzed. The children had undergone various other procedures such as serial casting along with physical and occupational therapies prior to surgery. They had been started on medication for spasticity reduction after assessment by the interdisciplinary team. Gait Analysis was done in the Gait Lab at the Rehabilitation Institute of the Christian Medical College Vellore. Stastical Methods: The kinematic and the kinetic data for 26 limbs (13 children) pre op and post op were analysed.The average for each group was calculated with standard deviation. The data were normally distributed and hence difference between the pre and post op averages was tested for statistical significance using students T test and T Distribution using the Microsoft Excel programme. CONCLUSIONS: 1. Instrumented Gait Analysis data in the sagittal plane showed a positive variation in kinematics of the hip, knee and ankle but the evidence was not of statistical significance. 2. The energy efficiency of gait following SEMLS was better but the difference in the reduction of the PCI was not statistically significant. 3. A prospective study such as a randomized controlled study is urgently required with the adequate sample size is recommended.