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- The gait profile score to assess the effects of ankle-foot orthoses in the gait of children with cerebral palsyPublication . Ricardo, Diogo; Raposo, Maria; Veloso, António; João, FilipaIntroduction: The ankle-foot orthosis is the most common non-invasive therapeutic intervention used to correct gait deviations, especially in children with Cerebral Palsy (CP). Several studies demonstrated that its use improved spatio-temporal and kinematic outcomes. However, biomechanical reports can be complex and may need experience to correctly interpret the results. Gait deviation indices, such as the Gait Profile Score (GPS) intend to summarize some clinically meaningful parameters and clarify in which way an ankle-foot orthosis impacts gait in children with CP. Research question: The aim of this study was to assess if GPS reflects the effect of AFO use on a sample of children with CP while walking.
- Test-retest reliability of a 6DoF marker set for gait analysis in cerebral palsy childrenPublication . Ricardo, Diogo; Teles, Júlia; Raposo, Maria Raquel; Veloso, António Prieto; João, FilipaBackground: Cerebral palsy (CP) is a complex pathology that describes a group of motor disorders with different presentations and functional levels. Three-dimensional gait analysis is widely used in the assessment of CP children to assist in clinical decision-making. Thus, it is crucial to assess the repeatability of gait measurements to evaluate the progress of the rehabilitation process. The purpose of the study is to evaluate the test-retest reliability of a six-degree-of-freedom (6DoF) marker set in key points of gait kinematics, kinetics, and time-distance parameters in children with CP. Methods: trials were performed on two different days within a period of 7.5 ± 1.4 days. Motion capture data was collected with 14 infrared, high-speed cameras at a frequency rate of 100 Hz, synchronized in time and space with two force plates. Intraclass correlation coefficients considering the two-way mixed model, and absolute agreement (ICC[A,k]) were calculated for anthropometric, time–distance, kinematic and kinetic parameters of both lower limbs. Results: the majority of gait parameters demonstrated a good ICC, and the lowest values were in the kinematic variables. Conclusions: This study indicates wide-ranging reliability values for lower limb joint angles and joint moments of force during gait, especially for frontal and transverse planes. Although the use of a 6DoF-CAST in CP children was shown to be a feasible method, the gait variation that can be observed between sessions in CP children seems to be related not only to the extrinsic factors but also to their different gait patterns and affected sides.
- Effects of ankle foot orthoses on the gait patterns in children with spastic bilateral cerebral palsy: a scoping reviewPublication . Ricardo, Diogo; Raposo, Maria; Cruz, Eduardo; Oliveira, Raul; Carnide, Filomena; Veloso, António; João, FilipaBackground: Cerebral palsy (CP) is the most common cause of motor disability in children and can cause severe gait deviations. The sagittal gait patterns classification for children with bilateral CP is an important guideline for the planning of the rehabilitation process. Ankle foot orthoses should improve the biomechanical parameters of pathological gait in the sagittal plane. Methods: A systematic search of the literature was conducted to identify randomized controlled trials (RCT) and controlled clinical trials (CCT) which measured the effect of ankle-foot orthoses (AFO) on the gait of children with spastic bilateral CP, with kinetic, kinematic, and functional outcomes. Five databases (Pubmed, Scopus, ISI Web of SCIENCE, SciELO, and Cochrane Library) were searched before February 2020. The PEDro score was used to assess the methodological quality of the selected studies and alignment with the Cochrane approach was also reviewed. Prospero registration number: CRD42018102670. Results: We included 10 studies considering a total of 285 children with spastic bilateral CP. None of the studies had a PEDro score below 4/10, including five RCTs. We identified five different types of AFO (solid; dynamic; hinged; ground reaction; posterior leaf spring) used across all studies. Only two studies referred to a classification for gait patterns. Across the different outcomes, significant differences were found in walking speed, stride length and cadence, range of motion, ground force reaction and joint moments, as well as functional scores, while wearing AFO. Conclusions: Overall, the use of AFO in children with spastic bilateral CP minimizes the impact of pathological gait, consistently improving some kinematic, kinetic, and spatial-temporal parameters, and making their gait closer to that of typically developing children. Creating a standardized protocol for future studies involving AFO would facilitate the reporting of new scientific data and help clinicians use their clinical reasoning skills to recommend the best AFO for their patients.
- Reliability of lower extremity kinematics in three-dimensional gait measurements in children with cerebral palsyPublication . Ricardo, Diogo; Teles, Júlia; Raposo, Maria; Veloso, António; João, FilipaBackground: Cerebral Palsy is a complex pathology that describes a group of motor disorders with different presentations and functional levels. Three-dimensional gait analysis is used in the assessment of CP children to assist in clinical decision-making and assessing outcomes in the rehabilitation process. Due to the CP intra-subject gait variability, it’s crucial to access the repeated gait measurements to evaluate the response to therapeutic interventions in the rehabilitation process. Aim of the study: The objective of this study was to determine the intra-subject measurement reliabilities of the kinematic parameters of children with hemiplegic and diplegic types of cerebral palsy.
- Gait analysis in children with cerebral palsy: are plantar pressure insoles a reliable tool?Publication . Raposo, Maria Raquel; Ricardo, Diogo; Teles, Júlia; Veloso, António Prieto; João, FilipaCerebral palsy (CP) is a common cause of motor disability, and pedobarography is a useful, non-invasive, portable, and accessible tool; it is easy to use in a clinical setting; and can provide plenty of information about a foot–soil interaction and gait deviations. The reliability of this method in children with CP is lacking. The aim of this study is to investigate test-retest reliability and minimal detectable change (MDC) of plantar pressure insole variables in children with CP. Eight children performed two trials 8 ± 2.5 days apart, using foot insoles to collect plantar pressure data. Whole and segmented foot measurements were analyzed using intraclass correlation coefficients (ICC). The variability of the data was measured by calculating the standard error of measurement (SEM) and the MDC/ICC values demonstrated high test-retest reliability for most variables, ranging from good to excellent (ICC ≥ 0.60). The SEM and the MDC values were considered low for the different variables. The variability observed between sessions may be attributed to the heterogeneous sub-diagnosis of CP.