Statistical Parametric Mapping to Identify Differences between Consensus-Based Joint Patterns during Gait in Children with Cerebral Palsy

PLoS One. 2017 Jan 12;12(1):e0169834. doi: 10.1371/journal.pone.0169834. eCollection 2017.

Abstract

Experts recently identified 49 joint motion patterns in children with cerebral palsy during a Delphi consensus study. Pattern definitions were therefore the result of subjective expert opinion. The present study aims to provide objective, quantitative data supporting the identification of these consensus-based patterns. To do so, statistical parametric mapping was used to compare the mean kinematic waveforms of 154 trials of typically developing children (n = 56) to the mean kinematic waveforms of 1719 trials of children with cerebral palsy (n = 356), which were classified following the classification rules of the Delphi study. Three hypotheses stated that: (a) joint motion patterns with 'no or minor gait deviations' (n = 11 patterns) do not differ significantly from the gait pattern of typically developing children; (b) all other pathological joint motion patterns (n = 38 patterns) differ from typically developing gait and the locations of difference within the gait cycle, highlighted by statistical parametric mapping, concur with the consensus-based classification rules. (c) all joint motion patterns at the level of each joint (n = 49 patterns) differ from each other during at least one phase of the gait cycle. Results showed that: (a) ten patterns with 'no or minor gait deviations' differed somewhat unexpectedly from typically developing gait, but these differences were generally small (≤3°); (b) all other joint motion patterns (n = 38) differed from typically developing gait and the significant locations within the gait cycle that were indicated by the statistical analyses, coincided well with the classification rules; (c) joint motion patterns at the level of each joint significantly differed from each other, apart from two sagittal plane pelvic patterns. In addition to these results, for several joints, statistical analyses indicated other significant areas during the gait cycle that were not included in the pattern definitions of the consensus study. Based on these findings, suggestions to improve pattern definitions were made.

MeSH terms

  • Adolescent
  • Cerebral Palsy / physiopathology*
  • Child
  • Child, Preschool
  • Female
  • Gait*
  • Humans
  • Joints / physiopathology*
  • Male

Grants and funding

AN is supported by an OT project of KU Leuven University (OT/12/100). EP is supported by the MD Paedigree project, a Model-Driven Paediatric European Digital Repository, partially funded by the European Commission under FP7 – ICT Programme (grant agreement no: 600932, http://www.md-paedigree.eu) and by the SIMCP IWT-project (Agentschap voor Innovatie door Wetenschap en Technologie), a simulation platform to predict gait performance following orthopedic intervention in children with cerebral palsy (IWT 140184). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.