Are clinical measurements linked to the gait deviation index in cerebral palsy patients?

Abstract

Objective: From a dataset of clinical assessments and gait analysis, this study was designed to determine which of the assessments or their combinations would most influence a low gait index (i.e., severe gait deviations) for individuals with cerebral palsy.

Design: A retrospective search, including clinical and gait assessments, was conducted from August 2005 to September 2009.

Population: One hundred and fifty-five individuals with a clinical diagnosis of cerebral palsy (CP) (mean age (SD): 11 (5.3) years) were selected for the study.

Method: Quinlan's Interactive Dichotomizer 3 algorithm for decision-tree induction, adapted to fuzzy data coding, was employed to predict a Gait Deviation Index (GDI) from a dataset of clinical assessments (i.e., range of motion, muscle strength, and level of spasticity).

Results: Seven rules that could explain severe gait deviation (a fuzzy GDI low class) were induced. Overall, the fuzzy decision-tree method was highly accurate and permitted us to correctly classify GDI classes 9 out of 10 times using our clinical assessments.

Conclusion: There is an important relationship between clinical parameters and gait analysis. We have identified the main clinical parameters and combinations of these parameters that lead to severe gait deviations. The strength of the hip extensor, the level of spasticity and the strength of the tibialis posterior were the most important clinical parameters for predicting a severe gait deviation.

Keywords: 3DGA; AB; CP; Cerebral palsy; Clinical measurements; FDT; Fuzzy decision tree; GDI; GMFCS; Gait; Gait Deviation Index; Gross Motor Function Classification System; RMSE; ROM; able-bodied individuals; cerebral palsy; fuzzy decision tree; passive range of motion; root mean square error; three-dimensional gait analysis.