What's New in the Orthopaedic Treatment of Ambulatory Children With Cerebral Palsy Using Gait Analysis.

BACKGROUND: Limb deformities in ambulatory children with cerebral palsy (CP) are common. The natural history of lower extremity deformities is variable and the impact on gait is managed with many treatment modalities. Effective interventions must consider the underlying pathophysiology, patient-specific goals, and incorporate objective outcome assessment. Evaluation and treatment include observation, tone management multilevel orthopaedic surgery to address muscle contractures and bony deformities, and the use of gait analysis for preoperative and postoperative assessment. METHODS: A PubMed search of the orthopaedic literature for studies published between January 2016 and February 2019 was performed. Eligible abstracts included the use of 3-dimensional instrumented gait analysis in the evaluation and treatment of the lower extremities in ambulatory children with CP. Seven hundred twenty abstracts were reviewed, with 84 papers identified as eligible, of which 45 full manuscripts were included for detailed review. RESULTS: The review summarized recent advances regarding the treatment of torsional alignment, knee deformities and clinical gait evaluation with visual assessment tools compared with instrumented gait analysis. CONCLUSIONS: Gait analysis of ambulatory children with CP remains essential to evaluation and surgical decision-making. Promising results have been reported with the goal of maintaining or reaching a higher level of function and increased endurance. LEVEL OF EVIDENCE: Level IV-literature review.

A Novel Multi-Dimensional Analysis of Rodent Gait Reveals the Compensation Strategies Used during Spontaneous Recovery from Spinal Cord and Traumatic Brain Injury.

As rodent locomotion becomes a more popular behavioral assay, proper rodent gait analysis becomes more and more important. Gait measures, such as stride length, cycle time, and duty factor, are not independent of one another, making statistical comparisons between groups a tricky endeavor. Instead of identifying the mathematical relationships between a group of locomotor measures, we simply tracked the steps of rodents in x,y,t space. By plotting with respect to the reference limb, we are able to quantify locomotor changes in space, time, and coordination simultaneously. With our technique, we show that the overall locomotion of 77 rats 1 week after a C4/5 right overhemisection injury was significantly different than pre-injury. This difference was maintained in untreated animals for the entire 7 weeks of the study, but how this difference arose changed. Initially, the right forelimb exhibited very abnormal stepping, but eventually reduced its difference from pre-injury levels. Conversely, the left forelimb was initially mildly different from pre-injury, but further deviated from normal stepping as the weeks went on. Our new gait analysis technique helps to show the trade-off between the restoration of function and the spontaneous development of compensatory techniques. When we applied this new analysis technique to 13 mice after a severe controlled cortical impact, we found that their locomotion was no different from 12 sham mice for the entire 4 weeks of the study. We believe that this gait analysis method succinctly addresses the confound of interdependency of gait measures and does so across multiple injury models.