Variation in kinematic and spatiotemporal gait parameters by Gross Motor Function Classification System level in children and adolescents with cerebral palsy

AimThe aim of this study was to examine differences in gait kinematics and spatiotemporal parameters in ambulatory children and adolescents with bilateral spastic cerebral palsy (BSCP) among Gross Motor Function Classification System (GMFCS) levels I-III. MethodA retrospective review was conducted of individuals with BSCP who had three-dimensional motion analysis (3DGA) at one of seven pediatric hospitals. Means and standard deviations of each gait parameter were stratified by GMFCS levels (I-III) and for a typically developing comparison group. ResultsData from 292 children and adolescents with BSCP (189 males, 103 females; mean age 13y) were compared to a typically developing comparison group (24 male, 26 female; mean age 10y 6mo). Gait patterns differed from typically developing in all GMFCS levels, with increasing deviation as GMFCS level increased in 21 out of 28 parameters. Despite significant differences in selected mean kinematic parameters among GMFCS levels such as knee angle at initial contact of 24 degrees, 29 degrees, and 41 degrees in GMFCS levels I, II and III respectively, there was also substantial overlap among GMFCS levels. InterpretationGMFCS levels cannot be identified using specific gait kinematics. Treatment decisions should be guided by comprehensive 3DGA that allows measurement of gait impairments at the joint level for each individual. What this paper adds <list list-type="bulleted" id="dmcn12760-list-0001"> Mean gait parameters for children and adolescents with Bilateral spastic cerebral palsy differ from typically developing and among Gross Motor Function Classification System (GMFCS) levels I to III. Gait impairment increases with increasing GMFCS level. There is substantial overlap in gait impairment among GMFCS levels. GMFCS level cannot be defined by specific gait characteristics.