Walking and gait assessment in children with cerebral palsy (CP) involves evaluating how they walk, identifying movement impairments, and determining how these affect their function and mobility. Since CP often leads to muscle weakness, spasticity, contractures, and poor coordination, assessing gait helps guide treatment decisions such as therapy, orthotics, assistive devices, or surgery.
Key Aspects of Gait Assessment
- Spatiotemporal Parameters – Step length, cadence (steps per minute), walking speed, and symmetry.
- Kinematics (Movement Patterns) – Joint angles, posture, and compensatory movements.
- Kinetics (Forces and Pressure Distribution) – How muscles and joints handle forces during walking.
- Muscle Activation (Electromyography – EMG) – Assesses which muscles are active and when.
Why Is It Important?
- Identifies gait abnormalities (e.g., crouch gait, scissoring, toe-walking).
- Helps determine functional mobility level (e.g., independent walker vs. assistive device user).
- Guides therapy planning (e.g., strengthening, stretching, bracing, or surgery).
- Tracks progress over time in response to interventions.
Importance of Walking and Gait Analysis in Children with Cerebral Palsy (CP)
Walking and gait analysis is crucial in children with cerebral palsy (CP) because CP affects muscle tone, coordination, and movement patterns, leading to abnormal walking mechanics. Assessing gait helps clinicians understand functional mobility limitations and develop targeted interventions.
Key Reasons Why Gait Analysis is Important:
- Identifies Gait Abnormalities
- Detects specific gait patterns common in CP, such as:
- Toe-walking (equinus gait)
- Crouch gait (excessive knee flexion)
- Scissor gait (excessive hip adduction)
- Helps differentiate spasticity-related vs. weakness-related gait issues.
- Detects specific gait patterns common in CP, such as:
- Guides Treatment and Rehabilitation
- Helps select appropriate interventions such as:
- Physical therapy (e.g., strength training, balance exercises)
- Orthotics (e.g., AFOs for foot positioning)
- Botox injections (for spasticity reduction)
- Surgical procedures (e.g., tendon lengthening, selective dorsal rhizotomy)
- Helps select appropriate interventions such as:
- Monitors Functional Mobility Over Time
- Tracks progress after interventions.
- Assesses if therapy or orthotic adjustments are needed.
- Improves Walking Efficiency and Independence
- Identifies compensatory movements that cause fatigue.
- Helps improve walking endurance and safety, reducing fall risks.
- Supports Assistive Device Selection
- Determines if a child needs:
- Ankle-foot orthoses (AFOs)
- Walkers, crutches, or wheelchairs
- Gait trainers for non-ambulatory children
- Determines if a child needs:
Conclusion
Gait analysis is essential for understanding walking difficulties, guiding treatment, and improving mobility in children with CP. It helps clinicians make evidence-based decisions to enhance a child’s quality of life and independence.
Measuring tools to assess Walking & Gait
10-Meter Walk Test (10MWT) – Measures walking speed.
6-Minute Walk Test (6MWT) – Assesses endurance.
Timed Up and Go (TUG) Test – Evaluates mobility and fall risk.
Edinburgh Visual Gait Score (EVGS) – Analyzes gait patterns.
Observational Gait Scale (OGS) – Evaluates gait deviations.
Functional Mobility Scale (FMS) – Rates mobility at different distances.
Assessment methods requiring special equipment
3D Gait Analysis (3DGA) – Motion Capture
GaitRite System – Pressure Mat Analysis
Comparison of the 10MWT, 6MWT, TUG, EVGS, OGS, and FMS
| Test | Purpose | Key Measures | Pros | Cons |
|---|---|---|---|---|
| 10-Meter Walk Test (10MWT) | Measures walking speed | Time taken to walk 10m | ✅ Quick and easy to administer ✅ Useful for tracking progress | ❌ Does not assess endurance or gait quality |
| 6-Minute Walk Test (6MWT) | Assesses endurance | Distance walked in 6 minutes | ✅ Reflects real-world walking ability ✅ Measures fatigue over time | ❌ Does not assess gait mechanics |
| Timed Up and Go (TUG) Test | Evaluates mobility and fall risk | Time taken to stand, walk 3m, turn, return, and sit | ✅ Simple and functional ✅ Assesses balance and turning ability | ❌ Does not provide detailed gait analysis |
| Edinburgh Visual Gait Score (EVGS) | Analyzes gait patterns using video | Knee, hip, foot, and arm movements | ✅ More structured than general observation ✅ Useful for tracking changes over time | ❌ Subjective, requires trained clinicians |
| Observational Gait Scale (OGS) | Evaluates gait deviations visually | Step symmetry, knee, ankle, and foot movement | ✅ Quick, structured, and easy to use ✅ Helps identify common gait abnormalities | ❌ Lacks precise motion or force measurements |
| Functional Mobility Scale (FMS) | Rates mobility at different distances | Walking ability at 5m, 50m, 500m | ✅ Considers real-world function ✅ Identifies assistive device needs | ❌ Does not assess gait mechanics or speed |
Which One to Use?
- For a quick clinical assessment: ✅ OGA or EVGS
- For detailed motion analysis: ✅ 3DGA or GaitRite
- For endurance and function: ✅ 6MWT or TUG
- For classifying mobility levels: ✅ FMS