Correlation between physical examination and three-dimensional gait analysis in the assessment of rotational abnormalities in children with cerebral palsy

Teixeira, Fernando Borge; Ramalho Júnior, Amancio; Morais Filho, Mauro César de; Speciali, Danielli Souza; Kawamura, Catia Miyuki; Lopes, José Augusto Fernandes; Blumetti, Francesco Camara

doi:10.1590/S1679-45082018AO4247

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Original Article • Einstein (São Paulo) 16 (1) • 2018 • https://doi.org/10.1590/S1679-45082018AO4247 copy

Correlation between physical examination and three-dimensional gait analysis in the assessment of rotational abnormalities in children with cerebral palsy

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To evaluate the correlation between physical examination data concerning hip rotation and tibial torsion with transverse plane kinematics in children with cerebral palsy; and to determine which time points and events of the gait cycle present higher correlation with physical examination findings.

Methods

A total of 195 children with cerebral palsy seen at two gait laboratories from 2008 and 2016 were included in this study. Physical examination measurements included internal hip rotation, external hip rotation, mid-point hip rotation and the transmalleolar axis angle. Six kinematic parameters were selected for each segment to assess hip rotation and shank-based foot rotation. Correlations between physical examination and kinematic measures were analyzed by Spearman correlation coefficients, and a significance level of 5% was considered.

Results

Comparing physical examination measurements of hip rotation and hip kinematics, we found moderate to strong correlations for all variables (p<0.001). The highest coefficients were seen between the mid-point hip rotation on physical examination and hip rotation kinematics (rho range: 0.48-0.61). Moderate correlations were also found between the transmalleolar axis angle measurement on physical examination and foot rotation kinematics (rho range 0.44-0.56; p<0.001).

Conclusion

These findings may have clinical implications in the assessment and management of transverse plane gait deviations in children with cerebral palsy.

Keywords
Cerebral palsy; Physical examination; Gait

Characteristics
Age, years [mean (SD)]		10.2 (3-18)
GMFCS n (%)
	I	61 (31)
	ii	90 (46)
	III	44 (23)
Motor distribution n (%)
	Hemiplegia	43 (22)
	Diplegia	152 (78)
Sex n (%)
	Male	109 (56)
	Female	86 (44)

Physical examination	Kinematics	rho	95%CI	p value
Internal hip rotation (left/right)	Hip rotation at initial contact	(0,53/0,43)	(0.42; 0.62)/(0.31; 0.54)	<0.001/<0.001
	Mean hip rotation in stance	(0,47/0,45)	(0.36; 0.57)/(0.34; 0.56)	<0.001/<0.001
	Mean hip rotation in single support	(0,43/0,45)	(0.31; 0.54)/(0.33; 0.55)	<0.001/<0.001
	Maximum hip rotation ^* * Maximum hip rotation reflects maximum internal rotation;	(0,51/0,46)	(0.40; 0.61)/(0.35; 0.57)	<0.001/<0.001
	Minimum hip rotation^† † minimum hip rotation reflects maximum external rotation.	(0,53/0,44)	(0.43; 0.63)/(0.32; 0.55)	<0.001/<0.001
	Mean hip rotation in swing	(0,57/0,46)	(0.46; 0.66)/(0.35; 0.57)	<0.001/<0.001
External hip rotation (left/right)	Hip rotation at initial contact	(0,40/0,48)	(0.27; 0.51)/(0.36; 0.58)	<0.001/<0.001
	Mean hip rotation in stance	(0,43/0,44)	(0.31; 0.54)/(0.32; 0.54)	<0.001/<0.001
	Mean hip rotation in single support	(0,40/0,42)	(0.27; 0.51)/(0.30; 0.53)	<0.001/<0.001
	Maximum hip rotation ^* * Maximum hip rotation reflects maximum internal rotation;	(0,41/0,39)	(0.28; 0.52)/(0.26; 0.50)	<0.001/<0.001
	Minimum hip rotation^† † minimum hip rotation reflects maximum external rotation.	(0,45/0,45)	(0.33; 0.55)/(0.33; 0.55)	<0.001/<0.001
	Mean hip rotation in swing	(0,48/0,45)	(0.36; 0.58)/(0.33; 0.56)	<0.001/<0.001
Midpoint hip rotation (left/right)	Hip rotation at initial contact	(0.53/0.57)	(0.42; 0.63)/(0.47; 0.66)	<0.001/<0.001
	Mean hip rotation in stance	(0.53/0.55)	(0.42; 0.62)/(0.44; 0.64)	<0.001/<0.001
	Mean hip rotation in single support	(0.48/0.53)	(0.36; 0.58)/(0.43; 0.63)	<0.001/<0.001
	Maximum hip rotation ^* * Maximum hip rotation reflects maximum internal rotation;	(0.53/0.53)	(0.42; 0.63)/(0.42; 0.62)	<0.001/<0.001
	Minimum hip rotation^† † minimum hip rotation reflects maximum external rotation.	(0.57/0.57)	(0.47; 0.66)/(0.46; 0.65)	<0.001/<0.001
	Mean hip rotation in swing	(0.61/0.58)	(0.52; 0.69)/(0.48; 0.67)	<0.001/<0.001

Physical examination	Kinematics	rho	95%CI	p value
Transmalleolar axis (left side)	Shank-based foot rotation at initial contact	0.44	0.32-0.55	<0.001
	Mean shank-based foot rotation in stance	0.49	0.38-0.59	<0.001
	Mean shank-based foot rotation in single support	0.50	0.38-0.60	<0.001
	Maximum shank-based foot rotation ^* * Maximum foot rotation reflects maximum internal rotation;	0.46	0.34-0.57	<0.001
	Minimum shank-based foot rotation^† † minimum foot rotation reflects maximum external rotation.	0.51	0.39-0.60	<0.001
	Mean shank-based foot rotationin swing	0.48	0.36-0.58	<0.001
Transmalleolar axis (right side)	Shank-based foot rotation at initial contact	0.49	0.38-0.59	<0.001
	Mean shank-based foot rotation in stance	0.54	0.43-0.64	<0.001
	Mean shank-based foot rotation in single support	0.54	0.43-0.64	<0.001
	Maximum shank-based foot rotation ^* * Maximum foot rotation reflects maximum internal rotation;	0.52	0.41-0.62	<0.001
	Minimum shank-based foot rotation^† † minimum foot rotation reflects maximum external rotation.	0.56	0.46-0.65	<0.001
	Mean shank-based foot rotation in swing	0.54	0.43-0.63	<0.001

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[1] Corresponding author: Fernando Borge Teixeira Avenida Albert Einstein, 627/701 - Morumbi Zip code: 05652-900 - São Paulo, SP Brazil Phone: (55 11) 2151-1233 E-mail: nandoborget@gmail.com