The validity of an existing gait classification system when applied to a representative population of children with hemiplegia☆

Abstract 

This study describes sagittal plane gait patterns in a representative sample of children with hemiplegic cerebral palsy (CP). Ninety-four children were prospectively recruited to the study (age range 5–18 yrs, mean age 10 yrs 7 mo) and valid kinematic data was captured for 91 participants. Data was also captured for 49 children (age range 5–18 yrs, mean age 10 yrs) with no physical impairment. One representative gait cycle from each child was exported to an Excel template and run through an algorithm that facilitated the description of gait, using logical arguments derived from Winters’ Classification. Children with hemiplegic CP, regardless of past surgery history, were allocated to the following gait types: Groups IV (n=9; 10%), III (n=7: 8%), II (n=5: 5%), I (n=32: 35%) and not classified (n=38: 42%). For children with no lower limb surgical history (n=61), gait types were: Groups IV (n=7: 12%), III (n=2: 3%), II (n=2: 3%), I (n=20: 33%) and not classified (n=30: 49%). The gait data taken from children with no physical impairment were not classified. The ability of the Winters’ classification system to distinguish between children with higher levels of hemiplegic involvement and children with no physical impairment was demonstrated: the majority of children with hemiplegic CP present with relatively minor gait deviations. A more complete definition of sagittal plane ankle joint kinematics may account for those children that were not classified.

Keywords: Cerebral palsy, Hemiplegia, Gait, Winters classification