Gait & Posture
Volume 34, Issue 2 , Pages 197-201, June 2011

Can biomechanical variables predict improvement in crouch gait?

  • Jennifer L. Hicks

      Affiliations

    • Department of Mechanical Engineering, Stanford University, Stanford, CA, USA
    • Department of Bioengineering, Stanford University, Stanford, CA, USA
    • Corresponding Author InformationCorresponding author at: James H. Clark Center, Room S231, Stanford University, Mail Code 5448, 318 Campus Drive, Stanford, CA 94305, USA. Tel.: +1 650 498 4403; fax: +1 650 724 1922.
    • ,
  • Scott L. Delp

      Affiliations

    • Department of Mechanical Engineering, Stanford University, Stanford, CA, USA
    • Department of Bioengineering, Stanford University, Stanford, CA, USA
    • ,
  • Michael H. Schwartz

      Affiliations

    • Center for Gait and Motion Analysis, Gillette Children's Specialty Healthcare, St. Paul, MN, USA
    • Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA

Received 27 October 2010; received in revised form 14 April 2011; accepted 18 April 2011. published online 27 May 2011.

Abstract 

Many patients respond positively to treatments for crouch gait, yet surgical outcomes are inconsistent and unpredictable. In this study, we developed a multivariable regression model to determine if biomechanical variables and other subject characteristics measured during a physical exam and gait analysis can predict which subjects with crouch gait will demonstrate improved knee kinematics on a follow-up gait analysis. We formulated the model and tested its performance by retrospectively analyzing 353 limbs of subjects who walked with crouch gait. The regression model was able to predict which subjects would demonstrate ‘Improved’ and ‘Unimproved’ knee kinematics with over 70% accuracy, and was able to explain approximately 49% of the variance in subjects’ change in knee flexion between gait analyses. We found that improvement in stance phase knee flexion was positively associated with three variables that were drawn from knowledge about the biomechanical contributors to crouch gait: (i) adequate hamstrings lengths and velocities, possibly achieved via hamstrings lengthening surgery, (ii) normal tibial torsion, possibly achieved via tibial derotation osteotomy, and (iii) sufficient muscle strength.

Keywords: Surgical outcomes, Cerebral palsy, Crouch gait, Modeling, Biomechanics

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PII: S0966-6362(11)00136-6

doi:10.1016/j.gaitpost.2011.04.009

Gait & Posture
Volume 34, Issue 2 , Pages 197-201, June 2011

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