Associations of Walk-and-Turn Spatiotemporal Gait Parameters With Functional Mobility in Children With Cerebral Palsy at GMFCS Levels I and II.

Abstract

To examine whether spatiotemporal gait parameters assessed during a 5-m walk-and-turn task, together with lower extremity muscle strength and limitations of motion (LOM), are associated with functional mobility and Gross Motor Function Classification System (GMFCS) level in ambulatory children with cerebral palsy (CP). Cross-sectional study. Public hospital-based rehabilitation center. A total of 107 ambulatory children with CP (GMFCS level I, n=40; level II, n=67). Not applicable. Spatiotemporal gait parameters assessed during a 5-m walk-and-turn task, lower extremity muscle strength, LOM, GMFCS level, and functional mobility measured using the Gross Motor Function Measure (GMFM) dimensions D-E. The GMFCS level II group showed shorter stride length, slower walking speed, and lower cadence than the GMFCS level I group (all P<.05). Linear regression analyses showed that hip extensor strength (B=15.61) and cadence (B=0.12) were significantly associated with GMFM D-E scores (both P<.05). Logistic regression analyses showed that hip extensor strength (OR=0.18), stride length (OR=0.97), walking speed (OR=0.01), and cadence (OR=0.96) were significantly associated with GMFCS level (all P<.05). In complementary cutoff-based analyses, values below the receiver operating characteristic-derived cutoffs for walking speed, cadence, and stride length were associated with relative risks of GMFCS level II ranging from 2.00 to 2.68 (all P<.001). Hip extensor strength and cadence were associated with functional mobility, whereas hip extensor strength and selected spatiotemporal gait parameters assessed during a walk-and-turn task were associated with GMFCS level in ambulatory children with CP. Cutoff-based analyses further suggest that quantitative gait assessment may provide complementary information regarding mobility performance across GMFCS levels I and II.