Diagnostic Gait Analysis Technique for Cerebral Palsy

  • Freeman Miller
Living reference work entry


Children with cerebral palsy (CP) develop very complex motor coordination and movement disorders that have a major impact on how the child walks. Although the primary etiology for CP resides with pathology in the central nervous system, during growth and development very significant secondary deformities occur in the musculoskeletal system. This combination of issues relating to the central nervous system around motor control, balance, and body coordination along with multiple musculoskeletal compensations make understanding pathologic gait in CP very difficult. In order to develop complex treatment plans, very detailed analysis and assessments of the child’s gait are required. These plans may include major surgical interventions which have significant risks and complications. The surgical interventions should not be undertaken unless there is a full comprehensive assessment and understanding of the expected outcomes. Measuring human walking with techniques that delineate the functional components is called gait analysis. This analysis is a critical process in understanding the problems of children with abnormal gait. The analysis needs to be performed with the same scientific understanding and organization upon which modern medical practice is based. This evaluation process follows the modern medical evaluation model currently used in almost all medical disciplines, which means physicians always start with a history and physical examination, and then order additional tests as indicated by the initial data. With gait, the additional tests include structured video recording, kinematic and kinetic evaluation, understanding muscle activation patterns with electromyogram (EMG), pediabarograph, and measuring the energy demands of walking. An assessment of the actual amount of day to day ambulation should also be considered.


Cerebral Palsy Gait analysis Physical Examination Kinematics Kinetics Pedobarograph Activity monitor Oxygen cost 


  1. Arnold AS, Liu MQ, Schwartz MH, Ounpuu S, Delp SL (2006) The role of estimating muscle-tendon lengths and velocities of the hamstrings in the evaluation and treatment of crouch gait. Gait Posture 23:273–281CrossRefGoogle Scholar
  2. Bella GP, Rodrigues NB, Valenciano PJ, Silva LM, Souza RC (2012) Correlation among the Visual Gait Assessment Scale, Edinburgh Visual Gait Scale and Observational Gait Scale in children with spastic diplegic cerebral palsy. Rev Bras Fisioter 16:134–140CrossRefGoogle Scholar
  3. Bowen TR, Cooley SR, Castagno PW, Miller F, Richards J (1998a) A method for normalization of oxygen cost and consumption in normal children while walking. J Pediatr Orthop 18:589–593CrossRefGoogle Scholar
  4. Bowen T, Lennon N, Castagno P, Miller F, Richards J (1998b) Variability of energy-consumption measures in children with cerebral palsy. J Pediatr Orthop 18:738–742PubMedGoogle Scholar
  5. Bowen TR, Miller F, Mackenzie W (1999) Comparison of oxygen consumption measurements in children with cerebral palsy to children with muscular dystrophy. J Pediatr Orthop 19:133–136PubMedGoogle Scholar
  6. Brown CR, Hillman SJ, Richardson AM, Herman JL, Robb JE (2008) Reliability and validity of the Visual Gait Assessment Scale for children with hemiplegic cerebral palsy when used by experienced and inexperienced observers. Gait Posture 27:648–652CrossRefGoogle Scholar
  7. Chang CH, Miller F, Schuyler J (2002) Dynamic pedobarograph in evaluation of varus and valgus foot deformities. J Pediatr Orthop 22:813–818PubMedGoogle Scholar
  8. Chao EY (1980) Justification of triaxial goniometer for the measurement of joint rotation. J Biomech 13:989–1006CrossRefGoogle Scholar
  9. Damiano DL, Abel MF (1996) Relation of gait analysis to gross motor function in cerebral palsy. Dev Med Child Neurol 38:389–396CrossRefGoogle Scholar
  10. Davids JR (2010) The foot and ankle in cerebral palsy. Orthop Clin North Am 41:579–593CrossRefGoogle Scholar
  11. Del Pilar Duque Orozco M, Abousamra O, Church C, Lennon N, Henley J, Rogers KJ, Sees JP, Connor J, Miller F (2016) Reliability and validity of Edinburgh visual gait score as an evaluation tool for children with cerebral palsy. Gait Posture 49:14–18CrossRefGoogle Scholar
  12. Delp SL, Arnold AS, Speers RA, Moore CA (1996) Hamstrings and psoas lengths during normal and crouch gait: implications for muscle-tendon surgery. J Orthop Res 14:144–151CrossRefGoogle Scholar
  13. Delp SL, Hess WE, Hungerford DS, Jones LC (1999) Variation of rotation moment arms with hip flexion. J Biomech 32:493–501CrossRefGoogle Scholar
  14. Enoka RM, Rankin LL, Stuart DG, Volz KA (1989) Fatigability of rat hindlimb muscle: associations between electromyogram and force during a fatigue test. J Physiol (Lond) 408:251–270CrossRefGoogle Scholar
  15. Gage J (1991) Gait analysis in cerebral palsy. Mac Keith Press, LondonGoogle Scholar
  16. Graham HK, Harvey A, Rodda J, Nattrass GR, Pirpiris M (2004) The Functional Mobility Scale (FMS). J Pediatr Orthop 24:514–520CrossRefGoogle Scholar
  17. Grood ES, Suntay WJ (1983) A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. J Biomech Eng 105:136–144CrossRefGoogle Scholar
  18. Gupta S, Raja K (2012) Responsiveness of Edinburgh Visual Gait Score to orthopedic surgical intervention of the lower limbs in children with cerebral palsy. Am J Phys Med Rehabil 91:761–767CrossRefGoogle Scholar
  19. Harris G, Smith PA (1996) Human motion analysis; current applications and future directions. The Institute of Electrical and Electronic Engineers, New YorkGoogle Scholar
  20. Hoffinger SA, Rab GT, Abou-Ghaida H (1993) Hamstrings in cerebral palsy crouch gait. J Pediatr Orthop 13:722–726CrossRefGoogle Scholar
  21. Ishikawa S, Kang M, Bjornson KF, Song K (2013) Reliably measuring ambulatory activity levels of children and adolescents with cerebral palsy. Arch Phys Med Rehabil 94:132–137CrossRefGoogle Scholar
  22. Kamp FA, Lennon N, Holmes L, Dallmeijer AJ, Henley J, Miller F (2014) Energy cost of walking in children with spastic cerebral palsy: relationship with age, body composition and mobility capacity. Gait Posture 40:209–214CrossRefGoogle Scholar
  23. Kawamura CM, de Morais Filho MC, Barreto MM, de Paula Asa SK, Juliano Y, Novo NF (2007) Comparison between visual and three-dimensional gait analysis in patients with spastic diplegic cerebral palsy. Gait Posture 25:18–24CrossRefGoogle Scholar
  24. Kim DJ, Park ES, Sim EG, Kim KJ, Kim YU, Rha DW (2011) Reliability of visual classification of sagittal gait patterns in patients with bilateral spastic cerebral palsy. Ann Rehabil Med 35(3):354–360CrossRefGoogle Scholar
  25. Maathuis KG, van der Schans CP, van Iperen A, Rietman HS, Geertzen JH (2005) Gait in children with cerebral palsy: observer reliability of Physician Rating Scale and Edinburgh Visual Gait Analysis Interval Testing scale. J Pediatr Orthop 25:268–272CrossRefGoogle Scholar
  26. Mackey AH, Lobb GL, Walt SE, Stott NS (2003) Reliability and validity of the Observational Gait Scale in children with spastic diplegia. Dev Med Child Neurol 45:4–11CrossRefGoogle Scholar
  27. McMulkin ML, Baird GO, Gordon AB, Caskey PM, Ferguson RL (2007) The pediatric outcomes data collection instrument detects improvements for children with ambulatory cerebral palsy after orthopaedic intervention. J Pediatr Orthop 27:1–6CrossRefGoogle Scholar
  28. Ong AM, Hillman SJ, Robb JE (2008) Reliability and validity of the Edinburgh Visual Gait Score for cerebral palsy when used by inexperienced observers. Gait Posture 28:323–326CrossRefGoogle Scholar
  29. Palisano RJ, Hanna SE, Rosenbaum PL, Russell DJ, Walter SD, Wood EP, Raina PS, Galuppi BE (2000) Validation of a model of gross motor function for children with cerebral palsy. Phys Ther 80:974–985PubMedGoogle Scholar
  30. Perry J, Thorofare NJ (1992) Gait analysis: normal and pathologic function. Slack, ThorofareGoogle Scholar
  31. Rao S, Saltzman CL, Yack HJ (2010) Relationships between segmental foot mobility and plantar loading in individuals with and without diabetes and neuropathy. Gait Posture 31:251–255CrossRefGoogle Scholar
  32. Rathinam C, Bateman A, Peirson J, Skinner J (2014) Observational gait assessment tools in paediatrics – a systematic review. Gait Posture 40:279–285CrossRefGoogle Scholar
  33. Read HS, Hazlewood ME, Hillman SJ, Prescott RJ, Robb JE (2003) Edinburgh visual gait score for use in cerebral palsy. J Pediatr Orthop 23:296–301PubMedGoogle Scholar
  34. Robinson LW, Clement N, Fullarton M, Richardson A, Herman J, Henderson G, Robb JE, Gaston MS (2015) The relationship between the Edinburgh Visual Gait Score, the Gait Profile Score and GMFCS levels I-III. Gait Posture 41:741–743CrossRefGoogle Scholar
  35. Spoor CW, Veldpaus FE (1980) Rigid body motion calculated from spatial co-ordinates of markers. J Biomech 13:391–393CrossRefGoogle Scholar
  36. Tervo RC, Azuma S, Stout J, Novacheck T (2002) Correlation between physical functioning and gait measures in children with cerebral palsy. Dev Med Child Neurol 44:185–190CrossRefGoogle Scholar
  37. Viehweger E, Zurcher Pfund L, Helix M, Rohon MA, Jacquemier M, Scavarda D, Jouve JL, Bollini G, Loundou A, Simeoni MC (2010) Influence of clinical and gait analysis experience on reliability of observational gait analysis (Edinburgh Gait Score Reliability). Ann Phys Rehabil Med 53:535–546CrossRefGoogle Scholar
  38. Vles GF, de Louw AJ, Speth LA, van Rhijn LW, Janssen-Potten YJ, Hendriksen JG, Vles JS (2008) Visual Analogue Scale to score the effects of Botulinum Toxin A treatment in children with cerebral palsy in daily clinical practice. Eur J Paediatr Neurol 12:231–238CrossRefGoogle Scholar
  39. Wright CJ, Arnold BL, Coffey TG, Pidcoe PE (2011) Repeatability of the modified Oxford foot model during gait in healthy adults. Gait Posture 33:108–112CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.AI DuPont Hospital for ChildrenWilmingtonUSA

Section editors and affiliations

  • Freeman Miller
    • 1
  1. 1.AI DuPont Hospital for ChildrenWilmingtonUSA

Personalised recommendations