The static examination of children and young adults with cerebral palsy in the gait analysis laboratory: technique and observer agreement

The assessment of ambulant children with spastic cerebral palsy frequently includes an evaluation in the motion analysis laboratory, consisting of a standardized physical examination and instrumented gait analysis. We therefore designed a repeatability study to evaluate observer agreement of five joint range of motion parameters, in 20 patients with cerebral palsy aged 5–25 years. These five parameters are some of the most important measurements made during the static examination in the gait laboratory. Intra-observer agreement was high (concordance correlation coefficient range, 0.67–0.96), and using Bland and Altman analysis it was clinically acceptable with 95% limits of agreement of all parameters close to within ±10°. The level of inter-observer agreement was less satisfactory, particularly in hip flexion deformity.

[1]  Low Jl,et al.  The reliability of joint measurement. , 1976 .

[2]  J M Rothstein,et al.  Goniometric reliability in a clinical setting. Elbow and knee measurements. , 1984, Physical therapy.

[3]  M. Michaels,et al.  The Range of Motion of Long Term Knee Contractures of Four Spastic Cerebral Palsied Children , 1984 .

[4]  J E Grohmann.  Comparison of two methods of goniometry. , 1983, Physical therapy.

[5]  L. Lin,et al.  A concordance correlation coefficient to evaluate reproducibility. , 1989, Biometrics.

[6]  R. Palisano,et al.  Development and reliability of a system to classify gross motor function in children with cerebral palsy , 1997, Developmental medicine and child neurology.

[7]  Diseases of the Hip, Knee, and Ankle Joints , 1991 .

[8]  R L Lamb,et al.  Reliability of goniometric measurements and visual estimates of knee range of motion obtained in a clinical setting. , 1991, Physical therapy.

[9]  D. Shurtleff,et al.  Hip flexion contractures: a comparison of measurement methods. , 1985, Archives of physical medicine and rehabilitation.

[10]  N. Temkin,et al.  Selective dorsal rhizotomy: meta‐analysis of three randomized controlled trials , 2002, Developmental medicine and child neurology.

[11]  Roslyn N. Boyd,et al.  Objective measurement of clinical findings in the use of botulinum toxin type A for the management of children with cerebral palsy , 1999 .

[12]  The Prone Hip Extension Test: A Method of Measuring Hip Flexion Deformity , 1977, Clinical orthopaedics and related research.

[13]  J A Fixsen,et al.  Orthopaedic management of cerebral palsy. , 1994, Archives of disease in childhood.

[14]  E. Zwick,et al.  Multilevel Surgery in Spastic Diplegia: Evaluation by Physical Examination and Gait Analysis in 25 Children , 2002, Journal of pediatric orthopedics.

[15]  H. Graham.  Painful hip dislocation in cerebral palsy , 2002, The Lancet.

[16]  B. Ashton,et al.  Reliability of Goniometric Measurements of Hip Motion in Spastic Cerebral Palsy , 1978, Developmental medicine and child neurology.

[17]  J. M. Rothstein,et al.  Goniometric Reliability in a Clinical Setting , 1983 .

[18]  A. Cosgrove,et al.  Botulinum toxin A compared with stretching casts in the treatment of spastic equinus: a randomised prospective trial. , 1998, Journal of pediatric orthopedics.

[19]  S L Wolf,et al.  Comparison of the reliability of the Orthoranger and the standard goniometer for assessing active lower extremity range of motion. , 1988, Physical therapy.

[20]  P. Grimaud.  [Cerebral palsy]. , 1972, Pediatrie.

[21]  A. Cosgrove,et al.  Relevance of the popliteal angle to hamstring length in cerebral palsy crouch gait. , 2001, Journal of pediatric orthopedics.

[22]  J. Gage.  Gait analysis. An essential tool in the treatment of cerebral palsy. , 1993, Clinical orthopaedics and related research.

[23]  The Measurement of Joint Motion: Part I–Introductory Review of the Literature , 1949 .

[24]  M. Chicoine,et al.  Selective dorsal rhizotomy and rates of orthopedic surgery in children with spastic cerebral palsy. , 1997, Journal of neurosurgery.

[25]  W. Stuberg,et al.  RELIABILITY OF GONIOMETRIC MEASUREMENTS OF CHILDREN WITH CEREBRAL PALSY , 1988, Developmental medicine and child neurology.

[26]  F. A. Hellebrandt,et al.  The Measurement of Joint Motion: Part III—Reliability of Goniometry , 1949 .

[27]  J. Darrah,et al.  Reliability of Passive Ankle Dorsiflexion Measurements in Children: Comparison of Universal and Biplane Goniometers , 1995 .

[28]  N. Mayerson,et al.  Goniometric measurement reliability in physical medicine. , 1984, Archives of physical medicine and rehabilitation.

[29]  C. Enwemeka,et al.  Radiographic verification of knee goniometry. , 1986, Scandinavian journal of rehabilitation medicine.

[30]  J. Youdas,et al.  Reliability of goniometric measurements and visual estimates of ankle joint active range of motion obtained in a clinical setting. , 1993, Archives of physical medicine and rehabilitation.

[31]  Mayerson Nh,et al.  Goniometric measurement reliability in physical medicine. , 1984 .

[32]  R Baker,et al.  The variability of goniometric measurements in ambulatory children with spastic cerebral palsy. , 2000, Gait & posture.

[33]  D. Burdon,et al.  Clinical methods of goniometry: a comparative study. , 1992, Disability and rehabilitation.

[34]  Margaret L. Moore.  The Measurement of Joint Motion: Part II: The Technic of Goniometry , 1949 .

[35]  S. Azen,et al.  Reliability of goniometric measurements. , 1978, Physical therapy.

[36]  D. Sutherland.  Gait Analysis in Cerebral Palsy , 1978, Developmental medicine and child neurology.

[37]  D. Altman,et al.  STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT , 1986, The Lancet.

[38]  M. Moore,et al.  The measurement of joint motion; the technic of goniometry. , 1949, The Physical therapy review.

[39]  J L Low,et al.  The reliability of joint measurement. , 1976, Physiotherapy.

[40]  M. Eliasziw,et al.  Statistical methodology for the concurrent assessment of interrater and intrarater reliability: using goniometric measurements as an example. , 1994, Physical therapy.