O'Sullivan Rory, French Helen, Horgan Frances
Specialist Services, Central Remedial Clinic, Dublin, Ireland.
School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland.
HRB Open Res. 2023 Aug 7;5:81. doi: 10.12688/hrbopenres.13647.2. eCollection 2022.
Background While prospectively assessed crouch gait in cerebral palsy (CP) does not necessarily progress, prospective changes in clinical examination measures have not been reported. This study prospectively examined the association between selected clinical examination variables and change in crouch gait in a cohort with bilateral CP. Methods Inclusion criteria were a diagnosis of ambulant bilateral CP, knee flexion at mid-stance >19 and a minimum of two-years between gait analyses. The change in kinematic variables was assessed using Statistical Parameter Mapping (SPM) and changes in clinical measures using appropriate paired tests. Linear regression examined the association between progression of crouch and clinical examination variables. Results There was no mean change in crouch in 27 participants over 3.29 years. However, there was significant variability within this group. Clinical hamstring tightness (60.00 to 70.48 , p<0.01) and external knee rotation during stance (SPM analysis, p<0.001) increased but there was no association between changes in clinical examination variables and changes in crouch (p-values 0.06 - 0.89). Conclusions This prospective study found no association between the changes in clinical examination variables and changes in crouch highlighting the likely multi-factorial aetiology of this gait pattern and the need for larger prospective studies. The variability crouch gait progression among the 27 participants highlights the pitfall of group mean values in such a heterogeneous population.
虽然前瞻性评估的脑瘫（CP）蹲伏步态不一定会进展，但尚未有关于临床检查指标前瞻性变化的报道。本研究前瞻性地探讨了双侧CP队列中选定临床检查变量与蹲伏步态变化之间的关联。方法：纳入标准为确诊为可步行的双侧CP、站立中期膝关节屈曲>19°且步态分析间隔至少两年。使用统计参数映射（SPM）评估运动学变量的变化，使用适当的配对检验评估临床指标的变化。线性回归分析蹲伏进展与临床检查变量之间的关联。结果：27名参与者在3.29年期间蹲伏无平均变化。然而，该组内存在显著差异。临床腘绳肌紧张度（从60.00°至70.48°，p<0.01）和站立时膝关节外旋（SPM分析，p<0.001）增加，但临床检查变量变化与蹲伏变化之间无关联（p值0.06 - 0.89）。结论：这项前瞻性研究发现临床检查变量变化与蹲伏变化之间无关联，突出了这种步态模式可能的多因素病因以及进行更大规模前瞻性研究的必要性。27名参与者中蹲伏步态进展的差异突出了在此类异质性人群中使用组均值的缺陷。
