Preoperative gait pattern as predictor of gait changes following selective dorsal rhizotomy

IF 2.4 3区医学 Q3 NEUROSCIENCES Gait & posture Pub Date : 2025-01-30 DOI:10.1016/j.gaitpost.2025.01.017

Liza M.M. van Dijk , Kirsten Veerkamp , Marjolein M. van der Krogt , K. Mariam Slot , Annemieke I. Buizer

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Abstract

Background

Selective dorsal rhizotomy (SDR) can improve gait in children with spastic paresis. However, outcomes vary, and selecting individuals who will benefit from the procedure remains challenging. How pre-SDR gait pattern predicts post-SDR gait has not previously been investigated.

Research question

This study aims to compare how different gait patterns change after SDR to gain insight into the potential relevance of gait patterns as a selection criterion for SDR.

Methods

Kinematic and kinetic data of nineteen children with bilateral spastic paresis due to cerebral palsy or hereditary spastic paraplegia, with 3D gait analysis before and two years after SDR, were extracted from an in-hospital database. A cluster analysis was performed to distinguish different gait patterns based on sagittal hip, knee and ankle angles pre-SDR. Deviations from typical gait per leg (38 legs) pre- and post-SDR were quantified with the Gait Profile Score (GPS), calculated for joint angles, moments, and powers. GPS was compared pre- and post-SDR per gait pattern, and pre-post differences were compared between gait patterns.

Results

Three distinct pre-SDR gait patterns (GPs) were identified using cluster analysis, with GP1 characterized by increased knee flexion (18 legs), GP2 by increased ankle plantarflexion (14 legs), and GP3 by increased knee flexion and increased ankle plantarflexion (6 legs). GPS-kinematics improved significantly for GP1 (-3.1°) and GP3 (-6.6°), but showed no significant change for GP2. GPS-kinematics improved significantly more in GP3 than in GP2. GPS-moments improved equally in all groups (-0.04Nm/kg--0.07Nm/kg). GPS-powers improved significantly more for GP1 and GP2 (0.07W/kg and 0.24W/kg, respectively) than for GP3 where no change occurred.

Significance

The results suggest that different pre-SDR gait patterns have distinct outcomes post-SDR in children with spastic paresis. Therefore gait patterns could guide selection and expectation management for SDR. Future studies should confirm these results in a larger cohort.

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术前步态模式作为选择性背根切断术后步态变化的预测因子。

背景：选择性背根切断术（SDR）可以改善痉挛性轻瘫患儿的步态。然而，结果各不相同，选择将从手术中受益的个体仍然具有挑战性。sdr前的步态模式如何预测sdr后的步态以前没有研究过。研究问题：本研究旨在比较不同步态模式在SDR后的变化，以深入了解步态模式作为SDR选择标准的潜在相关性。方法：从医院数据库中提取19例脑瘫或遗传性痉挛性截瘫患儿的运动学和动力学数据，以及SDR术前和术后2年的三维步态分析。基于矢状髋关节、膝关节和踝关节角度进行聚类分析，区分不同的步态模式。采用步态特征评分（GPS）对sdr前后每条腿（38条腿）的典型步态偏差进行量化，计算关节角度、力矩和功率。比较每种步态模式的GPS定位前后的差异，并比较步态模式前后的差异。结果：通过聚类分析确定了三种不同的sdr前步态模式（GPs）， GP1的特征是膝关节屈曲增加（18条腿），GP2的特征是踝关节屈曲增加（14条腿），GP3的特征是膝关节屈曲增加和踝关节屈曲增加（6条腿）。gpp1（-3.1°）和GP3（-6.6°）的gps -运动学显著改善，但GP2没有显著变化。GP3的gps -运动学改善明显大于GP2。各组的gps力矩均有相同的改善（-0.04Nm/kg—0.07Nm/kg）。与GP3相比，GP1和GP2的gps功率显著提高（分别为0.07W/kg和0.24W/kg）， GP3没有变化。意义：结果表明，sdr前不同的步态模式对痉挛性轻瘫儿童在sdr后的预后有不同的影响。因此，步态模式可以指导SDR的选择和期望管理。未来的研究应该在更大的队列中证实这些结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Gait & posture 医学-神经科学

CiteScore

4.70

自引率

12.50%

发文量

616

审稿时长

6 months

期刊介绍： Gait & Posture is a vehicle for the publication of up-to-date basic and clinical research on all aspects of locomotion and balance. The topics covered include: Techniques for the measurement of gait and posture, and the standardization of results presentation; Studies of normal and pathological gait; Treatment of gait and postural abnormalities; Biomechanical and theoretical approaches to gait and posture; Mathematical models of joint and muscle mechanics; Neurological and musculoskeletal function in gait and posture; The evolution of upright posture and bipedal locomotion; Adaptations of carrying loads, walking on uneven surfaces, climbing stairs etc; spinal biomechanics only if they are directly related to gait and/or posture and are of general interest to our readers; The effect of aging and development on gait and posture; Psychological and cultural aspects of gait; Patient education.