Gait analysis in children and adolescents with spinal cord injuries.

BACKGROUND/OBJECTIVE Improving ambulation in patients with spinal cord injuries (SCIs) is a major challenge for the clinician. Physical examination can be supplemented with biomechanic information from the gait laboratory to comprehensively evaluate and improve walking. Gait analysis is an effective method to evaluate 3-dimensional dynamic joint range of motion (kinematics) and forces (kinetics) occurring at the hip, knee, and ankle/foot. Clinical gait analysis has proved to be essential for surgical and rehabilitative planning and posttreatment assessment in many neuromuscular disorders. Benefits of gait analysis also may apply to walking patients with SCIs. The goal of this study was to demonstrate the utility of gait analysis in children and adolescents with SCIs. METHODS Motion analysis evaluations and physical examinations were performed on 33 children and adolescents with SCIs (16 males, 17 females). Mean age at time of gait analysis was 11.7 years, with an age range of 2.5 to 21 years. RESULTS Abnormal kinematic patterns, which were repeatable over several years, were demonstrated in the patients with SCI. Gait analysis was beneficial in making educated treatment decisions about orthotic prescription, surgery, postsurgical evaluation, prescription of new therapy, evaluation of spasticity medications, and experimental treatments. Another advantage of gait analysis is recording and reviewing changes in gait over time. In our study, 22 of the 33 patients received a 1-year follow-up gait analysis. Patients followed over multiyear intervals have demonstrated characteristic changes in mobility patterns, resulting in changes in prescription of mobility aids. The benefits of gait analysis are demonstrated by case presentation. CONCLUSION Improved ambulation for patients with SCI can be accomplished with physical therapy, orthotics, spasticity management, and surgery. These treatments, as well as innovative new areas such as functional electrical stimulation and robotic-assisted therapy, rely on gait analysis to provide a template of normal walking patterns and to measure function and document improvements.