Background Excessive ankle plantar flexion (equinus foot) is a common problem in Cerebral Palsy (CP) and several treatment options can be considered depending on the equinus type. Few attempts have been made to classify different forms of equinus foot for specific treatment. Aim This study is aimed at defining equinus foot types in CP patients according to the Ferrari classification, integrating clinical and instrumental assessments. The hypothesis is that clinical differentiation of equinus foot can be evidenced by recurrent anomalies identifiable through Gait Analysis (GA), which can make the assessment, usually based only on clinician semeiotics, more objective. Design Clinical and instrumental assessments were performed separately by a senior CP physiatrist and a senior GA physiatrist, the latter was blind to the clinical diagnosis of equinus type. Setting Outpatients Population Twenty patients, 16 diplegics and 4 hemiplegics (mean age 11 years, SD 4 years 11 months). Methods Clinical assessment by means of Modified Ashworth Scale, Gross Motor Function Measure (GMFM), Observational Gait Analysis (OGA), and measurement of lower limb muscle strength by dynamometer were used to classify the equinus type. Gait analysis assessed the kinematics of affected lower limbs. Results Ten different equinus types were identified. Since various forms of equinus can be present in the same patient, we were able to classify a total of 61 types of equinus in 36 feet. Substantial agreement was found between Clinical and Gait Analysis equinus assignment matched in 50 out of 61 types (Index of agreement with Fleiss’ Kappa 79.3 % ). In some case only Gait Analysis was able to identify the equinus type, while in others it did not confirm clinical assignment. Conclusion Gait analysis is able to distinguish different equinus types according to Ferrari classification, making the clinical decision less arbitrary. Clinical rehabilitation impact Correct objective diagnosis of equinus foot in CP patients is of paramount importance when choosing suitable rehabilitative interventions.

Equinus foot classification in cerebral palsy: an agreement study between clinical and gait analysis assessment / Benedetti MG; D'Apote G; Faccioli S; Costi S; Ferrari A.. - In: EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE. - ISSN 1973-9087. - STAMPA. - 47:(2011), pp. 213-221.

Equinus foot classification in cerebral palsy: an agreement study between clinical and gait analysis assessment.

BENEDETTI, MARIA GRAZIA;
2011

Abstract

Background Excessive ankle plantar flexion (equinus foot) is a common problem in Cerebral Palsy (CP) and several treatment options can be considered depending on the equinus type. Few attempts have been made to classify different forms of equinus foot for specific treatment. Aim This study is aimed at defining equinus foot types in CP patients according to the Ferrari classification, integrating clinical and instrumental assessments. The hypothesis is that clinical differentiation of equinus foot can be evidenced by recurrent anomalies identifiable through Gait Analysis (GA), which can make the assessment, usually based only on clinician semeiotics, more objective. Design Clinical and instrumental assessments were performed separately by a senior CP physiatrist and a senior GA physiatrist, the latter was blind to the clinical diagnosis of equinus type. Setting Outpatients Population Twenty patients, 16 diplegics and 4 hemiplegics (mean age 11 years, SD 4 years 11 months). Methods Clinical assessment by means of Modified Ashworth Scale, Gross Motor Function Measure (GMFM), Observational Gait Analysis (OGA), and measurement of lower limb muscle strength by dynamometer were used to classify the equinus type. Gait analysis assessed the kinematics of affected lower limbs. Results Ten different equinus types were identified. Since various forms of equinus can be present in the same patient, we were able to classify a total of 61 types of equinus in 36 feet. Substantial agreement was found between Clinical and Gait Analysis equinus assignment matched in 50 out of 61 types (Index of agreement with Fleiss’ Kappa 79.3 % ). In some case only Gait Analysis was able to identify the equinus type, while in others it did not confirm clinical assignment. Conclusion Gait analysis is able to distinguish different equinus types according to Ferrari classification, making the clinical decision less arbitrary. Clinical rehabilitation impact Correct objective diagnosis of equinus foot in CP patients is of paramount importance when choosing suitable rehabilitative interventions.
2011
Equinus foot classification in cerebral palsy: an agreement study between clinical and gait analysis assessment / Benedetti MG; D'Apote G; Faccioli S; Costi S; Ferrari A.. - In: EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE. - ISSN 1973-9087. - STAMPA. - 47:(2011), pp. 213-221.
Benedetti MG; D'Apote G; Faccioli S; Costi S; Ferrari A.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/116124
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