Identification of joint patterns during gait in children with cerebral palsy: a Delphi consensus study.
OBJECTIVE
This study aims to achieve an international expert consensus on joint patterns during gait for children with cerebral palsy (CP) by means of Delphi surveys.


METHODS
In Stage 1, seven local experts drafted a preliminary proposal of kinematic patterns for each lower limb joint in the sagittal, coronal, and transverse plane. In Stage 2, 13 experts from eight gait laboratories (four in the USA and four in Europe), participated in a Delphi consensus study. Consensus was defined by a pre-set cut-off point of 75% agreement among participants.


RESULTS
After the first stage, 44 joint patterns were presented in a first survey and 29 patterns reached consensus. Consensus improved to 47 out of 48 patterns in the third survey. Only one pattern, 'abnormal knee pattern during loading response', did not reach consensus. The expert panel agreed to define six patterns for the knee during swing, most of them representing characteristics of a stiff knee pattern.


CONCLUSIONS
The defined joint patterns can support clinical reasoning for children with CP as joint patterns during gait might be linked to different treatment approaches. Automating the classification process and incorporating additional trunk, foot, and electromyography features should be prioritized for the near future.
Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
Angela
A
Nieuwenhuys
Center for Motion Analysis, Division of Orthopaedics, Connecticut Children's Medical Center, Farmington, CT, USA.
Sylvia
S
Õunpuu
Department of Development and Regeneration, KU Leuven, Leuven, Belgium.|Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium.
Anja
A
Van Campenhout
Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK.
Tim
T
Theologis
Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.|Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium.
Josse
J
De Cat
Gillette Children's Specialty Healthcare, St. Paul, MN, USA.
Jean
J
Stout
Department of Development and Regeneration, KU Leuven, Leuven, Belgium.|Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium.
Guy
G
Molenaers
Faculty of Engineering Science, KU Leuven, Leuven, Belgium.
Tinne
T
De Laet
Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.|Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium.
Kaat
K
Desloovere
D000843:Ankle Joint / Q000503:physiopathology*; D001696:Biomechanical Phenomena; D002547:Cerebral Palsy / Q000150:complications / Q000503:physiopathology*; D002648:Child; D032921:Consensus; D003697:Delphi Technique; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology*; D006621:Hip Joint / Q000503:physiopathology*; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D010388:Pelvis / Q000503:physiopathology*