ALTERATIONS IN SURGICAL DECISION-MAKING IN PATIENTS WITH CEREBRAL-PALSY BASED ON 3-DIMENSIONAL GAIT ANALYSIS

The purpose of this study was to compare surgical recommendations made by clinicians experienced in gait analysis when using information pro vided from the clinical examination and videotape, with recommendation s made after the addition of kinematic, kinetic, and electromyographic (EMG) data. Ninety-one patients with a diagnosis of cerebral palsy we re seen in the gait laboratory as part of the surgical decision-making process. Experienced clinicians reviewed video and clinical examinati on data for each patient and made surgical recommendations. Joint kine matics and kinetics and EMG data were then reviewed, and a second set of surgical recommendations was made. Comparisons between these recomm endations showed that the addition of gait-analysis data resulted in c hanges in surgical recommendations in 52% of the patients, with an ass ociated reduction in cost of surgery, not to mention the human impact of an inappropriate surgical decision, which is more likely without ga it analysis. When changes in recommendations were made, an increase in surgical recommendations was observed for the gastrocnemius (59%) and rectus femoris (65%), whereas decreases were observed for the hamstri ngs (61%), psoas (78%), hip adductors (83%), femur (86%), and tibia (6 4%).