Pa. Deluca et al., ALTERATIONS IN SURGICAL DECISION-MAKING IN PATIENTS WITH CEREBRAL-PALSY BASED ON 3-DIMENSIONAL GAIT ANALYSIS, Journal of pediatric orthopedics, 17(5), 1997, pp. 608-614
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%).