Edinburgh visual gait score


Mar 06 2017

Edinburgh visual gait score

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The Edinburgh visual gait score is an evaluative tool that uses software and video cameras to provide 3D video gait analysis as well as onscreen drawing and measurement tools to evaluate each portion of gait. The software will then generate a EVGS report, with illustrative images from the video if desired, in PDF format. The Edinburgh visual gait score (EVGS) was developed for gait assessment using video recordings in children with CP and orthopedic injuries however it appears it could be used for all ages and populations. For each limb, this score includes 17 variables, and each of these variables can be scored 0, 1 or 2 according to the movement deviation from normal. These include: Initial contact,  Heel lift,  Max ankle dorsiflexion in stance, Hindfoot varus/valgus, Foot rotation, Clearance in swing, Max ankle dorsiflexion in swing, Knee progression angle, Peak knee extension in stance, Knee extension in terminal swing, Peak knee flexion in swing, Peak hip extension in stance, Peak hip flexion in swing, Max pelvic obliquity in midstance, Pelvic rotation in midstance, Peak sagittal trunk position, Max lateral shift of trunk. The assessment is carried out in both the sagittal and coronal planes and evaluates the lower limb joint angles in both the stance and swing phases of gait. By incorporating the sagittal and coronal planes it allows for inferences to be made about the transverse plane and provides a more comprehensive representation of the child’s gait pattern than gait classification systems based solely on sagittal plane data. Deviations from normal were subdivided into two clinically relevant degrees of severity according to magnitude. Scoring used a three-point ordinal scale: 0 normal (mean ± <1.5 SD); 1 moderate deviation (1.5–4.5 SD from mean); and 2 marked deviation (>4.5 SD from mean). The maximum total score per limb for 17 observations would theoretically be 34. Patients walked down a walkway and we recorded split-screen real-time images and close-up views of the feet and pelvis.

Observations from video recordings were made at six anatomic levels: trunk, pelvis, hip, knee, ankle, and foot. Similar to the other observational gait analysis scales, the EVGS has good intra-observer reliability, but poor inter-observer reliability. The EVGS has also shown good sensitivity to change in children with Cerebral Palsy following orthopaedic surgery and therapeutic interventions. To ensure consistently good levels of reliability and sensitivity are achieved, the assessor must be well trained and experienced in the evaluation and application of the EVGS. The EVGS has been proven to be valid and reliable and helps to gain quantitative data on top of the typical qualitative data when observing gait. It has great clinical application for kids with CP and orthopedic injuries however reliability decreases with complex CP patients, and with less experience and practice using the EVGS.

Edinburgh Visual Gait Score for Use in Cerebral Palsy Explanatory Notes The P&O Clinical Movement DATA software can assist you in calculating the Edinburgh Visual Gait Score (EVGS).  Use the on‐screen measurement and drawing tools to help you to evaluate each item of the score and enter the results in the EVGS pane on the left hand side of the screen. The software will then generate a EVGS report, with illustrative images from the video if desired, in PDF format. Foot 1. Initial Contact in Stance The heel normally contacts first.  The toe describes that portion of the foot distal to the metatarso‐phalangeal joints.   Simultaneous contact with the heel and toe comprises flatfoot contact. Observation Score Heel contact 0 Flatfoot contact 1 Toe contact 2 2. Heel Lift in Stance If there is no heel contact during stance, there can be no heel lift (i.e., “No heel contact”).  Heel lift normally occurs between opposite foot level and opposite foot contact (“Normal”).  “Early” heel lift indicates that heel lift precedes the opposite foot being level with the stance foot.  “Delayed” heel lift is present if heel lift occurs with or after opposite foot contact.  “No forefoot contact” describes the rare occasion of a calcaneous foot when the forefoot does not contact during stance. Observation Score No forefoot contact 2 Delayed 1 Normal 0 Early 1 No heel contact 2     3. Maximum Ankle Dorsiflexion in Stance There is normal forward progression of the tibial over the planted hindfoot from slight plantarflexion at initial contact to dorsiflexion at terminal stance.    Describe the maximum angle of dorsiflexion between hindfoot and shaft of the tibia during stance.    In pathological gait, lack of heel contact may be caused by either excessive plantarflexion of the foot or excessive knee flexion. The tibial‐hindfoot angle is therefore analysed irrespective of the position of the foot on the floor. Observation Score Excessive dorsiflxn (>40° df) 2 Increased dorsiflxn (26°‐ 40° df) 1 Normal dorsiflxn (5°‐ 25° df) 0 Reduced dorsiflxn (10° pl ‐ 4° df) 1 Marked plantarflxn (>10° pl) 2 4. Hind‐foot Varus/Valgus in Stance In the coronal plane, the normal hind‐foot is in neutral or very slight valgus. Observation Score Severe valgus (more than 15° valgus) 2 Mod valgus (6° to 15° valgus) 1 Neutral/slight valgus (0° to 5° valgus) 0 Mild varus (1° to 10° varus) 1 Severe varus (more than 10° varus) 2 5. Foot Rotation in Stance The normal foot is slightly externally rotated relative to the Knee Progression Angle (KPA, i.e., the direction in which the knee points during gait). Observation Score Marked ext >KPA (by >40°) 2 Mod ext >KPA (by 21°‐ 40°) 1 SI more ext than KPA (by 0°‐ 20° extn) 0 Mod int >KPA (by 1°‐ 25°) 1 Marked int >KPA (by >25°) 2 6. Clearance in Swing The whole foot including the toe should clear the foot and not make contact during swing phase.    “None” should be recorded if there is continuous contact between some part of the foot and the floor throughout swing phase.    “Reduced” indicates that there is a shortened but definite period of clearance during some part of the swing phase between the whole foot and the floor.    “Full” or normal clearance is when the foot does not touch at all in swing; however, normal clearance is a very small amount.    “High steps” describes excessive lifting of the foot from the floor.  When there is reduced clearance followed by high stepping, circle both, giving a score of 2 for this combination of features. Observation Score High Steps 1 Full 0 Reduced 1 None 2 7. Maximum Ankle Dorsiflexion in Swing The ankle is normally approximately neutral in swing, but very slight plantarflexion (5°) is acceptable. Observation Score Excessive dorsiflxn (>30° df) 2 Increased dorsiflxn (16°‐30° df) 1 Normal dorsiflxn (15° df‐ 5° pl) 0 Mod plantarflxn (6°‐ 20° pl) 1 Marked plantarflxn (>20° pl) 2 Knee 8. Knee Progression Angle in Mid‐Stance The knee normally points forward during gait.  Record the position in which the knee appears to point during most of the stance phase.   When either internal or external rotation is present but the whole knee cap is visible, score 1.  When rotation is present to such an extent that the knee cap is partially out of view (external or internal, part cap visible), score 2. Observation Score External, part knee cap visible 2 External, all knee cap visible 1 Neutral, knee cap midline 0 Internal, all knee cap visible 1 Internal, part knee cap visible 2 9. Peak Extension Stance The knee approaches full extension in terminal stance.  In pathological gait, the knee may remain more flexed throughout stance.  Alternatively, hypertension can occur as femoral progression proceeds over an arrested tibia. Observation Score Severe flexn (>25°) 2 Mod flexn (16°‐ 25°) 1 Normal (0°‐ 15° flexn) 0 Mod hyperextn (1°‐ 10°) 1 Severe hyperextn (<10°) 2 10.Terminal Swing Position The knee is normally in slight flexion immediately before heel strike. Observation Score Severe flexn (>30°) 2 Mod flexn (16°‐ 30°) 1 Normal (5°‐ 15° flxn) 0 Mod overextn (4° flx‐ 10° xtn) 1 Severe hyperextn (>10° xtn) 2 11.Peak Knee Flexion in Swing The normal range is 50° to 70°. Observation Score Severely increased (>85° flxn) 2 Mod increased (71°‐ 85° flxn) 1 Normal (50°‐ 70° flxn) 0 Mod reduced (35°‐ 49° flxn) 1 Severely reduced (<35° flxn) 2 Hip 12.Peak Hip Extension in Stance The hip normally extends in stance to between neutral and 20° of extension. Observation Score Mod flexn (°1‐ 15° flxn) 2 Mod flexn (°1‐ 15° flxn) 1 Normal (0°‐ 20° extn) 0 Mod hyperextn (21°‐ 35° extn) 1 Marked hyperextn (>35°) 2 13.Peak Hip Flexion during Swing Normal flexion is between 25° and 45°. Observation Score Marked increase (>60° flxn) 2 Increased flexn (46°‐ 60° flxn) 1 Normal flexn (25°‐ 45° flxn) 0 Reduced flexn (10°‐ 24° flxn) 1 Severely reduced (<10° flxn) 2 Pelvis 14.Obliquity at Mid‐Stance The pelvis normally drops slightly on the opposite side during loading, becoming level by terminal stance.   Estimate the position in mid stance.  “Up” and “down” refer to the position of the ASIS on the stance side, relative to the opposite side ASIS. Observation Score Marked down (>10°) 2 Mod down (1°‐ 10°) 1 Normal obliquity (0°‐ 5° up) 0 Mod up (6°‐ 15°) 1 Marked up (>15°) 2 15.Pelvic Rotation at Mid‐Stance In mid stance, the pelvis should be at approximately neutral rotation, between 5° backward rotation (retraction) of the stance leg, and 10° forward rotation (protraction). Observation Score Marked retraction (>15°) 2 Mod retraction (6°‐ 15°) 1 Normal (5° retr‐ 10° pro) 0 Mod protraction (11°‐ 20°) 1 Severe protraction (>20°) 2 Trunk 16.Peak Sagittal Position in Stance The trunk is erect during stance and swing phases. Suggested values here are:   0 = VerƟcal to 5° forward or backward   1 = more than 5° backwards or between 6° and 15° forward   2 = more than 15° forward Observation Score Marked 2 Moderate 1 Normal 0 Reduced 1 17.Maximum Lateral Shift Normally the trunk displaces laterally approximately 25 mm during stance, towards the stance leg.   “Excessive” thoracic shift laterally or lateral flexion should be considered when recording observations.   “Reduced” describes those cases in which the trunk remains leaning over the swinging leg. Observation Score Excessive 2 Normal 0 Reduced 1 Summary Total all the cores:

References:

Read, H. S., Hazlewood, M. E., Hillman, S. J., Prescott, R. J., & Robb, J. E. (2003). Edinburgh Visual Gait Score for Use in Cerebral Palsy. Journal of Pediatric Orthopaedics,23(3), 296-301. doi:10.1097/01241398-200305000-00005

 

Orozco et al. Reliability and validity of Edinburgh Visual Gait Score as an evaluation tool for children with cerebral palsy. (2016). Developmental Medicine & Child Neurology,58, 79-80. doi:10.1111/dmcn.117_13224

This article aimed to examine the intra and interreliability of the EVGS using video of 30 kids with spastic CP using 7 raters. Three observers had high level of experience in gait analysis, two had medium level and two had no previous experience. Reliability was evaluated using percentage of complete agreement and kappa values. Criterion validity was evaluated by comparing EVGS scores with 3DGA data taken from the same video. Interobserver agreement proved to be 60-90%. Reliability was increased in the distal segments, when the raters  had more clinical experience, when raters had more practice with EVGS, and when higher functioning kids were being evaluated. Intraobserver agreement was 64–92%. Agreement between EVGS and 3DGA was 52–73%. This study validates that the EVGS is a reliable tool however reliability increases with practice and experience and is less suited in complex cases. This limits its applicability and reliability.

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