Reliability of timed walking tests and temporo-spatial gait parameters in youths with neurological gait disorders- Article Summary
Title
Reliability of timed walking tests and temporo-spatial gait parameters in youths with neurological gait disorders.
Purpose
The purpose of this study was to investigate the test-retest reliability of temporo-spatial gait parameters in the 10-Meter Walk Test (10MWT) and 6 Minute Walk Test (6MWT) in a population of kids with neurological gait disorders.
Population
A total of 9 girls and 21 boys were included in the study, with a mean age of 13 years old. Diagnoses of participants included Cerebral Palsy (10), stroke (6), TBI (6), demyelination of CNS (2), astrocytome (2), postinfectious encephalopathy (1), medulla blastoma (1), transverse myelopathy (1), and ataxia with unclear etiology (1). 23 of the 30 participants were independent walkers, 4 individuals used walkers, 2 used crutches, and 1 with 4 point crutches. 8 participants utilized AFOs, 3 had insoles, and 1 utilized a foot lifter splint.
Methods
A convenience sample of patients were recruited for this study by recruiting patients at the Rehabilitation Centre for Children and Adolescents of the University Children’s Hospital Zurich located in Affoltern am Albis, Switzerland. Inclusion criteria consisted of kids with neurological gait disorders between 5 and 20 years old who were able to understand and follow walking test directions. Exclusion criteria consisted of kids unable to walk without another person’s assistance.
Examiners implemented a cross-sectional study design by performing 2 sessions of walk tests with a between-test interval of 7 days. Relative reliability was determined using a correlation coefficient within classes. Measurement error reflecting the absolute reliability was quantified using standard error of measurement and the smallest real difference.
Outcome Measures
Using the GAITRite Electronic Walkway Platinum was implemented in this cross-sectional study to analyze step length, step time, step ratio, cadence, velocity, and double support time of gait during the 3 timed trials. Participants performed the 10MWT at a preferred speed (10MWTpref), then the 10MWT at a maximum speed (10MWTmax), and finally performed the 6MWT, with a 5-10 minute break between outcome measures. For each measure, the GAITRite mat was placed at the start line.
Intervention
In between the two testing sessions, participants received individualized interventions according to their needs and goals. Comprehensive interventions consisted of PT, OT, SLP, school, sports, and/or robot assisted training.
Results
The intraclass correlation of the 10MWTpref and the 6MWT showed a significant difference (p=0.0001) between the two testing sessions for all measured parameters of the GAITRite system. The 10MWTmax showed moderate intraclass correlation (p=0.002) on 19/23 total GAITRite parameters.
Strengths
The strengths of this study were the wide variety of gait parameters measured, the validity of the GAITRite equipment, and the wide variety of diagnoses included. Each of these parameters allowed for a comprehensive analysis of gait in the pediatric neuro-rehabilitation setting.
Limitations
The main limitations of this study were the small sample size given the use of sampling for convenience, and the differences in intervention for each child. While it is appropriate to use an individualized intervention program, this makes it more difficult to compare pre and post-test data among a variety of individuals. In order to strengthen the conclusions from this study, a larger sample size should be included with a streamlined intervention for the participants.
Conclusion
In summary, the 6MWT and the 10MWTpref proved to have a high test-retest reliability, and moderate reliability for the 10MWTmax in the population studied. This evidence is clinically relevant and useful for pediatric neuro-rehabilitation specialists looking to track their patients’ change over time in response to given interventions.
Reference
Graser, J.V., Letsch, C. & van Hedel, H.J.A. Reliability of timed walking tests and temporo-spatial gait parameters in youths with neurological gait disorders. BMC Neurol 16, 15 (2016). https://doi.org/10.1186/s12883-016-0538-y
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