Instrumental gait analysis parameters for assessing lower limb spasticity: A systematic review

Ms Stella Kravtsov1, Dr  Ettie Ben-Shabat2, Dr  Corey  Joseph1, Dr Anna  Murphy1

1Monash Health, 2Alfred Health, ,

Background: Upper motor neuron lesions may cause spasticity (impairment), which in turn may affect walking (function). Instrumental gait analyses (GA) provide detailed and sensitive analysis of walking. We conducted a systematic review to identify the spatiotemporal, kinematic and kinetic parameters used in instrumental GA for assessing adults with lower limb spasticity.

Method: Data bases searched: Medline, EMBASE, CINAHL, AMED, Cochrane and PEDro. Inclusion criteria: empirical studies, adult participants, reported measurements of lower limb spasticity and instrumental GA. Exclusion criteria: interventions or history of orthopaedic surgery, GA studies published before 1991 and non-English manuscripts. At least two independent investigators reviewed each paper, and rated its quality (Quality Assessment Tools-NIH: good/fair/poor).

Results: Thirty-seven studies were included: 17 pre-post intervention (71% fair quality), 15 observational (73% fair), 4 controlled intervention (75% good) and 1 case study (poor). Total participants n=766 (489 stroke, 102 HSP,65 TBI, 46 SCI, 64 other). Spasticity was mainly assessed with the Modified Ashworth Scale n=32. In 8 studies direct correlation between spasticity and instrumental GA data was examined (significant correlation marked*).

  • Main spatiotemporal parameters:
  • Gait velocity n=30*, Cadence n=15*
  • Step stride/length n=15*, Step width n=7*
  • Duration of: Stance n=16, Swing n=7, Double leg support n=6*
  • Main kinematic parameters:
  • Amplitude/total ROM/Excursion n=10 (multiple parts of gait cycle-ankle n=7 cycle, hip n=6, knee n=11, pelvis n=3)
  • Peak angle n=16 (ankle n=16, knee n=10, hip n=9)
  • Angle at heel-strike/toe-off/midstance n=8:
  • Angular velocity n=8 (ankle n=3, knee n=4, hip n=2)
  • Main kinetic parameters:
  • Parameters were multiple and variable, most common being: Peak moment n=4 and peak power n=3.
  • EMG data supplemented instrumental GA data in 12 studies.

 

Discussion: Spatiotemporal and kinematic parameters were most comprehensively studied with instrumental GA. The parameters sensitive to spasticity were: gait velocity, cadence, step/stride length, step width and duration of double leg support. These findings confirm that spasticity does affect function.


Biography: To be confirmed

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