Gait patterns in hemiplegic cerebral palsy: Is it time for a new classification?

BACKGROUND

The Winters, Gage and Hicks classification (WGHC) for spastic hemiplegia has been widely used, despite its limitations. The purpose of this study was to evaluate the reliability of WGHC in large series of cerebral palsy (CP).

RESEARCH QUESTION: May all hemiplegic CP patients be classified according to WGHC?

METHODS

Participants with the diagnosis of spastic hemiplegic CP were identified in gait laboratory database. Only the first gait analysis of each patient was considered, and 983 patients met the inclusion criteria. Individuals with mixed tone (45), other pathologies combined with hemiplegia (11) and previous orthopedic surgeries or botulinum injections within 12 months (395) were excluded. The remaining 532 subjects were classified according to the 4 groups described by WGHC.

RESULTS

224 (42.1 %) patients were unclassified by WGHC and 4 additional groups were identified: group V (115/21.6 %)-none of the alterations described in WGHC; group VI (76/14.3 %)- WGHC III or IV, but with normal ankle dorsiflexion in stance and swing; group VII (29/5.5 %)- WGHC II, III or IV, but with normal ankle dorsiflexion in swing phase; group VIII (4/0.7 %)-reduction of ankle dorsiflexion in stance and swing phases with increased hip flexion in stance, but with normal knee range of motion. The age in group VI (14.5 years) was higher than other groups (p < 0.001). The GDI in group V (76.3) was similar (p = 0.979) to group I (73.9) and greater than other groups (p < 0.001). The mean pelvic asymmetry (32.70) and internal hip rotation (180) in group IV were higher than other groups (p < 0.001). The higher prevalence of perinatal anoxia (33.3 %) was observed in group VII.

SIGNIFICANCE: In the present study, 57.9 % of patients were classified according to WGHC and 4 additional patterns were identified, leading a proposal of update at WGHC.

LEVEL OF EVIDENCE: III.