Influence of gait analysis on decision-marketing for lower extremity surgery

Using the pendulum test to identify the stiff-knee gait pattern of children diagnosed with cerebral palsy


  1. 1. Shriners Hospital for Children;
  2. 2. Rehabilitation Sciences, University of Kentucky, Lexington, KY, USA

Objective: To determine the ability of the modified Ashworth scale (MAS), the Ely test, ande the pendulum test, to discriminate the stiff-knee gait pattern in children diagnosed with cerebral palsy (CP).

Study Design: Prospective cohort study.

Particpants/Setting: A convenience sample of 68 children (mean age 11y 8mo[SD 2y 7mo]) with the primary diagnosis of CP (Gross Motor Function Classification System Levels I-IV) referred to a motion analysis laboratory participated in the study. Exclusion criteria were children who had undergone lower extremity in the previous 12 months and children who had previously undergone rectus femoris transfer procedure.

Materials/Methods: Kinematic and electromyography data were collected during the pendulum test and when walking using a 3D motion analysis system.Participant’s quadriceps spasticity was assessed with the MAS. The Ely test was performed in two different manners to assess quadriceps spasticity (Ely-S) and quadriceps flexibility (Ely-F). Participants were categorized as stiff-knee if at least four of the six criteria were present: (1) decreased knee angular velocity at toe-off; (2) decreased maximum knee flexion during swing; (3) decreased total knee motion throughout the gait cycle; (4) delayed timing of maximum knee flexion in swing; (5) inappropriate swing phase activity of the quadriceps; and (6) toe-drag. Backward eleimination regression started with four predictor measures (MAS, Ely-F, Ely-S, and the magnitude of knee flexion during the first swing of the pendulum test).

Results: A discriminant analysis function using two predictor measures: the magnitude of knee flexion during the first swing of the pendulum test and the Ely-F test (quadriceps flexibility) demonstrated an overall accuracy of 84% in classifying group membership (sensitivity 85%, specificity 83%) with a positive likelihood ratio of 4.8 and the negative likelihood ratio of 0.18. The MAS and the Ely test for quadriceps spasticity were not significant measures in the discriminant analysis. The not-stiff knee group’s mean knee flexion during the first swing of the pendulum test (59 0 [SD 22]) was significantly higher compared to the stiff-knee group’s 34 0 (SD 14), p<0.001.

Conclusions/Significance: When combined, the pendulum test (measuring quadriceps’ active response to stretch) and the Ely test (measuring quadriceps’ flexibility) are good diagnosis tests for identifying a stiff-knee gait pattern in children diagnosed with CP

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