The quality assessment of walking in cerebral palsy

The primary aim of intervention in cerebral palsy is to improve the quality of walking. However, we have no means of measuring this quality or its change following treatment. In this study we set out to develop a duality score for walking which can objectively quantify quality and its change following intervention. We video recorded 60 children while walking, 55 with spastic diplegia and 5 normal children and asked 8 observers to grade the quality of their walking ability using an analogue scale. Having demonstrated the reliability of the scale, each child's quality score was then compared with their sagittal plane kinematic data and their functional data. Balance, speed, range of motion and effort emerged as the key objective and measurable features which determine the quality of walking. These four features were weighted in a formula to equate with the quality scores. The formula was tested using the final 20 patients by comparing their predicted quality scores as derived from the formula with the actual quality scores as determined by the observers.