Gait Treatment Outcome Assessments in Cerebral Palsy

Children with cerebral palsy (CP) who are able to ambulate almost all require treatment to improve their ambulatory abilities throughout growth and development. The treatment includes many modalities such as physical therapy, botulinum toxin, dorsal rhizotomy, orthopedic surgery, and the use of orthotics and assistive devices. In addition to all of these treatment modalities, the child’s gait is also strongly influenced by their normal motor development and the environment in which the child is living. To understand the individual impact of each of these influences requires good long-term outcome studies. And additional impact is the wide variety of motor ability for children with CP who are able to walk. The gross motor function classification system (GMFCS) is our current state-of-the-art method for classifying individual motor abilities. In addition to considering the individual’s level of impairment, it is important to consider the other domains as defined by the International Classification of Functioning, Disability and Health (ICF) which impact the individual’s function in society. This requires that we consider the person’s overall health condition as well as the local environmental factors which influence the person’s ability to be active. It is also important to consider the opportunity and personal interest in participation of specific activities and other personal factors which may influence their level of activity. In this context of multiple treatment modalities overlaying with multiple individual personal factors to assess makes outcome assessment a complicated and challenging problem. The goal of this chapter is to assess the individual areas which need to be evaluated.