Assessment of consistency of the observational Wisconsin Gait Scale and 3-dimensional gait analysis in patients with central nervous system injuries

The study is going to be conducted among selected 50 patients in the late period after cerebral stroke and 40 patients with hemiplegic cerebral palsy. The study is also going to be conducted in a group of 60 healthy persons in order to calculate the gait indexes such as Gait Deviation Index (GDI) and Gait Variability Index (GVI) which require standard values obtained from the analysis of healthy individuals. The main objective of the study is to compare consistency of observational scale of gait assessment with objective method which is 3-dimensional (3D) gait analysis in patients after stroke and in children as well as youth with hemiplegic cerebral palsy. And thus the answer to the question whether simple, inexpensive, easy to use, observational Wisconsin Gait Scale can fully substitute very costly and require technological knowledge, time and unique equipment 3D gait analysis. Specific objectives: - comparison of consistency of spatiotemporal parameters acquired during 3D gait analysis with spatiotemporal traits assessed in part one of WGS, as well as 3D kinematic parameters with the kinematic parameters in part one, two, three and four of WGS - comparison of results of the observational WGS and the global gait indexes such as GDI and GVI, constituting objective methods of assessing gait taking into account parameters identified during 3D gait analysis - assessment of inter- and intra-observer reliability of the WGS in observational gait analysis based on the analysis of video recording in children and youth with hemiplegic cerebral palsy and to present the possibility of using this scale in everyday practice in the case of hemiplegic cerebral palsy patients - examination of correlations between gait assessment performed by means of the WGS and the global gait indexes GDI and GVI and Gross Motor Function Classification Scale (GMFCS) The patients' gait is going to be assessed with the use of WGS, functional level of children and youth based on GMFCS, spatiotemporal and kinematic gait parameters are going to be examined in Gait Laboratory with the use of BTS Smart system (6 cameras, 120 Hz) from BTS Bioengineering (BTS Bioengineering,Milan, Italy). Reference markers are going to be placed according to the internal protocol of the system (Helen Hayes (Davis) Marker Placement) on the sacrum, pelvis (anterior posterior iliac spine), femur (lateral epicondyle, great trochanter and in lower one-third of the shank), fibula (lateral malleolus, lateral condyle end in lower one-third of the shank), foot (metatarsal head and heel). The subjects are going to walk at their comfortable speed and are going to use auxiliary equipment such as canes and elbow crutches, and tripods during the evaluation. During one study 6 passes of the patient are going to be registered and, subsequently, spatio-temporal and kinematic parameters are going to be calculated with use of Tracker and Analyzer programs (BTS Bioengineering), averaging the results to a single session. The following parameters are going to be analysed: cadency, gait speed, step width, duration of swing phase and duration of stance phase of the paretic and of the non-paretic limb, gait cycle length, step length and kinematic parameters of hip, knee, and ankle joint and pelvis. Furthermore, the global gait indexes GDI and GVI is going to be calculated, which are objective methods of assessing gait taking into account parameters identified during 3D gait analysis. GDI is going to be calculated based on the kinematic parameters and the GVI based on the spatiotemporal parameters. 3D gait recording is going to be performed simultaneously with two video cameras distributed in such a way as to obtain images record in both a frontal plane and a sagittal plane. The video camera filming the view of the frontal plane is going to be located in the middle of the delineated distance, 2 metres away from the route walked by the subject. The camera filming the view of the sagittal plane is going to be placed in line with the route walked. The recording is going to be made for 6 walks, with the minimum of 3 complete gait cycles. The films available for rating and gait assessment provide right and left side, as well as back and front view of the patient. The subjects are going to be instructed to walk the defined distance at self-selected (comfortable) speed, with the support of orthopaedic aids used on a daily basis. Interpretation of the recording and gait assessment based on WGS is going to be performed independently by three experienced physiotherapists, who were trained in gait disorders affecting post-stroke and with hemiplegic cerebral palsy patients, and possess knowledge of assessment criteria used in WGS. Intra-observer reliability of the WGS in the assessment of children and youth with hemiplegic cerebral palsy is going to be done by 3 independent researchers separately analyzing video recording, evaluation results are going to be compared between researchers. Inter-observer reliability of the WGS in the assessment of children and youth with hemiplegic cerebral palsy is going to be done by 3 independent researchers separately twice (two weeks apart) analyzing video recording, evaluation results are going to be compared between the study 1 and 2. The approximate duration of each of the assessment sessions will amount to 30 minutes for the first session and 30 minutes for the second session for hemiplegic cerebral palsy patients to complete WGS. Stroke patients will receive a single assessment session only to compare consistency of observational scale of gait assessment with objective method. Hemiplegic cerebral palsy patients will receive two assessments two weeks apart to assess inter-observer reliability of the WGS in observational gait analysis and evaluation results are going to be compared between the study 1 and 2. Inter-observer reliability of the WGS in the hemiplegic cerebral palsy patients aims at presenting the possibility of using this scale in everyday practice in the case of hemiplegic cerebral palsy patients. Single assessment session in patients after stroke results from the fact that the inter-observer reliability of the WGS in this group of patients has already been examined in the previous studies. All patients are going to be examined in the same laboratory by the same people and with the use of the same equipment. The observation period is 3 months. The observation period refers to total recruitment of all participants.