Gait Analysis and Interdisciplinary Interventions for Children With Cerebral Palsy (CPinMotion)

April 4, 2018 updated by: Helle Mätzke Rasmussen, University of Southern Denmark

Instrumented Gait Analysis and Individually Tailored Interdisciplinary Interventions for Children With Cerebral Palsy: A Randomized Controlled Trial

The aim of this study is to test the hypothesis, that improvements in gait pattern following individually tailored interventions guided by instrumented 3-dimensional gait analysis are superior to those used in 'care as usual'.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Children with cerebral palsy (CP) who walk independently often have an altered gait pattern. Interdisciplinary interventions in terms of orthopaedic surgery, spasticity management, physical therapy and orthotics aim to improve the gait pattern. Standardised measurements are used in the Cerebral Palsy follow-Up Program to assess walking. However, these measurements do not describe features in the gait pattern reflecting underlying neuro-musculoskeletal impairments. This can be done with instrumented 3-dimensional gait analysis (IGA). It has never been investigated whether interdisciplinary interventions designed to address impairments identified by IGA result in improved gait pattern compared with 'care as usual' without IGA in children with CP. The aim of this study is to test the hypothesis, that improvements in gait pattern following individually tailored interventions guided by IGA are superior to those used in 'care as usual'.

A prospective, single blind, randomised, parallel group study will be conducted. Participants will be recruited from the Cerebral Palsy follow-Up Program. Children aged 5 to 9 years with spastic CP, classified at Gross Motor Function Classification System levels I or II will be included. The interventions under investigation are 1) Individually tailored interdisciplinary intervention addressing impairments identified by IGA and 2) 'care as usual' (interdisciplinary interventions without IGA). The primary outcome is gait pattern measured by the Gait Deviation Index. Secondary outcome measures are, walking performance and patient-reported outcomes of functional mobility, health-related quality of life and overall health, pain and participation. Explorative outcome measures include walking performance, gait pattern, behavior of health care providers and the applied interventions. The primary endpoint for assessing the outcome of the two interventions will be 52 weeks after start of intervention. A follow up will also be performed at 26 weeks after start of intervention; however, exclusively for the patient-reported outcomes.

To our knowledge, this is the first randomised controlled trial comparing the effects of an individually tailored interdisciplinary intervention designed to address impairments identified by IGA versus 'care as usual' in children with CP. Consequently, the study will provide novel evidence for the use of IGA in interdisciplinary interventions.

Study Type

Interventional

Enrollment (Actual)

60

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

      • Odense, Denmark
        • University of Southern Denmark - Odense University Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

5 years to 8 years (Child)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Spastic Cerebral palsy
  • Gross Motor Function Classification System levels I or II.

Exclusion Criteria:

  • Earlier interventions in the form of orthopaedic surgery within the past 52 weeks, injection with botulinum toxin type A in the 12 weeks prior to baseline assessments
  • Relocation to another region during the trial.
  • If the child not are able to demonstrate sufficient co-operation and cognitive understanding to participate in the IGA.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Intervention with IGA
Individually tailored interdisciplinary intervention based on measures performed as part of the Cerebral Palsy follow-Up Program and other clinical examinations AND instrumented gait analysis (IGA)

Individually tailored interdisciplinary intervention based on measures performed as part of the Cerebral Palsy follow-Up Program and other clinical examinations AND instrumented gait analysis

The instrumented gait analysis consists of four steps:

  1. Instrumented gait analysis (data collection with a 8-camera Vicon T40 system (Vicon, Oxford, UK) and 2 force plates (AMTI, OR6-7-1000)
  2. Impairment-Focused Interpretation
  3. Recommendation for interdisciplinary interventions
  4. Dissemination of recommendations

The two modalities differs in the use of IGA, but the study is not indented to document the effect of IGA alone, but to document the difference in the effects of the interdisciplinary interventions, when IGA is implemented to the experimental group.

Other Names:
  • Vicon T40 system, Vicon, Oxford, UK
  • Advanced Mechanical Technology Inc. (AMTI), OR6-7-1000, Watertown, USA
No Intervention: Intervention without IGA
'Care as usual' - Individually tailored interdisciplinary interventions based on measures performed as part of the Cerebral Palsy follow-Up Program and other clinical examinations BUT NOT (IGA).

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change from baseline in Gait Deviation Index
Time Frame: Baseline, 52 weeks
Gait Deviation Index (GDI) is based upon kinematic data from the Instrumented Gait Analysis, and is an quantitative index that summarises the overall gait pattern into a single score for each patient by comparison with non-pathological gait. A GDI value of 100 represents the absence of gait pathology, and each 10-point decrement below 100 indicates one standard deviation from normal gait kinematics. For the primary outcome measure, the median of five trials for each leg will be used to calculate the average of both legs to provide a single index for each child.
Baseline, 52 weeks

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change from baseline in 1-minute walk test
Time Frame: Baseline, 52 weeks
Walking performance is assessed with the 1-minute walk test. The test measure the distance in meters, when the child walks as fast as possible.
Baseline, 52 weeks
Change from baseline in Mobility Scale of the Pediatric Evaluation of Disability Inventory
Time Frame: Baseline, 52 weeks
The Mobility Scale of the Pediatric Evaluation of Disability Inventory evaluates the child's functional mobility in everyday activities with regard to functional skills and caregiver assistance. The Paediatric Evaluation of Disability Inventory will be applied as a parental questionnaire, allowing comparison of the child's functional skills over time for each of the two dimensions.
Baseline, 52 weeks
Change from baseline in Pediatric Quality of Life Inventory Cerebral Palsy Module
Time Frame: Baseline, 52 weeks
The Pediatric Quality of Life Inventory Cerebral Palsy Module is a measure of health-related quality of life, specifically designed for children with CP. The Pediatric Quality of Life Inventory Cerebral Palsy Module is based upon the parents' report and measures physical, emotional, social and school functioning.
Baseline, 52 weeks
Change from baseline in Pediatric Outcome Data Collection Instrument
Time Frame: Baseline, 52 weeks
The Pediatric Outcome Data Collection Instrument assesses overall health, pain and participation in normal daily activities.
Baseline, 52 weeks
Change from baseline in Mobility Scale of the Pediatric Evaluation of Disability Inventory
Time Frame: Baseline, 26 weeks
The Mobility Scale of the Pediatric Evaluation of Disability Inventory evaluates the child's functional mobility in everyday activities with regard to functional skills and caregiver assistance. The Paediatric Evaluation of Disability Inventory will be applied as a parental questionnaire, allowing comparison of the child's functional skills over time for each of the two dimensions.
Baseline, 26 weeks
Change from baseline in Pediatric Quality of Life Inventory Cerebral Palsy Module
Time Frame: Baseline, 26 weeks
The Pediatric Quality of Life Inventory Cerebral Palsy Module is a measure of health-related quality of life, specifically designed for children with CP. The Pediatric Quality of Life Inventory Cerebral Palsy Module is based upon the parents' report and measures physical, emotional, social and school functioning.
Baseline, 26 weeks
Change from baseline in Pediatric Outcome Data Collection Instrument
Time Frame: Baseline, 26 weeks
The Pediatric Outcome Data Collection Instrument assesses overall health, pain and participation in normal daily activities.
Baseline, 26 weeks

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change from baseline in Gait Variable Score
Time Frame: Baseline, 52 weeks
The Gait Variable Score is used to measure changes in gait pattern. Gait Variable Score is an index for a single gait variable. The Gait Variable Scores are determined for the following nine variables: Pelvic tilt, pelvic obliquity, pelvic rotation, hip flexion, hip adduction, hip rotation, knee flexion, dorsiflexion and foot progression
Baseline, 52 weeks
Change from baseline in Measure of Processes of Care
Time Frame: Baseline, 52 weeks
Measure of Processes of Care is a self-report measure of parents' perception of the extent to which the health services that their child receives are family-centred.
Baseline, 52 weeks
Applied interventions
Time Frame: 52 weeks
Records from the Cerebral Palsy Follow-Up Program of the applied interventions will be used to explore differences (used vs. not used) in the use of the following intervention categories in the two groups: Orthopaedic surgery, Spasticity management, Physical Therapy and Orthotics.
52 weeks
Difference in recommended and applied interventions
Time Frame: Baseline, 52 weeks
Records from the Cerebral Palsy Follow-Up Program of the recommended and actually applied interventions in the experimental group will be used to explore the differences (used vs. not used) in the recommended and actually applied interventions in regard to the following categories: Orthopaedic surgery, Spasticity management, Physical Therapy and Orthotics.
Baseline, 52 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Investigators

  • Principal Investigator: Helle Rasmussen, Ph.d. stud., University of Southern Denmark and Odense University Hospital
  • Study Chair: Anders Holsgaard-Larsen, Ph.d., University of Southern Denmark and Odense University Hospital

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

August 6, 2014

Primary Completion (Actual)

July 5, 2017

Study Completion (Actual)

July 5, 2017

Study Registration Dates

First Submitted

June 2, 2014

First Submitted That Met QC Criteria

June 6, 2014

First Posted (Estimate)

June 10, 2014

Study Record Updates

Last Update Posted (Actual)

April 6, 2018

Last Update Submitted That Met QC Criteria

April 4, 2018

Last Verified

April 1, 2018

More Information

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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