Changes in upper limb kinematics in children with cerebral palsy after lower limb surgery: a retrospective comparative study

Cerebral palsy (CP), which is characterized by movement and posture disorders, is a neurological disorder that affects the movement of both the lower and upper extremities. Current research on gait analysis in children with cerebral palsy is mostly focused on the lower extremities, whereas research on the upper extremities is limited to three-dimensional gait analysis. However, in many countries, video-based gait analysis is used instead of three-dimensional gait analysis owing to its high cost. The primary aim of this study was to determine whether upper extremity kinematics change after lower extremity surgery in children with cerebral palsy. As a secondary aim, we developed a video-based analysis method to assess these changes in settings where 3D gait analysis is not available. The study included 30 children (17 diplegic and 13 hemiplegic including 18 boys and 12 girls) with a mean age of 8.9 years and 29 healthy children (15 boys and 14 girls) with a mean age of 9.3 years. The efficacy of the surgical procedure was determined using Edinburgh Visual Gait Scores before and after surgery. Bilateral upper limb kinematics, including wrist, elbow, shoulder, trunk, and head flexion/extension angles, as well as trunk and head lateral flexion and shoulder abduction in the coronal plane, were measured during the initial contact and mid-stance phases using Kinovea 0.9.5 software by 2 different observers. Measurements from the more and less affected sides in the CP group were compared with corresponding limbs of the healthy control group. Preoperative, postoperative, and control groups were compared by ANOVA. The ICC test was used to evaluate the interobserver reliability between the 2 observers. Wilcoxon signed-rank test was used to compare EVGS scores. Postoperative outcomes at the wrist and elbow were found to differ in the sagittal plane, with notable adjustments in the flexion/extension angles during the initial contact and midstance phases. In addition, compared with those in the preoperative phase, the Edinburgh Scale (Edinburgh) score showed favorable postoperative improvements. Postoperative improvements were observed in wrist and elbow kinematics, with values approaching those of the control group. Interobserver reliability was excellent for most sagittal plane measurements (ICC > 0.90). This study revealed changes in the kinematics of the upper extremities after lower extremity surgery. These findings demonstrates that video-based analysis can provide reliable measurements of upper limb kinematics in settings where 3D gait analysis is not available. This study was registered with ClinicalTrials.gov, number NCT05957783, titled “Changes in Upper Limb Kinematics in Children with Cerebral Palsy After Lower Limb Surgery.” The trial was publicly registered on 07/24/2023 to ensure transparency and reproducibility of the research process. Although the data were analyzed retrospectively, the study protocol was prospectively registered at ClinicalTrials.gov (NCT05957783) to ensure transparency. The party responsible for the trial registration was Yaşar Samet Gökçeoğlu, which is contactable via [email protected].