Measuring Outcomes for Children with Cerebral Palsy Who Use Gait Trainers

Abstract

Gait trainers are walking devices that provide additional trunk and pelvic support. The primary population of children using gait trainers includes children with cerebral palsy (CP) functioning at Gross Motor Function Classification System (GMFCS) levels IV and V. A recent systematic review found that evidence supporting the effectiveness of gait trainer interventions for children was primarily descriptive and insufficient to draw firm conclusions. A major limitation identified was the lack of valid, sensitive and reliable tools for measuring change in body structure and function, activity and participation outcomes. Twelve different clinical tools were identified in the systematic review and in this paper we review and discuss the evidence supporting their reliability, validity and clinical utility for use with children using gait trainers. We also describe seven additional clinical measurement tools that may be useful with this intervention and population. The Pediatric Evaluation of Disability Inventory (PEDI) rated highest across all areas at this time. Individualized outcome measures, such as the Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling and measuring user satisfaction with tools, such as the Quebec User Evaluation of Satisfaction with assistive Technology, show potential for gait trainer outcomes research. Spatiotemporal measures appear to be less useful than functional measures with this intervention and population. All tools would benefit from further development for use with children with CP functioning at GMFCS levels IV and V.