Case report: The gait deviation index may predict neurotherapeutic effects of FES-assisted gait training in children with cerebral palsy.
Ahad Behboodi, Aswhini Sansare, Nicole Zahradka and 1 others
PMID 36937105WHAT IT FOUND
In two children with cerebral palsy, the Gait Deviation Index (GDI) improved after FES training, with the most impaired child gaining 11 points.
Joint-by-joint error measures did not consistently predict these gains, so GDI may be a better indicator of lasting response than detailed kinematic analysis.
Key findings
01The Gait Deviation Index (GDI) increased in the same direction for both participants at the immediate post-application assessment and the post-training assessment, suggesting it may track lasting improvement.
02The child with greater baseline impairment (GMFCS level III) showed a clinically relevant GDI improvement of 11 points after training, while the less impaired child showed a smaller gain of 2.17 points.
03Root mean square error (RMSE) for individual joints did not consistently predict the direction of post-training improvement, as some joints showed immediate worsening but later improvement.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study included only two participants, which severely limits the generalizability of the findings and prevents any statistical conclusions about who will respond to FES. The results are based on a single case report structure, so the observed relationship between immediate GDI changes and post-training improvements may not hold for other individuals. The control group consisted of typically developing children, which provides a normative benchmark but does not account for the natural variability in gait patterns among children with cerebral palsy. The study did not include a control group that received training without FES, so it cannot separate the effects of the exercise training itself from the specific effects of electrical stimulation.
Declared interests
The authors declare that the study was approved by the University of Delaware and Shriners Hospitals for Children, Philadelphia. No specific funding sources or commercial conflicts of interest are detailed in the provided text, though the authors mention their group developed the FES system used.
The easy way to misread this
Do not assume that immediate changes in individual joint angles or RMSE predict long-term outcomes. In this study, some joints showed worsening during immediate FES application but improved after training, so relying on joint-specific data could lead to incorrectly dismissing a patient as a non-responder.