RESUMO
AIM: The Gait Deviation Index (GDI) is a score derived from three-dimensional gait analysis (3DGA). The GDI provides a numerical value that expresses overall gait pathology (ranging from 0 to 100, where 100 indicates the absence of gait pathology). The aim of this study was to investigate the association between the GDI and different levels of gross motor function [defined as the Gross Motor Function Classification System (GMFCS)] and to explore if age, height, weight, gender and cerebral palsy (CP) subclass (bilateral and unilateral CP) exert any influence on the GDI in children with unilateral and bilateral spastic CP. METHODS: We calculated the GDI of 109 children [73 % boys, mean age 9.7 years (standard deviation, SD 3.5)] with spastic CP, classified at GMFCS levels I, II and III. Twenty-three normally developing children were used as controls [61 % boys, mean age 9.9 years (SD 2.6)]. Multiple linear regression analysis was performed. RESULTS: The mean GDI in the control group was 100 (SD 7.5). The mean GDI in the GMFCS level I group was 81 (SD 11), in the GMFCS level II group 71 (SD 11) and in the GMFCS level III group 60 (SD 9). Multiple linear regression analysis showed that gender, age and CP subclass had no significant correlation with the GDI, whereas height and weight had a slight impact. CONCLUSION: This study showed a strong correlation between the GDI and GMFCS levels. The present data indicate that calculation of the GDI is a useful tool to characterise walking difficulties in children with spastic CP.
RESUMO
BACKGROUND: After the neonatal period, the incidence of arterial cerebral infarction is 1-2/100 000 children/year. Thrombolysis in cerebral stroke is recommended for adults, but is still controversial for children. The aim of this paper was to provide an overview of documentation on treatment with thrombolysis after arterial cerebral infarction in children. MATERIAL AND METHODS: The article is based on literature identified through a non-systematic search in PubMed and own clinical experience in treating young adults with cerebral infarction. RESULTS: In the western world cardiac disease, cardiac interventions and infections are the most important causes of cerebral infarction in children. Children with arterial cerebral infarction should initially be treated as adults, i.e. rapid admission to hospital and immediate imaging, preferably magnetic resonance imaging with diffusion and intracranial angiography. There are no randomized controlled trials of efficacy and safety of thrombolysis in cerebral infarction in children. Thrombolysis is normally not recommended for children because of the lack of scientific evidence. Nevertheless, thrombolysis is used in children with cerebral infarction and case reports are available. INTERPRETATION: The prospect of severe disability should lead to consideration of thrombolysis if age below 18 years is the only contraindication. Treatment of children with thrombolysis should be recorded in an international registry.
