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Original article
Age-related gait standards for healthy children and young people: the GOS-ICH paediatric gait centiles
  1. Lucy M. Alderson1,2,
  2. Sandra X Joksaite3,4,
  3. Jennifer Kemp1,5,
  4. Eleanor Main2,
  5. Tim Watson6,
  6. Frances M Platt7,
  7. Mario Cortina-Borja3
  1. 1 Department of Physiotherapy, Great Ormond Street Hospital For Children NHS Foundation Trust, London, London, UK
  2. 2 Great Ormond Street Institute of Child Health, University College London, London, UK
  3. 3 Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK
  4. 4 Clinical Statistics, R&D Projects Clinical Platforms and Sciences, GSK, Uxbridge, Middlesex, UK
  5. 5 Department of Physiotherapy, Addenbrooke’s Hospital, Cambridge, Cambridgeshire, UK
  6. 6 Department of Allied Health Professions and Midwifery, University of Hertfordshire, Hatfield, Hertfordshire, UK
  7. 7 Department of Pharmacology, University of Oxford, Oxford, Oxfordshire, UK
  1. Correspondence to Dr Lucy M. Alderson, Physiotherapy, Great Ormond Street Hospital For Children NHS Foundation Trust, London WC1N 3JH, UK; lucy.alderson{at}gosh.nhs.uk

Abstract

Objective To develop paediatric gait standards in healthy children and young people.

Methods This observational study aims to address the lack of population standards for gait measurements in children. Analysing gait in children affected by neurological or musculoskeletal conditions is an important component of paediatric assessment but is often confounded by developmental changes. The standards presented here do not require clinician expertise to interpret and offer an alternative to developmental tables of normalised gait data. Healthy children aged 1–19 years were recruited from community settings in London and Hertfordshire, UK. The GAITRite walkway was used to record measurements for each child for velocity, cadence, step length, base of support and stance, single and double support (as percentage of gait cycle). We fitted generalised linear additive models for location, scale and shape (gamlss).

Results We constructed percentile charts for seven gait variables measured on 624 (321 males) contemporary healthy children using a gamlss package in R. A clinical application of gait standards was explored.

Conclusion Age-related, gender-specific standards for seven gait variables were developed and are presented here. They have a familiar format and can be used clinically to aid diagnoses and to monitor change over time for both medical therapy and natural history of the condition. The clinical example demonstrates the potential of the Great Ormond Street Institute of Child Health Paediatric Gait Centiles to enable meaningful interpretation of change in an individual’s performance and describes characteristic features of gait from a specific population throughout childhood.

  • neurodevelopment
  • growth
  • outcomes research
  • physcial therapy
  • rehabilitation

https://doi.org/10.1136/archdischild-2018-316311

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    Footnotes

    • Contributors The normal gait data project (population 624) was the extension of a PhD study (LMA) and involved the close collaboration of LMA, EM, TW and JK in the development of protocol (planning) and execution (data collection and analysis). The gamlss analysis of gait measurements of typically developing children was codeveloped, with planning, execution and analysis by SXJ, MCB and FMP, with close collaboration with LMA. The application was firstly explored within a SXJ’s MSc thesis describing gait in children with NPC. The application of gamlss to the complete data set (624) was led by MCB and LMA with contributions from all other authors in the output including presentation format, text and supplementary materials. All authors have edited and contributed to the text of the final paper.

    • Funding This study was partly funded by Great Ormond Street Hospital Charity. The research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at the UCL Institute of Child Health/Great Ormond Street Hospital NHS Foundation Trust.

    • Competing interests LMA reports grants from Great Ormond Street Hospital Children’s Charity during the conduct of the study.

    • Ethics approval Ethical approval for the study was provided by the Barnet Enfield and Haringey REC 04/Q0509/49 in October 2004 and Bloomsbury Research and Ethics Committee REC 11/LO/1889 January 2012.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The data for slow and fast walking conditions is not included in the study described here. It has been the subject of oral presentations: Kemp, J; Main E; and Alderson LM. The importance of multispeed gait analysis in paediatrics. World Congress of Physiotherapy. Physiotherapy 101 Supplement 1 Pages e48-e49 (Abstract number 3043).

    • Patient consent for publication Not required.