Novel statistical data processing approach for evaluating rehabilitation effectiveness in children with hemiparetic cerebral palsy

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Abstract

BACKGROUND: Gait disturbances are a key factor contributing to disability in children with cerebral palsy. Conventional scales and group-based statistical tests poorly capture small but clinically significant improvements after rehabilitation. This highlights the need for new methods of objective evaluation of rehabilitation effectiveness.

AIM: The work aimed to compare the performance of an individualized statistical method of magnitude-based decisions in interpreting instrumented gait analysis data obtained with inertial sensors for assessing rehabilitation effectiveness in children with hemiparetic cerebral palsy, with conventional group statistical approaches (p-value).

METHODS: This was an observational, single-center, prospective, continuous study. It was based on the analysis of instrumented gait analysis with inertial sensors protocols performed before and after a rehabilitation course in children aged 8–17 years with hemiparetic cerebral palsy at the Department of Pediatric Medical Rehabilitation, Russian Children’s Clinical Hospital.

RESULTS: In a cohort of 23 children with hemiparetic cerebral palsy, the standard paired t-test did not reveal statistically significant group changes in spatiotemporal gait parameters (p > 0.05 for all indicators). However, individualized MBD analysis recorded clinically significant positive changes in most patients: increased step velocity and cycle length on the paretic side (in 47% and 33% of cases, respectively), greater ranges of motion in the knee (67%) and ankle (40%) joints, improved foot clearance (47%), as well as reduced pathological compensations in the lumbosacral region (53%). Thus, the MBD method demonstrated greater sensitivity to individual rehabilitation effects, detecting improvements that remained unnoticed with the classical group-based approach.

CONCLUSION: Individualized MBD analysis makes it possible to objectively register clinically significant improvements in gait that are not detected by conventional group tests, thereby justifying its use for evaluating rehabilitation effectiveness.

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About the authors

Igor O. Vedernikov

Russian Children's Clinical Hospital — Branch of the Pirogov Russian National Research Medical University

Author for correspondence.
Email: pulmar@bk.ru
ORCID iD: 0009-0006-1327-2525
SPIN-code: 5047-2594
Russian Federation, Moscow

Olga A. Laisheva

Russian Children's Clinical Hospital — Branch of the Pirogov Russian National Research Medical University; Pirogov Russian National Research Medical University

Email: olgalaisheva@mail.ru
ORCID iD: 0000-0002-8084-1277
SPIN-code: 8188-2819

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Moscow; Moscow

Boris A. Polyaev

Pirogov Russian National Research Medical University

Email: rasmirbi@gmail.com
ORCID iD: 0000-0002-9648-2336
SPIN-code: 1990-4635

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Moscow

Timofey S. Kovalchuk

Pirogov Russian National Research Medical University

Email: doctor@tim-kovalchuk.ru
ORCID iD: 0000-0002-9870-4596
Russian Federation, Moscow

Denis V. Chindilov

Neurosoft

Email: chindilov@neurosoft.com
SPIN-code: 9390-7483
Russian Federation, Ivanovo

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Supplementary files

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2. Fig. 1. Example of individualized assessment of differences in gait analysis parameters using inertial sensors before and after rehabilitation, based on the MBD method (patient N., 8 years old): paretic leg (left), non-paretic leg (right).

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3. Fig. 2. Box plots of gait parameters before and after the rehabilitation course: a and b, single support; c and d, stance phase; e and f, step velocity; g and h, step frequency; i, gait rhythmicity; j, number of steps per 100 meters.

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4. Fig. 3. Changes in gait parameters.

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