Edinburgh Visual Gait Score

NewsBot · Mar 11, 2008

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Reliability and validity of the Edinburgh Visual Gait Score for cerebral palsy when used by inexperienced observers.
Ong AM, Hillman SJ, Robb JE.
Gait Posture. 2008 Mar 5 [Epub ahead of print]

The Edinburgh Visual Gait Score (EVGS) for cerebral palsy has been validated for observer reliability and validity for observers experienced in gait analysis. This study investigated the reliability and validity of the EVGS for observers inexperienced in gait analysis. Six medical students used the score to analyse videotapes from the original study by Read et al. [Read HS, Hazlewood ME, Hillman SJ, Prescott RJ, Robb JE. Edinburgh visual gait score for use in cerebral palsy. J Pediatr Orthop 2003;23:296-301]. These were viewed on two separate occasions to provide inter- and intra-observer reliability, and the results of the numerical items were compared to those from three-dimensional (3D) gait analyses for validity. Observer agreement was tested using Coefficient of Repeatability (CoR), percentage of complete agreement and the kappa statistic. The CoR for inter-observer agreement for inexperienced observers was 5.99/5.07 (Session 1/Session 2) compared to 4.60/3.95 (Session 1/Session 2) for experienced observers. The CoR for intra-observer agreement for inexperienced observers was 5.15 compared to 4.21 for experienced observers. There was complete agreement for 52% of the 10 numerical items with 3D-gait analysis data for inexperienced observers compared to 64% for experienced observers. Ranking of reliability of individual items was similar between the two groups and was generally best for events occurring at the foot and ankle. Observations of gait events by the inexperienced observers using the EVGS were reasonably reliable but not very accurate when compared to experienced observers and 3D-gait analysis.
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Trent Baker · Mar 11, 2008

This raises the question.

We have a Foot Posture Index to standardize foot type classification. Is it possible to produce a Visual Gait Score for every patient that goes through a biomechanical assessment? If we were all looking for the same thing, based on a 'biomechanical guidline', then we may see fewer variants in treatment.

I know this is difficult given the many different theories about foot function, it's worth some thought though.

What do you think?

Trent

Craig Payne · Mar 19, 2008

Trent - I not sure how easy it would be.

The Edinburgh system if for more of a gross type gait problem (ie cerebral palsy) and may not be sensitive enough for a nearer normal gait.

Chip Sutherland published the GHORT shorthand system for recording gait in Valmassy's book, which is one possibility.

We did play with for a short time using the Foot Posture Index on sequential digital video frames, so a gait could have a series of FPI numbers associated with it (we did not follow through with this).

Trent Baker · Mar 19, 2008

Craig,

I hadn't understood the specificity of the Edinburgh system. However I like the idea of using the FPI on sequential digital video gait frames. You could even simplify this by having say just three Gait FPI scores, heel strike, mid stance and propulsion.

I just really like the idea of standardising gait assessment. Giving a 'normal' range, or what we consider to be normal, could allow us to more accurately set perimeters for treatment. This could be another step towards consistency of prescriptions for orthoses. I think this is a really interesting area.

Trent

NewsBot · Oct 19, 2010

Influence of clinical and gait analysis experience on reliability of observational gait analysis (Edinburgh Gait Score Reliability).
Viehweger E, Pfund LZ, Hélix M, Rohon MA, Jacquemier M, Scavarda D, Jouve JL, Bollini G, Loundou A, Simeoni MC.
Ann Phys Rehabil Med. 2010 Oct 15. [Epub ahead of print]

OBJECTIVES: Treatment complexity of cerebral palsy (CP) patients imposes outcome evaluation studies, which may include objective technical analysis and more subjective functional evaluation. The Edinburgh Gait Score (EGS) was proposed as an additive or alternative when complex instrumented three-dimensional gait analysis is not available. Our purposes were to apply a translated EGS to standard video recordings of independent walking spastic diplegic CP patients, to evaluate its intraobserver and interobserver reliability with respect to gait analysis familiar and not familiar observers.

METHODS: Ten standard video recordings acquired during routine clinical gait analysis were examined by eight observers gait analysis interpretation experienced or not, out of various specialities, two times with a two weeks interval. Kappa statistics and intraclass correlation coefficient were calculated.

RESULTS: Better reliability was observed for foot and knee scores than in proximal segments with significant differences between stance and swing phase. Significantly better results in gait analysis trained observers underlines the importance to either be used to clinical gait analysis interpretation, or to benefit of video analysis training before observational scoring.

CONCLUSION: Visual evaluation may be used for outcome studies to explore clinical changes in CP patients over time and may be associated to other validated evaluation tools.
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NewsBot · Dec 26, 2012

Are clinical measurements linked to the Gait Deviation Index in cerebral palsy patients?
Yoshimasa Sagawa Jr., Eric Watelain, Géraldo De Coulon, Andre Kaelin, Philippe Gorce, Stéphane Armand
Gait & Posture; Article in Press

Objective
From a dataset of clinical assessments and gait analysis, this study was designed to determine which of the assessments or their combinations would most influence a low gait index (i.e., severe gait deviations) for individuals with cerebral palsy.

Design
A retrospective search, including clinical and gait assessments, was conducted from August 2005 to September 2009.

Population
One hundred and fifty-five individuals with a clinical diagnosis of cerebral palsy (CP) (mean age (SD): 11 (5.3) years) were selected for the study.

Method
Quinlan's Interactive Dichotomizer 3 algorithm for decision-tree induction, adapted to fuzzy data coding, was employed to predict a Gait Deviation Index (GDI) from a dataset of clinical assessments (i.e., range of motion, muscle strength, and level of spasticity).

Results
Seven rules that could explain severe gait deviation (a fuzzy GDI low class) were induced. Overall, the fuzzy decision-tree method was highly accurate and permitted us to correctly classify GDI classes 9 out of 10 times using our clinical assessments.

Conclusion
There is an important relationship between clinical parameters and gait analysis. We have identified the main clinical parameters and combinations of these parameters that lead to severe gait deviations. The strength of the hip extensor, the level of spasticity and the strength of the tibialis posterior were the most important clinical parameters for predicting a severe gait deviation.
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► Fuzzy decision tree is a useful technique to model gait deviations.
► There is an important relationship between clinical parameters and gait deviations.
► The strength of the hip extensor is a good predictor of severe gait deviation.
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NewsBot · Feb 3, 2015

The relationship between the Edinburgh Visual Gait Score, the Gait Profile Score and GMFCS levels I-III
L W Robinson, N Clement, M Fullarton, A Richardson, J Herman, G Henderson, J E Robb, M S Gaston
Gait and Posture; Article in Press

Highlights
•The Edinburgh Visual Gait Score correlated strongly with the Gait Profile Score.
•There is a significant difference in EVGS between each level of the GMFCS (I-III).
•There is a significant difference in GPS between each level of the GMFCS (I-III).
•Kinematics, including the GPS, remain the gold-standard in gait analysis.
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Objective
To determine the relationship between the Edinburgh Visual Gait Score (EVGS) and the Gait Profile Score (GPS).

Method
Three dimensional gait data and EVGS scores from 151 diplegic children (Gross Motor Function Classification System (GMFCS) levels I-III) were used for analysis.

Results
The EVGS correlated strongly with GPS (r =0.816). There was a significant difference in both gait scores between each level of the GMFCS.

Conclusions
The strong correlation of GPS with EVGS implies that any advantages of using GPS can also be applied to centres without 3-dimensional gait analysis facilities if the EVGS is used.
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NewsBot · Jul 22, 2016

An Analysis of Relative Gait Impairment in Commonly Diagnosed Pediatric Conditions.
Litrenta, Jody MD; Gorton, George MS; Ahuja, Bhavna MPH; Masso, Peter MD; Drvaric, David MD
Journal of Pediatric Orthopaedics: July 20, 2016

Background: Gait indices were developed to represent the magnitude of impairment extracted from a gait analysis with a single value. The Gillette Gait Index (GGI), and the Gait Deviation Index (GDI) are 2 widely used indices that represent gait impairment differently based on their statistical properties. Our purpose was to (1) report on the results of gait analysis for a broad spectrum of pediatric conditions using the GGI and GDI, and (2) identify the parameters that dominate impairment.

Methods: A total of 1439 children with 13 different diagnoses with a complete, baseline gait analysis were identified. The GGI and its 16 parameters were calculated in all cases, and the GDI was calculated from a smaller subset. T tests, and z-scores were used to compare each of these values to typically developing children for each diagnosis. A separate linear regression controlling for age, sex, and use of an orthosis, or assistive device was performed for the GGI.

Results: In our series, there were 71 typically developing children with a GGI of 31. We qualify relative gait impairment as severe, mild, or moderate as based on the GGI, and propose that values <100 represent mild, 100 to 200 represent moderate, and >200 represents severe impairment. On the basis of strong correlation between the GGI and GDI, we suggest that GDI values >80 represent mild, and values <70 represent severe impairment. T tests and z-scores demonstrated that both the number and magnitude of abnormal parameters increase the GGI. These tests also identified the most clinically relevant parameters contributing to functional impairment for each diagnosis. Multivariate linear regression showed that all diagnoses except flatfoot and scoliosis demonstrated statistically significant differences in GGI scores.

Conclusions: This is the first study to apply these gait indices to a large population of diverse pediatric conditions. We propose GGI and GDI values to qualify gait impairment among these conditions as severe, moderate, or mild. Furthermore, impairment in gait reflects both the number and magnitude of abnormal parameters within each condition
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NewsBot · Jan 4, 2017

The Edinburgh Visual Gait Score – The Minimal Clinically Important Difference
L.W. Robinson, N.D. Clement, J. Herman, M.S. Gaston
Gait and Posture; Articles in Press

Highlights
•EVGS and GPS correlate with GMFCS and FAQ scores.
•The MCID for the EVGS is defined as 2.4.
•The previously reported MCID for GPS is supported by data from a second centre.
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Objective
The primary aim was to define the minimal clinically important difference (MCID) of the Edinburgh Visual Gait Score (EVGS) using correlations with the Gross Motor Function Classification System (GMFCS) and the Functional Assessment Questionnaire (FAQ). The secondary aim was to confirm the numerical value of the MCID in the Gait Profile Score (GPS).

Method
The EVGS and GPS scores for 151 patients with diplegic cerebral palsy (GMFCS Levels I–III) were retrospectively identified from a database held at the study centre. One-hundred and forty-one patients had FAQ data available.

Results
The EVGS and GPS correlated with increasing GMFCS level (p < 0.001) and FAQ score (p < 0.001). A gradient of 3.8 (2.9–4.7) for the EVGS and 2.9 (2.1–3.7) for the GPS corresponded to a one-level change in GMFCS level. A gradient of 1.9 (1.3–2.4) for EVGS and 1.5 (1.1–2.0) for GPS corresponded to a one-point change in FAQ.

Conclusions
The authors propose an MCID value of 2.4 for the EVGS; representing the improvement in gait score after surgery that is likely to reflect a clinical improvement in function. This MCID is closely related to other studies defining post-operative improvements in kinematic data (GPS) and may offer guidance to post-surgical changes that might reasonably be expected to either improve or prevent deteriorating function.
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NewsBot · Jul 1, 2021

Usability and Reliability of the Edinburgh Visual Gait Score in Children with Spastic Cerebral Palsy Using Smartphone Slow-Motion Video Technology and a Motion Analysis Application: A Pilot Study
Alaric Aroojis, Bhushan Sagade, Suresh Chand
Indian J Orthop. 2021 Jan 13;55(4):931-938

Background: The Edinburgh Visual Gait Score (EVGS) is a comprehensive measure of gait abnormalities in children with cerebral palsy (CP) and has good psychometric properties. However, it is cumbersome to administer and requires multiple devices to record and measure its various components. We conducted this study to determine if a smartphone video protocol could be used to improve the usability and reliability of the EVGS for daily use in a clinic setting.

Methods: We used a handheld smartphone camera with slow-motion video technology and a motion analysis application to record and measure the EVGS of 30 ambulatory children with spastic CP. We tested the inter- and intra-rater reliability of various components of the EVGS between two observers.

Results: Average age was 7 years 3 months (range 4-14 years). The mean (range) EVGS scores for the trunk, pelvis, hip, knee, ankle, and foot were 1.18 (0-3), 0.68 (0-3), 1.1 (0-4), 3.95 (1.5-7.5), 1.87 (0-4) and 4.13 (2-6.5) respectively. Total score was 12.92 (7-21.5). The mean (SD) scores for Gross Motor Function Classification System (GMFCS) levels II and III were 10.73 (3.86) and 14.96 (4.2) (p < 0.001). The intra-observer and inter-observer reliability using percentage of complete agreement was 65-98.3% and 61.7-92.5% respectively, with kappa values ranging from 0.15 to 0.87. Reliability was more for distal limb segments as compared to proximal segments.

Conclusion: We have described a simple and reliable method for quantitative OGA of children with CP, using smartphone video technology and motion analysis application, which can be performed by every clinician in an office setting.
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NewsBot · Mar 11, 2022

Intra-rater and inter-rater reliability, minimal detectable change, and construct validity of the Edinburgh Visual Gait Score in children with cerebral palsy
HirokazuAbea et al
Gait & PostureVolume 94, May 2022, Pages 119-123

Highlights
•The Edinburgh Visual Gait Score shows high reliability in CP.
•The recommended MDC of the Edinburgh Visual Gait Score is 6.0.
•The Edinburgh Visual Gait Score was highly correlated with the GMFM-66.
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Background
The Edinburgh Visual Gait Score (EVGS) has been used for observational gait assessment in children with cerebral palsy (CP). However, the measurement error of the EVGS and its detailed relationship with gross motor function remain unclear.

Research questions
This study aimed to confirm the intra-rater and inter-rater reliability as well as the minimal detectable change (MDC) values for the EVGS with the use of the video analysis software and examine the relationship between the EVGS and the Gross Motor Function Measure 66 (GMFM-66) with regard to construct validity.

Methods
This cross-sectional study was conducted for 62 children (mean age 11.3 ± 3.9 years) with spastic CP at Gross Motor Function Classification System (GMFCS) level I (32 children), II (25 children) or III (5 children). Three raters independently scored the EVGS using Kinovea video analysis software. The intra-rater and inter-rater reliability were calculated using intra-class correlation coefficients (ICC2,1), and the MDC90 was calculated using standard error of measurement. The construct validity was examined by correlating the EVGS with the GMFM-66.

Results
The EVGS showed good or excellent reliability within each rater (ICC2,1 = 0.90–0.97) and between raters (ICC2,1 = 0.91). The MDC90 of the EVGS ranged from 3.6 to 6.0. There was a significant correlation between the EVGS and the GMFM-66 (r = − 0.69 to − 0.73, p < 0.001).

Significance
The intra-rater and inter-rater reliability of the EVGS is sufficient for observational gait assessment. The high correlation between the EVGS and the GMFM-66 supports its construct validity. The authors propose an MDC of 6.0 for the EVGS. These results can help in the application of EVGS to children with CP at GMFCS level I-II with mild to moderate gait pathology, as there were few children with CP at GMFCS level III.
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NewsBot · Jun 29, 2022

Three decades of gait index development: A comparative review of clinical and research gait indices
Sérgio Barroso Gonçalves et al
May 22, 2022

Highlights
•Review of the gait indices published in the last 30 years.
•Comparison between observational- and instrumented-based human gait indices.
•Identification of the most relevant gait indices for clinical and research areas.
•Analysis of the intra- and inter-rater reliability, validity and sensitivity.
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Background
A wide variety of indices have been developed to quantify gait performance markers and associate them with their respective pathologies. Indices scores have enabled better decisions regarding patient treatments and allowed for optimized monitoring of the evolution of their condition. The extensive range of human gait indices presented over the last 30 years is evaluated and summarized in this narrative literature review exploring their application in clinical and research environments.
Methods
The analysis will explore historical and modern gait indices, focusing on the clinical efficacy with respect to their proposed pathology, age range, and associated parameter limits. Features, methods, and clinically acceptable errors are discussed while simultaneously assessing indices advantages and disadvantages. This review analyses all indices published between 1994 and February 2021 identified using the Medline, PubMed, ScienceDirect, CINAHL, EMBASE, and Google Scholar databases.
Findings
A total of 30 indices were identified as noteworthy for clinical and research purposes and another 137 works were included for discussion. The indices were divided in three major groups: observational (13), instrumented (16) and hybrid (1). The instrumented indices were further sub-divided in six groups, namely kinematic- (4), spatiotemporal- (5), kinetic- (2), kinematic- and kinetic- (2), electromyographic- (1) and Inertial Measurement Unit-based indices (2).
Interpretation
This work is one of the first reviews to summarize observational and instrumented gait indices, exploring their applicability in research and clinical contexts. The aim of this review is to assist members of these communities with the selection of the proper index for the group in analysis.
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