One step beyond: Advancing gait analysis to guide interventions in children with cerebral palsy

Throughout the day, most children engage in regular walking bouts, when they play outdoors with friends or go to school. While most typically developing children encounter no limitations in walking activity, children with cerebral palsy (CP) may face additional challenges. Interventions for children with CP often focus on improving walking performance, through treatment of underlying motor impairments. To guide prescription and evaluation of treatments, clinical gait analysis is often used to obtain insights into underlying biophysical mechanisms, responsible for walking limitations. The aim of this PhD thesis was to advance clinical gait analysis for indication and evaluation of interventions in order to improve walking performance in children with CP. This PhD thesis presents studies investigating the effects of three different interventions that are prescribed to improve gait in children with CP and it investigates underlying mechanisms related to improvements after treatment. The work in this thesis provides insights into biophysical mechanisms underlying the effect of treatments that aim to improve gait in children with CP. The presented work also illustrates how the results of clinical gait analysis are affected by methodological choices, ranging from proper comparison to reference data, to the use of tailored protocols, to challenge children to their individual boundaries during gait analysis. All of these aspects are important to consider to optimise the contribution of gait analysis in clinical practice.