Clinical Gait Measures for Ambulatory Children with Cerebral Palsy: A Review Torey J. Gilbertson, PT, PhD, Kristie F. Bjornson, PT, PhD, Cody McDonald, CPO, Brian J. Hafner, PhD ABSTRACT Purpose: Valid and reliable measures of walking ability are needed to document the effectiveness of orthotic and therapeutic inter- ventions for ambulatory children with cerebral palsy (CP). Selection of measures suited to evaluating children with CP can be in- formed by evidence of a measure's clinical utility and psychometric performance in the population of interest. The purpose of this review was to identify clinical measures that have been used to evaluate gait of children with CP, to review measures' evidence of psychometric testing, and to determine which measures are most appropriate for use with children with CP in a clinical setting. Materials and Methods: PubMed, Web of Science, and PsycINFO databases were searched for measures with evidence of psycho- metric testing in children with CP. Results: Eleven measures suitable for clinical administration were identified across 22 articles. Three measures had sufficient psychometric evidence to support clinical use in children with CP. Conclusions: The 6-minute walk test, 10-meter walk test, and the Edinburgh Gait Scale are recommended for directly mea- suring walking capacity, speed, and rating walking form, respectively. Results of this review suggest that, although a range of measures exist for evaluating pediatric gait, additional work is needed to assess and document measures' psychometric properties in children with CP. (J Prosthet Orthot. 2016;28:2–12.) KEY INDEXING TERMS: cerebral palsy, children, gait, outcome measures, psychometric properties, evaluation C erebral palsy (CP) is a group of permanent movement and posture disorders attributed to nonprogressive damage to the fetal or infant brain that affects three to four of every 1000 school-aged children in the United States. 1,2 Although persons with CP may present with a variety of motor impairments, CP is typically categorized by the domi- nant movement disorder (e.g., spasticity, ataxia, dystonia, or athetosis), distribution of affected body parts (e.g., one, two, three, or four limbs), and/or topography of impairment (e.g., bilateral lower limbs, arm and leg on one side). 1 Spasticity is common in children with CP and often impairs basic move- ments such as walking. 3,4 Walking is a fundamental motor skill that enables participa- tion in numerous daily activities such as play and interaction with siblings or peers at home, school, and within the com- munity. 5 As such, interventions intended to positively affect walking ability are key modalities for members of an interdis- ciplinary rehabilitation team (e.g., orthotists and therapists). 6 Ankle-foot orthoses (AFOs), for example, have the potential to improve walking ability and gait efficiency in ambulatory children with CP. 7 However, AFOs also may impair aspects of walking abil- ity as well as transitional gross motor skills (e.g., floor-to-stand) by restricting ankle joint motion. The ability to accurately mea- sure children's walking ability before, during, and after interven- tion is therefore essential to effective evaluation, planning, and treatment. Use of standardized outcome instruments is critical for accu- rate assessment and documentation of a variety of treatment outcomes, including gait, both within and across treatment sessions. 8–10 Standardized instruments selected to assess patient outcomes need to have sufficient evidence of psychometric test- ing (e.g., reliability, validity, and responsiveness), and evidence of the use of measures in specific populations or diagnostic groups is essential. 10 Furthermore, information gained from measures administered in a clinic is often generalized to environ- ments a child may encounter (e.g., home, school, and commu- nity) outside of the clinic; however, evidence of this relationship is yet to be documented in children with CP. However, there is literature that suggests clinical walking tests can predict community-based walking activity in persons poststroke. 11 Thus, measures used with children with CP require review to determine if any clinical measures possess characteristics from which ambu- lation in community or daily life can be predicted, as ambulation beyond the clinic should be the goal of orthotic and therapeutic intervention. TOREY J. GILBERTSON, PT, PhD; KRISTIE F. BJORNSON, PT, PhD; CODY MCDONALD, CPO; and BRIAN J. HAFNER, PhD, are affiliated with the Department of Rehabilitation Medicine, University of Washington Seattle, Washington. KRISTIE BJORNSON, PT, PhD, is affiliated with the Department of Pediatrics, University of Washington; and the Seattle Children's Re- search Institute, Seattle, Washington. Disclosure: The authors declare no conflict of interest. Copyright © 2015 American Academy of Orthotists and Prosthetists. Correspondence to: Torey J. Gilbertson, PT, PhD, Department of Reha- bilitation Medicine, University of Washington, 1959 NE Pacific St., Box 356490, Seattle, WA 98195; email: gilbet@uw.edu CME ARTICLE 2 Volume 28 • Number 1 • 2016 Copyright © 2015 by the American Academy of Orthotists and Prosthetists. Unauthorized reproduction of this article is prohibited.