PurposeThis pilot study assessed the safety and effects of progressive functional high-intensity training in a group setting for adolescents with unilateral cerebral palsy (CP) on daily function indicators.MethodsNine adolescents (mean age 16.9 years, GMFCS levels I-II) participated in 12 weeks of training (2x/week). Evaluations included 3D gait analysis, the 6-min walking test (6MWT), clinical exams, and the Gross Motor Function Measure-66 (GMFM-66).ResultsNo adverse events occurred, and GMFM-66 scores significantly improved (p = .031, Delta = 2.19%). Although increases in 6MWT (p = .09, Delta = 29.8 m) performance and propulsion ratio (p = .067, Delta = 5.4%) for the affected leg were observed, they were not statistically significant.DiscussionThe study suggests that this training is safe and may enhance gross motor function, endurance, and gait asymmetry in unilateral CP. Future research should include upper limb evaluations and out-of-clinic motion analysis with wearable inertial measurement units (IMUs) to provide a more comprehensive assessment of functional movements.

Purpose: Tibialis anterior tendon shortening combined with tendon Achilles lengthening showed satisfactory short- and long-term outcomes for pes equinus treatment. This retrospective study aimed to evaluate the effectiveness of a single tibialis anterior tendon shortening-tendon Achilles lengthening procedure for treating pes equinus, in a homogeneous unilateral cerebral palsy patient group. Methods: Gait analysis was conducted on 22 unilateral cerebral palsy patients (mean age at surgery = 13.3 years, standard deviation = 3 years) before and within 2.5 years (standard deviation = 0.61 years) after the tibialis anterior tendon shortening-tendon Achilles lengthening procedure. Primary outcome measures included foot drop occurrence in swing, foot dorsiflexion and the first ankle rocker presence compared to healthy reference data. Movement analysis profile and gait profile score were also calculated for the entire gait cycle. The clinical exam and the A2 peak ankle power were analyzed. Statistical analysis used the paired Wilcoxon’s sign rank test (p < 0.05). Results: Post-operatively, significant improvements were observed in ankle dorsiflexion during swing (p = 0.0006) and reduced foot drop in swing (p = 0.0107). The occurrence of a first ankle rocker did not significantly change (p = 0.1489). Significant improvements in gait profile score and movement analysis profile for all joints and planes indicate overall gait quality improvement. The foot progression changed significantly (p = 0.0285), with a greater external orientation. Nineteen out of 22 patients were able to quit wearing their ankle foot orthoses. Conclusion: Tibialis anterior tendon shortening and tendon Achilles lengthening combination yielded positive outcomes, showing increased foot dorsiflexion, first ankle rocker presence, and overall improved gait quality. These findings support the effectiveness of this surgical approach for treating pes equinus in children with unilateral spastic cerebral palsy.

Children with idiopathic toe walking present with reduced ankle mobility, impaired balance, and difficulties in motor control. There is a need to diagnose idiopathic toe walking in a holistic manner and improve the monitoring of interventions. The aim is to assess dynamic stability with measures of margin of stability and whole-body angular momentum and evaluate their clinical relevance. A retrospective cross-sectional study with 35 idiopathic toe walkers (23 male, mean age (SD) 10.0 (2.9) years) and 20 typically developing controls (10 male, 11.4 (2.8) years). All participants had a clinical gait analysis at the local hospital. Dynamic stability was assessed with margin of stability, whole-body angular momentum, GaitSD, and spatiotemporal gait parameters. Student t-tests with adjustments for multiple comparisons were performed. Margin of stability in anterior direction was significantly shorter (ES = 1.29) and whole-body angular momentum in the coronal plane was significantly larger (ES = 0.90) in idiopathic toe walkers compared to typically developing children. No other results were below the set threshold for significance. Children with idiopathic toe walking continue to use an immature, falling forward movement strategy to maintain forward momentum. It is probable that those children adopted toe walking behavior to support increased energy absorption during the initial fall. Furthermore, the addition of dynamic stability measures not only provides insight into their ability to balance, these measures also allow an understanding of the plausible strategies adopted during walking and could potentially improve diagnosis and quantification of therapeutic outcomes.

Duchenne muscular dystrophy is primarily a disease of progressive muscle degeneration affecting the whole body. It is important to preserve the patients' walking ability as long as possible. Inconclusive information on Duchenne muscular dystrophy gait pattern is available for the lower body and missing for the upper body. This study aimed to objectively investigate upper body gait deviations in a group of patients with Duchenne muscular dystrophy compared to typically developing peers. Kinematic data of twelve boys with Duchenne muscular dystrophy that underwent three-dimensional full-body gait analysis were investigated retrospectively. Data were compared to sixteen healthy children of same age at similar walking speed. Statistical tests included the student independent t-test (with Holm-Bonferroni correction), Hedges'g for effect size, and statistical non-parametric mapping two-sample t-test (with Bonferroni correction). Duchenne muscular dystrophy compared to the healthy group: In the sagittal plane, the thorax segment was more posteriorly tilted. In addition, the relative angle between pelvis and thorax segment showed more backwards lean with increased shoulder extension. In the frontal plane, the patients walked with increased shoulder abduction and took wider strides. In the transverse plane, thorax rotation was not different between groups. Thorax range of motion was increased in all three planes. Including the upper body gait kinematics, especially of the trunk, adds valuable objective information on the understanding of the Duchenne muscular dystrophy gait pattern. Our findings contribute to improved understanding of full-body gait compensations in this patient group.

Three-dimensional instrumented gait analysis is widely used to guide surgical decision-making in children with cerebral palsy (CP), but its interpretation is time-consuming and prone to inter-rater variability. In this single-centre pilot study, we investigated whether a generative large language model (LLM) could consistently generate gait deviation findings and surgical procedure suggestions that align with expert judgement. Kinematic features for lower-limb joints across the gait cycle, stance, and swing were extracted from eight children with unilateral CP using the open-source GaitSharing Toolkit and a structured prompt, then submitted three times per patient to OpenAI’s GPT-5.5 model. The model assessed 28 kinematic deviations and 12 surgical procedure groups using majority voting. One gait analyst and two paediatric orthopaedic surgeons independently rated outputs on a 0–2 ordinal scale, blinded to all clinical information beyond the kinematic curves and diagnosis. Agreement was summarised descriptively as the percentage of the maximum attainable score with 95% confidence intervals (CIs), and quadratic-weighted Cohen’s kappa was used to quantify inter-surgeon agreement. Agreement with the gait expert was highest at the hip (90.6%) and lowest at the knee, particularly in the transverse plane (65.2%). For surgical procedures, agreement with the LLM reached 83.9% and 73.4% for the two surgeons, with the tibialis anterior procedure showing the lowest concordance. Inter-surgeon agreement was 79.2% (95% CI 71.9–85.4) with a kappa of 0.59 (0.47–0.70), indicating moderate agreement. The LLM showed high self-consistency (>90% across runs). These preliminary findings suggest that generative LLMs may be feasible as assistive tools in clinical gait analysis for deviation detection and future treatment planning and should be interpreted as hypothesis-generating, warranting confirmation in larger, more diverse cohorts.

BACKGROUND Telemedicine offers potential benefits for patients with chronic neuro-orthopedic conditions, yet its integration into routine care remains limited. OBJECTIVE This study evaluated stakeholder perspectives on implementing complementary telemedicine consultations at our institution. METHODS This study followed a three-round Delphi design. The first round consisted of iterative questionnaire development in collaboration with two neuro-orthopedic specialists. The second and third rounds involved cross-sectional surveys distributed to patients and parents, healthcare professionals, and administrative staff. Participants completed items assessing demand, feasibility, preferred telemedicine settings, and perceived advantages and disadvantages. The first survey was conducted between August and November 2024, and the second between January and February 2025. RESULTS A total of 139 participants responded to the first survey, of whom 78 also replied to the second. High feasibility was reported, with most participants having access to necessary technology (78.6%) and an undisturbed environment (80.3%). The most frequently cited disadvantage across all groups was the inability to perform a physical examination. Potential advantages included faster management of acute concerns, shorter waiting times, improved interprofessional collaboration, and fewer last-minute appointment cancellations. The discussion of results was the preferred telemedicine setting in both rounds for patients/parents. Stakeholders also expressed strong support for multiprofessional consultations, particularly involving physiotherapists and orthopedic technicians. CONCLUSIONS There is clear demand for multiprofessional telemedicine consultations in neuro-orthopedics. Based on stakeholder consensus, result-discussion appointments represent the most suitable starting point for implementation, with potential to improve accessibility, reduce travel burden, and support more flexible workflow organization. CLINICALTRIAL Since this is not a RCT we did not register this study.