Commentary on “Validity of an Accelerometer Used to Measure Step Count in Children With Idiopathic Toe Walking”

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“How could I apply this information?”
Outcome measures that are valid and reliable, clinically relevant, and readily available to clinicians are needed to improve the efficacy of physical therapy (PT) interventions for children with idiopathic toe walking (ITW). Heel-toe gait with appropriate ankle rockers during stance phase of walking is the overall PT goal for individuals with ITW. Common outcome measures used for this population include ankle dorsiflexion passive range of motion, observational gait measures, standardized gross motor measures, and parent report of percentage of time toe walking. The waist-mounted accelerometer in this study measures steps with a graded response to vertical movement, is relatively inexpensive, is commercially available, and could be applied by clinicians or parents. Further work is needed to correlate the data generated by this accelerometer with percentage of heel strikes during ambulation, as well as to outcomes in the treatment of ITW.
“What should I be mindful about when applying this information?”
Establishment of reliability of both the device and the rater documenting steps in the videos is needed to have confidence in the results provided in this study. Children with ITW are known to change their gait pattern, with or without ankle plantar flexion contractures, when they are aware they are being observed. The distraction techniques used to produce a “self-selected” gait pattern are commonly used in the clinic, but have not been shown to be a valid means of producing a typical gait pattern for children with ITW. Measurement of gait variables for ITW in the child's home, school, and community will provide the best information about whether PT interventions have resulted in a functional improvement in gait across settings and experiences. Future research is needed to correlate gait data in children with ITW with parent report of heel-toe walking, gross motor skill development, and patient/caregiver satisfaction with PT intervention.
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