Many authors have reported increased energy expenditure during walking in children with hemiplegia. The origin of this increase is not well documented. The aim of our study was to understand better the origin of this increased energy expenditure of walking in children with cerebral palsy (CP) by simultaneously assessing the total mechanical work performed by the muscles and the efficiency of the work production.Twenty independently walking children with spastic, hemiplegic CP and a dynamic foot equinus deformity participated in the study. Instrumented gait analysis, including the analysis of kinematic, mechanical, and energetic variables, was performed. Despite excellent Gross Motor Function Measurement scores (range, 97-99), the energy cost was 1.3 times greater in children with CP than in healthy children. This increase in energy cost was related to an increase in the total positive mechanical work performed by the muscles and not related to a decrease in the efficiency of this work production. This study shows how segmental impairments (foot spastic equinus) increase the total mechanical work performed by the muscles and the energetic cost and how these segmental impairments contribute to the patient's disability. It is useful to associate the clinical examination, classic gait analysis, mechanical work, and energetic assessment to complete the evaluation of the condition of children with CP.
We assessed the influence of digitigrade gait pattern, topographical types, severity of motor involvement, and locomotor experience on the body's centre of mass (COM) displacement during gait in children with spastic cerebral palsy (CP). Three-dimensional COM displacements were computed from ground reaction forces in 51 independent digitigrade walkers (29 males, 22 females; mean age 10 years 6 months, SD 2 years 7 months, range 7 to 15 years). Results obtained from 10 participants without disabilities (five males, five females), in the same age range as the patients with CP, were used as a reference plantigrade group. Vertical and forward COM displacements were significantly different between the digitigrade and the plantigrade walkers. Neither the topographical type (quadriplegia, n=5; diplegia, n=20; right hemiplegia, n=13; left hemiplegia, n=13), nor the severity of motor involvement, nor the locomotor experience influenced COM displacements. We conclude that the COM displacement during gait in patients with CP was mainly influenced by the digitigrade gait pattern encountered in this neurological disorder rather than the different topographical types and motor involvements.
The aims of this study were to assess the characteristics of three-dimensional displacement of the centre of mass of the body (CMb) during walking in healthy children and to compare it with those of young adults. Twenty-one children (11 males, 10 females; age range 1 to 9 years) were recruited from the nursery and school attached to the Université catholique de Louvain, Brussels, Belgium; and three young adults (one male two females; mean age 26 years 4 months) were recruited from the Rehabilitation and Physical Medicine Unit of the same university. Displacement of CMb was assessed at different walking velocities in the children and adults by two successive mathematical integrations of ground reaction forces, measured by a large strain-gauge force platform. Displacement of CMb was controlled for leg length of the participant to eliminate the scaling effect that is dependent on growth. Results showed that vertical and lateral amplitudes of the CMb when controlled for leg length were greater for children before 4 years of age and that the forward amplitude when controlled for leg length was greater for children before 7 years of age. We conclude that the development of mature human CMb displacement during independent walking is a gradual neural process, evolving until the age of 7 years.
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