Gait stability in children with Cerebral Palsy

Bruijn, Sjoerd M.; Millard, Matthew; Gestel, Leen Van; Meyns, Pieter; Jonkers, Ilse; Desloovere, Kaat

doi:10.1016/j.ridd.2013.02.011

Cited by 46 publications

(38 citation statements)

References 31 publications

(51 reference statements)

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“…The locomotor patterns exhibited by children with CP have been widely studied in terms of lower limb kinematics, using a classical gait analysis approach [ 14 ]. The control of upper body movements during gait has also been assessed in children with CP, either using motion analysis [ 15 , 16 ], or by adopting musculoskeletal models such as the foot placement estimator [ 17 ]. Increased ranges of motion in head and trunk movements have been observed in each anatomical plane during gait [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Multilevel Upper Body Movement Control during Gait in Children with Cerebral Palsy

et al. 2016

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Upper body movements during walking provide information about balance control and gait stability. Typically developing (TD) children normally present a progressive decrease of accelerations from the pelvis to the head, whereas children with cerebral palsy (CP) exhibit a general increase of upper body accelerations. However, the literature describing how they are transmitted from the pelvis to the head is lacking. This study proposes a multilevel motion sensor approach to characterize upper body accelerations and how they propagate from pelvis to head in children with CP, comparing with their TD peers. Two age- and gender-matched groups of 20 children performed a 10m walking test at self-selected speed while wearing three magneto-inertial sensors located at pelvis, sternum, and head levels. The root mean square value of the accelerations at each level was computed in a local anatomical frame and its variation from lower to upper levels was described using attenuation coefficients. Between-group differences were assessed performing an ANCOVA, while the mutual dependence between acceleration components and the relationship between biomechanical parameters and typical clinical scores were investigated using Regression Analysis and Spearman’s Correlation, respectively (α = 0.05). New insights were obtained on how the CP group managed the transmission of accelerations through the upper body. Despite a significant reduction of the acceleration from pelvis to sternum, children with CP do not compensate for large accelerations, which are greater than in TD children. Furthermore, those with CP showed negative sternum-to-head attenuations, in agreement with the documented rigidity of the head-trunk system observed in this population. In addition, the estimated parameters proved to correlate with the scores used in daily clinical practice. The proposed multilevel approach was fruitful in highlighting CP-TD gait differences, supported the in-field quantitative gait assessment in children with CP and might prove beneficial to designing innovative intervention protocols based on pelvis stabilization.

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Section: Introductionmentioning

confidence: 99%

Multilevel Upper Body Movement Control during Gait in Children with Cerebral Palsy

et al. 2016

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“…Additionally, other authors previously suggested a possible influence of walking speed on gait stability. However, the exact relationship remains unclear (Dingwell and Marin, 2006 ; England and Granata, 2007 ; Bruijn et al, 2009 , 2013b ), especially in children with cerebral palsy. Therefore, current study aimed to examine the influence of increasing walking speed on gait stability in typically developing children, children with bilateral cerebral palsy and children with unilateral cerebral palsy.…”

Section: Introductionmentioning

confidence: 99%

Restricted Arm Swing Affects Gait Stability and Increased Walking Speed Alters Trunk Movements in Children with Cerebral Palsy

Delabastita

Desloovere

Meyns³

2016

Front. Hum. Neurosci.

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Observational research suggests that in children with cerebral palsy, the altered arm swing is linked to instability during walking. Therefore, the current study investigates whether children with cerebral palsy use their arms more than typically developing children, to enhance gait stability. Evidence also suggests an influence of walking speed on gait stability. Moreover, previous research highlighted a link between walking speed and arm swing. Hence, the experiment aimed to explore differences between typically developing children and children with cerebral palsy taking into account the combined influence of restricting arm swing and increasing walking speed on gait stability. Spatiotemporal gait characteristics, trunk movement parameters and margins of stability were obtained using three dimensional gait analysis to assess gait stability of 26 children with cerebral palsy and 24 typically developing children. Four walking conditions were evaluated: (i) free arm swing and preferred walking speed; (ii) restricted arm swing and preferred walking speed; (iii) free arm swing and high walking speed; and (iv) restricted arm swing and high walking speed. Double support time and trunk acceleration variability increased more when arm swing was restricted in children with bilateral cerebral palsy compared to typically developing children and children with unilateral cerebral palsy. Trunk sway velocity increased more when walking speed was increased in children with unilateral cerebral palsy compared to children with bilateral cerebral palsy and typically developing children and in children with bilateral cerebral palsy compared to typically developing children. Trunk sway velocity increased more when both arm swing was restricted and walking speed was increased in children with bilateral cerebral palsy compared to typically developing children. It is proposed that facilitating arm swing during gait rehabilitation can improve gait stability and decrease trunk movements in children with cerebral palsy. The current results thereby partly support the suggestion that facilitating arm swing in specific situations possibly enhances safety and reduces the risk of falling in children with cerebral palsy.

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“…They were recruited from CP children referring to Neurology centers in Isfahan City, Iran, using convenience sampling method. Inclusion criteria were having spastic diplegic CP, ability to stand and walk independently, no use of walker or other assistive devices, no history of lower limbs and trunk surgery affecting walking, ability to follow the verbal instructions, no history of treatment with botulinum toxin within the last 6 months [3], and being categorized at level II or III based on Gross Motor Function Classification System (GM-FCS). An informed consent form was obtained from the parents of the children before conducting any measurement.…”

Section: Methodsmentioning

confidence: 99%

“…The postural balance in children with CP is weak and puts them at risk of falling [2]. However, few studies have been conducted on the dynamic balance of walking in children with CP [3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…Few studies are available on the dynamic balance of CP children. Some drawbacks of these studies include the lack of upper body markers [3], invalidity of models to assess children's balance [3], lack of Margin of Stability (MOS) calculations [7], use of safety belts during walking [4], variable age range [3,4,6,7], and variable intensity of CP. We assessed the dynamic balance of children with spastic diplegic CP at a low age range; also we calculated the MOS in these children during walking.…”

Section: Introductionmentioning

confidence: 99%

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Dynamic Balance During Gait in Children With Spastic Diplegic Cerebral Palsy Versus Normal Children

Sharifmoradi

Kamali

Tahmasebi

2018

PTJ

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Purpose: Cerebral Palsy (CP) can negatively affect dynamic stability in children with spastic diplegic Cerebral Palsy during walking. This condition results in a high risk of falling. There is limited evidence regarding the dynamic stability of children with Cerebral Palsy. Thus, this study aimed to investigate the dynamic stability of children with spastic diplegic Cerebral Palsy, compared to typically developed children during walking. Methods: Sixteen children including 8 with spastic diplegic Cerebral Palsy and 8 normal ones with an age range of 5 to 8 years participated in this quasi-experimental study. A Qualysis motion analysis system capturing at a frequency of 100 Hz was used to record data. Qualysis software and Visual3D software were utilized for data extraction. Data analysis was conducted using the Independent t-test with P<0.05. Results: The stride length and velocity of gait in children with Cerebral Palsy were 32.25 cm and 0.34 m/s lower than the normal children, respectively. Center of mass displacement was 12.25% lower in anteroposterior plane and 1.23% higher in mediolateral plane in children with Cerebral Palsy, compared to the normal children. The margin of stability was 1.72 cm higher in the children with Cerebral Palsy, compared to normal children. Conclusion: The lower anteroposterior and higher mediolateral displacement of the center of mass result in an altered pattern of gait in children with Cerebral Palsy, compared to the normal children. Considering the aforementioned changes and the lower velocity of gait in children with Cerebral Palsy, the dynamic stability of children with spastic diplegic Cerebral Palsy is lower, compared to the normal children during walking.

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Gait stability in children with Cerebral Palsy

Cited by 46 publications

References 31 publications

Multilevel Upper Body Movement Control during Gait in Children with Cerebral Palsy

Multilevel Upper Body Movement Control during Gait in Children with Cerebral Palsy

Restricted Arm Swing Affects Gait Stability and Increased Walking Speed Alters Trunk Movements in Children with Cerebral Palsy

Dynamic Balance During Gait in Children With Spastic Diplegic Cerebral Palsy Versus Normal Children

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