Biomechanical Study of Walking and Vertical Posture in 4-6-year-old Children with Spastic Forms of Cerebral Palsy

Abstract

Rehabilitation of children with cerebral palsy (CP) requires a systematic approach and dynamic assessment of the results achieved. The development of methods for assessing the dynamics of motor disorders during medical rehabilitation is of great importance for modern medical rehabilitation. In recent years, there are more and more scientific papers devoted to the study of biomechanical disorders of locomotion in patients with CP. Aim. To assess the features of walking biomechanical characteristics and vertical pose stability in of children 4-6 years old with spastic forms of CP for further formation of rehabilitation groups, taking into account the identified functional disorders. Material and methods. The study included 20 patients (5.4±0.67 years) with spastic forms of CP. A comparative analysis of walking parameters and stabilography of children with spastic diplegia and hepiplegic CP among themselves and with a group of conditionally healthy children (norm group) (n=12) was performed. Results. A statistically significant decrease in the following indicators was found in children with hemi-and paraparesis: walking speed, double step length, and hip flexion/extension angle. Deviations of indicators are more pronounced in spastic diplegia, but are not always equivalent for both limbs; there is a violation step cycle proportions. the decrease in the length of the double step is more pronounced on the affected limb; there is a decrease in the angle of flexion/extension in the knee joint, more pronounced on a healthy limb in patients with hemiplegic CP. A wide range of stabilographic indicators values is observed in both study groups. However, only the average position of the pressure center relative to the frontal plane statistically significantly differs from the norm in the group of children with hemiparesis. In paraparesis, such differences from the norm are much more common: the area of the statokinesiogram, the maximum amplitude of fluctuations in the center of pressure and the energy of the frequency spectrum. The range of values for most indicators in paraparesis is wider. Conclusion. The revealed biomechanical features of walking and stability of the vertical posture of children with spastic forms of CP can serve as a basis for the development of rehabilitation programs. Clinical and rehabilitation groups of children with CP should be formed taking into account the severity of static-dynamic disorders present in patients. This approach will make it possible to plan further rehabilitation treatment of such patients and adequately assess the results obtained.