Canonical correlation between body-posture deviations and gait disorders in children with cerebral palsy

Abstract

Children with Cerebral Palsy (CP) show the postural constraints while standing, and gait disorders, resulting from both primary and secondary impairments of brain injury. In our previous studies, several characteristic postural and gait patterns in children with unilateral as well as with bilateral CP were defined, and the relationship between these patterns was demonstrated. The purpose of present study was to identify which features of body posture deviation during standing were strongly related to gait deviations in independently ambulatory children with CP. For this aim we explored the cross-relationship between features of body posture while standing examined by surface topography and the selected gait parameters from three-dimensional instrumented gait analysis in one hundred twenty children with cerebral palsy, aged between 7 and 13 years, who were able to walk independently. First, our study documented that that sagittal misalignment of the spine curvature was significantly related to kinematic deviations such as deviations of pelvic tilt, inadequate swing phase and knee flexion, and peak dorsiflexion in stance. Second, the study shows that the static asymmetry of pelvis and trunk was significantly associated with kinematic deviations during gait cycle such as pelvic rotation, hip abduction in swing, ROM of knee flexion, peak dorsiflexion in stance. Based on obtained results and referring to our previous findings it can be assumed that the first model of the relationship between postural deviation and gait disturbances, called 'postural and gait complex of disorders in sagittal plane', is related to children with bilateral CP, whereas the second model 'postural and gait complex of disorders in coronal plane' to children with unilateral CP. The clinical applications of this study relate to the early recognition of particular features of postural deviation using surface topography, instead of more difficult and demanding expensive tools 3-D gait analysis.

Transversal Malalignment and Proximal Involvement Play a Relevant Role in Unilateral Cerebral Palsy Regardless the Subtype

“…Our findings compare to those of other authors [ 20 , 21 , 31 , 32 , 33 , 34 ]. Pelvic deviations in all planes have been encountered not only in classifiable patients [ 21 ].…”

“…Trendelenburg and Duchenne limp generally represent sufficient but energy-consuming compensatory mechanisms to unload weak hip abductors [ 8 , 27 , 32 , 33 , 34 , 38 , 39 ]. Furthermore, other than in bilateral CP (postural/gait disorders in the sagittal plane), patients with unilateral CP predominantly show coronal plane gait disorders [ 31 ].…”

An effect of spinal and ankle-foot orthoses on gait of spastic diplegic child: A case report

“…Like other researchers [25,26], we can confirm the fact that the position of the spine also affects the biomechanics of the lower extremities. We noticed, increased ROMs: in ankle ranged 26-60 It is very important to mention that the child had been wearing the TLSO for a long time and was already used it, which we cannot say about AFOs, as the child only wore them for a week.…”

“…The effectiveness of TLSO was manifested in: increased ankle dorsiflexion from 30.7 to 40.2 • in the right leg and from 7.7 to 25.5 • in the left leg (norm 37.03 • ); decreased hip extension from 31.7 to −11.4 • on the right and from 6.7 to −12.7 • on the left (norm −9.93 • ); shortened and more close to normal double support and stance phases; and greater symmetry between movements. The results confirm the fact that the spine position influences gait parameters[25,26]. However, co-application of AFOs results in greater efficiency.…”

“…It was determined, that the trunk position is correlated with the excessive knee flexion severity and ankle joint kinematic in CP children with crouch gait patterns [24]. There is also a relationship between standing balance, which is affected by the position of the spine, and kinematic gait parameters [26].…”