Dependence of Gait Deviation on Weight-Bearing Asymmetry and Postural Instability in Children with Unilateral Cerebral Palsy

Abstract

Postural control deficits have been suggested to be a major component of gait disorders in children with cerebral palsy. The purpose of this study was to investigate the relationship between postural stability and treadmill walking, in children with unilateral cerebral palsy, by defining dependence between the posturographic weight-bearing distribution and center of pressure (CoP) sway during quiet standing with Gillette Gait Index and the 16 distinct gait parameters that composed the Gillette Gait Index. Forty-five children with unilateral cerebral palsy from 7–12 years of age were included in this study. A posturographic procedure and 3-dimensional instrumented gait analysis was developed. In general, across the entire tested group, the significant correlations concerned only the asymmetry of the weight bearing and a few of the distinct gait parameters that compose the Gillette Gait Index; moreover, correlation coefficients were low. The division of subjects into two clinical subgroups: children that exhibited a tendency to overload (1) and to underload (2) the affected body side, modified the results of the explored relationships. Our findings revealed that the difficulties experienced by children with hemiplegia while controlled in a standing position result from tendency to excessively or insufficiently load the affected lower limbs, and thus establishes a direct relationship with inadequate affected peak ankle DF in both stance and swing gait phases. Given the presented relationship between postural instability and deviation of the particular gait parameters in children with unilateral cerebral palsy, a follow-up study will be needed to determine the therapeutic approaches that will be most effective in promoting increased improvement in gait pattern, as well as the static and dynamic balance in standing.

Dynamic and static stability in para‐athletes with cerebral palsy considering their impairment profile

“…This finding would be explained by the weight-bearing responses to keep balance and the overrepresentation of those with spastic hemiplegia in our sample (62.8%). A study by Domagalska-Szopa et al 50 on children with unilateral spasticity revealed that their balance difficulties in keeping a standing position were caused by their tendency to load the affected lower limbs excessively or insufficiently. Therefore, it is plausible to think that, when performing TW, individuals with spastic hemiplegia tend to bear their weight on the nonaffected leg, leading to the positive correlations between TW and OLS D variables.…”

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

“…However, due to the occurrence of further consecutive and compensatory movements (e.g., pelvic obliquity/trunk lean), the internal hip rotation seems to just partially compensate for the lever arm deficit and weak hip abductors [ 34 , 37 ]. 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 ].…”

The Effects of Short-Term Wearing of Customized 3D Printed Single-Sided Lateral Wedge Insoles on Lower Limbs in Healthy Males: A Randomized Controlled Trial

“…Previous studies have clearly indicated that improving COP symmetry in patients with unilateral knee arthritis can improve their walking stability [23]. Experiments have shown that the focus of rehabilitation in patients with unilateral lower extremity is to improve the symmetry of COP displacement and enhance the gait and balance of patients [24].…”