Gait cycle and plantar pressure distribution in children with cerebral palsy: Clinically useful outcome measures for a management and rehabilitation

Abstract

BACKGROUND: Information on altered foot pressures during ambulation would clarify how far limb deformities modify walking patterns in cerebral palsy (CP), and whether such data can inform prognosis and guide rehabilitation. OBJECTIVE: To compare patterns of plantar pressures during walking between children with CP and their able-bodied (AB) peers. METHODS: Twenty-five children/adolescents (10 with hemiplegia, 5 with diplegia, and 10 AB, respective ages 13.0 ± 1.9, 13.0 ± 0.6 and 14.0 ± 0.7 years) walked a 12 m line at a self-selected speed. Spatio-temporal parameters and peak in-shoe plantar pressures were recorded for both feet, using the Parotec analysis system. RESULTS: Walking speeds (m·s −1 ) differed significantly between groups (0.65 ± 0.13, hemiplegia, 0.93 ± 0.22 diplegia and 1.26 ± 0.05 AB), with shorter stride lengths in CP. Contact time, double support time and step duration were also shorter in hemiplegia. Plantar pressures differed substantially and consistently between AB and CP, with increased medial heel pressures in hemiplegia, and reduced hallux and lateral heel pressures but increased lateral, medial mid-foot and first metatarsal pressures in diplegia. CONCLUSIONS: Substantial alterations in spatio-temporal parameters (greater in hemiplegia than in diplegia) and plantar pressure distribution reflect attempts to compensate for poor stability of posture in CP. Further study of these adaptive changes holds clinical promise in providing data relevant to the design of orthotics, determinations of prognosis and the planning of neurorehabilitation.

Reproducibility of Isometric Strength in Children with Cerebral Palsy

“…Cerebral Palsy (CP) is a diagnosis based on an insult to the immature brain and resultant observed movement disorders, the maturation or development central nervous system function is often the focus of intervention [1]. Children with cerebral palsy are very weak compared to their able-bodies match controlled [2,3]. Additionally, muscle weakness can be a major problem for many young people with spastic hemiplegic CP [2][3][4][5].…”

“…Children with cerebral palsy are very weak compared to their able-bodies match controlled [2,3]. Additionally, muscle weakness can be a major problem for many young people with spastic hemiplegic CP [2][3][4][5]. The term "hemiplegia" refers to weakness and movement in coordination involving one side of the body [2,6].…”

“…Although functional measures of muscle strength are important indicators of a child's motor ability, they do not quantify muscle force, lack the ability to detect small incremental changes in strength, and confounded by motor planning and control issues [5]. For another way, the evidence supporting the case for either inclusion or exclusion of strength training is based on sound scientific results from reproducible studies [3]. In general, further research of sufficient methodological quality is required to increase evidence on trainability after a good reproducibility of all fitness parameters and functional ability in children with cerebral palsy [2,3].…”

“…For another way, the evidence supporting the case for either inclusion or exclusion of strength training is based on sound scientific results from reproducible studies [3]. In general, further research of sufficient methodological quality is required to increase evidence on trainability after a good reproducibility of all fitness parameters and functional ability in children with cerebral palsy [2,3]. Then, a better knowledge of the innocuity of sports, if correctly practiced, as well as a precise appreciation of the clinical and physiological parameters, should also help and overprotection and, eventually, to delay as long as possible the course towards cerebral palsy.…”

“…However, most of the relevant literature consists of one trial of isokinetic and/or isometric contractions without reproducibility for almost. Whereas it is the best strategy of the validation of a test before apply the clinical feasibility of the programs [2,3]. Quantitative measurement instruments have been shown to reliably assess muscle strength in children with and without neuromuscular disorders [9][10][11].…”