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

Abstract

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.

Head and trunk kinematics and kinetics in normal and cerebral palsy gait: a systematic review

“…The selected articles with characteristics findings have been shown in Tables 2 and 3. [13] 2018 Cross-sectional 52 30 22 9.1-11.7 1-3 [14] 2017 Cross-sectional 72 52 20 8.5-14.5 1-2 [15] 2016 Cross-sectional 52 30 22 9.1-11.7 1-3 [16] 2016 Cross-sectional 40 20 20 2-9 1-3 [4] 2016 Cross-sectional 50 26 24 4-12 -17] 2014 Cross-sectional 36 16 20 8-14 - [18] 2014 Cross-sectional 40 23 17 8-18 - [19] 2014 Cross-sectional 34 17 17 5-18 1-3 [20] 2014 Cross-sectional 114 92 22 0-25 1-3 [6] 2014 Cross-sectional 32 16 16 9-13 1-2 [21] 2014 Cross-sectional 70 41 29 5-18 1-3 [22] 2014 Cross-sectional 107 92 15 5-30 1-3 [23] 2014 Cross-sectional 20 20 0 5-15 1-2 [24] 2013 Cross-sectional 100 100 0 8-15 1-3 [12] 2013 Cross-sectional 40 20 20 2-10 1-2 [25] 2011 Cross-sectional 56 26 30 8-15 1-3 [26] 2013 Cross-sectional 48 31 17 11-26 1-2 [27] 2013 Cross-sectional 149 122 27 17-23 1-3…”

“…Due to the developmental changes that occur in children as they grow, longitudinal studies are needed to identify the relationship between age and postural control and its impact on gait. Most of the studies compared CP children with age-matched TD children [4,6,7,12,[14][15][16][17][18][19][20][21][22][27][28][29][30][31][32]34,35] except two studies did not have TD as a comparable group [11,33]. Considering age-matched TD children in the gait analysis could provide accurate and effective measures of comparison regarding functional capacity and postural deviation from the baseline.…”

“…In few studies, distribution of participants could also be seen based on CP classification [4,16,20,[23][24][25]27,31]. The most common type of CP under inclusion criteria of the review studies was spastic hemiplegia or diplegia.…”

“…The participants were assessed for their functional capacity and categorised according to Gross Motor Function Classification System (GMFCS). Six studies included participants with a GMFCS score of I-II [7,12,14,23,27,29] whereas nine authors categorised their participants under GMFCS score of I-III [13,15,16,[19][20][21][22]24,25,28,30]. However, nine studies did not use GMFCS for functional classification and categorisation of the studied sample population [4,6,11,17,18,31,32,34,35].…”

Biomechanical control-based locomotor function rehabilitation technology for children with cerebral palsy

“…People with special needs (PSN) -the definition recorded in Russian legislation -within this paradigm are treated as full members of society (Platt, 2016). Herewith, the task of society is not to expand the range of health and social services for these people, but to facilitate their full adaptation and inclusion in all spheres of public life with overcoming both social and physical barriers (Summa, & Vannozz, 2016).…”