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A dynamical model of locomotion in spastic hemiplegic cerebral palsy: influence of walking speed
S T Fonseca1, K G Holt, E Saltzman
1Departamento de Fisioterapia, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Unidade Administrativa II, 3 degrees andar, 270-010, Belo Horizonte, MG, Brazil. sfonseca@metalink.com.br
Insights
Children with spastic cerebral palsy exhibit altered limb dynamics, with greater stiffness and less muscle forcing in affected limbs. Rehabilitation should focus on these dynamic variables for improved gait patterns.
Area of Science:
- Biomechanics
- Neurorehabilitation
- Pediatric Movement Science
Background:
- Cerebral palsy (CP) often leads to impairments like spasticity and muscle weakness, affecting motor control and gait.
- Understanding the dynamic properties of locomotion in children with CP is crucial for effective intervention strategies.
Purpose of the Study:
- To evaluate an inverted pendulum model for estimating the impact of impairments on gait dynamics in children with spastic cerebral palsy (CP).
- To analyze how spasticity and muscle weakness influence the dynamic patterns of walking in children with CP.
Main Methods:
- Collected kinematic data from children with spastic hemiplegic CP and typically developing peers across five walking speeds.
- Applied an escapement-driven inverted pendulum model to estimate forcing, stiffness, and gravitational potentials during the stance phase of gait.
Main Results:
- Children with spastic hemiplegic CP showed significantly greater limb stiffness and reduced muscle forcing in more affected limbs compared to controls.
- The non-affected limb in children with CP demonstrated greater forcing than in typically developing children.
Conclusions:
- Individuals with CP adapt their gait by utilizing remaining dynamic resources (stiffness, forcing) to compensate for impairments.
- Interventions targeting gait normalization may be less effective than those focusing on improving underlying dynamic variables.
- A dynamic systems approach to rehabilitation can enhance functional capabilities in children with CP by addressing individual action capabilities and dynamic properties.
Objective:
The objective of this study was to assess the capability of an escapement-driven inverted pendulum with springs and damping model to estimate the effects of impairments (e.g. spasticity, muscle weakness) on the dynamics and patterns of locomotion of children with spastic cerebral palsy.
Methods:
Kinematic data of six children with spastic hemiplegic cerebral palsy and six matched, typically developing children were collected at five different self-selected overground walking speeds ('very slow' to 'very fast'). Changes in forcing, stiffness and gravitational potentials were estimated during the stance phase of each leg according to the model's equation of motion.
Results:
Significantly greater stiffness and decreased forcing was observed in the more affected limbs of children with spastic hemiplegic cerebral palsy and compared to typically developing peers. The forcing term of the non-affected limb was greater than that of the matched typically developing children.
Conclusions:
Results support the claim that disabled individuals with losses in dynamic resources (stiffness, muscle forcing capability) exploit and develop the remaining resources in their adapted gait patterns. It was suggested that clinical interventions aimed at normalizing a gait pattern may be contraindicated, and that rehabilitation might be more effective if focused at the level of dynamics.
Relevance:
Pattern formation is seen as an optimal solution based on the individuals' action capabilities and dynamic properties under environmental and task demands. This perspective could lead to the development of interventions that address these dynamic variables with the objective of improving the functional capabilities of children with cerebral palsy.
