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Gait asymmetries in children with cerebral palsy: do they deteriorate with running?
Harald Böhm1, Leonhard Döderlein
1Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bernauerstr. 18, 83229 Aschau i. Chiemgau, Germany. h.boehm@bz-aschau.de
Insights
Running does not improve gait symmetry in children with cerebral palsy (CP). Analysis of both walking and running reveals more about gait pathology for better clinical decisions.
Area of Science:
- Pediatrics
- Neurology
- Biomechanics
Background:
- Gait asymmetry analysis in children with cerebral palsy (CP) aids in understanding walking control and treatment.
- Gait deviations in CP may be better tolerated during running, suggesting potential for increased symmetry.
Purpose of the Study:
- To investigate the effect of running on spatio-temporal, kinematic, and kinetic gait asymmetries in children with CP.
- To test the hypothesis that running increases gait symmetry in children with CP.
Main Methods:
- 3D gait analysis was used to examine 24 children with diplegia and 25 with hemiplegia.
- Participants were assessed during both walking and running.
- Multivariate analysis of variance (MANOVA) was performed on 22 gait parameters, considering diagnosis and movement type.
Main Results:
- Significant differences in gait symmetry were found between walking and running (p<0.001) and between patient groups (p=0.004).
- Symmetry decreased in 13 of 22 investigated gait parameters during running compared to walking.
- Only step time symmetry showed a significant increase during running.
Conclusions:
- The hypothesis that running improves gait symmetry in children with CP is rejected.
- Running may reveal gait asymmetries not apparent during walking.
- Combined analysis of walking and running asymmetries provides a more comprehensive assessment for clinical decision-making in CP gait pathology.
Abstract:
In children with cerebral palsy (CP) analysis of gait asymmetry can provide insight into the control of walking and may help in guiding the clinician's treatment decisions. Running is more difficult that walking for the musculoskeletal system, however, in the literature it has been shown that gait deviations associated with CP maybe better tolerated during running. This leads us to the hypothesis that running might increase gait symmetry in patients with CP. Therefore the purpose of this study was to investigate the effect of running on asymmetries in spatio-temporal, kinematic and kinetic gait parameters for children with CP. Twenty-four children with diplegia and 25 with hemiplegia were examined using 3D gait analysis during running and walking. MANOVA on two factors: diagnosis (hemiplegic, diplegic) and movement (walking, running) was conducted on a total of 22 gait parameters. The MANOVA revealed a significant difference in symmetry between walking and running (p<0.001) and between patients groups (p=0.004). The detailed analysis of gait parameters demonstrated a significant decrease of symmetry in 13 of the 22 gait parameters investigated, only symmetry of step time was significantly increased. Therefore the hypothesis that gait symmetry improved with running in children with CP can be rejected. Based on the results of this study, asymmetries masked during walking might appear during running. Therefore, analysis of asymmetry of walking and running gives a more comprehensive assessment of the gait pathology for clinical decision making.
