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Updated: Apr 16, 2026
Lower-Limb Biomechanical Characteristics Associated with Unplanned Gait Termination Under Different Walking Speeds
Published on: August 25, 2020
Do children with cerebral palsy change their gait when walking over uneven ground?
Ailish Malone1, Damien Kiernan1, Helen French2
1Gait Laboratory, Central Remedial Clinic, Vernon Avenue, Clontarf, Dublin 3, Ireland.
Insights
Children with Cerebral Palsy (CP) exhibit impaired dynamic balance and trunk control, struggling to adapt their gait on uneven surfaces compared to typically developing peers. This impacts their ability to navigate challenging environments.
Area of Science:
- Biomedical Engineering
- Orthopedics
- Pediatric Rehabilitation
Background:
- Children with Cerebral Palsy (CP) often experience balance deficits during ambulation, particularly in complex environments.
- Assessing dynamic balance through gait analysis is crucial for understanding functional limitations in children with CP.
Purpose of the Study:
- To compare gait dynamics and balance control in ambulant children with CP versus typically developing (TD) children on level and uneven ground.
- To evaluate the adaptive strategies employed by children with CP when walking on challenging surfaces.
Main Methods:
- Gait analysis of 17 children with CP and 17 TD children using 3D kinematic and kinetic data (Codamotion®).
- Data collected during walking on both level and uneven ground surfaces.
- Statistical analysis employed a mixed-effects model two-factor Analysis of Variance (Group×Surface).
Main Results:
- Children with CP demonstrated significantly increased trunk and pelvic movements, indicating impaired trunk control.
- Reduced peak separation between the center of mass and center of pressure in children with CP signifies impaired dynamic balance.
- TD children adapted gait to uneven surfaces (e.g., reduced hip extension, ankle movement), but children with CP showed limited adaptive responses.
Conclusions:
- Children with CP exhibit deficits in dynamic balance and trunk control during gait.
- Children with CP are less adaptable to uneven terrain compared to TD children, especially concerning ankle adjustments.
- These findings highlight the challenges children with CP face in navigating varied environments and inform targeted rehabilitation strategies.
Abstract:
Independently ambulant children with Cerebral Palsy (CP) often report balance difficulties when walking in challenging settings. The aim of this study was to compare gait in children with CP to typically developing (TD) children walking over level ground and uneven ground, as an evaluation of dynamic balance. Thirty-four children participated, 17 with CP (10 hemiplegia and 7 diplegia, mean age 10 years) and 17 TD (mean age 10 years 1 month). Three-dimensional kinematic and kinetic data of the lower limbs and trunk were captured during walking over level and uneven ground using Codamotion®. Statistical analysis was performed using a mixed-effects model two-factor Analysis of Variance (Group×Surface). Over both surfaces, children with CP showed increased trunk movement in the sagittal (Group effect, p<0.001) and transverse planes (p<0.001), and increased pelvic movement in the coronal plane (p=0.008), indicating impaired trunk control. Peak separation between the centre of mass and centre of pressure was reduced in CP, indicating impaired dynamic balance (p=0.027). TD children made a number of significant adaptations to uneven ground, including reduced hip extension (mean difference 3.4°, 95% CI [-5.3, -1.0] p=0.006), and reduced ankle movement in the sagittal (5.2°, 95% CI [0.01, 10] p=0.049) and coronal planes (2.4°, 95% CI [0.3, 4.5], p=0.029), but these adaptations were not measured in CP. A significant Group×Surface interaction was detected for knee sagittal range (p=0.009). The findings indicate that children with CP walk show impaired control of trunk movement and are less able to adapt their gait to uneven ground, particularly at the ankle.
