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Coordination between pelvis and shoulder girdle during walking in bilateral cerebral palsy
Emanuela Tavernese1, Marco Paoloni2, Massimiliano Mangone3
1Pediatric Neuro-Rehabilitation Division, Bambino Gesù Children's Hospital, IRCCS, Via Torre di Palidoro, snc, 00050 Fiumicino (Rome), Italy.
Insights
Children with cerebral palsy exhibit altered walking patterns and more synchronized pelvis-shoulder coordination. This study investigated 3D coordination in bilateral cerebral palsy during gait.
Area of Science:
- Biomechanical analysis of human locomotion.
- Pediatric movement disorders.
- Neuromuscular rehabilitation.
Background:
- Impaired pelvis and shoulder girdle kinematics are documented in children with diplegic bilateral cerebral palsy during walking.
- Three-dimensional (3D) coordination between these segments during gait has not been previously evaluated.
Purpose of the Study:
- To evaluate the 3D coordination between the pelvis and shoulder girdle in children with bilateral cerebral palsy during walking.
- To compare the gait parameters and coordination patterns between children with bilateral cerebral palsy and typically developing children.
Main Methods:
- Retrospective analysis of gait data from 27 children with bilateral cerebral palsy and 10 typically developing children.
- Calculation of spatial-temporal parameters and range-of-motion for pelvis and shoulder girdle in three planes.
- Determination of 3D pelvis-shoulder girdle coordination using continuous relative phase analysis.
Main Results:
- Children with bilateral cerebral palsy demonstrated significantly reduced walking velocity, shorter step length, wider base of support, and prolonged double support phase compared to controls.
- A lower continuous relative phase was observed in the cerebral palsy group, indicating more in-phase coordination between the pelvis and shoulder girdle on the transverse plane.
- Age, gait speed, and pelvic range-of-motion on the transverse plane correlated with the continuous relative phase.
Conclusions:
- Children with bilateral cerebral palsy exhibit altered gait characteristics and more synchronized (in-phase) coordination between the pelvis and shoulder girdle on the transverse plane during walking.
- Findings suggest a potential compensatory mechanism or a characteristic motor control strategy in this population.
Background:
Studies revealed that pelvis and shoulder girdle kinematics is impaired in children with the diplegic form of bilateral cerebral palsy while walking. The features of 3D coordination between these segments, however, have never been evaluated.
Methods:
The gait analyses of 27 children with bilateral cerebral palsy (18 males; mean age 124 months) have been retrospectively reviewed from the database of a Movement Analysis Laboratory. The spatial-temporal parameters and the range-of-motions of the pelvis and of the shoulder girdle on the three planes of motion have been calculated. Continuous relative phase has been calculated for the 3D pelvis-shoulder girdle couplings on the transverse, sagittal and frontal planes of motion to determine coordination between these segments. Data from 10 typically developed children have been used for comparison.
Findings:
Children with bilateral cerebral palsy walk with lower velocity (P=0.01), shorter steps (P<0.0001), larger base of support (P<0.01) and increased duration of the double support phase (P=0.005) when compared to typically developed children. The mean continuous relative phase on the transverse plane has been found lower in the cerebral palsy group throughout the gait cycle (P=0.003), as well as in terminal stance, pre-swing and mid-swing. The age, gait speed and pelvis range-of-motions on the transverse plane have been found correlated to continuous relative phase on the transverse plane.
Interpretation:
Compared with typically developed children, children with bilateral cerebral palsy show a more in-phase coordination between the pelvis and the shoulder girdle on the transverse plane while walking.
