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Clinical-oriented Three-dimensional Gait Analysis Method for Evaluating Gait Disorder
Published on: March 4, 2018
Elbow Kinematics During Gait Improve With Age in Children With Hemiplegic Cerebral Palsy
Benjamin L Gordon1, Aviva L Wolff1, Aaron Daluiski2,3
1Leon Root, MD Motion Analysis Laboratory, Hospital for Special Surgery.
Insights
Children with hemiplegic cerebral palsy (hCP) show increased elbow flexion during gait compared to typically developing (TD) children. Elbow flexion and symmetry during gait improve with age in hCP children, approaching TD norms by adolescence.
Area of Science:
- Biomedical Engineering
- Pediatric Orthopedics
- Movement Science
Background:
- Children with hemiplegic cerebral palsy (hCP) often display a characteristic elbow flexion posture during gait.
- Limited data exists on age-related changes in elbow kinematics and symmetry during gait for both hCP and typically developing (TD) children.
Purpose of the Study:
- To quantify and compare the changes in elbow kinematics and symmetry during gait across different age groups in children with hCP versus TD children.
Main Methods:
- Analysis of upper extremity kinematic data from a gait database (2009-2015).
- Included 35 hCP and 51 TD children aged 4-18, categorized into three age groups (4-7, 8-11, 12+ years).
- Calculated peak elbow flexion, range of motion, and asymmetry indices, analyzed using one-way ANOVA and Tukey's post hoc tests.
Main Results:
- Peak elbow flexion increased with age in TD children but decreased on the affected side in hCP children.
- Affected side in hCP children showed significantly greater peak elbow flexion (82.1°) compared to TD children (51.9°) across all ages.
- Elbow asymmetry improved with age in hCP children, with differences from TD children resolving by adolescence.
Conclusions:
- Children with hCP exhibit greater peak elbow flexion on the affected side during gait compared to TD children.
- Elbow flexion angles converge between groups with age, decreasing in hCP and increasing in TD children.
- Improved elbow symmetry in hCP children with age suggests potential for optimizing surgical intervention timing.
Background:
Children with hemiplegic cerebral palsy (hCP) exhibit a typical posture of elbow flexion during gait. However, the change in elbow kinematics and symmetry during gait across age span in both hCP and typically developing (TD) children is not well described. The aim of this study was to quantify the change in elbow kinematics and symmetry across age span in hCP children compared with TD children.
Methods:
Upper extremity kinematic data were extracted and analyzed from a database for gait studies performed between 2009 and 2015. A total of 35 hCP and 51 TD children between the ages of 4 and 18 (mean age: TD=11.2±0.6, hCP=9.8±0.5) met inclusionary criteria. The groups were further subdivided into 3 age categories: 4 to 7, 8 to 11, 12+ years old. Elbow angles were extracted and peak elbow flexion, overall range of motion during gait, and asymmetry indices were calculated. A 1-way analysis of variance was performed on each group with post hoc Tukey honestly significant difference pairwise comparisons.
Results:
Peak elbow flexion during gait increased with age in TD children (P<0.05) and decreased with age in hCP children on the affected side (P<0.05). There was no change on the less affected side of hCP children. TD children demonstrated significantly less elbow flexion (mean=51.9±2.1 deg.) compared with the affected side in hCP (mean=82.1±3.8 deg.) across all age categories (P<0.05). There was no change in elbow asymmetry index (0=perfect symmetry) across age in either controls or hCP children; however, there were differences between hCP and TD groups in younger age groups (TD=28, hCP=62, P<0.05) that resolved by adolescence (TD=32, hCP=40).
Conclusions:
During gait, hCP children have greater peak elbow flexion on the affected side than do TD children. Peak elbow flexion angle converged between the 2 groups with age, decreasing in hCP children and increasing in TD children. Furthermore, elbow symmetry during gait improves with age in hCP children, approximating symmetry of TD children by adolescence. These findings have implications for both consideration and optimal timing of surgical intervention to improve elbow flexion in children with hCP.
Level Of Evidence:
Level III-retrospective case-control study.
