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Children with Spastic Cerebral Palsy Experience Difficulties Adjusting Their Gait Pattern to Weight Added to the
Pieter Meyns1, Leen Van Gestel2, Lynn Bar-On3
1Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center Amsterdam, Netherlands.
Insights
Increased body weight negatively impacts gait in children with Cerebral Palsy (CP). This study found weight gain alters gait parameters differently in CP children compared to typically developing peers, affecting mobility and intervention assessments.
Area of Science:
- Biomedical Engineering
- Pediatric Rehabilitation
- Movement Science
Background:
- Childhood overweight and obesity rates are rising globally, including in children with Cerebral Palsy (CP).
- The impact of increased body weight on gait characteristics in children with CP remains under-investigated.
- Weight fluctuations can affect pre-post intervention gait analysis in CP, potentially leading to misinterpretation of results.
Purpose of the Study:
- To investigate the effects of increased body weight on gait parameters in children with CP.
- To compare the gait responses to added weight between children with CP and typically developing (TD) children.
- To highlight the clinical implications of weight changes on gait analysis in CP.
Main Methods:
- Three-dimensional gait analysis was performed on 30 children with spastic CP and 15 TD children (ages 3-15).
- Participants underwent gait trials under two conditions: weight-free (baseline) and weighted (10% body weight added around the waist).
- Key gait parameters, joint kinematics, kinetics, and muscle activity (gastrocnemius EMG) were analyzed.
Main Results:
- Children with CP exhibited opposite responses to added weight compared to TD children, including decreased walking velocity and step length.
- TD children showed improvements in gait parameters with added weight, while CP children showed no change or decreases in joint motion and power.
- Gastrocnemius EMG amplitude decreased in CP children with added weight, contrasting with an increase in TD children.
Conclusions:
- Increased body weight significantly alters gait patterns in children with CP.
- Clinical gait assessments in CP must account for the influence of body weight to accurately interpret intervention outcomes.
- Preventing or managing overweight and obesity in children with CP is crucial due to the detrimental effects on gait.
Abstract:
The prevalence of childhood overweight and obesity is increasing in the last decades, also in children with Cerebral Palsy (CP). Even though it has been established that an increase in weight can have important negative effects on gait in healthy adults and children, it has not been investigated what the effect is of an increase in body weight on the characteristics of gait in children with CP. In CP, pre and post three-dimensional gait analyses are performed to assess the effectiveness of an intervention. As a considerable amount of time can elapse between these measurements, and the effect of an alteration in the body weight is not taken into consideration, this effect of increased body weight is of specific importance. Thirty children with the predominantly spastic type of CP and 15 typically developing (TD) children were enrolled (age 3-15 years). All children underwent three-dimensional gait analysis with weight-free (baseline) and weighted (10% of the body weight added around their waist) trials. Numerous gait parameters showed a different response to the added weight for TD and CP children. TD children increased walking velocity, step- and stride length, and decreased double support duration with a slightly earlier timing of foot-off, while the opposite was found in CP. Similarly, increased ranges of motion at the pelvis (coronal plane) and hip (all planes), higher joint angular velocities at the hip and ankle, as well as increased moments and powers at the hip, knee and ankle were observed for TD children, while CP children did not change or even showed decreases in the respective measures in response to walking with added weight. Further, while TD children increased their gastrocnemius EMG amplitude during weighted walking, CP children slightly decreased their gastrocnemius EMG amplitude. As such, an increase in weight has a significant effect on the gait pattern in CP children. Clinical gait analysts should therefore take into account the negative effects of increased weight during pre-post measurements to avoid misinterpretation of treatment results. Overweight and obesity in CP should be counteracted or prevented as the increased weight has detrimental effects on the gait pattern.
