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Kinematic adaptation and changes in gait classification in running compared to walking in children with unilateral

Rafael Krätschmer¹, Harald Böhm², Leonhard Döderlein²

¹Department of Sport and Health Sciences, Technical University of Munich, Connollystr. 32, 80809 Munich, Germany; Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bernauerstr. 18, 83229 Aschau I, Chiemgau, Germany.

|October 13, 2018

Insights

Running may alter gait classification in children with cerebral palsy (CP). Gait analysis during running reveals natural resolution of some abnormalities, impacting treatment decisions for knee and hip joint issues.

Area of Science:

Biomechanics
Pediatric Orthopedics
Neurology

Background:

Unilateral spastic cerebral palsy (CP) gait classification guides treatment.
Current classification focuses on walking patterns.
Observed knee flexion deficits in CP gait resolve during running.

Purpose of the Study:

To investigate if gait classification changes during running in children with unilateral spastic CP.
To understand how patients' kinematics adapt to running compared to walking.

Main Methods:

Instrumented gait analysis of 64 children with unilateral spastic CP and typically developing (TD) children during walking and running.
Classification based on deviations in ankle dorsiflexion, knee range of motion, and hip range of motion.
Statistical analysis using a three-factor ANOVA.

Main Results:

Gait classification shifted from walking to running, with decreases in types 1, 3, and 4, and increases in types 0 and 2.
Most pathological limb adaptations in CP patients normalized during running, similar to TD children, except for ankle dorsiflexion in stance.
Kinematic analysis indicated running facilitates natural resolution of certain gait abnormalities.

Conclusions:

Running analysis offers a different perspective on gait abnormalities in unilateral spastic CP.
Current treatment strategies based solely on walking classification may need reevaluation.
Inclusion of running analysis is crucial for informed surgical decision-making in CP management.

Read full analysis

Abstract

Background:

Classification of sagittal gait patterns in unilateral spastic cerebral palsy (CP) provides direct implication for treatment. Five types are described: type 0 has minor gait deviation; type 1 has inadequate ankle dorsiflexion in swing; type 2 has inadequate ankle dorsiflexion throughout the gait cycle; types 3 and 4 have abnormal function of the knee and hip joint respectively. During gait analysis of children with unilateral spastic CP we observed frequently that a knee flexion deficit disappeared during running. That may have an impact on classification and treatment.

Research Question:

Does the classification type change while running and how do patients' kinematics adapt to running?

Methods:

64 children with unilateral spastic CP were classified using instrumented gait analysis for walking and running. The deviation of four parameters from typically developing children (TD) were used to distinguish between types: peak ankle dorsiflexion in swing for type 1, peak ankle dorsiflexion in stance for type 2, knee range of motion for type 3, and hip range of motion for type 4. A three-factor ANOVA for factors group (CP/TD), locomotion (walk/run) and limb side (in-/uninvolved) was conducted.

Results:

The number of patients with type 1, 3 and 4 decreased considerably from walking to running, whereas, the number of type 0 and 2 patients increased. The ANOVA showed that three of four parameters of patients' pathologic limb adapt similarly to TD to running, except for the ankle dorsiflexion in stance.

Significance:

Running shows that there is a natural way to resolve abnormalities. Therefore, recommended treatments of hip and knee joint abnormalities based on the walking classification can be questioned and additional running analysis may be important for surgical decision making.

Keywords:

Gait analysis Gait classification Running Unilateral spastic cerebral palsy

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