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Propulsion strategy in running in children and adolescents with cerebral palsy
A Chappell1, N Gibson2, G Williams3
1School of Physiotherapy and Exercise Sciences, Curtin University, Kent St., Bentley, Western Australia 6102, Australia.
Insights
Children with cerebral palsy (CP) demonstrate reduced ankle power generation during running, impacting their speed. This deficit is linked to Gross Motor Function Classification Scale (GMFCS) levels and partially compensated by hip flexor power.
Area of Science:
- Biomechanics of human movement
- Pediatric physical therapy
- Neuromuscular disorders
Background:
- Running is a key physical activity, yet children with cerebral palsy (CP) face limitations due to neuromuscular impairments.
- Children classified at Gross Motor Function Classification Scale (GMFCS) levels I and II can run but with potential deficits.
Purpose of the Study:
- To investigate and describe the propulsion strategy (PS) employed during running in children and adolescents with CP.
- To compare running biomechanics between typically developing (TD) children and those with CP across different GMFCS levels.
Main Methods:
- A cross-sectional study involving 40 children/adolescents with CP and 21 TD children.
- Kinematic and kinetic data were collected during running to calculate maximum speed, peak ankle power generation (A2), peak hip flexor power generation (H3), and PS (PS = A2/(A2 + H3)).
- Linear mixed models were used to analyze group differences.
Main Results:
- Children with CP (GMFCS I and II) exhibited significantly lower maximum speed, A2, and PS compared to TD children.
- A2 and PS were significantly reduced in the affected legs of children with CP compared to their non-affected legs.
- Increased H3 in affected legs of GMFCS II children with CP was observed, potentially as a compensatory mechanism.
Conclusions:
- The contribution of ankle power to running propulsion is diminished in young individuals with CP, correlating with GMFCS level.
- While increased hip flexor power may partially compensate, it does not fully overcome the reduced ankle power, ultimately limiting sprinting speed in children with CP.
Background:
Running is a fundamental movement skill important for participation in physical activity. Children with cerebral palsy (CP) who are classified at Gross Motor Function Classification Scale (GMFCS) level I and II are able to run but may be limited by neuromuscular impairments.
Research Question:
To describe the propulsion strategy (PS) during running of children and adolescents with CP.
Methods:
This cross-sectional study used kinematic and kinetic data collected during running from 40 children and adolescents with unilateral or bilateral CP and 21 typically developing (TD) children. Maximum speed, peak ankle power generation (A2), peak hip flexor power generation in swing (H3) and PS (PS = A2/(A2 + H3)) were calculated. Linear mixed models were developed to analyze differences between groups.
Results:
Maximum speed, A2 and PS were significantly less in children with CP GMFCS level I than in TD children and significantly less in children in GMFCS level II than level I. For children with CP, A2 and PS were significantly smaller in affected legs than non-affected legs. In affected legs, H3 was significantly larger in children in GMFCS level II than GMFCS level I but not different between TD children and children in GFMCS level II.
Significance:
The contribution of ankle plantarflexor power to forward propulsion in running is reduced in young people with CP and is related to GMFCS level. This deficit appears to be compensated in part by increased hip flexor power generation but limits maximum sprinting speed.
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