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Are spasticity, weakness, selectivity, and passive range of motion related to gait deviations in children with
Eirini Papageorgiou1,2, Cristina Simon-Martinez1, Guy Molenaers3,4
1KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.
Insights
This study maps how clinical impairments relate to gait deviations in children with cerebral palsy (CP). Findings highlight differences between unilateral CP (uCP) and bilateral CP (bCP), aiding personalized treatment.
Area of Science:
- Biomedical Engineering
- Clinical Biomechanics
- Pediatric Neurology
Background:
- Cerebral palsy (CP) significantly impacts motor function, particularly gait.
- Understanding the link between specific impairments and gait deviations is crucial for effective management.
- Previous research has explored these relationships, but a detailed mapping across different CP types is needed.
Purpose of the Study:
- To identify and map the relationships between clinical impairments and gait deviations in children with CP.
- To differentiate these relationships based on clinical symptomatology (unilateral vs. bilateral CP).
- To provide data supporting individualized treatment planning for children with CP.
Main Methods:
- Retrospective analysis of 367 children with CP (3-18 years old), categorized into unilateral (uCP) and bilateral (bCP) groups.
- Utilized 3D gait analysis and standardized clinical examinations to assess gait deviations and impairments (spasticity, weakness, selectivity, range of motion).
- Applied statistical non-parametric mapping to correlate gait parameters (vector and individual joint levels) with composite and joint-specific impairment scores.
Main Results:
- Composite impairment scores correlated significantly with most gait parameters in both uCP and bCP groups.
- Specific gait deviations were directly and indirectly related to joint-specific impairments.
- Relationships between gait deviations and impairments (weakness, selectivity) were more pronounced in the bCP group compared to the uCP group.
Conclusions:
- This study successfully mapped specific gait deviations to clinical impairments across the gait cycle in children with CP.
- Distinct patterns of impairment-gait relationships were observed between uCP and bCP, particularly concerning weakness and selectivity.
- These findings offer a comprehensive understanding of CP pathophysiology and can inform tailored therapeutic strategies.
Abstract:
This study aimed to identify the relationships between clinical impairments and gait deviations in children with cerebral palsy (CP). A retrospective convenience sample of 367 children with CP was selected (3-18 years old) and divided in two groups based on clinical symptomatology [unilateral (uCP) / bilateral CP (bCP), (n = 167/200)]. All children underwent a three-dimensional gait analysis and a standardized clinical examination. Gait was inspected on a vector level (all sagittal motions combined), and an individual joint level (pelvis, hip, knee and ankle joint motions). Statistical non-parametric mapping was applied to identify specific parts of the gait cycle displaying relationships between the gait deviations of both groups and the impairment scores of spasticity, weakness, selectivity, and passive range of motion. Impairment scores were summarized in two ways: a) composite impairment scores (e.g. combined spasticity of all assessed muscles acting around the hip, knee and ankle joints) and b) joint specific impairment scores (e.g. spasticity of the muscles acting around the knee joint). Results showed that the vector and most of the individual motions were related to the composite scores. Direct and carry-over relationships were found between certain individual motions and joint impairment scores (around the same or neighboring joints, respectively). All correlations were more prominent for children with bCP compared to uCP, especially regarding the relationships of gait deviations with weakness and reduced selectivity. In conclusion, this study enabled the mapping of relationships between clinical impairments and gait deviations in children with CP, by identifying specific parts of the gait cycle that are related to each of these impairments. These results provide a comprehensive description of these relationships, while simultaneously highlighting the differences between the two CP groups. Integration of these findings could lead to a better understanding of the pathophysiology of gait deviations and, eventually, support individualized treatment planning.
