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Walking on uneven ground: How do patients with unilateral cerebral palsy adapt?
Jacqueline Romkes1, Marie Freslier1, Erich Rutz2
1Laboratory for Movement Analysis, University of Basle Children's Hospital Basel (UKBB), Switzerland.
Insights
Children with unilateral cerebral palsy adapt gait on uneven ground differently than typically developing peers. Patients increase stride width for stability, unlike controls who adjust foot angle, indicating unique challenges on varied terrain.
Area of Science:
- Biomechanical analysis
- Pediatric movement disorders
- Gait dynamics
Background:
- Cerebral palsy (CP) affects children's movement, impacting gait stability.
- Walking on uneven surfaces likely exacerbates gait instability in children with CP.
Purpose of the Study:
- Investigate gait adaptations in children with unilateral CP on uneven ground.
- Compare gait parameters between children with unilateral CP and typically developing children on varied terrain.
Main Methods:
- Utilized 3D gait analysis for 20 children with unilateral CP and 20 controls.
- Assessed spatio-temporal parameters, joint kinematics, and center of mass displacements on even and uneven surfaces.
Main Results:
- Both groups increased toe clearance via knee/hip flexion on uneven ground.
- Children with CP widened stride and increased elbow flexion; controls slowed gait and increased foot progression.
- Children with CP showed less compensatory movement on the non-affected side.
Conclusions:
- Children with unilateral CP employ distinct strategies (e.g., stride width) to manage uneven terrain compared to controls.
- Patients exhibit altered arm positioning, suggesting insecurity and fall preparedness.
- Lack of non-affected side compensation in patients highlights unique challenges on uneven surfaces.
Background:
Children with cerebral palsy experience movement disorders that influence gait stability. It is likely that gait stability further decreases when walking on uneven compared to even ground. Therefore, the aim of this study was to investigate gait on uneven ground in children with unilateral cerebral palsy.
Methods:
Twenty children with unilateral cerebral palsy and twenty typically developing children performed a three-dimensional gait analysis when walking on even and uneven ground. Spatio-temporal parameters, full-body joint kinematics and centre of mass displacements were compared.
Findings:
On uneven versus even ground, both groups showed decreased cadence, increased stance phase and double support time, increased toe clearance height, and increased knee and hip flexion during swing phase. Whereas only the typically developing children walked slower and had increased dorsiflexion and external foot progression during stance phase, only the patients showed increased stride width, increased elbow flexion (affected and non-affected side), and kept the centre of mass more medial when standing on the affected leg.
Interpretation:
Patients and healthy children use similar adaptation mechanisms when walking on uneven ground. Both groups increased the toe clearance height by increasing knee and hip flexion during swing. However, whereas patients enlarge their base of support by increasing stride width, healthy children do so by increasing their external foot progression angle. Furthermore, patients seem to feel more insecure and hold their arms in a position to prepare for falls on uneven ground. They also do not compensate with their non-affected side for their affected side on uneven ground.
