Coordination of the upper and lower extremities during walking in children with cerebral palsy
Alexis Sidiropoulos1, Richard Magill1, Andrew Gordon1
1Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, USA.
Insights
Children with cerebral palsy show poor gait coordination. Enhancing upper limb function through rehabilitation may improve arm-leg coordination, but more research is needed.
Area of Science:
- Neurology
- Biomedical Engineering
- Pediatrics
Background:
- Children with cerebral palsy (CP) exhibit impaired continuous gait inter-limb coordination compared to typically developing peers.
- There is a lack of research on the arm-leg coordinative relationship and its potential for improvement in children with CP.
Purpose of the Study:
- To review current knowledge on continuous inter-limb coordination in children with CP.
- To identify factors impacting coordination and the potential for intervention-based improvements.
- To discuss appropriate analysis methods for evaluating movement coordination.
Main Methods:
- A literature review of peer-reviewed research articles focusing on inter-limb coordination during gait in children with CP.
- Identification of research gaps to inform future study designs.
- Evaluation of analytical methods for movement coordination.
Main Results:
- Coordinative deficits in CP may stem from central nervous system damage affecting motor control, muscle tone, and weakness.
- Inter-limb coordination in children with CP may be enhanced by improving upper extremity function via intensive motor-learning rehabilitation or botulinum toxin.
- Continuous relative phase analysis offers a more detailed assessment of coordination than discrete measures.
Conclusions:
- Improved upper extremity function holds potential to positively alter arm-leg phasing relationships during gait in children with CP.
- Relative phase analysis is recommended for a more comprehensive understanding of coordination.
- Further research is necessary to fully elucidate the impact of enhanced upper extremity function on gait coordination in children with CP.
Background:
Children with cerebral palsy indicate poor continuous gait inter-limb coordination compared to typically developing children. Limited research exists in the understanding of the coordinative relationship between the arms and legs of these children and if the phasing relationships between limbs can be improved.
Research Question:
Which motor control factors impact coordination in children with cerebral palsy and can coordination improve with intervention?
Methods:
This literature review provides a comprehensive overview of the current knowledge of continuous coordination in a pediatric, pathologic population with an emphasis on inter-limb coordination. Peer-reviewed research articles related to inter-limb coordination, with a focus on gait, were reviewed to identify relevant research and any gaps in the literature which could inform future study design. Consideration of the most appropriate analysis for evaluation of such movement is also presented.
Results:
The coordinative difficulties experienced by children with cerebral palsy may originate from the deficits in motor control, muscle tone, and weakness caused by damage to the central nervous system, which is vital in motor control of inter-limb coordination. Continuous inter-limb coordination in children with cerebral palsy may be improved with enhanced function of the upper extremities through intensive motor-learning based rehabilitation or botulinum toxin injection of the more-affected arm. Importantly, analysis of limb movements should include continuous measures of relative phase, as it provides a more detailed description of coordination compared to discrete measures.
Significance:
Improved upper extremity function may produce a positive change in the phasing relationship between the arms and legs. This type of coordination should be analyzed using relative phase analysis, as this type of analysis can provide more information compared to traditional spatiotemporal parameters. However, more research is required to fully understand the connection between improved upper extremity function and its positive impact on gait coordination in children with cerebral palsy.
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