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Published on: March 11, 2021
Gait stability in ambulant children with cerebral palsy during dual tasks
Sophie Wist1,2, Lena Carcreff2, Sjoerd M Bruijn3
1Zürcher Hochschule für Angewandte Wissenschaften, ZHAW, Institut für Physiotherapie, Winterthur, Switzerland.
Insights
Children with cerebral palsy (CP) showed greater challenges with gait stability during dual tasks compared to typically developing children. Both groups experienced altered gait, highlighting attention
Area of Science:
- Neuroscience
- Biomechanical Engineering
- Developmental Pediatrics
Background:
- Gait stability is crucial for mobility in children.
- Cerebral palsy (CP) often affects motor control, potentially impacting gait.
- Dual-tasking (performing a cognitive and motor task simultaneously) can reveal subtle functional deficits.
Purpose of the Study:
- To compare the effects of dual tasks on gait stability in ambulant children with CP versus typically developing (TD) children.
- To quantify gait stability changes under cognitive load.
- To investigate the strategies employed by children with CP during dual-task walking.
Main Methods:
- A cross-sectional study involving 20 children with CP and 20 TD children.
- Gait stability was assessed using an optoelectronic system measuring foot placement variability (DFPEAP, DFPEML).
- Participants performed walking trials under single-task and dual-task conditions (counting, naming items).
Main Results:
- Dual tasks significantly impacted gait stability (DFPEAP, DFPEML) in the CP group.
- The CP group exhibited greater instability in the mediolateral direction (DFPEML) during dual tasks compared to the TD group.
- Both groups demonstrated significant changes in gait stability when performing cognitive tasks concurrently with walking.
Conclusions:
- Dual-tasking challenges gait stability in ambulant children with CP more than in TD children.
- Children with CP may adopt a 'posture second' strategy, prioritizing the cognitive task.
- Increased mediolateral stability in children with CP during dual tasks suggests a compensatory mechanism.
Aim:
The aim of this cross-sectional study was to measure the effect of dual tasks on gait stability in ambulant children with cerebral palsy (CP) compared to typically developing (TD) children.
Methods:
The children of the CP (n = 20) and TD groups (n = 20) walked first without a dual task, then while counting forward and finally while alternatively naming fruits and animals (DTf/a). They then completed the same cognitive exercises while sitting comfortably. We calculated the distance between the foot placement estimator (FPE) and the real foot placement in the anterior direction (DFPEAP) and in the mediolateral direction (DFPEML) as a measure of gait stability, in a gait laboratory using an optoelectronic system. Cognitive scores were computed. Comparisons within and between groups were analysed with linear mixed models.
Results:
The dual task had a significant effect on the CP group in DFPEAP and DFPEML. The CP group was more affected than the TD group during dual task in the DFPEML. Children in both groups showed significant changes in gait stability during dual tasks.
Interpretation:
The impact of dual task on gait stability is possibly due to the sharing of attention between gait and the cognitive task. All children favoured a 'posture second' strategy during the dual task of alternatively naming animals and fruits. Children with CP increased their mediolateral stability during dual task.
