The effect of uneven surfaces on inter-joint coordination during walking in children with cerebral palsy

Area of Science:

• Biomechanics
• Pediatric Rehabilitation
• Neurology

Background:

• Clinical gait analysis on uneven surfaces is crucial for assessing gait deviations in children with spastic cerebral palsy (CP).
• Uneven terrain necessitates specific motor strategies, making lower-limb kinematics and inter-joint coordination key assessment metrics.

Purpose of the Study:

• To compare lower-limb kinematics and inter-joint coordination in children with CP versus typically developing (TD) children.
• To analyze gait adaptations on even, medium, and high uneven surfaces.

Main Methods:

• Seventeen children with CP and 17 TD children participated.
• Participants completed gait trials on three different surfaces (even, medium uneven, high uneven).
• Lower-limb retro-reflective markers were used for kinematic and coordination analysis.

Main Results:

• Children with CP exhibited proximal gait adaptations (hip and knee) on uneven surfaces.
• Compared to TD peers, the CP group showed reduced hip extension during late stance on high uneven surfaces.
• CP group displayed a more in-phase knee-hip coordination strategy during the swing phase on high uneven surfaces.

Conclusions:

• Children with spastic CP employ specific kinematic strategies, particularly proximal joint adaptations, when navigating uneven terrain.
• Findings enhance understanding of gait challenges faced by children with CP in daily life.
• Further research is recommended to explore the therapeutic potential of uneven surfaces in CP rehabilitation.