Exploring harmonic walking development in children with unilateral cerebral palsy and typically developing toddlers:
Daniela De Bartolo1, Marzieh Borhanazad2, Marije Goudriaan2
1Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences & Institute for Brain and Behaviour Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Laboratory of Neuromotor Physiology, Scientific Institute for Research, Hospitalization and Health Care (IRCCS) Santa Lucia Foundation, Rome, Italy.
Insights
The first independent steps are crucial for developing harmonic gait in children. Typically developing children achieve this faster than those with cerebral palsy (CP), who show overall harmonic walking despite leg asymmetry.
Area of Science:
- Developmental Pediatrics
- Biomechanics
- Motor Control
Background:
- Harmonic walking, characterized by a golden ratio (1.618) in gait parameters, is observed in healthy adults.
- The development of harmonic gait in children, particularly those with unilateral cerebral palsy (CP), requires further investigation.
Purpose of the Study:
- To investigate the impact of initial independent steps on harmonic gait development in children with unilateral CP and typically developing (TD) children.
- To analyze gait ratio values (GR) and their trend towards the golden ratio post-independent walking.
Main Methods:
- Longitudinal study assessing locomotor ability at different developmental stages (pre- and post-independent walking).
- Analysis of gait ratio values (stride/stance, stance/swing, swing/double support) and their fit to the golden ratio.
- Comparison between TD children and children with CP, including analysis of affected and unaffected legs.
Main Results:
- An exponential fit towards harmonic walking was observed only after the first unsupported steps.
- TD children achieved harmonic walking in approximately one month, while children with CP took about seven months.
- Children with CP demonstrated overall harmonic walking with converging gait ratios, despite leg asymmetry; the most affected leg approached GR 1.5 and the least affected leg exceeded GR 1.7 for stride/stance.
Conclusions:
- The emergence of independent walking is a critical factor in the development of harmonic gait.
- Children with CP exhibit a developmental trend towards harmonic walking, indicating successful adaptation and motor control despite asymmetry.
- The study highlights the importance of early motor milestones in achieving balanced and efficient locomotion.
Abstract:
This longitudinal study investigated the impact of the first independent steps on harmonic gait development in unilateral cerebral palsy (CP) and typically developing (TD) children. We analysed the gait ratio values (GR) by comparing the duration of stride/stance, stance/swing and swing/double support phases. Our investigation focused on identifying a potential trend towards the golden ratio value of 1.618, which has been observed in the locomotion of healthy adults as a characteristic of harmonic walking. Locomotor ability was assessed in both groups at different developmental stages: before and after the emergence of independent walking. Results revealed that an exponential fit was observed only after the first unsupported steps were taken. TD children achieved harmonic walking within a relatively short period (approximately one month) compared to children with CP, who took about seven months to develop harmonic walking. Converging values for stride/stance and stance/swing gait ratios, averaged on the two legs, closely approached the golden ratio in TD children (R2 = 0.9) with no difference in the analysis of the left vs right leg separately. In contrast, children with CP exhibited a trend for stride/stance and stance/swing (R2 = 0.7), with distinct trends observed for the most affected leg which did not reach the golden ratio value for the stride/stance ratio (GR = 1.5), while the least affected leg exceeded it (GR = 1.7). On the contrary, the opposite trend was observed for the stance/swing ratio. These findings indicate an overall harmonic walking in children with CP despite the presence of asymmetry between the two legs. These results underscore the crucial role of the first independent steps in the progressive development of harmonic gait over time.
