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Published on: January 15, 2016
Gait pattern differences in unilaterally affected children with cerebral palsy and children with acquired brain
Jose Salazar-Torres1, Chris Church1, Freeman Miller1
1Department of Orthopedics, Nemours Children's Hospital, 1600 Rockland Rd, Wilmington, DE 19803, USA.
Insights
Children with acquired brain injury (ABI) exhibit less stable gait patterns, characterized by reduced knee flexion and shorter single support time, compared to those with cerebral palsy (CP). The timing of the brain insult significantly impacts hip rotation in children with ABI.
Area of Science:
- Pediatric neurology
- Movement science
- Rehabilitation medicine
Background:
- Children with cerebral palsy (CP) or acquired brain insult (ABI) experience motor disorders affecting movement, muscle tone, and posture.
- CP often results from perinatal brain insult (PBI), while pediatric ABI can occur later, leading to potentially different movement patterns.
- Distinguishing gait patterns between CP and pediatric ABI is crucial for targeted interventions.
Purpose of the Study:
- To investigate and compare the gait patterns of children with CP versus those with pediatric ABI.
- To determine if specific kinematic and temporospatial parameters differ between these two pediatric populations.
Main Methods:
- Matched cohort study comparing children with unilateral CP (history of PBI ≤ 1 year) and unilateral ABI (≥ 18 months).
- Analysis of kinematic and temporospatial data from the earliest Instrumented Gait Analysis (IGA).
- Primary outcome: average knee flexion in stance; secondary outcomes: temporospatial parameters and lower limb kinematics.
Main Results:
- Children with ABI demonstrated significantly lower knee flexion during stance and swing compared to children with CP.
- The ABI group exhibited shorter single support duration on the affected side.
- In children with ABI, a negative correlation was found between the age of insult and the severity of internal hip rotation.
Conclusions:
- Children with ABI tend to exhibit less stable gait on the affected side, with more extended knees and reduced single support, compared to children with CP.
- The age of brain insult significantly influences hip rotational patterns in children with ABI.
- Further research into muscle activation, kinetics, and treatment response is needed to understand the developmental impact on gait.
Background:
Children with cerebral palsy (CP) or acquired brain insult (ABI) present with motor disorders affecting movement, muscle tone, and posture. While CP is commonly a consequence of perinatal brain insult (PBI), pediatric ABI can occur between birth and adolescence, with movement patterns that may not be consistent with CP.
Research Question:
Are gait patterns associated with CP different from those with pediatric ABI?
Materials/Methods:
Children with unilateral motor impairment and history of ABI at ≥18 months of age were identified from gait lab records and matched with children with CP having a history of PBI at ≤ 1 year old. Matching was by GMFM-D, age at Instrumented Gait Analysis (IGA), and sex. Kinematic and temporospatial data from the earliest IGA were analyzed. The primary outcome measurement was average knee flexion in stance, as children with CP tend to walk with a more flexed knee and individuals with a brain insult as older children, youth and adults tend to walk with a more extended knee. Secondary variables were temporospatial parameters and lower limb kinematics in stance and swing. Wilcoxon or T-Tests were used.
Results:
Twenty-six unilaterally affected children with CP (age: 10.8±3.3 years; f:6/m:20; GMFCS I:14, II:38), and 26 unilateral children with ABI (age:11.1±4.3 years; f:6/m:20) were included in each group. Significantly lower knee flexion angles during stance and swing, and shorter single support duration on the affected side were found in the ABI group as compared to CP (p<0.05). In children with ABI, there was a negative correlation between age of insult and severity of internal hip rotation (p<0.05).
Conclusions/Significance:
Children with ABI tend to walk with less stability on the affected side as reflected by the more extended knee and reduced single support compared with children with CP. The age at which the brain insult occurs has a significant effect on the hip rotational profile in children with ABI. Further studies on muscle activation patterns, kinetic data and response to treatment are warranted to gain insight on how the stage of brain and musculoskeletal system development at the time of injury affect gait patterns.
