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Low multiscale entropy of ankle joint position during toe gait in children with cerebral palsy is related to
Tony Biakceunung Rungling1, Thomas Sinkjær2, Jens Bo Nielsen3
1Department of Neuroscience, University of Copenhagen, Blegdamsvej 3, Panum Institute 33.3, DK-2200 København N, Denmark.
Insights
Children with cerebral palsy may exhibit more stable toe walking due to contractures. This stability differs by age, with younger children showing greater stability than typically developing peers.
Area of Science:
- Biomechanics
- Pediatrics
- Neurology
Background:
- Toe walking in children with cerebral palsy (CP) is often less stable and energy-efficient than typical plantigrade walking.
- Contractures may paradoxically enhance stability in CP toe walking.
- This study investigates ankle joint stability in children with CP who habitually toe walk.
Purpose of the Study:
- To compare ankle joint stability during toe walking between children with cerebral palsy and typically developing children.
- To investigate the influence of contractures on ankle joint stability in children with CP.
- To examine age-related differences in stability.
Main Methods:
- Multiscale entropy analysis of ankle vertical position during walking.
- Kinematic data collected from 37 children with spastic CP and 21 typically developing children.
- Comparison of plantigrade and toe walking in typically developing children.
Main Results:
- Toe walking showed higher multiscale entropy (greater stability) than plantigrade walking in typically developing children.
- Children with CP under 6 years had higher multiscale entropy than typically developing peers.
- In children with CP over 6 years, the opposite trend was observed, with stability decreasing as ankle range of motion reduced.
Conclusions:
- Contractures appear to stabilize the ankle in children with CP during toe walking.
- Younger children with CP may benefit from early contracture development for enhanced stability.
- Advanced contractures in older children with CP might compromise ankle stability.
Background:
Toe walking in children with cerebral palsy is typically less stable and less energy-efficient than plantigrade walking in typically developing children. We hypothesized that children with cerebral palsy may, nevertheless, show more stable toe walking due to the development of contractures compared to age-matched typically developing children.
Methods:
Multiscale entropy of the vertical position of the ankle joint was used to measure ankle joint stability during the stance phase of walking. Kinematic data were obtained from 37 children with spastic cerebral palsy and habitual toe walking, who walked on a treadmill at their preferred speed (1.3 ± 0.5 km/h for cerebral palsy children and 1.5 ± 0.4 km/h for typically developing children). Recordings from 21 age-matched typically developing children were used for comparison. Typically developing children walked both normally (plantigrade) and on toes.
Findings:
Multiscale entropy was significantly higher during toe walking than plantigrade walking in typically developing children (P < 0.001). For children under 6 years, multiscale entropy was higher in cerebral palsy children than in typically developing children. For children over 6 years, the opposite was observed. In children with cerebral palsy, multiscale entropy decreased with reduced passive range of motion in the ankle joint (P < 0.001).
Interpretation:
These findings suggest that contractures in children with cerebral palsy stabilize the ankle during toe walking. Younger children may show greater stability due to early contracture development, while advanced contractures in older children may reduce stability.
