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Gait Variability in Children with Periventricular Leukomalacia and Perinatal Stroke: A Comparison of Between-Subject
Nathalie Alexander1, Melissa Köckemann2, Christoph Tobias Kuenzle2
1Children's Hospital of Eastern Switzerland, Laboratory for Motion Analysis, Switzerland, St. Gallen.
Insights
Children with periventricular leukomalacia (PVL) show more varied gait patterns than those with perinatal stroke. This highlights the need to tailor rehabilitation for cerebral palsy (CP) based on lesion type and gait heterogeneity.
Area of Science:
- Neurology
- Pediatrics
- Biomechanical Engineering
Background:
- Cerebral palsy (CP) in children can result from various brain injuries, including periventricular leukomalacia (PVL) and perinatal stroke.
- Distinct lesion types may lead to different motor impairments and gait characteristics.
- Understanding gait heterogeneity is crucial for effective therapeutic interventions.
Purpose of the Study:
- To compare gait patterns between children with PVL and perinatal stroke.
- To quantify and compare between-subject gait variability in these two pediatric CP groups.
- To investigate how different brain lesion types influence gait pattern heterogeneity.
Main Methods:
- Three-dimensional gait analysis was performed on 43 children with CP (32 PVL, 11 perinatal stroke).
- Kinematic waveforms and temporospatial parameters of the more affected leg were analyzed.
- Between-subject gait variability was assessed using Dynamic Time Warping (DTW) and Principal Component Analysis (PCA).
Main Results:
- No significant differences in temporospatial gait parameters or overall kinematic profiles were found between PVL and stroke groups.
- Children with PVL exhibited significantly greater between-subject gait variability, particularly in knee flexion and sagittal knee kinematics.
- Dynamic Time Warping and Principal Component Analysis confirmed higher gait pattern heterogeneity in the PVL group.
Conclusions:
- Periventricular leukomalacia is associated with greater gait variability compared to perinatal stroke in children with CP.
- This increased variability in PVL may reflect the diffuse nature of white matter injury.
- Considering lesion type and gait variability is essential for developing individualized rehabilitation strategies for children with CP.
Aim:
This study aimed to (1) compare gait patterns between children with periventricular leukomalacia (PVL) and those with perinatal stroke and (2) assess between-subject gait variability within each group to quantify differences in the heterogeneity of gait patterns associated with distinct brain lesion types.
Methods:
A total of 43 children with cerebral palsy (CP) (32 PVL, 11 perinatal stroke) underwent three-dimensional gait analysis. Kinematic waveforms of the more affected leg and temporospatial gait parameters were compared between groups. Furthermore, between-subject gait variability in gait kinematics was evaluated. Differences in discrete kinematic parameters were assessed with Levene's tests. Dynamic time warping (DTW) quantified deviations from group mean trajectories, and principal component analysis (PCA) evaluated the number of components required to explain cumulative variance in gait patterns.
Results:
Children with PVL and stroke did not differ significantly in temporospatial gait parameters or overall kinematic profiles, except for greater hip adduction during mid-stance in PVL. However, gait variability was consistently higher in the PVL group across analytical methods. PVL was associated with greater variability in knee flexion at initial contact (p = 0.040) and a trend during swing (p = 0.069). DTW distances were larger for PVL in sagittal knee kinematics (p = 0.002), and PCA indicated that more components were needed to explain 90% of variance.
Conclusion:
Children with PVL exhibited greater between-subject gait variability than those with stroke, reflecting the diffuse nature of white matter injury. These findings highlight the importance of considering lesion type and gait variability when designing individualized rehabilitation strategies for children with CP.
