Elsevier

Gait & Posture

Volume 79, June 2020, Pages 224-228
Gait & Posture

Full length article
Relationship Between Transverse-plane Kinematic Deviations of Lower Limbs and Gait Performance in Children with Unilateral Cerebral Palsy: A Descriptive Analysis

https://doi.org/10.1016/j.gaitpost.2020.05.003Get rights and content

Highlights

  • Normal alignment of lower limbs is crucial for normal gait pattern.

  • Rotational deviations and gait performance were measured for hemiplegic children.

  • Gait velocity and spatial walking-symmetry are primarily influenced by hip rotation.

  • Temporal gait-symmetry is associated with the foot progression angle.

  • This knowledge guide clinicians to plan effectively for hemiplegic children.

Abstract

Background

Transverse-plane kinematic deviations of lower limbs are common in children with unilateral cerebral palsy (UCP), often with detrimental consequences for gait.

Research question

To identify the most important factor among rotational anomalies of lower limbs for gait in children with UCP.

Methods

In a descriptive observational study, 42 children with UCP (age; 5–8 years) who had the ability of independent walking were included. Comprehensive gait analysis was performed and included assessment of the transverse-plane kinematic deviations of the lower limbs [pelvis, hip, and ankle rotation angles, and foot progression (FP) angle], and spatial-temporal gait features [velocity, step length (SL), single-limb support time (SLSt), temporal gait-symmetry index (T-GSI), and spatial gait-symmetry index (S-GSI)].

Results and Significance

The regression analysis indicated that hip rotation was the key determinant of gait velocity (R2 = 0.75, P < .001) and S-GSI (R2 = 0.24, P = .001). The FP angle was the most important factor for T-GSI (R2 = 0.22, P = .002). The ankle rotation explained in part the variance in T-GSI (R2 = 0.10, P = .001).

Conclusion

Gait velocity and spatial gait-symmetry are primarily affected by hip rotation anomalies. The temporal gait-symmetry is generally associated with the FP angle deviation and partly with ankle rotation deviation.

Introduction

Cerebral palsy (CP), the most common cause of pediatric motor disability, is a heterogeneous group of neurological disorders that result from a non-progressive lesion to, or mal-development of the brain arising before, during, or shortly after birth. Estimates of the worldwide prevalence of CP ranges from 1.5 to 2.5 per 1000 live births, with a high risk among pre-term and low-birthweight babies [1]. Unilateral CP (UCP) is a form of CP in which motor disturbance dominates one vertical half of the body, accounting for 38% of the spastic CP [2].

Gait performance in children with UCP is slow and asymmetrical [3]. Achieving normal gait-pattern and velocity is an important target of the treatment of those children. Despite the diversity of the factors that contribute to gait abnormalities in children with CP, they generally involve abnormal muscle tone, motor drive, muscle activation, biomechanical imbalance around joints, disuse, and/or neglect, and subsequent musculoskeletal and sensorimotor changes [4]. Identifying the relationship between these impairment factors and gait performance supposed to have a significant implication for the treatment planning for children with UCP [5]. Several researchers have explored these relationships [4,6,7], but, the transverse-plane kinematic deviations on gait performance has not received its deserved attention for children with UCP.

Transverse-plane kinematic deviations are common in children with UCP, usually on multiple levels, including pelvic retraction, hip internal rotation, ankle internal rotation, and internal foot progression [8,9]. These deviations change the tendon excursion and muscle moment-arm, thus can lead to a deviant gait [10]. Previous studies suggested that these deviations can result from the primary neurological deficits, weakness and contractures, or compensatory strategies during walking [11,12]. Several investigations exploring rotational deviations have been reported [[13], [14], [15], [16]], but were variable regarding the type of CP, as the data from heterogeneous samples of children with hemiplegia, diplegia, and quadriplegia were analyzed collectively. Additionally, they focused on a specific level and did not provide clear reports on the relationship between those deviations and gait performance.

Despite the mechanisms of rotational deviations in children with CP are well-documented, their role for gait has not been clearly verified in children with UCP. This study was conducted to identify the most important factor among transverse plane kinematic deviations of the lower limbs for gait velocity and gait-symmetry in children with UCP.

Section snippets

Study protocol and subjects

This was a prospective descriptive observational study conducted at the Physical Rehabilitation Center, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia. The study protocol approved by the Institutional Review Board (Protocol No: RHPT/18/0058). Experimental procedures were in accordance with the ethical standards of the Helsinki declaration issued in 1964. A consent form to authorize children’s participation was signed by parents.

Children with UCP referred from three local

Results

Fifty-nine children were initially screened. Among them, 45 children were eligible and agreed to participate. Three children were lost, since they took part in the preparatory screening and orientation sessions but did not attend the actual gait analysis session for anonymous causes. Thereby, 42 children completed the required measurements and their data were analyzed. The participants’ characteristics are explained in Table 1. There were 24 boys and 18 girls who had a mean age of 6.71 ± 0.99

Discussion

Considering that the lower-limb rotational deviations have been related to gait abnormalities in children with CP [10,25,26], this study endeavored to identify the most important factor among transverse-plane kinematic deviations of the lower limbs for gait in children with UCP. The results revealed a disparity between the affected and non-affected limbs concerning the SL, and SLSt, and rotational profile. Compared to the typically-developing children, our subjects walked with slower velocity,

Conclusion

Our results suggested that hip rotation was the major contributing factor for gait velocity and S-GSI. FP angle was the underlying determinant, considerably for T-GSI, and partially for gait velocity. Ankle rotation was partially responsible for T-GSI.

Declaration of Competing Interest

The author has no conflict of interest for this work.

Acknowledgement

The author is thankful for all the children and their parents for taking the time to participate in this study.

References (36)

  • E. Papageorgiou et al.

    Are spasticity, weakness, selectivity, and passive range of motion related to gait deviations in children with spastic cerebral palsy? A statistical parametric mapping study

    PloS one

    (2019)
  • J. Zhou et al.

    Influence of impaired selective motor control on gait in children with cerebral palsy

    J Pediatr Orthop

    (2019)
  • H.K. Graham et al.

    Musculoskeletal aspects of cerebral palsy

    J Bone Surg Brit

    (2003)
  • T.F. Novacheck

    Management options for gait abnormalities

    Clin Dev Med

    (2000)
  • S.A. Rethlefsen et al.

    Transverse plane gait problems in children with cerebral palsy

    J Pediatr Orthop

    (2013)
  • F. Dobson et al.

    Multilevel orthopaedic surgery in group IV spastic hemiplegia

    J Bone Surg Brit

    (2005)
  • A. Aminian et al.

    Spastic hemiplegic cerebral palsy and the femoral derotation osteotomy: effect at the pelvis and hip in the transverse plane during gait

    J Pediatr Orthop

    (2003)
  • M.C. de Morais Filho et al.

    Factors associated with pelvic asymmetry in transverse plane during gait in patients with cerebral palsy

    J Pediatr Orthop

    (2009)
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      Undoubtedly, children with hCP have the chance achieving independent walking, however, evidence suggests that increased reliance on the non-affected side and disregard use of the affected side “learned non-use” can have negative consequences such as the poor ability to weight shift to the affected lower extremity, diminished balance response, and development of asymmetrical gait patterns (Coker, Karakostas, Dodds, & Hsiang, 2010; Elnaggar, 2020a; Elnaggar, Elbanna, Mahmoud, & Alqahtani, 2019). Gait asymmetries could be measured in several ways (Böhm & Döderlein, 2012; Elnaggar, 2020b; Elnaggar, 2021; Kim et al., 2011; Mileti et al., 2016; Zonta, Ramalho Júnior, Camargo, Dias, & Santos, 2010), generally falling into two major items: spatial and temporal. The spatial gait-asymmetry quantifies the relationship of the step length between the affected and the non-affected sides, while the temporal gait-asymmetry is generally quantified by relating the single-stance time of the affected side to the non-affected (Elnaggar, Alqahtani, Alsubaie, Mohamed, & Elbanna, 2021; Mileti et al., 2016).

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