Article

Independently ambulant children with Cerebral Palsy (CP) often report balance
difficulties when walking in challenging settings. The aim of this study was to
compare gait in children with CP to typically developing (TD) children walking
over level ground and uneven ground, as an evaluation of dynamic balance.
Thirty-four children participated, 17 with CP (10 hemiplegia and 7 diplegia, mean
age 10 years) and 17 TD (mean age 10 years 1 month). Three-dimensional kinematic
and kinetic data of the lower limbs and trunk were captured during walking over
level and uneven ground using Codamotion(R). Statistical analysis was performed
using a mixed-effects model two-factor Analysis of Variance (GroupxSurface). Over
both surfaces, children with CP showed increased trunk movement in the sagittal
(Group effect, p<0.001) and transverse planes (p<0.001), and increased pelvic
movement in the coronal plane (p=0.008), indicating impaired trunk control. Peak
separation between the centre of mass and centre of pressure was reduced in CP,
indicating impaired dynamic balance (p=0.027). TD children made a number of
significant adaptations to uneven ground, including reduced hip extension (mean
difference 3.4 degrees , 95% CI [-5.3, -1.0] p=0.006), and reduced ankle movement
in the sagittal (5.2 degrees , 95% CI [0.01, 10] p=0.049) and coronal planes (2.4
degrees , 95% CI [0.3, 4.5], p=0.029), but these adaptations were not measured in
CP. A significant GroupxSurface interaction was detected for knee sagittal range
(p=0.009). The findings indicate that children with CP walk show impaired control
of trunk movement and are less able to adapt their gait to uneven ground,
particularly at the ankle.
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Langue : ANGLAIS