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Pathological Movements of the Pelvis and Trunk During Gait in Children With Cerebral Palsy : A Cross-Sectional Study With 3-Dimensional Kinematics and Lower Lumbar Spinal Loading

Increased loading at the lumbar spine, particularly in the coronal
plane, has been reported in children with cerebral palsy (CP). As pelvic and
trunk movements associated with Trendelenburg and Duchenne type gait are most
significant in the coronal plane, the potential exists for lower lumbar spinal
loading to be negatively affected in children with CP and these types of movement
patterns. Objective: The objective of this study was to assess trunk and pelvic
kinematics and lower lumbar spinal loading patterns in children with CP and
Trendelenburg and Duchenne type gait. Design: This was a cross-sectional study.
Methods: Three-dimensional kinematic (lower limb and thorax) and L5-S1 kinetic
data were recorded. Children were divided according to clinical presentation of
Trendelenburg or Duchenne type gait. Several discrete kinematic and kinetic
parameters were assessed between groups. Results: Three distinct pelvic and trunk
movement patterns were identified for children with CP: Trendelenburg, Duchenne,
and complex Trendelenburg-Duchenne. Peak L5-S1 lateral bending moments were
increased by 62% in children with CP and Duchenne type gait. Children with CP and
complex Trendelenburg-Duchenne gait demonstrated the largest deviations from
normal, with increased peak ipsilateral and contralateral directed moments of 69%
and 54%, respectively, compared with children with typical development.
Limitations: A test-retest reliability analysis or measure of minimal detectable
change was not conducted as part of this study. Results suggest that measures of
minimal detectable change may be high for some of the reported variables. In
addition, the inverse dynamic approach determines only the net intersegmental
reactive forces that reflect the effect of external loads. Previous studies have
shown that spinal loads may be larger than the net intersegmental force.
Conclusions: Trendelenburg and Duchenne type movements were not always distinct,
and a third type of movement, a combination of the two, was the most common in
this study. Clinicians should be aware that children with CP and the Duchenne
type or the complex Trendelenburg-Duchenne type of gait pattern experience
abnormal loading that may have significant implications for the lower spine in
the long term.
CI - (c) 2017 American Physical Therapy Association

Langue : ANGLAIS

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