Bilateral symmetry in leg and joint stiffness in children with spastic hemiplegic cerebral palsy during gait

Abstract

Deviations are often identified at individual joints in the gait analysis of patients with cerebral palsy. Previous gait studies on hemiplegic cerebral palsy (HCP) have focused mainly on deviations of the affected side. The current study aimed to quantify and compare the joint and leg stiffness, the contributions of skeletal and muscular components, and the associated joint angles and moments of the affected and nonaffected lower limbs during level walking in children with spastic HCP. A total of 12 children with spastic HCP and 12 healthy controls walked at a self‐selected speed in a gait laboratory while their kinematic and forceplate data were measured and analyzed during loading response, midstance, terminal stance, and preswing. The altered joint kinematics and kinetics in the nonaffected limb in the HCP group appeared to be mainly a compensatory strategy to minimize the bilateral asymmetry in leg stiffness during the double‐limb support phase and joint stiffness during the entire stance phase. The current results suggest that therapeutic planning and decision‐making for children with HCP should consider not only the mechanics of the affected side but also the control of the nonaffected side.

Effects of Tendon Release Surgery on Inter-Limb Leg Stiffness Control in Children with Spastic Diplegic Cerebral Palsy during Gait

“…Fe(t) is effective GRF, Le (t) is effective leg length and φ(t) is the angle between the longitudinal axis of the shank and the line joining the COP to the center of the hip joint. KT is defined as the sum of KL of the left leg (KLL) and KL of the right leg (KRL) (Adapted from [14]). The proportional share, KS(t), was then time-averaged over the double-limb support phases of gait (i.e., LR and PS).…”

“…Thus, very few studies have examined how the lower limbs coordinate with each other for the observed gait patterns, especially during weight transfer between limbs in DLS. Previous studies have shown that leg stiffness, incorporating information of both the kinematics and kinetics of the lower limb joints, is a useful measure and should be included in future clinical gait analysis for a more complete assessment of gait in children with CP [13][14][15]. For assessing the effects of pathology and the efficacy of TRS on the inter-limb coordination and bilateral symmetry in body-weight transfer and balance control during CP gait, quantitative analysis of leg stiffness during the phases of gait for both limbs can be a useful approach.…”

Gait Deviations of the Uninvolved Limb and Their Significance in Unilateral Cerebral Palsy

“…Here, the extent of the secondary movement disorder (secondary deviation of the involved limb) is dependent on the primary brain lesion [1,[4][5][6]. The secondary deviation itself causes adaption/compensatory movement patterns (tertiary deviation) of the uninvolved limb [7][8][9].…”

“…Particularly in unilateral CP, the naturally given asymmetry and consecutive highly complex movement patterns of the disorder on the one hand, and the ability of the sound limb concerning functional strategies to compensate on the other hand, affect the overall functional impairment, which is commonly classified using the Gross Motor Function Classification System (GMFCS) [8,9,17]. The functional capabilities of the sound limb are highly relevant for the overall propulsion and stability of walking [18,19].…”

“…However, the effects and possible tertiary (compensatory) deviations of the uninvolved limb due to gait deviations of the involved limb (secondary deviations) in unilateral CP have received little attention so far [7,8,21]. But it is clear that the gait deviations of the involved limb have an impact on the gait pattern of the sound limb [22].…”