Influence of body weight unloading and support surface during walking of children with cerebral palsy

Abstract

Introduction Partial body weight support (BWS) systems have been employed for gait training of children with cerebral palsy (CP). Therefore, it would be important to analyze if the type of walking surface and the amount of body weight unloading over lower limbs change the way these children walk. Objectives Investigate the influence of walking surface and amount of body weight unloading on the spatial temporal characteristics during walking of children with CP. Materials and methods Seven children with spastic CP between four and eight years old and GMFCS (Gross Motor Function Classification System) between I and IV, were videotaped walking with 0%, 15% and 30% of BWS on both dynamic (treadmill) and static (ground level) surfaces. Walking spatial temporal variables were calculated. Results Children walked with similar velocity in all experimental conditions. While stance duration decreased as the percentage of BWS increased, no differences were found for stance and swing periods and cadence. Children walked with longer steps and strides and with faster strides on static surface compared to dynamic surface. Conclusion Children with CP presenting different levels of motor impairment presented some alterations in the spatial temporal walking parameters as they walked with body unloading. However, such alterations might be due mainly to the type of walking surface than the percentage of body weight unloading on lower limbs.

Constraint manipulation as a feasible strategy for gait alteration and intervention: a scoping review

“…In a subsequent study, 56 we investigated spatiotemporal parameters and joint angles under the same experimental conditions as the previous one. 55 Overall, the second study revealed that even the children who could not walk independently were able to walk with a BWS system on a treadmill and on the ground. More importantly, even though we found a high variability among the children who participated in this study, we observed that children with CP walking with the overground BWS system presented a gait pattern more similar to that presented by typically developing children.…”

“…52,53 Instead of conducting a gait intervention, we investigated children with CP walking with BWS on a treadmill and on the ground. 54,55,56 Initially, we investigated children with CP with mild motor impairment (independent walkers) walking with 0% and 30% of BWS on a treadmill and on the ground. 54 Spatiotemporal parameters and joint angles were compared among the experimental conditions and free walking.…”

“…54 Next, we investigated whether children with more severe motor impairment could walk with 0%, 15%, and 30% of BWS on a treadmill and on the ground. 55,56 First, we investigated children between 4 and 8 years of age walking at similar speeds in both systems. These children maintained similar cadence and temporal organization (that is, single-and double-limb support, and swing durations) among experimental conditions, though, they walked with longer steps and strides on the ground than on the treadmill.…”

“…These children maintained similar cadence and temporal organization (that is, single-and double-limb support, and swing durations) among experimental conditions, though, they walked with longer steps and strides on the ground than on the treadmill. 55 Although, in this first study, we investigated a small and heterogenic sample of children with CP, it was the first attempt to test the overground BWS system with a servo motor controlled by a computer program, and it was possible to verify that such a system allowed more impaired children to walk under different amounts of body weight unloading. In a subsequent study, 56 we investigated spatiotemporal parameters and joint angles under the same experimental conditions as the previous one.…”

Load modulation affects pediatric lower limb joint moments during a step-up task

“…Body weight modulation, including providing partial support of a person’s body weight (Celestino et al, 2014; Cherng et al, 2007; Kurz et al, 2011; Phillips et al, 2007; Provost et al, 2007) and addition of external loads (Dodd et al, 2003; McBurney et al, 2003; Simão et al, 2014), is broadly used in research and clinical practice. This method is often adopted for individuals with neurodevelopmental disorders during steady-state gait training (Celestino et al, 2014; Cherng et al, 2007; Kurz et al, 2011; Phillips et al, 2007; Provost et al, 2007; Simão et al, 2014). The evidence is less robust for the effect of body weight modulation on the initiation of stair ascent.…”