Restricted Arm Swing Affects Gait Stability and Increased Walking Speed Alters Trunk Movements in Children with Cerebral Palsy

Abstract

Observational research suggests that in children with cerebral palsy, the altered arm swing is linked to instability during walking. Therefore, the current study investigates whether children with cerebral palsy use their arms more than typically developing children, to enhance gait stability. Evidence also suggests an influence of walking speed on gait stability. Moreover, previous research highlighted a link between walking speed and arm swing. Hence, the experiment aimed to explore differences between typically developing children and children with cerebral palsy taking into account the combined influence of restricting arm swing and increasing walking speed on gait stability. Spatiotemporal gait characteristics, trunk movement parameters and margins of stability were obtained using three dimensional gait analysis to assess gait stability of 26 children with cerebral palsy and 24 typically developing children. Four walking conditions were evaluated: (i) free arm swing and preferred walking speed; (ii) restricted arm swing and preferred walking speed; (iii) free arm swing and high walking speed; and (iv) restricted arm swing and high walking speed. Double support time and trunk acceleration variability increased more when arm swing was restricted in children with bilateral cerebral palsy compared to typically developing children and children with unilateral cerebral palsy. Trunk sway velocity increased more when walking speed was increased in children with unilateral cerebral palsy compared to children with bilateral cerebral palsy and typically developing children and in children with bilateral cerebral palsy compared to typically developing children. Trunk sway velocity increased more when both arm swing was restricted and walking speed was increased in children with bilateral cerebral palsy compared to typically developing children. It is proposed that facilitating arm swing during gait rehabilitation can improve gait stability and decrease trunk movements in children with cerebral palsy. The current results thereby partly support the suggestion that facilitating arm swing in specific situations possibly enhances safety and reduces the risk of falling in children with cerebral palsy.

Head and trunk kinematics and kinetics in normal and cerebral palsy gait: a systematic review

“…The selected articles with characteristics findings have been shown in Tables 2 and 3. [13] 2018 Cross-sectional 52 30 22 9.1-11.7 1-3 [14] 2017 Cross-sectional 72 52 20 8.5-14.5 1-2 [15] 2016 Cross-sectional 52 30 22 9.1-11.7 1-3 [16] 2016 Cross-sectional 40 20 20 2-9 1-3 [4] 2016 Cross-sectional 50 26 24 4-12 -17] 2014 Cross-sectional 36 16 20 8-14 - [18] 2014 Cross-sectional 40 23 17 8-18 - [19] 2014 Cross-sectional 34 17 17 5-18 1-3 [20] 2014 Cross-sectional 114 92 22 0-25 1-3 [6] 2014 Cross-sectional 32 16 16 9-13 1-2 [21] 2014 Cross-sectional 70 41 29 5-18 1-3 [22] 2014 Cross-sectional 107 92 15 5-30 1-3 [23] 2014 Cross-sectional 20 20 0 5-15 1-2 [24] 2013 Cross-sectional 100 100 0 8-15 1-3 [12] 2013 Cross-sectional 40 20 20 2-10 1-2 [25] 2011 Cross-sectional 56 26 30 8-15 1-3 [26] 2013 Cross-sectional 48 31 17 11-26 1-2 [27] 2013 Cross-sectional 149 122 27 17-23 1-3…”

“…Due to the developmental changes that occur in children as they grow, longitudinal studies are needed to identify the relationship between age and postural control and its impact on gait. Most of the studies compared CP children with age-matched TD children [4,6,7,12,[14][15][16][17][18][19][20][21][22][27][28][29][30][31][32]34,35] except two studies did not have TD as a comparable group [11,33]. Considering age-matched TD children in the gait analysis could provide accurate and effective measures of comparison regarding functional capacity and postural deviation from the baseline.…”

“…In few studies, distribution of participants could also be seen based on CP classification [4,16,20,[23][24][25]27,31]. The most common type of CP under inclusion criteria of the review studies was spastic hemiplegia or diplegia.…”

“…The most common type of CP under inclusion criteria of the review studies was spastic hemiplegia or diplegia. Only two studies included participants with either hemiplegia or diplegia [4,17]. In addition, some authors compared two different types of CP viz.…”

“…However, in children with cerebral palsy (CP), gait is compromised in a variety of ways due to a non-progressive lesion in a developing brain [3]. Children with CP show altered movements such as decreased head and trunk stability [4]. Typical gait comprises the movements of various body segments but gait in a developing CP child is a complex process [5].…”