Locomotor skills and balance strategies in children with internal rotations of the lower limbs

Assessing dynamic stability in children with idiopathic toe walking during overground walking

BACKGROUND

Children with idiopathic toe walking present with reduced ankle mobility, impaired balance, and difficulties in motor control. There is a need to diagnose idiopathic toe walking in a holistic manner and improve the monitoring of interventions. The aim is to assess dynamic stability with measures of margin of stability and whole-body angular momentum and evaluate their clinical relevance.

METHODS

A retrospective cross-sectional study with 35 idiopathic toe walkers (23 male, mean age (SD) 10.0 (2.9) years) and 20 typically developing controls (10 male, 11.4 (2.8) years). All participants had a clinical gait analysis at the local hospital. Dynamic stability was assessed with margin of stability, whole-body angular momentum, GaitSD, and spatiotemporal gait parameters. Student t-tests with adjustments for multiple comparisons were performed.

FINDINGS

Margin of stability in anterior direction was significantly shorter (ES = 1.29) and whole-body angular momentum in the coronal plane was significantly larger (ES = 0.90) in idiopathic toe walkers compared to typically developing children. No other results were below the set threshold for significance.

INTERPRETATION

Children with idiopathic toe walking continue to use an immature, falling forward movement strategy to maintain forward momentum. It is probable that those children adopted toe walking behavior to support increased energy absorption during the initial fall. Furthermore, the addition of dynamic stability measures not only provides insight into their ability to balance, these measures also allow an understanding of the plausible strategies adopted during walking and could potentially improve diagnosis and quantification of therapeutic outcomes.

On the clinical interpretation of overground gait stability indices in children with cerebral palsy

Several indices have been devised to quantify a person's stability from its gait pattern during overground walking. However, clinical interpretation of the indices is difficult because the link between being stable and adopting a mechanically stable gait pattern may not be straightforward. This is particularly true for one of these indices, the margin of stability, for which opposite interpretations are available in the literature. We collected overground walking data in two groups of 20 children, with unilateral cerebral palsy (CP) and typically developing (TD), for two conditions, on flat and on uneven grounds (UG). We postulated that TD children were more stable during gait than children with CP and that both groups were more stable on flat compared to UG. We explored the coherent association between several indices and the two postulates to clarify clinical interpretation. Our results showed that increased margin of stability, increased amplitude of the whole-body angular momentum, decreased duration of single limb support, increased variability (gait kinematics, step length, and step width) were associated with reduced stability for both postulates. However, results for the margin of stability were paradoxical between the sides in the CP group where small margin of stability was indicative of a fall forward strategy on the affected side rather than improved stability. Whole-body angular momentum and duration of single limb support appeared as the most sensitive indices. However, walking speed influenced these and would need to be considered when comparing groups of different walking speed.

Does the Type of Toeing Affect Balance in Children With Diplegic Cerebral Palsy? An Observational Cross-sectional Study

Objective

The purpose of the study was to find out effect of toeing on balance in children with diplegic cerebral palsy.

Methods

An observational study was conducted. Thirty children with spastic diplegic cerebral palsy, aged 5 to 8 years, participated in this study. They were classified into 2 groups: group A was children with out-toeing, and group B was children with in-toeing. Foot progression angle was measured by using dynamic footprint, and balance was evaluated using Biodex Balance System equipment. The outcome of interest was postural control (overall stability, anteroposterior stability, and mediolateral stability).

Results

Statistical analysis revealed a significant difference for the tested variables of interest between the 2 tested groups. Multiple pairwise comparison tests revealed that there was significantly better overall stability, anteroposterior stability, and mediolateral stability (P < .05) in group A.

Conclusion

It can be concluded that children with out-toeing have higher balance and stability than children with in-toeing.

Do adolescent idiopathic scoliosis (AIS) neglect proprioceptive information in sensory integration of postural control?

Introduction

It has been reported that AIS rely much more on ankle proprioception to control the amplitude of the balance control commands as compared to age-matched healthy adolescents. Our hypothesis was that AIS do not neglect proprioceptive information to control posture probably because of their vestibular deficits. We investigated the proprioceptive contribution to postural control in AIS which expresses spinal deformity during a crucial transitional period of ontogenesis.

Methods

10 adolescents with idiopathic scoliosis (AIS) with moderate spinal deformity (10° < Cobb Angle >35°) and 10 control adolescents (CA) had to maintain vertical stance while very slow oscillations in the frontal plane (below the detection threshold of the semicircular canal system) were applied to the support with the eyes open and closed. Postural orientation and segmental stabilisation were analysed at head, shoulder, trunk and pelvis levels.

Results

Scoliosis did not affect vertical orientation control and segmental stabilization strategies. Vision improves postural control in both CA and AIS, which seem more dependent on visual cues than adults.

Conclusions

AIS as CA were unable to control efficiently their postural orientation on the basis of the proprioceptive cues, the only sensory information available in the EC situation, whereas in the same condition healthy young adults present no difficulty to achieve the postural control. This suggests that AIS as CA transitory neglect proprioceptive information to control their posture. These results and previous studies suggest the existence of different afferent pathways for proprioceptive information subserving different parts in sensory integration of postural control. We conclude that the static proprioceptive system is not affected by the idiopathic scoliosis, while the dynamic proprioceptive system would be mainly affected.

[Developmental and locomotor disorders in children]

From one year of age, gait and balance disorders are frequent complaints in neurology. During the first year following the acquisition of independent walking, most of the gait, such as transition from digitigrade to plantigrade locomotion, parameters are well-established in children. Nevertheless, bipedal locomotion means solving a large number of balance problems. Locomotor balance needs many years to mature in the course of ontogenesis. From various gait analysis, it was possible to establish a repertoire of locomotor strategies used in typical and pathological development. The last part of this paper is devoted to the possible responses that can be proposed for gait and balance disorders occurring during childhood.