Mechanisms contributing to gait speed and metabolic cost in children with unilateral cerebral palsy

Exploring harmonic walking development in children with unilateral cerebral palsy and typically developing toddlers: Insights from walking experience

This longitudinal study investigated the impact of the first independent steps on harmonic gait development in unilateral cerebral palsy (CP) and typically developing (TD) children. We analysed the gait ratio values (GR) by comparing the duration of stride/stance, stance/swing and swing/double support phases. Our investigation focused on identifying a potential trend towards the golden ratio value of 1.618, which has been observed in the locomotion of healthy adults as a characteristic of harmonic walking. Locomotor ability was assessed in both groups at different developmental stages: before and after the emergence of independent walking. Results revealed that an exponential fit was observed only after the first unsupported steps were taken. TD children achieved harmonic walking within a relatively short period (approximately one month) compared to children with CP, who took about seven months to develop harmonic walking. Converging values for stride/stance and stance/swing gait ratios, averaged on the two legs, closely approached the golden ratio in TD children (R2 = 0.9) with no difference in the analysis of the left vs right leg separately. In contrast, children with CP exhibited a trend for stride/stance and stance/swing (R2 = 0.7), with distinct trends observed for the most affected leg which did not reach the golden ratio value for the stride/stance ratio (GR = 1.5), while the least affected leg exceeded it (GR = 1.7). On the contrary, the opposite trend was observed for the stance/swing ratio. These findings indicate an overall harmonic walking in children with CP despite the presence of asymmetry between the two legs. These results underscore the crucial role of the first independent steps in the progressive development of harmonic gait over time.

Muscle co-contraction and co-activation in cerebral palsy during gait: A scoping review

BACKGROUND

Cerebral palsy (CP) results from an injury to a developing brain. Muscle activation patterns during walking are disrupted in individuals with CP. Indeed, excessive muscle co-contraction or co-activation (MCo/MCa) is one of the characteristics of pathological gait. Although some researchers have studied MCo/MCa in individuals with CP during gait, inconsistent results limit our understanding of this literature. Increased knowledge of MCo/MCa patterns in individuals with CP may help the development of improved gait management approaches.

RESEARCH QUESTION

This review aims to summarize MCo/MCa patterns while walking in individuals with CP across the existing literature and compare them with their healthy peers.

METHODS

This study follows the Joanna Briggs Institute (JBI) guidelines and the recommendations presented in PRISMA Extension for Scoping Reviews (PRISMA-ScR). The recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for scoping Reviews statement were respected. The following databases were searched: MEDLINE (Ovid), EMBASE (Ovid), CINAHL Plus with Full Text (Ebsco), SPORTDiscus with Full Text (Ebsco), and Web of Science.

RESULTS

Among 2545 identified studies, 21 studies remained after screening. In total, 337 participants with CP and 249 healthy participants were included. Both MCo and MCa terminologies are used for describing simultaneous muscle activation; however, when it is measured by electromyography (EMG), MCa terminology should be preferred to facilitate interpretation. A wide range of MCo/MCa patterns has been found across studies using different methodologies (e.g., gait protocol, computation methods). Finally, most of the included studies confirm that MCo/MCa is increased in individuals with CP during walking compared to controls.

SIGNIFICANCE

This review identified missing concepts and common limitations in the literature which could be addressed in future research such as the association between MCo/MCa and gait deviations, and the most appropriate MCo/MCa computation method.

Gait adaptations of individuals with cerebral palsy on irregular surfaces: A scoping review

BACKGROUND

Individuals with cerebral palsy (CP) have a reduced ability to perform motor tasks such as walking. During daily walking, they are confronted with environmental constraints such as irregular surfaces (e.g., relief and uneven surfaces) which may require adaptations to maintain stability and avoid falls. Laboratory gait assessments are conventionally conducted under ideal conditions (e.g., regular and even surfaces) and may overlook subtle problems which may only present in challenging walking environments. Increased knowledge of adaptations to successfully navigate irregular surfaces may contribute to a better understanding of everyday walking barriers.

RESEARCH QUESTION

This scoping review aims to describe gait adaptations to irregular surfaces in individuals with CP and contrast adaptations with those of healthy individuals.

METHODS

This review followed the 6-stage Joanna Briggs Institute methodology and respected the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews statement. The MEDLINE, EMBASE, CINAHL, SPORTDiscus, and Web of Science databases were searched on March 2021.

RESULTS

The research strategy identified 1616 studies published between 2014 and 2020, of which 10 were included after abstract and full-text screening. This review reported on 152 individuals with CP (diplegia: n = 117, hemiplegia: n = 35) and 159 healthy individuals. The included studies focused on spatial-temporal, kinematic, kinetic, and muscle activity parameters over relief, inclined, and staircase surfaces. 7/10 studies were conducted in laboratories, often using surfaces that are not representative of the real-world. The results suggest that for individuals with CP, adaptations on irregular surfaces differ from flat surface walking and across CP subtype. Moreover, individuals with CP present with typical and pathology-specific adaptations to irregular surfaces compared to healthy individuals.

SIGNIFICANCE

This review highlights the clinical and research interest of focusing future studies on more ecologically valid data collection approaches and provides important recommendations to overcome research gaps in the existing literature.

Family Caregivers’ Experiences of Caring for Children With Cerebral Palsy in China: A Qualitative Descriptive Study

This study aimed to investigate family caregivers’ experiences of caring for children with cerebral palsy in China. This study used a descriptive qualitative design. We selected 18 family caregivers from 3 children’s hospitals in Jiangsu Province, China, using a purposive sampling method. The following 5 themes emerged as needs of family caregivers’ experiences of caring for children with cerebral palsy: overall responsibility, being alone, exhaustion from caring, being a prisoner of life, and uncertainty regarding the future. The findings of our research contribute to a better understanding of the life situation of family caregivers of children with cerebral palsy as we identify the difficulties they experience as well as their specific needs.

Effect of functional electrical stimulation versus TheraTogs on gait and balance in children with hemiplegic cerebral palsy: a randomized controlled trial

Background

Children with cerebral palsy exhibit postural restrictions and gait problems as a result of both primary and secondary brain damage impairments. One of the main goals of cerebral palsy rehabilitation is to improve gait and balance. As a result, the purpose of this study was to compare the effects of FES and TheraTogs on gait and balance in children with hemiplegic CP. A randomized controlled study was conducted on 30 children with hemiplegic CP (18 boys and 12 girls) between the ages of 8 and 12 years. The children were divided into two equal groups. In addition to the traditional physical treatment program, the FES group received functional electrical stimulation (pulse width 300 μs, frequency 33 Hz, 2 h/day, 3 days/week, 3 months). The TheraTogs group, on the other hand, received the TheraTogs strapping system as well as the same traditional program for the same time period. The 3-D motion analysis and the Biodex balance system were used to analyze gait parameters and postural stability at baseline and 3 months after the intervention.

Results

When comparing the mean values of the gait parameters and postural stability indices of children in both groups before and after treatment, a significant improvement was reported. Furthermore, the FES group showed a greater improvement in all of the measured outcomes (P < 0.001).

Conclusion

Functional electrical stimulation improves gait pattern and postural stability in children with hemiplegic cerebral palsy significantly more than TheraTogs strapping systems.

Clinical trial registration

This study was registered in the ClinicalTrial.gov PRS (NCT05020834).

Efficacy and safety of core stability training on gait of children with cerebral palsy: A protocol for a systematic review and meta-analysis

BACKGROUND

Cerebral palsy (CP) is a common disability in children featured with pathological gait and limb function limitation due to muscle weakness. Improving limb function and quality of life is currently considered to be highlighted. Physiotherapy is a chief component of rehabilitation for children with CP, correcting gait and improve walking capacity through muscle strength training. Standard rehabilitation programs for CP have not been determined. Core stability training (CST), which coordinates limb balance via trunk control, is widely used in sports competition. And it is gradually introduced into the rehabilitation of children with cerebral palsy with a positive impact on the patients' gait performance. By screening published literatures, this study aims to conduct a meta-analysis to systematically evaluate the effectiveness and safety of CST in gait of children with CP.

METHODS

Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) on CST in the treatment of children with CP were searched from 6 databases. Moreover, the reference lists of conference papers and included literatures will be manually searched to avoid omissions. Literature screening and data extraction were performed independently by 2 researchers. RCTs carry out the risk of bias analysis evaluation from seven aspects through the Cochrane Collaboration's risk of bias tool. Fixed or random effect model will be performed to analyze the outcomes. When higher heterogeneity occurs (I > 50%), the sensitivity or subgroup analysis will also be conducted to find potential factors. And the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach is used for assessing the quality of evidence.

RESULTS

The study will evaluate the effect of CST on gait of children with CP from multiple outcomes, including walking speed, endurance, stride length, and safety.

CONCLUSION

Based on evidence-based medicine, the conclusion of this study can demonstrate the effectiveness and safety of CST in gait correction for children with CP.

PROSPERO REGISTRATION NUMBER

PROSPERO CRD 42019134094.

Identification of gait events in children with spastic cerebral palsy: comparison between the force plate and algorithms

OBJECTIVE

To compare the gait event identification of five algorithms recommended in the literature with those provided by force plate (gold standard) in children with unilateral or bilateral spastic cerebral palsy (SCP).

METHODS

This was a cross-sectional study of the gait of three girls and four boys with a mean age of 8.6±4.7 years. Four children had unilateral SCP with an equinus gait pattern, and the remaining three children exhibited bilateral SCP with a slide/drag gait pattern. Kinematic and kinetic gait data were collected during barefoot walking at a comfortable speed. From a total of 202 steps, the detection of 202 foot-strike (FS) and 194 toe-off (TO) events by each algorithm was compared with the detection of these same events by the force plate. The error between the events detected by the algorithms and those detected by the force plate was determined in milliseconds. Repeated measures ANOVA was used to compare the errors among the algorithms.

RESULTS

The algorithm reported by Ghoussayni et al. showed the best performance in all situations, except for the identification of FS events on the unaffected side in children with unilateral SCP. For these events, the algorithms reported by Desailly et al. and Zeni et al. showed the best performance.

CONCLUSION

Ghoussayni et al.'s algorithm can be used to detect gait events in children with SCP when a force plate is not available.

Functional Task Training Combined With Electrical Stimulation Improves Motor Capacity in Children With Unilateral Cerebral Palsy: A Single-Subject Design

PURPOSE

Reduced propulsive capability can impact negatively on mobility activities of many children with spastic unilateral cerebral palsy (SUCP). This study investigated the effect of a task-oriented training program combined with functional electrical stimulation (FES) on the motor capacity of children with SUCP.

METHODS

Single-case A-B design with follow-up. Gross motor function and biomechanical walking data of 4 children with SUCP were measured repeatedly across the baseline, intervention, and follow-up phases. Intervention was a task-oriented training program combined with FES applied on the gastrocnemius. Outcome variables included gait speed, impulsive torque, and ankle/hip power generation ratio. The 2-SD band and celeration line methods compared outcomes among the baseline, intervention, and follow-up periods.

RESULTS

One child improved walking speed. All children improved impulsive torque and ankle/hip power ratio of the affected leg. All children improved gross motor function.

CONCLUSION

The intervention improved children's propulsive capability and positively influenced their mobility.