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Head and trunk movements during turn while walking in children with cerebral palsy
ESMAC Abstracts 2015 / Gait & Posture 42S (2015) S1–S101
Session OS11 Trunk – Gait and Balance Head and trunk movements during turn while walking in children with cerebral palsy
S51
In CPIII, moreover, their walkers not only facilitated motor performance but also most likely compensated for insufficient spatial awareness during walking. http://dx.doi.org/10.1016/j.gaitpost.2015.06.096
Å. Bartonek 1,∗ , C. Lidbeck 1 , E.M. Gutierrez-Farewik 2 1
Karolinska Institutet, Women’s and Children’s Health, Stockholm, Sweden 2 Karolinska Institutet, KTH Mechanics, Royal Institute of Technology, Stockholm, Sweden Research question: The aim of this study was to explore whether head and trunk movements during turning differed with various motor function. Introduction: To understand the variability in the gross motor levels in children with cerebral palsy (CP), more knowledge about the impact of, among others, cognitive factors on motor function ability is needed (1). Sense of movement is likely more affected the more severe their motor function (2). Despite turning being an important daily activity, it is a relatively neglected area of study in children with CP. Our hypothesis was that movements during turning are associated with impaired motor function as well as with disturbances in the sensory system. Materials and methods: Thirty children with bilateral spastic CP (GMFCS I;8, II;12, III;10)(mean age 12.1 yrs) and 22 typically developing (TD) children (mean age 10.4) participated in the study. All children were tested with 3D-motion analysis (Vicon) with a full-body biomechanical model. The children were instructed to walk around a 20 cm tall target, situated 3 m away, and return to the starting point. Head and trunk rotations and sagittal tilt were registered at turn. Non- parametric statistics was used at p-level < 0.05. Results: Time duration during turn differed between the groups, with the shortest in TD, thereafter increasingly longer in CPI, CPII and CPIII (2.6, 3.1, 4.8, 5.5 s respectively, I-III indicates GMFCS level). There was no difference in head rotation movements among the groups, but significantly less trunk rotation in TD than in CPI and CPII (Fig. 1a). Both maximum sagittal anterior head and trunk movements in CPIII were larger than in TD, CPI, and CPII, whereas head anterior movements were larger in TD than in CPI and CPII (Fig. 1b). Discussion: Although rotation movements in children with CP are commonly described as challenging, CPIII, with most severe gross motor impairment, did not demonstrate less rotation movements during turn than TD, CPI and CPII. CPIII, however, required the most time to accomplish the turn. The most increased anterior head and trunk position, found in CPIII, may illustrate the necessity for visual control of the bare feet, which is likely related to lack of sensation and disturbances in proprioception in the lower limbs.
Fig. 1. Head and trunk rotation (a) (“+” = rotation >midline) and sagittal movements (b) (“−” = anterior) during turn.
Session OS11 Trunk – Gait and Balance Excessive lateral trunk lean during walking in cerebral palsy: Does it return to normal during running? H. Böhm ∗ , M. Hösl, K. Baumgart, L. Döderlein Orthopädische Kinderklinik, Ganglabor, Aschau, Germany Research question: Do patients with cerebral palsy and excessive trunk lean during walking normalize their trunk movements during running, and if so what is the reason and may running be useful as therapy. Introduction: Patients with CP are often concerned about their excessive lateral trunk lean during walking mainly because of their unsightly physical appearance among peers. Trunk lean might assist foot clearance to compensate for contractures and muscle weakness. In particular, weakness of the hip abductors was suggested to cause trunk lean [1]. However compared to other patient groups the relation between abductor weakness and trunk lean in CP is rather low [2]. Thus the causes are not completely understood. We observed that some patients improved excessive trunk lean during running. Therefore, the purpose of the study was to investigate the effect of running to reveal insight into the origin of excessive trunk lean in patients with CP. Materials and methods: 73 patients with bilateral spastic cerebral palsy GMFCS I & II, between 6 and 17 years had instrumented barefoot gait and running analysis using a Vicon camera system with two force plates and the Plug-in-Gait model. 20 typically developed (TD) peers served as controls. 51/73 patients had excessive trunk lean (greater than 3 SD of TD). Their range of trunk lean (RTL) was statistically compared to TD during running and walking using a 2 factor ANOVA with post hoc tests. Results: The ANOVA showed a significant difference in RTL between patients and TD and between walking and running with a significant interaction effect. Post hoc tests revealed that TD significantly increased RTL during running whereas CP patients significantly (p< 0.001) reduced RTL during running to about the range of TD in running. The range in pelvic obliquity was decreased and peak abduction moments during stance increased during running similarly in TD and CP. The hip flexion increased during stance and particularly during swing phase from walking to running in CP and TD, whereas the hip extension moment decreased. Discussion: Excessive trunk lean during walking was significantly reduced during running in CP patients. The reason may be that CP patients were not able to activate hip abductors and flexors selectively. In consequence, increased activation of abductors may result in increased hip flexion. Trunk lean may reduce the required abduction strength during walking to reduce further increase of their already pathological hip flexion during walking. Contrary running requires more hip flexion so that abductors do not need to be unloaded. Whether running can be recommended as therapy for excessive trunk lean may be critically discussed because running reduces hip extension and promotes toe contact [3] which is the major pathology in patients with CP during walking.
Session OS11 Trunk – Gait and Balance Head and trunk movements during turn while walking in children with cerebral palsy
S51
In CPIII, moreover, their walkers not only facilitated motor performance but also most likely compensated for insufficient spatial awareness during walking. http://dx.doi.org/10.1016/j.gaitpost.2015.06.096
Å. Bartonek 1,∗ , C. Lidbeck 1 , E.M. Gutierrez-Farewik 2 1
Karolinska Institutet, Women’s and Children’s Health, Stockholm, Sweden 2 Karolinska Institutet, KTH Mechanics, Royal Institute of Technology, Stockholm, Sweden Research question: The aim of this study was to explore whether head and trunk movements during turning differed with various motor function. Introduction: To understand the variability in the gross motor levels in children with cerebral palsy (CP), more knowledge about the impact of, among others, cognitive factors on motor function ability is needed (1). Sense of movement is likely more affected the more severe their motor function (2). Despite turning being an important daily activity, it is a relatively neglected area of study in children with CP. Our hypothesis was that movements during turning are associated with impaired motor function as well as with disturbances in the sensory system. Materials and methods: Thirty children with bilateral spastic CP (GMFCS I;8, II;12, III;10)(mean age 12.1 yrs) and 22 typically developing (TD) children (mean age 10.4) participated in the study. All children were tested with 3D-motion analysis (Vicon) with a full-body biomechanical model. The children were instructed to walk around a 20 cm tall target, situated 3 m away, and return to the starting point. Head and trunk rotations and sagittal tilt were registered at turn. Non- parametric statistics was used at p-level < 0.05. Results: Time duration during turn differed between the groups, with the shortest in TD, thereafter increasingly longer in CPI, CPII and CPIII (2.6, 3.1, 4.8, 5.5 s respectively, I-III indicates GMFCS level). There was no difference in head rotation movements among the groups, but significantly less trunk rotation in TD than in CPI and CPII (Fig. 1a). Both maximum sagittal anterior head and trunk movements in CPIII were larger than in TD, CPI, and CPII, whereas head anterior movements were larger in TD than in CPI and CPII (Fig. 1b). Discussion: Although rotation movements in children with CP are commonly described as challenging, CPIII, with most severe gross motor impairment, did not demonstrate less rotation movements during turn than TD, CPI and CPII. CPIII, however, required the most time to accomplish the turn. The most increased anterior head and trunk position, found in CPIII, may illustrate the necessity for visual control of the bare feet, which is likely related to lack of sensation and disturbances in proprioception in the lower limbs.
Fig. 1. Head and trunk rotation (a) (“+” = rotation >midline) and sagittal movements (b) (“−” = anterior) during turn.
Session OS11 Trunk – Gait and Balance Excessive lateral trunk lean during walking in cerebral palsy: Does it return to normal during running? H. Böhm ∗ , M. Hösl, K. Baumgart, L. Döderlein Orthopädische Kinderklinik, Ganglabor, Aschau, Germany Research question: Do patients with cerebral palsy and excessive trunk lean during walking normalize their trunk movements during running, and if so what is the reason and may running be useful as therapy. Introduction: Patients with CP are often concerned about their excessive lateral trunk lean during walking mainly because of their unsightly physical appearance among peers. Trunk lean might assist foot clearance to compensate for contractures and muscle weakness. In particular, weakness of the hip abductors was suggested to cause trunk lean [1]. However compared to other patient groups the relation between abductor weakness and trunk lean in CP is rather low [2]. Thus the causes are not completely understood. We observed that some patients improved excessive trunk lean during running. Therefore, the purpose of the study was to investigate the effect of running to reveal insight into the origin of excessive trunk lean in patients with CP. Materials and methods: 73 patients with bilateral spastic cerebral palsy GMFCS I & II, between 6 and 17 years had instrumented barefoot gait and running analysis using a Vicon camera system with two force plates and the Plug-in-Gait model. 20 typically developed (TD) peers served as controls. 51/73 patients had excessive trunk lean (greater than 3 SD of TD). Their range of trunk lean (RTL) was statistically compared to TD during running and walking using a 2 factor ANOVA with post hoc tests. Results: The ANOVA showed a significant difference in RTL between patients and TD and between walking and running with a significant interaction effect. Post hoc tests revealed that TD significantly increased RTL during running whereas CP patients significantly (p< 0.001) reduced RTL during running to about the range of TD in running. The range in pelvic obliquity was decreased and peak abduction moments during stance increased during running similarly in TD and CP. The hip flexion increased during stance and particularly during swing phase from walking to running in CP and TD, whereas the hip extension moment decreased. Discussion: Excessive trunk lean during walking was significantly reduced during running in CP patients. The reason may be that CP patients were not able to activate hip abductors and flexors selectively. In consequence, increased activation of abductors may result in increased hip flexion. Trunk lean may reduce the required abduction strength during walking to reduce further increase of their already pathological hip flexion during walking. Contrary running requires more hip flexion so that abductors do not need to be unloaded. Whether running can be recommended as therapy for excessive trunk lean may be critically discussed because running reduces hip extension and promotes toe contact [3] which is the major pathology in patients with CP during walking.