Deliberately Light Interpersonal Contact Affects the Control of Head Stability During Walking in Children and Adolescents With Cerebral Palsy.

To evaluate the potential of deliberately light interpersonal touch (IPT) for reducing excessive head and trunk sway during self-paced walking in children and adolescents with cerebral palsy (CP). Quasi-experimental, proof-of-concept study with between-groups comparison. Ambulant care facility, community center. Children and adolescents (N=65), consisting of those with CP (spastic and ataxic, n=26; Gross Motor Function Classification System I-III; mean age, 9.8y; 11 girls, 15 boys) and those who were typically developed (TD, n=39; mean age, 10.0y; 23 girls, 16 boys). IPT applied by a therapist to locations at the back and the head. As primary outcomes, head and trunk sway during self-paced walking were assessed by inertial measurement units. Secondary outcomes were average step length and gait speed. CP group: apex and occiput IPT reduced head velocity sway compared with thoracic IPT (both P=.04) irrespective of individuals' specific clinical symptoms. TD group: all testing conditions reduced head velocity sway compared with walking alone (all P≤.03), as well as in apex and occiput IPT compared with paired walking (both P≤.02). Deliberately light IPT at the apex of the head alters control of head sway in children and adolescents with CP. The effect of IPT varies as a function of contact location and acts differently in TD individuals.

Schulleri KH ，Burfeind F ，Höß-Zenker B ，Feketené Szabó É ，Herzig N ，Ledebt A ，Johannsen L ... -  《-》

How do children with bilateral spastic cerebral palsy manage walking on inclines?

Walking on inclined surfaces is an everyday task, which challenges stability and propulsion even in healthy adults. Children with cerebral palsy adapt similarly to inclines like healthy children do. However, how stability and propulsion in these subjects are influenced by different inclines remained unaddressed as of yet. The aim was to examine the feeling of safety, stability and propulsion of children with cerebral palsy when walking on inclines to gain insight into the challenges they might face on these conditions. Eighteen children with bilateral spastic cerebral palsy with gross motor function classification scale level I and II and nineteen healthy children underwent instrumented 3D gait analysis on level ground and on a 5° and a 10° incline. A mixed linear model was used to draw between and within group comparisons. Reduced lateral trunk sway, a relative lengthening of the lower limb at initial contact and a controlled walking speed were employed during downhill gait compared to level walking. Patients showed an increased sagittal ROM of trunk (3-4°) and pelvis (2-3°) and a decreased sagittal knee ROM (13°) compared to the typically developed children. During uphill gait, an insufficient increase of push-off power at the ankle (increase by 0.48 W/kg) was noted in children with CP, which appeared to lead to particularly shorter strides (about 0.1 m) in patients compared to healthy children (increase by 1.32 W/kg). Depending on inclination angle, children with cerebral palsy managed to walk on inclines in a controlled manner. The steeper the incline, the more the gait appeared to be affected: decreased feeling of safety, increased need for stabilising mechanisms for downhill gait and less sufficient uphill propulsion were seen. Helping these patients to attain better control during downhill gait and strengthening uphill gait mechanisms may support their participation in everyday life.

Yılmaz Topçuoğlu MS ，Krautwurst BK ，Klotz M ，Dreher T ，Wolf SI ... -  《-》

Segmental Contributions to Trunk Control in Children With Moderate-to-Severe Cerebral Palsy.

To examine postural constraints in children with moderate-to-severe cerebral palsy (CP) using a segmental approach. Quasi-experimental repeated-measures study; case series. Motor control research laboratory. Children (N=15; age range, 4-16y) with moderate (Gross Motor Function Classification System [GMFCS] IV; n=8; 4 boys) or severe (GMFCS V) (n=7; 4 boys) CP. Each child participated in 3 data collection sessions. During each session, we evaluated postural control for sitting using kinematics and clinical assessments. Kinematic data were used to document head alignment and stabilization with external support at 4 levels (axillae, midrib, waist, hip). Two clinical assessments, the Segmental Assessment of Trunk Control and behavioral assessment for stage of trunk control, were also used to compare results for children with CP to previous longitudinal data from typically developing (TD) infants (3-9mo of age). Children with GMFCS V had difficulty aligning and stabilizing their head along the medial-lateral and anterior-posterior axes. External support improved postural control for children with GMFCS V but not for those classified as GMFCS IV, who had opposite responses to support compared with TD infants. Children with GMFCS V have limited trunk control but respond to support similarly to young TD infants, suggesting delayed postural control. Response to external support for children with GMFCS IV suggests a unique strategy for trunk control not observed in typical infants. Overall a segmental approach offers new insights into development of trunk control in children with moderate-to-severe CP.

Saavedra SL ，Woollacott MH 《-》

Dynamic stability in cerebral palsy during walking and running: Predictors and regulation strategies.

The postural control in cerebral palsy (CP) is often deficient and manifests in a variety of impairments. Consequently, maintaining balance and controlling posture is impeded and results in an increased cost of locomotion and higher risk of falls. The margin of stability is an established measure to quantify dynamic stability during gait. It can be facilitated to analyze impaired control mechanisms, but it is unknown if and how people with CP manage to control the margin of stability during a more demanding motor task, such as running. How do people with cerebral palsy regulate dynamic stability during walking and running? Children and adolescents with bilateral cerebral palsy (N = 117; 50 female, 67 male; age 11.0 ± 3.2) were retrospectively included. All underwent instrumented 3D gait analysis, walking and running barefoot at a self-selected gait speed. People with CP were compared to a control group of N = 25 typically developed (TD). Repeated measures ANOVAs were computed to analyze group differences and multiple linear regressions to identify predictors for the medio-lateral margin of stability. The medio-lateral margin of stability was significantly higher in the CP group and was statistically unchanged during running. Different adaptions when running were particularly observed in the lateral trunk lean and step width, which remained high in CP, whereas the TD increased the trunk lean and reduced their step width. Step width was the main predictor for the medio-lateral margin of stability in both gait conditions. Young people with cerebral palsy manage to maintain their medio-lateral margin of stability during walking and running, however, with significantly higher safety margins compared to typically developed. This conservative strategy may reflect an adaption to motor and postural control impairments.

Rethwilm R ，Böhm H ，Haase M ，Perchthaler D ，Dussa CU ，Federolf P ... -  《-》

Discriminant ability and criterion validity of the Trunk Impairment Scale for cerebral palsy.

Pavão SL ，Maeda DA ，Corsi C ，Santos MMD ，Costa CSND ，de Campos AC ，Rocha NACF ... -  《-》