Determinants of gait as applied to children with cerebral palsy.

In the present study, we quantified the isolated contributions of eight determinants of gait on the vertical center of mass (CoM) displacement of both typically developing children and children with cerebral palsy (CP). The role of these determinants, on vertical excursion, has never been examined for children or children with CP. We hypothesized that the relative contributions of the determinants to vertical CoM excursion of children with CP would be the same as the age-matched controls. We found that based on the similarities in the determinants effect on gait between the controls and adults reflect that children of this age walk with a mature gait. When applied to subjects with CP the determinant analysis found similar, but slightly exaggerated effects of those of the controls. All determinants that negatively affect CoM excursion were significantly worse in the children with CP, while those determinants that decreased excursion were varied. Heel rise, single support knee flexion, and pelvic obliquity had similar effects for on both groups. Pelvic rotation resulted in more excursion reduction in the controls, while leg inclination was more beneficial in reducing the CP groups excursion. The main cause for increased vertical excursion of the CoM in the children with CP was the increased knee flexion of both legs during double support. This excessive lowering of the CoM means that extra work is done to raise the CoM over the single support leg. The situation is aggravated by the fact that the CoM was lifted higher than typical because of the heel lifting during single support. Although these determinants allow quantification of the effects of gait kinematics and provide some useful information for gait they are limited in their ability to quantify the dynamics and kinetics of gait that are important for individuals with walking disabilities.