Motion of the center of mass in children with spastic hemiplegia: balance, energy transfer, and work performed by the affected leg vs. the unaffected leg.

Asymmetry between limbs in people with spastic hemiplegic cerebral palsy (HEMI) adversely affects limb coordination and energy generation and consumption. This study compared how the affected leg and the unaffected leg of children with HEMI would differ based on which leg trails. Full-body gait analysis data and force-plate data were analyzed for 31 children (11.9 ± 3.8 years) with HEMI and 23 children (11.1 ± 3.1 years) with typical development (TD). Results showed that peak posterior center of mass-center of pressure (COM-COP) inclination angles of HEMI were smaller than TD when the affected leg trailed but not when the unaffected leg trailed. HEMI showed greater peak medial COM-COP inclination angles and wider step width than TD, no matter which leg trailed. More importantly, when the affected leg of HEMI trailed, it did not perform enough positive work during double support to propel COM motion. Consequently, the unaffected leg had to perform additional positive work during the early portion of single support, which costs more energy. When the unaffected leg trailed, the affected leg performed more negative work during double support; therefore, more positive work was still needed during early single support, but energy efficiency was closer to that of TD. Energy recovery factor was lower when the affected leg trailed than when the unaffected leg trailed; both were lower than TD. These findings suggest that the trailing leg plays a significant role in propelling COM motion during double support, and the 'unaffected' side of HEMI may not be completely unaffected. It is important to strengthen both legs.