Anca Irina Grigoriu1, Mathieu Lempereur2, Sandra Bouvier3, Liliana Padure4, Sylvain Brochard5. 1. National Center of Neurologic Rehabilitation for Children "Dr. N. Robanescu", Bucharest, Romania; Laboratoire de Traitement de l'Information Médicale, Inserm UMR 1101, Brest, France. Electronic address: an_ir_ra@yahoo.fr. 2. Laboratoire de Traitement de l'Information Médicale, Inserm UMR 1101, Brest, France; Université de Bretagne Occidentale, Brest, France; Department of physical and medical rehabilitation, CHRU MORVAN, Brest, France. 3. Laboratoire de Traitement de l'Information Médicale, Inserm UMR 1101, Brest, France. 4. National Center of Neurologic Rehabilitation for Children "Dr. N. Robanescu", Bucharest, Romania; University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania. 5. Laboratoire de Traitement de l'Information Médicale, Inserm UMR 1101, Brest, France; Université de Bretagne Occidentale, Brest, France; Department of physical and medical rehabilitation, CHRU MORVAN, Brest, France; Department of pediatric physical and medical rehabilitation, Fondation ILDYS, Brest, France.
Abstract
BACKGROUND: Knowledge of the characteristics of newly acquired gait in toddlers with cerebral palsy (CP) is limited. OBJECTIVES: This study compared gait characteristics (spatiotemporal parameters, kinematics and lower-limb muscle activation) within the first 6 months of independent walking in toddlers with unilateral cerebral palsy (UCP) and typically developing (TD) children. METHODS: The gait of 28 TD toddlers and 13 toddlers with UCP, all up to 3 years old with maximum walking experience of 6 months, was recorded by using a 3-D optoelectronic system and surface electromyography (EMG). Statistical parametric mapping was used to compare the kinematic parameters and EMG envelopes. Mann-Whitney U test was used to compare spatiotemporal parameters between groups. Principal component analysis was used to determine whether the main kinematic results were related to the clinical measures. RESULTS: Toddlers with UCP had bilateral modifications of the spatiotemporal parameters during gait as compared with TD toddlers and temporal asymmetry. The largest kinematic difference between the UCP and TD groups was external pelvic rotation on the affected side (13.3°). Foot progression angle was external during swing phase on the affected side. The groups did not differ in muscle activation for the set of muscles recorded. Pelvic rotation was not associated with any of the clinical measures on the affected or non-affected sides of toddlers with UCP. CONCLUSIONS: Alterations in kinematic gait parameters were mostly found at the pelvis in toddlers with UCP and newly acquired gait. At that age, the external pelvic rotation on the affected side is more likely due to primary motor control disorders than compensatory mechanisms. These findings suggest that early rehabilitation should focus on proximal motor control, balance and symmetry to optimize gait development from the early stages in children with UCP.
BACKGROUND: Knowledge of the characteristics of newly acquired gait in toddlers with cerebral palsy (CP) is limited. OBJECTIVES: This study compared gait characteristics (spatiotemporal parameters, kinematics and lower-limb muscle activation) within the first 6 months of independent walking in toddlers with unilateral cerebral palsy (UCP) and typically developing (TD) children. METHODS: The gait of 28 TD toddlers and 13 toddlers with UCP, all up to 3 years old with maximum walking experience of 6 months, was recorded by using a 3-D optoelectronic system and surface electromyography (EMG). Statistical parametric mapping was used to compare the kinematic parameters and EMG envelopes. Mann-Whitney U test was used to compare spatiotemporal parameters between groups. Principal component analysis was used to determine whether the main kinematic results were related to the clinical measures. RESULTS: Toddlers with UCP had bilateral modifications of the spatiotemporal parameters during gait as compared with TD toddlers and temporal asymmetry. The largest kinematic difference between the UCP and TD groups was external pelvic rotation on the affected side (13.3°). Foot progression angle was external during swing phase on the affected side. The groups did not differ in muscle activation for the set of muscles recorded. Pelvic rotation was not associated with any of the clinical measures on the affected or non-affected sides of toddlers with UCP. CONCLUSIONS: Alterations in kinematic gait parameters were mostly found at the pelvis in toddlers with UCP and newly acquired gait. At that age, the external pelvic rotation on the affected side is more likely due to primary motor control disorders than compensatory mechanisms. These findings suggest that early rehabilitation should focus on proximal motor control, balance and symmetry to optimize gait development from the early stages in children with UCP.