Common Gait Abnormalities of Each Joint in Children with Spastic Cerebral Palsy

OBJECTIVE: To investigate the prevalence of gait abnormalities of each joint of lower legs in children with spastic cerebral palsy (CP) and to find out the influences of subtype of CP, age, previous surgery and motor function on the gait abnormalities. METHOD: The gait analysis and foot scan from 320 children with CP were reviewed. Types of gait abnormalities were classified into 5 types for hip joint, 4 types for knee joint and 8 types for foot and ankle joint. The prevalence of gait abnormalities was assessed and the influence of subtype of CP, age, previous surgery and GMFCS (gross motor function classification system) level were also investigated. RESULTS: In foot and ankle joint, intoeing (63.8%) was the most common in all CP. In knee joint, jumping knee (32.8%) was the most common in diplegic and hemiplegic CP but crouch (47.6%) was the most common in quadriplegic CP. The likelihood of having planovalgus and crouch significantly increased with age and pes calcaneus increased after orthopaedic surgery. The children with lower functional level on GMFCS tended to show stiff and recurvatum knee pattern. CONCLUSION: Predominent gait abnormalities in each joint were assessed. Age, previous surgery, motor function and subtype of children with CP had a significant effect on the prevalence of gait abnormalities in each joint.

Acoustic Analysis of Vowel Sound in Children with Spastic Cerebral Palsy

OBJECTIVE: To investigate the acoustic characteristics of the vowel phonation in children with spastic cerebral palsy (CP) and normal children METHOD: Twenty-six children with spastic diplegic CP and seventeen normally developed children were recruited as subjects. Voice samples were collected by pronouncing at full length /a/, /i/, and /u/ three times each into a microphone. With these samples, maximum phonation time using Multi-speech model 3,700, fundamental frequency, jitter percent, shimmer percent, noise to harmony ratio using Multi-Dimensional Voice Program model 5105, and 1st formant, 2nd formant using PraatTM were measured. RESULTS: Maximum phonation time was significantly shorterin the CP group than normal group (p<0.05). Jitter percent and Shimmer percent were significantly increased in the CP group than in the normal group (p<0.05). Fundamental frequency, 1st formant and 2nd formant were not significantly different between the two groups. CONCLUSION: Relatively short duration of maximum phonation time in the CP group suggests poor respiratory control and capacity in children with CP. Higher level of shimmer percent in CP group indicates instability of voice quality that result from poor laryngeal function. No significant difference in 1st formant and 2nd formant between the CP and control group suggests similar vowel articulatory ability.

Comparison of Postural Control Mechanisms during Quiet Standing between Healthy Children and Children with Spastic Diplegic Cerebral Palsy

OBJECTIVE: To identify the difference of postural control mechanisms between healthy children and children with spastic diplegic cerebral palsy (CP) METHOD: Nineteen children with spastic diplegic CP and 22 healthy children were enrolled. Pressure data were recorded while subjects stood on the dual force platform and net body coordinates of center-of-pressure (COP) were calculated. Outcome measurements included net body COP calculations for path length, medio-lateral and antero-posterior displacements, and correlation coefficients between parameters representing ankle, hip and transverse body rotation mechanisms. RESULTS: Children with CP showed more medio-lateral and antero-posterior displacements compared to healthy children. The coordinate of net body COP showed more correlation with transverse body rotation parameters for both medio-lateral and antero-posterior rections, and less correlation with ankle mechanism parameters for medio-lateral direction in children with CP. The visual information did not show a significant influence on keeping balance during quiet standing in children with CP. CONCLUSION: This study revealed that the ankle control mechanism for medio-lateral balance control during quiet standing was less used in children with CP. The transverse body rotation mechanisms contributed more significantly to postural control during quiet standing in children with CP.