ABSTRACT
This study uses a recently developed trunk model to determine which head and trunk kinematic parameters differentiate children with spastic diplegia from typically developing (TD) children while walking. Differences in head and trunk parameters in relation to the severity of the motor involvement (GMFCS levels) were additionally examined. The trunk model consisted of five segments (pelvis, thorax, head, shoulder line, spine). Discrete kinematic parameters (ROM, mean position) and angular waveforms were compared between 20 children with spastic diplegia (age 9.8 years±2.9 years; GMFCS I: n=10, GMFCS II: n=10) and 20 individually age-matched TD children (9.7 years±3 years). A new measure for overall trunk pathology, the trunk profile score (TPS), was proposed and included in the comparative analysis. Compared to TD children, children with GMFCS II showed a significantly higher TPS and increased ROM for pelvis tilt, for thorax and head in nearly all planes, and the angle of kyphosis. In children with GMFCS I, only ROM of thorax lateral bending was significantly increased. Sagittal ROM differentiated best between GMFCS levels, with higher ROM found in children with GMFCS II. Current results provide new insights into head and trunk kinematics during gait in children with spastic diplegia.
Subject(s)
Cerebral Palsy/physiopathology , Gait Disorders, Neurologic/physiopathology , Head/physiopathology , Movement/physiology , Torso/physiopathology , Biomechanical Phenomena , Case-Control Studies , Cerebral Palsy/complications , Child , Female , Gait Disorders, Neurologic/etiology , Humans , Male , Pelvis/physiopathology , Range of Motion, Articular/physiology , Thorax/physiopathologyABSTRACT
This study describes the reliability of a clinically oriented model for three-dimensional movement analysis of head and trunk movements in children with spastic diplegia. The model consists of five rigid segments (head, thorax, pelvis, shoulder line, spine) and includes a detailed analysis of spinal segmental movements. Within and between session reliability during gait was tested in 10 children with spastic diplegia (6-14yrs). Reliability of discrete parameters was assessed with the intraclass correlation coefficient (ICC) and similarity of thorax and pelvis waveforms with the coefficient of multiple correlation (CMC). Measurement errors were calculated for all parameters (SEM, σ). Results indicated acceptable within and between session reliability of discrete parameters for thorax, pelvis, shoulder line, angle of kyphosis and the majority of the spinal segmental angles, reflected by low SEMs (<4°) and most ICCs>0.60. Within and between session waveform errors were below 4°. CMCs ranged from poor to very good, with highest values for movements in the frontal and transversal planes. The angle of lordosis showed lower between session reliability for several discrete parameters, although waveform errors were still below 5°. Head parameters showed lower overall reliability. The results of this study support the reliability of the proposed model. Head kinematic parameters should be interpreted with caution, due to difficulties in standardization. Accurate palpation of the spinal markers, especially the lumbar spine, is critical and demands thorough training of the assessor.
