Effect of supporting 3D-garment on gait postural stability in children with bilateral spastic cerebral palsy.

BACKGROUND: Children with cerebral palsy show dysfunctional postural control which interferes with their functional performance and daily-life activities. OBJECTIVE: The aim of the study was to identify the effect of a 3D supporting garment on trunk postural control and interjoint coordination during gait in children with bilateral cerebral palsy. METHODS: We analyzed tridimensional trunk motion, trunk-thigh and interjoint coordination in 15 4-10 year-old children with bilateral spastic cerebral palsy (GMFCS I or II) and 16 4-10 year-old typically developing children while walking with or without a supporting garment. RESULTS: We found significantly changes in the coordination between trunk and lower limbs in children with cerebral palsy. Step velocity and cadence both increased significantly in children with cerebral palsy but in controls, the cadence remained unaltered. Interjoint coordination between hip-knee and knee-ankle was altered during the stance phase only in the subgroup of children with cerebral palsy without any limitations in ankle joint passive range of motion. CONCLUSION: 3D supporting garments improve trunk-thigh and lower limb interjoint coordination in walking in children with bilateral cerebral palsy.

Influence of botulinum toxin therapy on postural control and lower limb intersegmental coordination in children with spastic cerebral palsy.

Botulinum toxin injections may significantly improve lower limb kinematics in gait of children with spastic forms of cerebral palsy. Here we aimed to analyze the effect of lower limb botulinum toxin injections on trunk postural control and lower limb intralimb (intersegmental) coordination in children with spastic diplegia or spastic hemiplegia (GMFCS I or II). We recorded tridimensional trunk kinematics and thigh, shank and foot elevation angles in fourteen 3-12 year-old children with spastic diplegia and 14 with spastic hemiplegia while walking either barefoot or with ankle-foot orthoses (AFO) before and after botulinum toxin infiltration according to a management protocol. We found significantly greater trunk excursions in the transverse plane (barefoot condition) and in the frontal plane (AFO condition). Intralimb coordination showed significant differences only in the barefoot condition, suggesting that reducing the degrees of freedom may limit the emergence of selective coordination. Minimal relative phase analysis showed differences between the groups (diplegia and hemiplegia) but there were no significant alterations unless the children wore AFO. We conclude that botulinum toxin injection in lower limb spastic muscles leads to changes in motor planning, including through interference with trunk stability, but a combination of therapies (orthoses and physical therapy) is needed in order to learn new motor strategies.

Effect of ankle-foot orthoses on trunk sway and lower limb intersegmental coordination in children with bilateral cerebral palsy.

INTRODUCTION: Ankle-foot orthoses may significantly improve lower limb kinematics in the gait of children with cerebral palsy. Here we aimed to analyze the effect of ankle-foot orthoses on trunk postural control and lower limb intersegmental coordination in children with mild spastic diplegia (GMFCS I or II). METHODS: We recorded tridimensional trunk kinematics and thigh, shank, and foot elevation angles in 20 4-12 year-old children born preterm with spastic diplegia and 20 typically developing children while walking either barefoot or with ankle-foot orthoses. RESULTS: We found significantly greater trunk excursions in children with cerebral palsy compared to typically developing children in both conditions. When wearing ankle-foot orthoses cerebral palsy children showed increased trunk frontal angular velocity. No significant changes in trunk displacement and angular velocity were recorded in the sagittal plane in either group. Typically developing children wearing orthoses showed increased trunk frontal displacement. Wearing orthoses induced significant changes in shank and foot elevation in both groups. CONCLUSION: Ankle-foot orthoses affect postural control and intersegmental coordination in children with cerebral palsy. This should be taken into account when planning therapeutic management.

Effect of ankle-foot orthoses on gait in typically developing children: Developmental trend in segmental coordination.

OBJECTIVE: As orthoses, and particularly ankle-foot orthoses, are widely used in the management of children with motor disorders, including cerebral palsy, we aimed to study their effect in normal children in order to add to normative gait data, which are essential for diagnosing, understanding and treating abnormal gait patterns. DESIGN: We analyzed the effect of ankle-foot orthoses on classical gait parameters and lower limb segments coordination patterns in typically developing children in two age groups reflecting different neuromaturational/developmental situations. We recorded 3D kinematic gait patterns in 9 children (4-5 years) and 11 children (9-10 years) walking barefoot or wearing bilateral solid ankle-foot orthoses maintaining the ankle joint angle at a neutral position. RESULTS: Ankle-foot orthoses induced little change in cadence, step length, step width or walking velocity in younger children, though they altered intralimb coordination through the gait cycle. In older children, walking velocity was reduced, shank elevation amplitude increased, while lower limb coordination changed less significantly. In this age group, ankle-foot orthoses significantly reduced the variability of coordinative strategies. CONCLUSION: Ankle-foot orthoses affect the gait pattern in children with a typical development at different levels in younger and older subjects, but the resulting changes are minimal.