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Lower-limb joint-coordination and coordination variability during gait in children with cerebral palsy

  • C. Dussault-Picard
    Correspondence
    Corresponding author at: School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Canada.
    Affiliations
    School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Canada

    Research Center of the Sainte-Justine University Hospital (CRCHUSJ), Canada
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  • P. Ippersiel
    Affiliations
    School of Physical and Occupational Therapy, McGill University, Canada

    Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Lethbridge-Layton-Mackay Rehabilitation Centre, Canada
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  • H. Böhm
    Affiliations
    Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bernauerstr, Chiemgau, Germany
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  • P.C. Dixon
    Affiliations
    School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Canada

    Research Center of the Sainte-Justine University Hospital (CRCHUSJ), Canada
    Search for articles by this author

      Highlights

      • Children with cerebral palsy used a Knee-Hip in-phase gait strategy.
      • Cerebral palsy had lower variability at Ankle-Knee and Knee-Hip joint pairs.
      • Impaired coordination in cerebral palsy is noticeable at specific gait events.
      • A knee-Hip in-phase gait strategy is related to fewer gait deviations.
      • Inter-joint coordination metrics are pertinent to assess motor control impairment.

      Abstract

      Background

      Children with cerebral palsy present with poor motor control, altering their ability to perform tasks such as walking. Continuous relative phase analysis is a popular method to quantify motor control impairments via inter-joint coordination and coordination variability; however, it has not been explored in children with cerebral palsy.

      Methods

      45 children with cerebral palsy and 45 typically developing children walked while fit with retroreflective markers. Continuous relative phase analysis for knee-hip and ankle-knee joint pairs quantified inter-joint coordination and coordination variability. The Gait Profile Score estimated gait pathology. Group differences were assessed with unpaired t-tests for coordination amplitude and variability (knee-hip, ankle-knee) across gait events. For the cerebral palsy group, correlations assessed the relation between the gait profile score and coordination metrics.

      Findings

      The cerebral palsy group showed more in-phase patterns for knee-hip coupling compared to the typically developing group (initial contact, loading response, mid-stance, terminal swing) (p ≤ 0.03). The cerebral palsy group showed lower knee-hip coordination variability (mid-stance, mid-swing) (p ≤ 0.037) and lower ankle-knee coordination variability (initial contact, loading response, terminal swing) (p < 0.001). The gait profile score correlated weakly to moderately (r = [0.323–0.472]), and negatively with the knee-hip inter-joint coordination (initial contact, loading response, mid-stance, terminal swing) (p ≤ 0.042).

      Interpretation

      Children with cerebral palsy showed a more in-phase gait strategy during challenging transitional gait cycle phases (beginning and end) and less flexible and adaptable motor behaviors. Moreover, the correlation between in-phase joint patterns and increased gait deviations (gait profile score) reinforces the relevance of coordination analysis to assess motor control impairment.

      Keywords

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      References

        • Armand S.
        • Decoulon G.
        • Bonnefoy-Mazure A.
        Gait analysis in children with cerebral palsy.
        EFORT Open Rev. 2016; 1: 448-460https://doi.org/10.1302/2058-5241.1.000052
        • Baker R.
        • McGinley J.L.
        • Schwartz M.H.
        • Beynon S.
        • Rozumalski A.
        • Graham H.K.
        • Tirosh O.
        The gait profile score and movement analysis profile.
        Gait Posture. 2009; 30: 265-269https://doi.org/10.1016/j.gaitpost.2009.05.020
        • Ballaz L.
        • Robert M.
        • Parent A.
        • Prince F.
        • Lemay M.
        Impaired visually guided weight-shifting ability in children with cerebral palsy.
        Res. Dev. Disabil. 2014; 35: 1970-1977https://doi.org/10.1016/j.ridd.2014.04.019
        • Burgess-Limerick R.
        • Abernethy B.
        • Neal R.J.
        Relative phase quantifies interjoint coordination.
        J. Biomech. 1993; 26: 91-94https://doi.org/10.1016/0021-9290(93)90617-N
        • Byrne J.E.
        • Stergiou N.
        • Blanke D.
        • Houser J.J.
        • Kurz M.J.
        • Hageman P.A.
        Comparison of gait patterns between young and elderly women: an examination of coordination.
        Percept. Mot. Skills. 2002; 94: 265-280https://doi.org/10.2466/pms.2002.94.1.265
        • Caballero C.
        • Davids K.
        • Heller B.
        • Wheat J.
        • Moreno F.J.
        Movement variability emerges in gait as adaptation to task constraints in dynamic environments.
        Gait Posture. 2019; 70: 1-5https://doi.org/10.1016/j.gaitpost.2019.02.002
        • Carollo J.J.
        • Worster K.
        • Pan Z.
        • Ma J.
        • Chang F.
        • Valvano J.
        Relative phase measures of intersegmental coordination describe motor control impairments in children with cerebral palsy who exhibit stiff-knee gait.
        Clin. Biomech. 2018; 59: 40-46https://doi.org/10.1016/j.clinbiomech.2018.07.015
        • Chiu S.-L.
        • Chou L.-S.
        Effect of walking speed on inter-joint coordination differs between young and elderly adults.
        J. Biomech. 2012; 45: 275-280https://doi.org/10.1016/j.jbiomech.2011.10.028
        • Cohen J.
        Statistical Power Analysis for the Behavioral Sciences.
        Elsevier, 1977https://doi.org/10.1016/C2013-0-10517-X
        • Dixon P.C.
        • Stebbins J.
        • Theologis T.
        • Zavatsky A.B.
        The use of turning tasks in clinical gait analysis for children with cerebral palsy.
        Clin. Biomech. 2016; 32: 286-294https://doi.org/10.1016/j.clinbiomech.2015.10.010
        • Dixon P.C.
        • Loh J.J.
        • Michaud-Paquette Y.
        • Pearsall D.J.
        biomechZoo: an open-source toolbox for the processing, analysis, and visualization of biomechanical movement data.
        Comput. Methods Prog. Biomed. 2017; 140: 1-10https://doi.org/10.1016/j.cmpb.2016.11.007
        • Dixon P.C.
        • Schütte K.H.
        • Vanwanseele B.
        • Jacobs J.V.
        • Dennerlein J.T.
        • Schiffman J.M.
        Gait adaptations of older adults on an uneven brick surface can be predicted by age-related physiological changes in strength.
        Gait Posture. 2018; 61: 257-262https://doi.org/10.1016/j.gaitpost.2018.01.027
        • Farmer S.E.
        • Pearce G.
        • Stewart C.
        Developing a technique to measure intra-limb coordination in gait: applicable to children with cerebral palsy.
        Gait Posture. 2008; 28: 217-221https://doi.org/10.1016/j.gaitpost.2007.12.005
        • Harbourne R.T.
        • Stergiou N.
        Movement variability and the use of nonlinear tools: principles to guide physical therapist practice.
        Phys. Ther. 2009; 89: 267-282https://doi.org/10.2522/ptj.20080130
        • Ialongo C.
        Understanding the effect size and its measures.
        Biochem. Medica. 2016; : 150-163https://doi.org/10.11613/BM.2016.015
        • Ippersiel P.
        • Robbins S.M.
        • Dixon P.C.
        Lower-limb coordination and variability during gait: the effects of age and walking surface.
        Gait Posture. 2021; 85: 251-257https://doi.org/10.1016/j.gaitpost.2021.02.009
        • Kadaba M.P.
        • Ramakrishnan H.K.
        • Wootten M.E.
        Measurement of lower extremity kinematics during level walking.
        J. Orthop. Res. 1990; 8: 383-392https://doi.org/10.1002/jor.1100080310
        • Lamb P.F.
        • Stöckl M.
        On the use of continuous relative phase: review of current approaches and outline for a new standard.
        Clin. Biomech. 2014; 29: 484-493https://doi.org/10.1016/j.clinbiomech.2014.03.008
        • Meyns P.
        • Van Gestel L.
        • Bruijn S.M.
        • Desloovere K.
        • Swinnen S.P.
        • Duysens J.
        Is interlimb coordination during walking preserved in children with cerebral palsy?.
        Res. Dev. Disabil. 2012; 33: 1418-1428https://doi.org/10.1016/j.ridd.2012.03.020
        • Perry J.
        • Burnfield J.M.
        Gait Analysis: Normal and Pathological Function.
        2nd ed. SLACK, Thorofare, NJ2010
        • Peters B.T.
        • Haddad J.M.
        • Heiderscheit B.C.
        • Van Emmerik R.E.A.
        • Hamill J.
        Limitations in the use and interpretation of continuous relative phase.
        J. Biomech. 2003; 36: 271-274https://doi.org/10.1016/S0021-9290(02)00341-X
        • Rosenbaum P.
        • Paneth N.
        • Leviton A.
        • Goldstein M.
        • Bax M.
        • Damiano D.
        • Dan B.
        • Jacobsson B.
        A report: the definition and classification of cerebral palsy April 2006.
        Dev. Med. Child Neurol. Suppl. 2007; 109: 8-14
        • Sanger T.D.
        • Chen D.
        • Delgado M.R.
        • Gaebler-Spira D.
        • Hallett M.
        • Mink J.W.
        • the Taskforce on Childhood Motor Disorders
        Definition and classification of negative motor signs in childhood.
        Pediatrics. 2006; 118: 2159-2167https://doi.org/10.1542/peds.2005-3016
        • Schober P.
        • Boer C.
        • Schwarte L.A.
        Correlation coefficients: appropriate use and interpretation.
        Anesth. Analg. 2018; 126: 1763-1768https://doi.org/10.1213/ANE.0000000000002864
        • Stergiou N.
        • Decker L.M.
        Human movement variability, nonlinear dynamics, and pathology: is there a connection?.
        Hum. Mov. Sci. 2011; 30: 869-888https://doi.org/10.1016/j.humov.2011.06.002
        • Stergiou N.
        • Jensen J.L.
        • Bates B.T.
        • Scholten S.D.
        • Tzetzis G.
        A dynamical systems investigation of lower extremity coordination during running over obstacles.
        Clin. Biomech. 2001; 16: 213-221https://doi.org/10.1016/S0268-0033(00)00090-5
        • Stergiou N.
        • Harbourne R.T.
        • Cavanaugh J.T.
        Optimal movement variability: a new theoretical perspective for neurologic physical therapy.
        J. Neurol. Phys. Ther. 2006; 30: 120-129https://doi.org/10.1097/01.NPT.0000281949.48193.d9
        • Wu M.
        • Kim J.
        • Arora P.
        • Gaebler-Spira D.J.
        • Zhang Y.
        Effects of the integration of dynamic weight shifting training into treadmill training on walking function of children with cerebral palsy: a randomized controlled study.
        Am. J. Phys. Med. Rehabil. 2017; https://doi.org/10.1097/PHM.0000000000000776