Changes in intersegmental stability during gait in patients with spastic cerebral palsy.

Abstract

Dysfunction in peripheral and neural structure with spastic cerebral palsy (CP) causes impaired performance and stability of various behaviors. Recent progress of quantification methods for the stability properties, which is based on the uncontrolled manifold hypothesis, has been applied to various neurological disorders. A prior study revealed that the ability for purposeful regulation of stability properties is weakened with CP during finger and hand actions. Successive regulation of stability properties is crucial for human locomotion; therefore, it is imperative to quantify the changes in the intersegmental coordination as to the stable performance in CP individuals during gait. We hypothesized that (1) Spastic CP group will show smaller step length and gait velocity with larger variability, and (2) Spastic CP group will show no changes in average stability indices for both the COM and head position stabilization, while the smaller difference between stable and unstable posture during the gait cycle. Whole-body kinematic data during walking were collected from CP and control subjects. Step length, velocity, and coefficient of variation (CV) were calculated as spatiotemporal parameters. We quantified the intersegmental stability index in time-series during gait for the stabilization of the whole-body COM and head position. The CP subjects showed smaller step length and velocity with larger CV than the controls. However, the CP group showed a significantly less difference in the stability indices between the single- and double-limb support phases as compared to the controls for both the COM and head position stabilization. Present study is the first to document the quantification of changing intersegmental stability in the spastic CP during locomotion. The dysfunction of intentional modulation of stability properties in CP individuals may be a more common problem, which is not limited to a specific body effector.