Abstract

The prevalence of childhood overweight and obesity is increasing in the last decades, also in children with Cerebral Palsy (CP). Even though it has been established that an increase in weight can have important negative effects on gait in healthy adults and children, it has not been investigated what the effect is of an increase in body weight on the characteristics of gait in children with CP. In CP, pre and post three-dimensional gait analyses are performed to assess the effectiveness of an intervention. As a considerable amount of time can elapse between these measurements, and the effect of an alteration in the body weight is not taken into consideration, this effect of increased body weight is of specific importance. Thirty children with the predominantly spastic type of CP and 15 typically developing (TD) children were enrolled (age 3–15 years). All children underwent three-dimensional gait analysis with weight-free (baseline) and weighted (10% of the body weight added around their waist) trials. Numerous gait parameters showed a different response to the added weight for TD and CP children. TD children increased walking velocity, step- and stride length, and decreased double support duration with a slightly earlier timing of foot-off, while the opposite was found in CP. Similarly, increased ranges of motion at the pelvis (coronal plane) and hip (all planes), higher joint angular velocities at the hip and ankle, as well as increased moments and powers at the hip, knee and ankle were observed for TD children, while CP children did not change or even showed decreases in the respective measures in response to walking with added weight. Further, while TD children increased their gastrocnemius EMG amplitude during weighted walking, CP children slightly decreased their gastrocnemius EMG amplitude. As such, an increase in weight has a significant effect on the gait pattern in CP children. Clinical gait analysts should therefore take into account the negative effects of increased weight during pre–post measurements to avoid misinterpretation of treatment results. Overweight and obesity in CP should be counteracted or prevented as the increased weight has detrimental effects on the gait pattern.

Highlights

  • According to the World Health Organization (WHO), in 2014 more than 1.9 billion adults were overweight

  • When children walked with added weight, changes in the gait pattern were observed for both typically developing children (TDc) and CPc

  • Increased ranges of motion at the pelvis and hip, as well as higher joint angular velocities at the hip and ankle appeared for TDc, while CPc did not seem to change or even decreased the respective ranges of motion and joint angular velocities in response to walking with added weight (Figure 2)

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Summary

Introduction

According to the World Health Organization (WHO), in 2014 more than 1.9 billion adults were overweight. Of these over 600 million were obese (World Health Organization, 2016b). In children an increase in overweight and obesity has been observed over the last decades (de Onis et al, 2010). This is the case in typically developing children (TDc), and in children that already present with a pathology; e.g., children with Cerebral Palsy (CPc) (Rogozinski et al, 2007; Park et al, 2011)

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