Effects Of Dual-tasking On Stability During Walking In Children With Cerebral Palsy

Abstract

Background: Many children with Cerebral Palsy (CP) have impaired walking abilities associated with poor maintenance of balance. Such impairments unseen in typically developing children include reduced walking speed, reduced step length, and wider step width. Further, dual-tasking has been associated with reductions in walking speed, stride length, step width and toe clearance compared to normal walking in children with CP but not in typically developing children. However, little is known about the effects of dual-tasking on other balance characteristics during walking in this population. PURPOSE: To examine the effects of dual-tasking on stability (dynamic balance) during walking in children with CP. METHODS: Five assenting children with CP (four boys, one girl; 7.0 ± 0.9 yrs, 125.7 ± 6.5 cm, 26.0 ± 4.5 kg) participated in the experiment and walked four times across a 3.4 m GAITRite® instrumented walkway system (CIR Systems Inc., GAITRite, Sparta, NJ; 120 Hz) at their self-selected speed. Next, participants completed the same walking protocol while simultaneously carrying a tray, similar to what they might do in a school lunchroom. Foot pressure data were extracted and analyzed by footfall (minimum 12 strides per participant) to compare velocity, unilateral step width, stride width, and base of support width for each condition. Data were evaluated using a single-subject procedure (Model Statistic, α = 0.05). RESULTS: Walking velocity decreased significantly when dual tasking for two children (44.0 cm/sec and 40.7 cm/sec, respectively; p < 0.05) while two other children elicited a significant velocity increase (9.4 cm/sec and 12.5 cm/sec, respectively; p < 0.05). Three children reduced base of support when dual-tasking (2.9 ± 2.8 cm, 5.1 ± 4.2 cm, 7.6 ± 7.5 cm, respectively; p < 0.05). Stride width was reduced in two children as a result of the dual-tasking condition (3.7 ± 1.8 cm and 2.3 ± 3.2 cm, respectively; p < 0.05), and one of five children showed reduced step width (9.7 ± 5.1 cm; p < 0.05). CONCLUSION: This dual-tasking condition significantly altered dynamic balance characteristics in children with CP, most notably velocity, base of support, and stride width. Whether this was a function of the observed change in self-selected walking velocity or a characteristic of the population warrants further investigation.