Abstract
Purpose: Motor impairments affect functional abilities and gait in children and adolescents with cerebral palsy (CP). Improving their walking is an essential objective of treatment, and the use of a treadmill for gait analysis and training could offer several advantages in adolescents with CP. However, there is a controversy regarding the similarity between treadmill and overground walking both for gait analysis and training in children and adolescents. The aim of this study was to compare the external mechanical work and pendular energy transduction of these two types of gait modalities at standard and preferred walking speeds in adolescents with unilateral cerebral palsy (UCP) and typically developing (TD) adolescents matched on age, height and body mass.Methods: Spatiotemporal parameters, external mechanical work and pendular energy transduction of walking were computed using two inertial sensors equipped with a triaxial accelerometer and gyroscope and compared in 10 UCP (14.2 ± 1.7 year) and 10 TD (14.1 ± 1.9 year) adolescents during treadmill and overground walking at standard and preferred speeds.Results: The treadmill induced almost identical mechanical changes to overground walking in TD adolescents and those with UCP, with the exception of potential and kinetic vertical and lateral mechanical works, which are both significantly increased in the overground-treadmill transition only in UCP (P < 0.05).Conclusions: Adolescents with UCP have a reduced adaptive capacity in absorbing and decelerating the speed created by a treadmill (i.e., dynamic stability) compared to TD adolescents. This may have an important implication in rehabilitation programs that assess and train gait by using a treadmill in adolescents with UCP.
Highlights
Walking impairments associated with neuromuscular weakness and low aerobic fitness may be involved in chronic fatigue and induce important limitations in the daily walking activity of children and adolescents with cerebral palsy (CP) compared with typically developing (TD) children and adolescents (Brunton and Rice, 2012)
We examined the hypothesis that preferred walking speed (PWS) would be faster overground in both groups compared to treadmill walking, and that for the two gait modalities the slower PWS in adolescents with CP would be associated with similar or higher External mechanical work (Wext) as compared to TD adolescents
The lateral Center of mass of the human body (COM) displacements were significantly higher in the overground condition compared to treadmill walking (P = 0.021) and in Unilateral cerebral palsy (UCP) compared with TD within both walking conditions (P < 0.001; Table 2)
Summary
Walking impairments associated with neuromuscular weakness and low aerobic fitness may be involved in chronic fatigue and induce important limitations in the daily walking activity of children and adolescents with cerebral palsy (CP) compared with typically developing (TD) children and adolescents (Brunton and Rice, 2012). One of the aims of therapeutic interventions is to help these patients achieve maximal independence by improving their functional capacity and mobility (Myrhaug et al, 2014). To improve their walking is an essential objective and the use of a treadmill for walking analysis and training may offer several advantages, such as the opportunity to repeat and train the gait cycle at controlled and fixed walking speeds. Recent evidence has indicated that similar neural networks may be involved in treadmill and overground walking (Choi and Bastian, 2007) and that there are only minor kinetic and spatiotemporal changes between these modalities for any given speed in healthy adults and children (i.e., a slightly increased step frequency and shorter step length
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