Abstract
This study was conducted to investigate the effects of asymmetrical body posture alone, i.e., the effects seen in children with mild scoliosis, vs. the effects of body posture control impairment, i.e., those seen in children with unilateral cerebral palsy on gait patterns. Three-dimensional instrumented gait analysis (3DGA) was conducted in 45 children with hemiplegia and 51 children with mild scoliosis. All the children were able to walk without assistance devices. A set of 35 selected spatiotemporal gait and kinematics parameters were evaluated when subjects walked on a treadmill. A cluster analysis revealed 3 different gait patterns: a scoliotic gait pattern and 2 different hemiplegic gait patterns. The results showed that the discrepancy in gait patterns was not simply a lower limb kinematic deviation in the sagittal plane, as expected. Additional altered kinematics, such as pelvic misorientation in the coronal plane in both the stance and swing phases and inadequate stance phase hip ad/abduction, which resulted from postural pattern features, were distinguished between the 3 gait patterns. Our study provides evidence for a strong correlation between postural and gait patterns in children with unilateral cerebral palsy. Information on differences in gait patterns may be used to improve the guidelines for early therapy for children with hemiplegia before abnormal gait patterns are fully established. The gait pathology characteristic of scoliotic children is a potential new direction for treating scoliosis that complements the standard posture and walking control therapy exercises with the use of biofeedback.
Highlights
Scoliosis is primarily considered to be a structural deformation of the spine; the majority of patients with this diagnosis exhibit structural changes in the pelvic drop as part of the scoliotic curve [1]
These differences are illustrated by the variety of different classifications of hemiplegic gaits: 4 groups of hemiplegic gait patterns found by Winters et al [9], 5 types of gait disturbances described by Hullin and coworkers [10] and 8 different gait patterns in children with hemiplegia reported by Stebbins et al [11]
Three gait patterns emerged in accordance with the diagnosis, SPP, PGPP, and AGPP, and were found to clearly correspond to the cluster patterns defined as follows: 1. Scoliotic gait pattern (SGP) (Cluster 2) 2
Summary
Scoliosis is primarily considered to be a structural deformation of the spine; the majority of patients with this diagnosis exhibit structural changes in the pelvic drop as part of the scoliotic curve [1]. In children with cerebral palsy (CP), abnormal gait patterns are observed immediately, resulting from functional strategies to compensate for primary anomalies. The gait patterns in children with unilateral CP share several typical features involved in the mechanism of their gait disturbances but differ inter-individually according to the extent and the location of the cerebral injury These differences are illustrated by the variety of different classifications of hemiplegic gaits: 4 groups of hemiplegic gait patterns found by Winters et al [9], 5 types of gait disturbances described by Hullin and coworkers [10] and 8 different gait patterns in children with hemiplegia reported by Stebbins et al [11]. Most classifications of CP gait have been constructed using only sagittal plane data
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