Abstract
Upper body movements during walking provide information about balance control and gait stability. Typically developing (TD) children normally present a progressive decrease of accelerations from the pelvis to the head, whereas children with cerebral palsy (CP) exhibit a general increase of upper body accelerations. However, the literature describing how they are transmitted from the pelvis to the head is lacking. This study proposes a multilevel motion sensor approach to characterize upper body accelerations and how they propagate from pelvis to head in children with CP, comparing with their TD peers. Two age- and gender-matched groups of 20 children performed a 10m walking test at self-selected speed while wearing three magneto-inertial sensors located at pelvis, sternum, and head levels. The root mean square value of the accelerations at each level was computed in a local anatomical frame and its variation from lower to upper levels was described using attenuation coefficients. Between-group differences were assessed performing an ANCOVA, while the mutual dependence between acceleration components and the relationship between biomechanical parameters and typical clinical scores were investigated using Regression Analysis and Spearman’s Correlation, respectively (α = 0.05). New insights were obtained on how the CP group managed the transmission of accelerations through the upper body. Despite a significant reduction of the acceleration from pelvis to sternum, children with CP do not compensate for large accelerations, which are greater than in TD children. Furthermore, those with CP showed negative sternum-to-head attenuations, in agreement with the documented rigidity of the head-trunk system observed in this population. In addition, the estimated parameters proved to correlate with the scores used in daily clinical practice. The proposed multilevel approach was fruitful in highlighting CP-TD gait differences, supported the in-field quantitative gait assessment in children with CP and might prove beneficial to designing innovative intervention protocols based on pelvis stabilization.
Highlights
Locomotion is the result of a number of complex interactions involving neuromuscular activity, joint movements, bone alignment, and the rules that govern bodies in motion [1]
This study proposes a multilevel motion sensor approach to characterize upper body accelerations and how they propagate from pelvis to head in children with cerebral palsy (CP), comparing with their Typically developing (TD) peers
No significant differences was found between the TD and CP groups in either walking speed or normalized walking speed values
Summary
Locomotion is the result of a number of complex interactions involving neuromuscular activity, joint movements, bone alignment, and the rules that govern bodies in motion [1]. Since a considerable portion of the human body mass is located above the pelvis, the scientific literature is increasingly considering the analysis of upper body motion. In this respect, empirical observation suggests that the trunk plays an important dynamic role in balance control and gait stability [2,3]. Gait stability has been referred to as the capacity to minimize oscillations during walking from the lower to the upper levels of the human body [4]. Healthy subjects typically present a progressive reduction of acceleration from pelvis to sternum and from sternum to head which reflects the adoption of postural control strategies. In the case of any loss, or alteration, of physiological motor functions, as is the case of neurological disorders, the above mentioned control strategy can be defective, and the physiological stabilization of the head may be compromised
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