Obstacle Crossing During Gait in Children With Cerebral Palsy: Cross-Sectional Study With Kinematic Analysis of Dynamic Balance and Trunk Control.

Abstract

Balance problems are common in children who have cerebral palsy (CP) but are active and ambulant. Control of the whole-body center of mass is critical in maintaining dynamic stability during challenging mobility tasks, such as clearing an obstacle while walking. The objective of this study was to compare trunk and lower limb kinematics and center-of-mass control in children with CP and those in children with typical development during obstacle crossing. This was a cross-sectional study. Thirty-four children who were 5 to 17 years of age (17 with CP and 17 with typical development) and matched in age and height completed 2 gait trials involving crossing a 10-cm obstacle. Three-dimensional kinematic and kinetic data were captured with a general-purpose 3-dimensional motion tracking system and forceplates. Trunk data were captured with a validated model. All children cleared the obstacle with similar hip and knee kinematics, step length, and single-support duration. In children with CP, step width was increased by 4.81 cm, and center-of-mass velocity was significantly slower at lead limb toe-off (0.31 m/s) and during lead limb clearance (0.2 m/s). Children with CP showed altered trunk and pelvis movement, characterized by significantly greater pelvic obliquity, pelvic tilt, and trunk rotation throughout the task, increased lateral trunk lean during lead limb crossing (3.7°), and greater sagittal trunk movement as the trail limb crossed (5.1°). The study was not powered to analyze differences between children with diplegia and those with hemiplegia. Children with CP required greater adjustments at the trunk and pelvis to achieve successful obstacle crossing. The increase in trunk movement could have been compensatory for reduced stability distally or for a primary problem reflecting poor proximal control. The findings suggest that rehabilitation should focus on both proximal trunk control and distal stability to improve balance.