Abstract
Observational research suggests that in children with cerebral palsy, the altered arm swing is linked to instability during walking. Therefore, the current study investigates whether children with cerebral palsy use their arms more than typically developing children, to enhance gait stability. Evidence also suggests an influence of walking speed on gait stability. Moreover, previous research highlighted a link between walking speed and arm swing. Hence, the experiment aimed to explore differences between typically developing children and children with cerebral palsy taking into account the combined influence of restricting arm swing and increasing walking speed on gait stability. Spatiotemporal gait characteristics, trunk movement parameters and margins of stability were obtained using three dimensional gait analysis to assess gait stability of 26 children with cerebral palsy and 24 typically developing children. Four walking conditions were evaluated: (i) free arm swing and preferred walking speed; (ii) restricted arm swing and preferred walking speed; (iii) free arm swing and high walking speed; and (iv) restricted arm swing and high walking speed. Double support time and trunk acceleration variability increased more when arm swing was restricted in children with bilateral cerebral palsy compared to typically developing children and children with unilateral cerebral palsy. Trunk sway velocity increased more when walking speed was increased in children with unilateral cerebral palsy compared to children with bilateral cerebral palsy and typically developing children and in children with bilateral cerebral palsy compared to typically developing children. Trunk sway velocity increased more when both arm swing was restricted and walking speed was increased in children with bilateral cerebral palsy compared to typically developing children. It is proposed that facilitating arm swing during gait rehabilitation can improve gait stability and decrease trunk movements in children with cerebral palsy. The current results thereby partly support the suggestion that facilitating arm swing in specific situations possibly enhances safety and reduces the risk of falling in children with cerebral palsy.
Highlights
The forelimbs have a clear locomotor function in quadrupedal walking
It is hypothesized that gait stability would decrease more in children with bilateral cerebral palsy compared to children with unilateral cerebral palsy when arm swing is restricted
It was expected that gait stability would decrease more in children with bilateral cerebral palsy compared to children with unilateral cerebral palsy when arm swing is restricted
Summary
The forelimbs have a clear locomotor function in quadrupedal walking. In human walking, this function most likely changed as the upper limbs do not make contact to the ground during upright walking. Previous research found that arm swing amplitude was decreased on the hemiplegic side compared to the non-hemiplegic side in children with unilateral cerebral palsy (Meyns et al, 2011). The altered arm swing amplitude and arm posture changed inter-limb coordination in children with cerebral palsy (Meyns et al, 2012b). Children with cerebral palsy showed less stable coordination patterns and altered arm-leg movement frequency ratios compared to typically developing children (Meyns et al, 2012b)
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