The gait is less stable in children with cerebral palsy in normal and dual-task gait compared to typically developed peers

Harri Piitulainen,Juha-Pekka Kulmala,Helena Mäenpää,Timo Rantalainen

doi:10.1016/j.jbiomech.2021.110244

Harri Piitulainen, Juha-Pekka Kulmala + Show 2 more

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https://doi.org/10.1016/j.jbiomech.2021.110244

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Abstract

There is limited evidence about gait stability and its alteration by concurrent motor and cognitive tasks in children with cerebral palsy (CP). We examined gait stability and how it is altered by constrained cognitive or motor task in CP and their typically developed (TD) controls.Gait kinematics were recorded using inertial-measurement units (IMU) from 18 patients with hemiplegia (13.5 ± 2.4 years), 12 with diplegia (13.0 ± 2.1 years), and 31 TD controls (13.5 ± 2.2 years) during unconstrained gait, and motor (carrying a tray) and cognitive (word naming) task constrained gait at preferred speed (~400 steps/task). Step duration, its standard deviation and refined-compound-multiscale entropy (RCME) were computed independently for vertical and resultant horizontal accelerations.Gait complexity was higher for patients with CP than TD in all tasks and directions (p < 0.001–0.01), being pronounced in vertical direction, cognitive task and for diplegic patients (p < 0.05–0.001). The gait complexity increased more (i.e. higher dual-task cost) from the unconstrained to the constrained gait in CP compared to TD (p < 0.05). Step duration was similar in all groups (p > 0.586), but its variation was higher in CP than TD (p < 0.001–0.05), and during the constrained than unconstrained gait in all groups (p < 0.01–0.001). The gait in children with CP was more complex and the dual-task cost was higher primarily for children with diplegic CP than TD during cognitive task, indicating that attentional load hinders their gait more. This raises the hypothesis that more attention and cortical resources are needed to compensate for the impaired gait in children with CP.

Highlights

Cerebral palsy (CP) is a permanent disorder affecting the motor development attributed to non-progressive lesion or trauma occurred prenatally or early in life in the developing brain (Bax et al, 2005)
The number of words listed during the cognitive task did not differ between the typically developed (TD) (17.3 ± 5.5 words/min), DP (14.1 ± 4.1 words/ min) and HP (13.7 ± 4.9 words/min) groups (p = 0.058)
Postural sway during static standing task was correlated with gait complexity both in vertical (r = 0.42, p = 0.001) and horizontal (r = 0.51, p < 0.001) directions (Fig. 2)

Summary

Introduction

Cerebral palsy (CP) is a permanent disorder affecting the motor development attributed to non-progressive lesion or trauma occurred prenatally or early in life in the developing brain (Bax et al, 2005). The gait in CP appears less stable than in typically developed (TD) controls, it is not straight forward to objectively quantify the gait stability (Bruijn et al, 2013a). The methods for this are emerging but may require sample of > 100 steps when using wearable assessment devices (Riva et al, 2014a), such as inertial measurement units (IMUs), and the derived indices can lack intuitive physical meaning. E.g., multiscalecomplexity measures, indicating the total amount of entropy can be challenging to interpret (Riva et al, 2013, 2014a).

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