Abstract
This study analyzes the immediate effects of wearing a Therasuit on sagittal plane lower limb angular displacements during gait in children with unilateral spastic cerebral palsy (US-CP). Seven participants (median age = 7.00 years; ranging from 5.83 to 9.00 years) with US-CP, levels I and II of the Gross Motor Function Classification System, were assessed with kinematic gait analysis in three different conditions: (A) Baseline; (B) Therasuit without elastics and (C) Therasuit with elastics. Significant improvements were observed at the hip joint of both lower limbs during most of the gait cycle in participants wearing a Therasuit, including a decrease in the flexion pattern at the initial contact and swing phase in both lower limbs, and an increase in the extension pattern in the paretic lower limb during the stance phase. At the knee joint in the paretic lower limb, significant differences were found between the baseline and Therasuit with elastics conditions on the knee angle at initial contact, and between baseline and both Therasuit conditions on the flexion angle at swing phase. However, the inter-individual variability in kinematic patterns at the knee joint was high. At the ankle joint, decreased plantar flexion at initial contact and increased dorsiflexion during stance and swing phases were observed at the Therasuit with elastics condition, helping to correct the equinus-foot in the paretic lower limb during the whole gait cycle. The Z-values showed large effect sizes particularly for most of the angular hip variables in both lower limbs and for the angular ankle variables in the paretic lower limb. The Therasuit seems to have some positive immediate effects on gait kinematics in children with spastic unilateral cerebral palsy by providing a more functional and safer gait pattern. Future investigations with larger samples are recommended to further support these findings.
Highlights
Cerebral Palsy (CP) is a group of pediatric disorders presenting movement and posture symptoms caused by disturbances occurring during the development of the fetal or infant brain
For the NPLL differences were found at the following stages: (i) knee angle at initial contact between BL and TS without elastics (TSWE) (p = 0.008, r = 0.63), (ii) knee angle at mid-stance between BL and TSWE (p = 0.008, r = 0.63)
Our results seem to suggest that wearing a Therasuit promotes: [1] positive kinematic changes on gait pattern in the paretic lower limb; [2] decrease hip flexion angles at initial contact in both lower limbs; [3] increase of the extension pattern at the hip joint during stance phase in the paretic lower limb, and a decrease of the flexion pattern during swing phase in both lower limbs; [4] a decrease of the equinus-foot pattern at the ankle joint in the paretic lower limb, during whole gait cycle, on Therasuit R (TS) condition
Summary
Cerebral Palsy (CP) is a group of pediatric disorders presenting movement and posture symptoms caused by disturbances occurring during the development of the fetal or infant brain. Children with unilateral (or hemiplegic) spastic CP (US-CP) have multiple physical impairments, including muscle weakness, sensory loss, and spasticity, in the upper and lower limbs of one side of the body. Asymmetry between the paretic and the non-paretic sides is common [3], a decrease in muscle volume on the paretic side [4, 5] and lower limb length discrepency [6]. “hemiplegia” refers to disorders affecting only one side of the body, hemiplegic children often have motor impairments on the non-paretic side, in more severe types of hemiplegia, which are typically characterized by altered gait patterns in both lower limbs [10]. Physical therapy aims to maximize functional independence and minimize secondary complications [11]
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