Évaluation de l’effet d’un plan incliné sur la marche des enfants avec paralysie cérébrale : quelles pistes pour la rééducation ?

Abstract

IntroductionPhysiotherapists lack scientific evidence regarding their interventions with children with cerebral palsy (CP), in particular on the use of inclined surface to improve their gait in ecological conditions. We propose to assess the benefit of inclined surface in rehabilitation on the knee kinematics and the muscular strengthening of diplegic children with “crouch gait”. MethodFive diplegic children and six typically developing (TD) children were included in this study. We measured the spatiotemporal, kinematic and muscular parameters during gait on flat floor, for three conditions of slopes on a treadmill and after a short training at a 7° slope. ResultsKnee flexion/extension range of motion increased with slope. Both CP or TD children maintained their knee extension during stance phase but increased their knee flexion at heel contact and at the end of swing phase. There was a tendency to increased activation of all the studied muscles in both groups. The strategy of propulsion was different between the groups. No post-effect was detected after the short training at 7°. Discussion/ConclusionWalking on ascending treadmill contributes to improved knee extension and muscular strengthening in children with crouch gait. We were not able to prove that this gain is maintained over time. However, we have to continue exploring methods of rehabilitation with inclined surface, to improve the intervention, and propose this protocol to hemiplegic children and children with stiff knee gait.