Walking Patterns In Children Research Articles

Hubungan Manajemen Latihan dengan Parameter Pola Jalan pada Anak dengan Cerebral Palsy (CP)

Background: Cerebral Palsy is a non-progressive disorder due to the presence of lesions in the brain. This affects the early development of the baby which affects the ability to move, balance, and posture. Cerebral Palsy is causes of children's motor disabilities, mostly in decreasing the flexibility of lower extremity muscles and affecting the pattern of walking in sufferers. Objectives: This study aims to identify the relationship between exercise management and the Dynamic Gait Index (DGI) as a parameter of walking patterns in children with cerebral palsy. Research Design: This study used a descriptive observational-analytical cross sectional study in 15 cerebral palsy patients aged 4 to 19 years with GMFCS I-II and had received an exercise program of at least 8 weeks. Data analysis using the Spearman test on SPSS Statistics 26.0. Result: Obtained the value of p = 0.001 (p < 0.01) and the correlation coefficient (ρ) = 0.848 on the relationship of exercise intensity and road pattern parameters. Conclusion: There is a relationship between exercise management and gait pattern parameters.

Impact of Altered Gastrocnemius Morphometrics and Fascicle Behavior on Walking Patterns in Children With Spastic Cerebral Palsy.

Spastic cerebral palsy (SCP) affects neural control, deteriorates muscle morphometrics, and may progressively impair functional walking ability. Upon passive testing, gastrocnemius medialis (GM) muscle bellies or fascicles are typically shorter, thinner, and less extensible. Relationships between muscle and gait parameters might help to understand gait pathology and pathogenesis of spastic muscles. The current aim was to link resting and dynamic GM morphometrics and contractile fascicle behavior (both excursion and velocity) during walking to determinants of gait. We explored the associations between gait variables and ultrasonography of the GM muscle belly captured during rest and during gait in children with SCP [n = 15, gross motor function classification system (GMFCS) levels I and II, age: 7–16 years] and age-matched healthy peers (n = 17). The SCP children’s plantar flexors were 27% weaker. They walked 12% slower with more knee flexion produced 42% less peak ankle push-off power (all p < 0.05) and 7/15 landed on their forefoot. During the stance phase, fascicles in SCP on average operated on 9% shorter length (normalized to rest length) and displayed less and slower fascicle shortening (37 and 30.6%, respectively) during push-off (all p ≤ 0.024). Correlation analyses in SCP patients revealed that (1) longer-resting fascicles and thicker muscle bellies are positively correlated with walking speed and negatively to knee flexion (r = 0.60–0.69, p < 0.0127) but not to better ankle kinematics; (2) reduced muscle strength was associated with the extent of eccentric fascicle excursion (r = −0.57, p = 0.015); and (3) a shorter operating length of the fascicles was correlated with push-off power (r = −0.58, p = 0.013). Only in controls, a correlation (r = 0.61, p = 0.0054) between slower fascicle shortening velocity and push-off power was found. Our results indicate that a thicker gastrocnemius muscle belly and longer gastrocnemius muscle fascicles may be reasonable morphometric properties that should be targeted in interventions for individuals with SCP, since GM muscle atrophy may be related to decreases in walking speed and undesired knee flexion during gait. Furthermore, children with SCP and weaker gastrocnemius muscle may be more susceptible to chronic eccentric muscle overloading. The relationship between shorter operating length of the fascicles and push-off power may further support the idea of a compensation mechanism for the longer sarcomeres found in children with SCP. Nevertheless, more studies are needed to support our explorative findings.

Lesser magnitudes of lower extremity variability during terminal swing characterizes walking patterns in children with autism

BackgroundAnecdotally, children with Autism Spectrum Disorder have highly variable lower extremity walking patterns, yet, this has not been sufficiently quantified. As such, the purpose of this study was to examine walking pattern variability by way of lower extremity coordination and spatio-temporal characteristics in children with autism compared with individuals with typical development during over-ground walking. MethodsBilateral continuous relative phase variability was computed for the thigh-leg, leg-foot, and thigh-foot segment couples for 11 children with autism and 9 children with typical development at each gait sub-phase. Furthermore, left and right stride lengths and stride width were computed and compared. The Model Statistic was utilized to test for statistical differences in variability between each child with autism to an aggregate group with typical development. Effect sizes were computed to determine the meaningfulness between responses for children with autism and typical development. Coefficient of variation and effect sizes were computed for stride lengths and stride width. FindingsAnalysis revealed that children with autism exhibited differences in variability in each gait sub-phase. Notably, all but two children with autism exhibited lesser variability in all segment couples during terminal swing. Differences in stride lengths were relatively minimal, however, greater coefficient of variation magnitudes in stride width were observed in children with autism. InterpretationThis finding reveals that children with autism may have limited or a preferred movement strategy when preparing the foot for ground contact. The findings from this study suggest variability may be an identifiable characteristic during movement in children with autism.

Selective motor control correlates with gait abnormality in children with cerebral palsy

Children with bilateral cerebral palsy (CP) commonly have limited selective motor control (SMC). This affects their ability to complete functional tasks. The impact of impaired SMC on walking has yet to be fully understood. Measures of SMC have been shown to correlate with specific characteristics of gait, however the impact of SMC on overall gait pattern has not been reported. This study explored SMC data collected as part of routine gait analysis in children with bilateral CP.As part of their clinical assessment, SMC was measured with the Selective Control Assessment of the Lower Extremities (SCALE) in 194 patients with bilateral cerebral palsy attending for clinical gait analysis at a single centre. Their summed SCALE score was compared with overall gait impairment, as measured by Gait Profile Score (GPS).Score on SCALE showed a significant negative correlation with GPS (rs=−0.603, p<0.001). Cerebral injuries in CP result in damage to the motor tracts responsible for SMC. Our results indicate that this damage is also associated with changes in the development of walking pattern in children with CP.

Can Rhythmical Auditory Stimulation Alter Gait Pattern in Children with Asperger Syndrome?

The aims of this study were to evaluate the gait abnormalities in children with Asperger syndrome (AS) and to investigate the effectiveness of rhythmical auditory stimulation (RAS) on gait training in children with this condition. Five children with AS (mean age: 8.5 ± 2.0 years) and 6 children with normal development (mean age: 9.5 ± 2.0 years) participated in this study. The participants were asked to walk on a treadmill under each of the following conditions conducted in sequence: (1) walk at a comfortable speed with no RAS (baseline), (2) walk at a comfortable speed accompanied by RAS (sound-on condition), and (3) walk again at a comfortable speed with no RAS (sound-off condition). The temporal and kinematic gait parameters of the walking in each condition were recorded with a VICON 370 system. No significant differences were found among the baseline, sound-on, and sound-off gait parameters in either group. The children with AS rotated their pelvis more during walking than the control group did at baseline (p=0.018) and during the sound-on (p=0.011) condition. Moreover, the control group spent less time in the doubleleg supporting position in the sound-on and subsequent sound-off condition than the AS group did. No statistically significant differences were found between the two groups in all other gait parameters (i.e., step length, step width, step height, hip and knee joint angles at mid-stance phase of gait) in the three testing conditions. The children with AS demonstrated excessive pelvic rotation during walking when compared to children with normal development. A short period of gait training with RAS might not be able to improve the walking pattern in children with AS.

Is age or speed the predominant factor in the development of trunk movement in normally developing children?

BackgroundGait analysis is an increasingly used tool in the evaluation of neurological or orthopaedic problems in children. A good insight into age-related changes in normal paediatric gait is necessary to evaluate gait inefficiency caused by pathological walking patterns in children. However, no systematic evaluation of the normal development of trunk movement has yet been made. MethodsData of n=85 healthy children were available. They were asked to walk at self selected speed. The gait data were measured with the Vicon Plug-In-Gait model, including the trunk. We assessed gait cycles of thorax, spine and pelvis in the sagittal, frontal and transverse plane, respectively, stratified by age (categories: <4, 4–6, 7–9, 10–12 and 13–16 years) as well as by normalized speed (≤0.40, 0.41–0.49, ≥0.50). ResultsThe sagittal thorax and spine movement was found to be gradually and significantly associated with age, but less so with speed, indicating that, with increasing age, children tend to lean their trunk forward relative to both the global co-ordinate system and the pelvis. In contrast, the frontal and transverse parameters of spine and pelvic movement seemed to depend mainly on speed, not age. ConclusionOur study shows that age dependency has to be considered with respect to sagittal thorax and spine movements. This finding might be of great importance with respect to the identification of pathological patterns in trunk movement.

Does botulinum toxin A improve the walking pattern in children with idiopathic toe-walking?

Numerous recommendations have been made for treating idiopathic toe-walking (ITW), but the treatment results have been questioned. The purpose of this study was to investigate whether botulinum toxin A (BTX) improves the walking pattern in ITW as examined with 3-D gait analysis. A consecutive series of 15 children (aged 5-13 years) were enrolled in the study. The children underwent a 3-D gait analysis prior to treatment with a total of 6 units/kg bodyweight Botox(®) in the calf muscles and an exercise program. The gait analysis was repeated 3 weeks and 3, 6, and 12 months after treatment. A classification of toe-walking severity was made before treatment and after 12 months. The parents rated the perceived amount of toe-walking prior to treatment and 6 and 12 months after treatment. Eleven children completed the 12-month follow-up. The gait analysis results displayed a significant improvement, indicating decreased plantarflexion angle at initial contact and during swing phase and increased dorsiflexion angle during midstance at all post-treatment testing instances. According to the parents' perception of toe-walking, 3/11 children followed for 12 months had ceased toe-walking completely, 4/11 decreased toe-walking, and 4/11 continued toe-walking. After 6-12 months, the toe-walking severity classification improved in 9 of the 14 children for whom data could be assessed. A single injection of BTX in combination with an exercise program can improve the walking pattern in children with ITW seen at gait analysis, but the obvious goal of ceasing toe-walking is only occasionally reached.

Changes in soleus H-reflex modulation after treadmill training in children with cerebral palsy

In healthy children, short latency leg muscle reflexes are profoundly modulated throughout the step cycle in a functionally meaningful way and contribute to the electromyographic (EMG) pattern observed during gait. With maturation of the corticospinal tract, the reflex amplitudes are depressed via supraspinal inhibitory mechanisms. In the soleus muscle the rhythmic part of the modulation pattern is present in children with cerebral palsy (CP), but the development of tonic depression with increasing age, as seen in healthy children, is disturbed. Treadmill training clinically improves the walking pattern in children with CP. Presuming that short latency reflexes contribute significantly to the walking pattern, a change in the modulation may occur after training. The aim of this study was to assess whether treadmill training also improves the soleus reflex modulation during gait in children with CP. Seven children with CP underwent brief treadmill training for 10 min a day over 10 consecutive days; all of them were functional walkers. Soleus Hoffmann (H-) reflexes were investigated during walking on a treadmill before the first, and one day after the last, training session. Treadmill training led to a considerable clinical improvement in gait velocity. After 10 days of training, soleus H-reflexes during gait were almost completely depressed during the swing phase. The complete suppression of the soleus H-reflex during the swing phase, which is also exhibited by healthy subjects, could reflect an improvement towards a functionally more useful pattern. In conclusion, treadmill training can induce changes in the modulation of short latency reflexes during gait.

Dynamic Resources Used in Ambulation by Children With Spastic Hemiplegic Cerebral Palsy: Relationship to Kinematics, Energetics, and Asymmetries

The atypical walking pattern in children with spastic cerebral palsy is assumed to involve kinematic and morphological adaptations that allow them to move. The purpose of this study was to explore how the requirements of the task and the energy-generating and energy-conserving capabilities of children with cerebral palsy relate to kinematic and mechanical energy patterns of walking. Six children with hemiplegic cerebral palsy and a matched group of typically developing children participated in the study. Kinematic data were collected at 5 different walking speeds. Vertical stiffness, mechanical energy parameters, and landing angle were measured during the stance phase. The affected side of the children with cerebral palsy showed greater vertical stiffness, a greater ratio of kinetic forward energy to potential energy, and a smaller landing angle when compared with those of the nonaffected lower extremity and with those of typically developing children. Previous research has shown that children with cerebral palsy assumed a gait similar to an inverted pendulum on the nonaffected limb and a pogo stick on the affected limb. Our results indicate that asymmetries between lower extremities and differences from typically developing children in the landing angle of the lower extremity, vertical lower-extremity stiffness, and kinetic and potential energy profiles support the claim that walking patterns in children with spastic hemiplegic cerebral palsy emerge as a function of the resources available to them.