Title: Influence of increased weight on gait characteristics in children with cerebral palsy
Authors: Van Gestel, Leen
Meyns, Pieter
De Cock, Paul
Molenaers, Guy
Severijns, Deborah
Desloovere, Kaat #
Issue Date: Sep-2009
Conference: European Society of Movement Analysis in Adults and Children (ESMAC) edition:18 location:London, U.K. date:17-19 September 2009
Abstract: SUMMARY
Objective of the study was to explore changes in gait patterns caused by artificially enlarging
the impact of weakness in children with cerebral palsy (CP).
Walking with 10% extra weight in children with CP resulted in reduced walking speed, increased
crouch and decreased pelvic ROM.
One of the primary neurological motor deficits in CP is weakness. Overall moderate correlations
were found between lower limb strength and gait data1,2,3,4. Prediction on gait patterns based
upon clinical measurements, such as strength evaluation, remains limited5. Manipulating
primary neurological deficits, such as weakness, may enable a more precise evaluation and
objective quantification of the impact of the deficit on the gait pattern.
Ten children with CP (6 hemi-, 4 diplegia, mean age 8.9 years) were included into this
prospective pilot study (inclusion criteria: diagnosis of CP, 5-12 years of age, no history of
surgery or recent BTX-A treatment). All children first received full barefoot gait analysis (lower
limb kinematics and kinetics, 8 camera vicon system, 2 AMTI force plates, PlugInGait
markerset). Subsequently, extra gait trials were collected after indirectly enlarging the impact of
weakness on the gait pattern. Muscle strength was therefore relatively reduced by adding 10%
weight to the body, by means of a diving belt (lead was fixed to the belt). To avoid asymmetry,
the weight was evenly distributed around the waist, close to S-2, which is considered to be the
approximate location of the centre of mass. For each patient the gait analysis data of two trials
were used. 72 gait parameters per gait trial were compared between the baseline and extra
weight condition by one-way ANOVA (with posthoc Tuckey).
Children with CP who walked with
increased weight showed
significantly reduced walking
speed and a delayed timing of toeoff
compared to the baseline
condition. Extra weight also
caused increased knee flexion at
initial contact and an overall more
flexed position in stance.
Significant changes due to extra weight were also recognized at the hip and pelvis (Table 1).
This pilot study highlighted some changes in gait due to extra weight, which may be considered
as parameters that measure the ‘provoked’ weakness. Our conclusions concerning gait
parameters that are sensitive to weakness should be tentative as we have a limited number of
analysed patients so far. Future analysis in a larger group, including a control group of typical
children, and with increased intersubject variability for strength and functional level, can help to
recognize patients who walk with a gait pattern that is mainly related to overall weakness.
[1] Ross et al. (2007), Arch Phys Med Rehabil 8(8):1114-1120.
[2] Damiano et al. (2001), Eur J Neurol 8(5):40-49.
[3] Engsberg et al. (2006) Pediatr Phys Ther 18(4):266-275.
[4] Morton et al. (2005) Clinic Rehab 19(3):283-289.
Publication status: published
KU Leuven publication type: IMa
Appears in Collections:Movement Control & Neuroplasticity Research Group
Research Group for Neuromotor Rehabilitation
Brain & Metabolism Section (-)
Orthopaedics Section (-)
Youth Health (-)
# (joint) last author

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