Trunk Kinematic Analysis during Gait in Cerebral Palsy Children with Crouch Gait Pattern

Abbasi, L; Rojhani-Shirazi, Z; Razeghi, M; Raeisi Shahraki, H

Trunk Kinematic Analysis during Gait in Cerebral Palsy Children with Crouch Gait Pattern

Document Type : Original Research

Authors

L Abbasi ¹

Z Rojhani-Shirazi ²^{, 3}

M Razeghi ²^{, 3}

H Raeisi Shahraki ⁴

¹ Student Research Committee, Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran

² Associated Professor, Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran

³ Rehabilitation Sciences Research Center,Shiraz University of Medical Sciences, Shiraz, Iran

⁴ Student Research Committee, Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

Background: Deficits in upper body movement have received little attention during gait in cerebral palsy (CP) children with crouch gait pattern (CGP).Objective: Purpose of this research is to describe the correlation of trunk movement with the excessive knee flexion and ankle kinematic in CP children with CGP.Methods: Gait analysis data from 57 limbs of diplegic CP children with CGP and 26 limbs of normal children was gathered. Kinematic parameters of trunk in relation to the pelvis were extracted in the sagittal, transverse and coronal planes. CP limbs were clustered using K-means cluster analysis according to the knee flexion angle at initial contact and the mean position of ankle joint during the stance phase of gait cycle, to three clusters. Pearson correlation coefficient between knee, ankle and trunk kinematic variables was assessed. Differences between clusters were analyzed with Kruskalâ€“Wallis and post hoc tests.Results: The results revealed: 1) crouch clusters had more trunk obliquity and rotation mean position than normal; 2) the range of motions of the trunk obliquity and rotation exhibited significant differences between crouch and normal clusters; 3) the level of excessive knee flexion had positive correlation with the trunk mean position in all planes; 4) the ankle kinematic at stance phase was associated with the trunk mean position in all planes.Conclusion: The results revealed the trunk mean position is correlated with the excessive knee flexion severity and ankle joint kinematic in CP children with CGP.

Keywords

Trunk Kinematic

cerebral palsy

Crouch Gait Pattern

Excessive Knee Flexion

Gait

Wren TA, Rethlefsen S, Kay RM. Prevalence of specific gait abnormalities in children with cerebral palsy: influence of cerebral palsy subtype, age, and previous surgery. Journal of Pediatric Orthopaedics. 2005;25(1):79-83.
Hoffinger SA, Rab GT, Abou-Ghaida H. Hamstrings in cerebral palsy crouch gait. Journal of Pediatric Orthopaedics. 1993;13(6):722-6.
Arnold AS, Anderson FC, Pandy MG, Delp SL. Muscular contributions to hip and knee extension during the single limb stance phase of normal gait: a framework for investigating the causes of crouch gait. Journal of biomechanics. 2005;38(11):2181-9.
Delp SL, Arnold AS, Speers RA, Moore CA. Hamstrings and psoas lengths during normal and crouch gait: Implications for muscle-tendon surgery. Journal of Orthopaedic Research. 1996;14(1):144-51.
Winter DA. Biomechanics and motor control of human movement: John Wiley & Sons; 2009.
Winter D, MacKinnon C, Ruder G, Wieman C. An integrated EMG/biomechanical model of upper body balance and posture during human gait. Progress in brain research. 1992;97:359-67.
Cheron G, Bouillot E, Dan B, Bengoetxea A, Draye J-P, Lacquaniti F. Development of a kinematic coordination pattern in toddler locomotion: planar covariation. Experimental brain research. 2001;137(3-4):455-66.
Scruffon D, Rosenbaum P. 5. LOCOMOTOR DEVELOPMENT IN CHILDREN WITH CEREBRAL PALSY. Clinics in Developmental Medicine. 1997(143):101-23.
Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007;109(suppl 109):8-14.
Nicholson J, Morton R, Attfield S, Rennie D. Assessment of upper-limb function and movement in children with cerebral palsy wearing lycra garments. Developmental Medicine & Child Neurology. 2001;43(6):384-91.
Rozumalski A, Schwartz MH. Crouch gait patterns defined using k-means cluster analysis are related to underlying clinical pathology. Gait & posture. 2009;30(2):155-60.
Toro B, Nester CJ, Farren PC. Cluster analysis for the extraction of sagittal gait patterns in children with cerebral palsy. Gait & posture. 2007;25(2):157-65.
Delp SL, Anderson FC, Arnold AS, Loan P, Habib A, John CT, et al. OpenSim: open-source software to create and analyze dynamic simulations of movement. Biomedical Engineering, IEEE Transactions on. 2007;54(11):1940-50.
Desailly E, Daniel Y, Sardain P, Lacouture P. Foot contact event detection using kinematic data in cerebral palsy children and normal adults gait. Gait & posture. 2009;29(1):76-80.
Heyrman L, Feys H, Molenaers G, Jaspers E, Monari D, Nieuwenhuys A, et al. Altered trunk movements during gait in children with spastic diplegia: Compensatory or underlying trunk control deficit? Research in developmental disabilities. 2014;35(9):2044-52.
Romkes J, Peeters W, Oosterom AM, Molenaar S, Bakels I, Brunner R. Evaluating upper body movements during gait in healthy children and children with diplegic cerebral palsy. Journal of Pediatric Orthopaedics B. 2007;16(3):175-80.
Attias M, Bonnefoy-Mazure A, Lempereur M, Lascombes P, De Coulon G, Armand S. Trunk movements during gait in cerebral palsy. Clinical Biomechanics. 2015;30(1):28-32.
Perry J, Burnfield JM. Gait analysis: normal and pathological function. 1992.
Lamoth CJC, Beek PJ, Meijer OG. Pelvis–thorax coordination in the transverse plane during gait. Gait & Posture. 2002;16(2):101-14.
Swinnen E, Baeyens J-P, Pintens S, Buyl R, Goossens M, Meeusen R, et al. Walking more slowly than with normal velocity: The influence on trunk and pelvis kinematics in young and older healthy persons. Clinical Biomechanics. 2013;28(7):800-6.
Kavanagh J, Barrett R, Morrison S. The role of the neck and trunk in facilitating head stability during walking. Experimental brain research. 2006;172(4):454-63.
Pozzo T, Berthoz A, Vitte E, Lefort L. Head stabilization during locomotion: perturbations induced by vestibular disorders. Acta Oto-Laryngologica. 1991;111(sup481):322-7.
Hoang HX, Reinbolt JA. Crouched posture maximizes ground reaction forces generated by muscles. Gait & Posture. 2012;36(3):405-8.
Armand S, Sangeux M, Baker R. Optimal markers’ placement on the thorax for clinical gait analysis. Gait & posture. 2014;39(1):147-53.
Bruijn SM, Meijer OG, van Dieën JH, Kingma I, Lamoth CJC. Coordination of leg swing, thorax rotations, and pelvis rotations during gait: The organisation of total body angular momentum. Gait & Posture. 2008;27(3):455-62.