Relative phase measures of intersegmental coordination describe motor control impairments in children with cerebral palsy who exhibit stiff-knee gait |
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| Institution: | 1. Center for Gait and Movement Analysis (CGMA), Children''s Hospital Colorado, Aurora, CO, USA;2. Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA;3. Medtronic Neurosurgery, Louisville, CO, USA;4. Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA;5. Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA;6. Department of Orthopedics, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA;1. School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada;2. Centre for Interdisciplinary Research in Rehabilitation, Lethbridge-Layton-MacKay Rehabilitation Centre, Montreal, Quebec, Canada;3. McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada;1. Department of Prosthetics and Orthotics, Faculty of Health Sciences, Hokkaido University of Science, Sapporo, Hokkaido, Japan;2. Orthocare Innovations, Edmonds, WA, USA;3. Lucille Packard Children''s Hospital, Stanford University, Motion & Sports Performance Laboratory, Palo Alto, CA, USA;4. Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, UT, USA;5. Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY, USA;6. Becker Orthopedic, Troy, MI, USA;1. University of Aachen Medical Center, Department of Orthopaedic Trauma, Pauwelsstraße 30, 52074 Aachen, Germany;2. University of Aachen Medical Center, Department of Diagnostic and Interventional Radiology, Pauwelsstraße 30, 52074 Aachen, Germany;3. University of Zurich, Department of Trauma, Rämistrasse 100, 8091 Zürich, Switzerland |
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| Abstract: | BackgroundThe purpose of this retrospective study was to explore lower limb intersegmental coordination as a clinically important indicator of motor control mechanisms in individuals with cerebral palsy exhibiting stiff-knee gait. We used the relative phase of thigh and foot segments around foot-off to describe motor control, given the relevance of the pre-swing phase of gait to the existence of stiff-knee gait.MethodsTraditional gait parameters and thigh/foot intersegmental coordination were calculated using pre-and postoperative kinematic data from a cohort of 54 subjects (92 legs) with spastic cerebral palsy. All participants had stiff-knee gait, walked without assistive devices, and underwent rectus femoris transfer surgery to improve swing period knee flexion. Analyses included correlations between a) preoperative intersegmental coordination and gait variables (knee flexion range, rate and gait performance) and b) pre-to-postoperative intersegmental coordination change and change in gait variables.FindingsThigh/foot intersegmental coordination significantly (P < 0.001) correlated with knee flexion range, rate and walking speed. Postoperative intersegmental coordination was significantly more uncoupled than preoperative. Pre-to-postoperative intersegmental coordination improvement also significantly correlated with improvements in knee flexion range, rate and walking speed. Pre-to-postoperative changes in intersegmental coordination accounted for 43% and 36% of variance in knee flexion range change and knee flexion rate change respectively.InterpretationIntersegmental coordination is a clinically important factor in knee flexion limitations associated with stiff-knee gait for individuals with cerebral palsy. These findings are a foundation for further study of intersegmental coordination measures as complements to traditional instrumented gait analysis. |
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