The Magnitude of Temporal–Spatial Gait Asymmetry Is Related to the Proficiency of Dynamic Balance Control in Children with Hemiplegic Cerebral Palsy: An Analytical Inquiry

• Published in: Symmetry (Basel) 2024-10, Vol.16 (10), p.1274
• Main Author: Elnaggar, Ragab K
• Format: Article
• Language: English
• Subjects: Analysis; Asymmetry; Balance; base of support; Cerebral palsy; Correlation; dynamic balance control; Gait; gait analysis; gait symmetry index; Heels; Investigations; Kinematics; Laboratories; Mobility; Pediatrics; Physical therapy; Rehabilitation; Software; Spasticity; Stability; Walking
• ISSN: 2073-8994; 2073-8994
• DOI: 10.3390/sym16101274

Children with hemiplegic cerebral palsy (hemi-CP) frequently experience deficits in dynamic balance, a crucial factor influencing gait function. This imbalance can manifest as temporal–spatial gait asymmetry, where movement patterns differ between the affected and less affected sides. This study investigated how temporal–spatial gait asymmetries and dynamic balance are associated in children with hemi-CP. Eighty-five children with hemi-CP (age: 13.27 ± 1.72 years) were included. The temporal (AITemporal) and spatial (AISpatial) gait asymmetry indices were, respectively, computed with reference to the swing time and step length of affected and less affected sides, which were collected through a 3D gait analysis. Measures of dynamic balance included the directional dynamic limit-of-stability (D-LOSdirectional) assessed across multiple directions (forward, rearward, affected, and less affected) and the overall dynamic limit-of-stability (D-LOSoverall) during static stance, in addition to the heel-to-heel base of support (BOSH-to-H) during walking, the dynamic gait index (DynGI), and the Timed Up and Down Stair (TUDS) test.The D-LOSoverall correlated negatively with the temporal (r = −0.437, p < 0.001) and spatial (r = −0.279, p = 0.009) asymmetries. The D-LOSdirectional (forward, rearward, affected, and less affected) correlated negatively with temporal asymmetry (r ranged from −0.219 to −0.411, all p < 0.05), but only the D-LOSdirectional rearward (r = −0.325, p = 0.002) and less affected (r = −0.216, p = 0.046) correlated with spatial asymmetry. The BOSH-to-H correlated positively with both temporal (r = 0.694, p < 0.001) and spatial (r = 0.503, p < 0.001) asymmetries. The variation in D-LOSoverall and BOSH-to-H accounted for 19.1% and 48.2%, respectively, of the variations in the temporal asymmetry and 7.8% and 25.3% of the variations in the spatial asymmetry. The findings of this study suggest that dynamic balance control is related to the magnitude of temporal–spatial gait asymmetries in children with hemi-CP. This evidence lays the groundwork for further research into the mechanism linking gait asymmetry and dynamic balance, potentially leading to a deeper understanding of these impairments, while also highlighting the need for longitudinal studies with the inclusion of a broader population to enhance the generalizability of the findings.