The dynamics of gait in children with spastic hemiplegic cerebral palsy: Theoretical and clinical implications

• Published in: Human movement science 2000-08, Vol.19 (3), p.375-405
• Main Authors: Holt, Kenneth G., Fonseca, Sergio T., LaFiandra, Michael E.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Cerebral palsy; Dynamic systems; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Locomotion; Medical sciences; Nervous system (semeiology, syndromes); Neurology; Stiffness
• ISSN: 0167-9457; 1872-7646
• DOI: 10.1016/S0167-9457(00)00019-1

Previously, we suggested that neurological insults will change the dynamic resources available to an individual, and a pattern will emerge that is specified by, and facilitates the use of the available resources [K.G. Holt, J. Obusek, S.T. Fonseca, Human Movement Science, 15 (1996) 177]. Dynamic resources refer to the sources of energy (e.g., muscular force, elasticity energy return from soft tissues, and pendulum-like transfers) that are available to an individual to perform a function. It was hypothesized that in children with spastic hemiplegic cerebral palsy (CP), neurological impairments would result in increases in global body stiffness on the affected side that could be quantified using an escapement-driven, damped hybrid pendulum and spring model. It was also hypothesized that increases in stiffness and an assumed decrease in the forcing capability would result in, respectively, a decreased stance time on the affected side, and smaller angular displacement of the body center of mass around the ankle joint. Five children with spastic hemiplegic CP and five age, height and weight matched non-disabled children walked overground at their preferred speed and at metronome-driven frequencies that were ±10% and ±20% of their preferred. Significantly greater stiffness on the affected limb of CP was found when compared to the non-affected limb, and to the limbs of non-disabled children. Significantly smaller amplitudes and shorter stance periods on the affected side were also observed. Results provide initial support for the claim that gait patterns and their adaptations reflect the capability of persons with disabilities to exploit the dynamic resources available to them. These findings raise two issues for discussion. First, we discuss the clinical implications of the notion that dynamic resources provide a causal link between the neurologic and morphologic changes due to upper motor neuron diseases and abnormal kinematics of gait. Second, we discuss the broader implications of biomechanical modeling in the ability to lawfully capture the interplay of the relevant constraints that contribute to the emergence of specific movement patterns.