Analysis of center of mass and center of pressure displacement in the transverse plane during gait termination in children with cerebral palsy

Abstract Objective To evaluate the correlation between physical examination data concerning hip rotation and tibial torsion with transverse plane kinematics in children with cerebral palsy; and to determine which time points and events of the gait cycle present higher correlation with physical examination findings. Methods A total of 195 children with cerebral palsy seen at two gait laboratories from 2008 and 2016 were included in this study. Physical examination measurements included internal hip rotation, external hip rotation, mid-point hip rotation and the transmalleolar axis angle. Six kinematic parameters were selected for each segment to assess hip rotation and shank-based foot rotation. Correlations between physical examination and kinematic measures were analyzed by Spearman correlation coefficients, and a significance level of 5% was considered. Results Comparing physical examination measurements of hip rotation and hip kinematics, we found moderate to strong correlations for all variables (p<0.001). The highest coefficients were seen between the mid-point hip rotation on physical examination and hip rotation kinematics (rho range: 0.48-0.61). Moderate correlations were also found between the transmalleolar axis angle measurement on physical examination and foot rotation kinematics (rho range 0.44-0.56; p<0.001). Conclusion These findings may have clinical implications in the assessment and management of transverse plane gait deviations in children with cerebral palsy.

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Fast Computational Analysis of Sway Area Using Center of Pressure Data in Normal Children and Children with Cerebral Palsy

American Journal of Biomedical Sciences ◽

10.5099/aj090400364 ◽

2009 ◽

pp. 364-372 ◽

Cited By ~ 19

Author(s):

GyuTae Kim ◽

Mohammed Ferdjallah ◽

Gerald Harris

Keyword(s):

Cerebral Palsy ◽

Computational Analysis ◽

Center Of Pressure ◽

Pressure Data ◽

Normal Children ◽

Children With Cerebral Palsy

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Changes in Mobility and Muscle Function of Children with Cerebral Palsy after Gait Training: A Pilot Study

Journal of Applied Biomechanics ◽

10.1123/jab.2015-0311 ◽

2016 ◽

Vol 32 (5) ◽

pp. 469-486 ◽

Cited By ~ 6

Author(s):

Amy K. Hegarty ◽

Max J. Kurz ◽

Wayne Stuberg ◽

Anne K. Silverman

Keyword(s):

Cerebral Palsy ◽

Pilot Study ◽

Center Of Mass ◽

Gait Training ◽

Musculoskeletal Modeling ◽

Knee Extensors ◽

Lower Limb Muscles ◽

Study Results ◽

Children With Cerebral Palsy ◽

Walking Endurance

The goal of this pilot study was to characterize the effects of gait training on the capacity of muscles to produce body accelerations and relate these changes to mobility improvements seen in children with cerebral palsy (CP). Five children (14 years ± 3 y; GMFCS I-II) with spastic diplegic CP participated in a 6-week gait training program. Changes in 10-m fast-as-possible walking speed and 6-minute walking endurance were used to assess changes in mobility. In addition, musculoskeletal modeling was used to determine the potential of lower-limb muscles to accelerate the body’s center of mass vertically and forward during stance. The mobility changes after the training were mixed, with some children demonstrating vast improvements, while others appeared to be minimal. However, the musculoskeletal results revealed unique responses for each child. The most common changes occurred in the capacity for the hip and knee extensors to produce body support and the hip flexors to produce body propulsion. These results cannot yet be generalized to the broad population of children with CP, but demonstrate that therapy protocols may be enhanced by modeling analyses. The pilot study results provide motivation for gait training emphasizing upright leg posture, mediolateral balance, and ankle push-off.

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The Effects of Acute Intense Physical Exercise on Postural Stability in Children With Cerebral Palsy

Adapted Physical Activity Quarterly ◽

10.1123/apaq.2015-0115 ◽

2016 ◽

Vol 33 (3) ◽

pp. 271-282 ◽

Cited By ~ 3

Author(s):

Matthew J. Leineweber ◽

Dominik Wyss ◽

Sophie-Krystale Dufour ◽

Claire Gane ◽

Karl Zabjek ◽

...

Keyword(s):

Cerebral Palsy ◽

Physical Exercise ◽

Postural Stability ◽

Sagittal Plane ◽

Center Of Pressure ◽

Force Plate ◽

Frontal Plane ◽

Increased Risk ◽

Children With Cerebral Palsy ◽

Risk Of Falls

This study evaluated the effects of intense physical exercise on postural stability of children with cerebral palsy (CP). Center of pressure (CoP) was measured in 9 typically developing (TD) children and 8 with CP before and after a maximal aerobic shuttle-run test (SRT) using a single force plate. Anteroposterior and mediolateral sway velocities, sway area, and sway regularity were calculated from the CoP data and compared between pre- and postexercise levels and between groups. Children with CP demonstrated significantly higher pre-SRT CoP velocities than TD children in the sagittal (18.6 ± 7.6 vs. 6.75 1.78 m/s) and frontal planes (15.4 ± 5.3 vs. 8.04 ± 1.51 m/s). Post-SRT, CoP velocities significantly increased for children with CP in the sagittal plane (27.0 ± 1.2 m/s), with near-significant increases in the frontal plane (25.0 ± 1.5m/s). Similarly, children with CP evidenced larger sway areas than the TD children both pre- and postexercise. The diminished postural stability in children with CP after short but intense physical exercise may have important implications including increased risk of falls and injury.

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Postural Dysfunction During Standing and Walking in Children With Cerebral Palsy: What are the Underlying Problems and What New Therapies Might Improve Balance?

Neural Plasticity ◽

10.1155/np.2005.211 ◽

2005 ◽

Vol 12 (2-3) ◽

pp. 211-219 ◽

Cited By ~ 114

Author(s):

Marjorie Hines Woollacott ◽

Anne Shumway-Cook

Keyword(s):

Cerebral Palsy ◽

Muscle Activation ◽

Center Of Pressure ◽

School Age Children ◽

Muscle Response ◽

Balance Recovery ◽

Response Characteristics ◽

Ankle Muscles ◽

Children With Cerebral Palsy ◽

Response Organization

In this review we explore studies related to constraints on balance and walking in children with cerebral palsy (CP) and the efficacy of training reactive balance (recovering from a slip induced by a platform displacement) in children with both spastic hemiplegic and diplegic CP. Children with CP show (a) crouched posture, contributing to decreased ability to recover balance (longer time/increased sway); (b) delayed responses in ankle muscles; (c) inappropriate muscle response sequencing; (d) increased coactivation of agonists/antagonists. Constraints on gait include (a) crouched gait; (b) increased co-activation of agonists/antagonists; (c) decreased muscle activation; (d) spasticity. The efficiency of balance recovery can be improved in children with CP, indicated by both a reduction in the total center of pressure path used during balance recovery and in the time to restabilize balance after training. Changes in muscle response characteristics contributing to improved recovery include reductions in time of contraction onset, improved muscle response organization, and reduced co-contraction of agonists/antagonists. Clinical implications include the suggestion that improvement in the ability to recover balance is possible in school age children with CP.

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Control of Dynamic Stability During Gait Termination on a Slippery Surface

Journal of Neurophysiology ◽

10.1152/jn.00423.2004 ◽

2005 ◽

Vol 93 (1) ◽

pp. 64-70 ◽

Cited By ~ 32

Author(s):

A. R. Oates ◽

A. E. Patla ◽

J. S. Frank ◽

M. A. Greig

Keyword(s):

Kinetic Data ◽

Center Of Pressure ◽

Center Of Mass ◽

Lower Limbs ◽

Whole Body ◽

Healthy Individuals ◽

Gait Termination ◽

Normal Gait ◽

Body Center ◽

Slippery Surface

There are three common ways by which to successfully terminate gait: decreased acceleration of whole-body center of mass (COM) through a flexor synergy in the trail leg, increased deceleration of whole-body COM through an extensor synergy in the front limb, and an energy/momentum transfer to dissipate any remaining momentum if the first two strategies are unsuccessful. Healthy individuals were asked to stop on a slippery surface while we examined their unexpected response to the slippery surface. Kinetic data from the forceplates revealed lower braking forces in the slip trials compared with normal gait-termination trials. Subjects were unable to control their center of pressure (COP) to manipulate the COM as revealed by increased deviations and maximum absolute ranges of COP movement. Subject COM deviated farther in both horizontal planes and lowered further during the slip compared with normal gait-termination trials. Arm movements were effective in dissipating forward COM movement. In addition, there likely was a transfer of forward to lateral momentum to stop forward progression. All recorded muscle activity in the lower limbs and back increased during the slip to provide support to the lower limbs and correct upright balance. The trailing limb shortened its final step to provide support to the lowering COM. The balance-correction response seen here resembles previous reactions to perturbations during locomotion suggesting there is a generalized strategy employed by the nervous system to correct for disturbances and maintain balance.

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