Article

Balance problems are common in children who have cerebral palsy (CP)
but are active and ambulant. Control of the whole-body center of mass is critical
in maintaining dynamic stability during challenging mobility tasks, such as
clearing an obstacle while walking. The objective of this study was to
compare trunk and lower limb kinematics and center-of-mass control in children
with CP and those in children with typical development during obstacle crossing.
DESIGN: This was a cross-sectional study. Thirty-four children who were 5 to 17
years of age (17 with CP and 17 with typical development) and matched in age and
height completed 2 gait trials involving crossing a 10-cm obstacle. METHODS:
Three-dimensional kinematic and kinetic data were captured with a general-purpose
3-dimensional motion tracking system and forceplates. Trunk data were captured
with a validated model. RESULTS: All children cleared the obstacle with similar
hip and knee kinematics, step length, and single-support duration. In children
with CP, step width was increased by 4.81 cm, and center-of-mass velocity was
significantly slower at lead limb toe-off (0.31 m/s) and during lead limb
clearance (0.2 m/s). Children with CP showed altered trunk and pelvis movement,
characterized by significantly greater pelvic obliquity, pelvic tilt, and trunk
rotation throughout the task, increased lateral trunk lean during lead limb
crossing (3.7 degrees ), and greater sagittal trunk movement as the trail limb
crossed (5.1 degrees ). LIMITATIONS: The study was not powered to analyze
differences between children with diplegia and those with hemiplegia.
CONCLUSIONS: Children with CP required greater adjustments at the trunk and
pelvis to achieve successful obstacle crossing. The increase in trunk movement
could have been compensatory for reduced stability distally or for a primary
problem reflecting poor proximal control. The findings suggest that
rehabilitation should focus on both proximal trunk control and distal stability
to improve balance.
CI - (c) 2016 American Physical Therapy Association.

Langue : ANGLAIS