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Experimental Brain Research

, Volume 237, Issue 6, pp 1409–1419 | Cite as

Modulation of gait inter-limb coordination in children with unilateral spastic cerebral palsy after intensive upper extremity intervention

  • Alexis N. SidiropoulosEmail author
  • Siyun Chen
  • Terry R. M. Kaminski
  • Andrew M. Gordon
Research Article
  • 88 Downloads

Abstract

Motor function difficulties associated with unilateral spastic cerebral palsy (USCP) impact gait inter-limb coordination between the upper and lower extremities. Two motor learning based, upper extremity treatments, Constraint Induced Movement Therapy (CIMT) and Hand Arm Bimanual Therapy (HABIT), have resulted in improvements in coordination and function between the arms in children with USCP. However, no study has investigated whether coordination between the upper and lower extremities improves after either intervention during a functional task, such as walking. Gait analysis was performed before and after participation in intensive (3 weeks, 90 h total) CIMT and HABIT interventions to determine if intensive upper extremity treatment can improve inter-limb coordination between the upper and lower extremities of children (n = 20, 6–17 years old) with USCP. While upper extremity clinical evaluations indicated hand function improvements, there were no changes in lower extremity parameters for either treatment. However, we found that 10 out of 11 children with a 2:1 arm swing-to-stride ratio at pre-test improved to a 1:1 ratio at post-test. Temporal synchronicity of contralateral limbs, swing displacement of the more affected arm, and arm swing side symmetry unexpectedly decreased. Positive changes in coordination were observed in children who demonstrated poor coordination during walking at pre-test, yet the changes were not robust. Principle component analysis did not indicate changes in limb coupling. While more coordinated, gross-motor training of the upper and lower extremity may reveal greater changes, lower extremity gait patterns were not improved in high functioning children with USCP.

Keywords

Cerebral palsy Children Gait Coordination Intervention 

Notes

Acknowledgements

The authors would like to acknowledge Dr. Victor Santamaria for his statistical advisement, Dr. Lily Hung for her assistance with data collection, and the children and families for their participation in the interventions.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

References

  1. Abdi H, Williams LJ (2010) Principal component analysis. Wiley Interdiscip Rev Comput Stat 2(4):433–459CrossRefGoogle Scholar
  2. Bax M, Goldstein M, Rosenbaum P, Leviton A, Paneth N (2005) Proposed definition and classification of cerebral palsy, April 2005. Dev Med Child Neurol 47:571–576CrossRefGoogle Scholar
  3. Bell K, Ounpuu S, DeLuca P, Romness M (2002) Natural progression of gait in children with cerebral palsy. J Pediatr Orthop 22:677–682Google Scholar
  4. Bleyenheuft C, Detrembleur C (2012) Kinematic covariation in pediatric, adult and elderly subjects: Is gait control influenced by age? Clin Biomech 27(6):568–572CrossRefGoogle Scholar
  5. Bleyenheuft C, Deltombe T, Detrembleur C (2013) Influence of ankle-foot orthoses on kinematic segmental covariation among stroke patients. Ann Phys Rehabil Med 56(1):3–13CrossRefGoogle Scholar
  6. Bleyenheuft Y, Ebner-Karestinos D, Surana B, Paradis J, Sidiropoulos A, Renders A et al (2017) Intensive upper- and lower-extremity training for children with bilateral cerebral palsy: A quasi-randomized trial. Dev Med Child Neurol 59(6):625–633CrossRefGoogle Scholar
  7. Bohm H, Doderlein L (2012) Gait asymmetries in children with cerebral palsy: Do they deteriorate with running? Gait Posture 35:322–327CrossRefGoogle Scholar
  8. Bruijin S, Meyns P, Jonkers I, Kaat D, Duysens J (2011) Control of angular momentum during walking in children with cerebral palsy. Res Dev Disabil 32:2860–2866CrossRefGoogle Scholar
  9. Cappellini G, Sylos-Labini F, MacLellan MJ, Sacco A, Morelli D, Lacquaniti F, Ivanenko Y (2018) Backward walking highlights gait asymmetries in children with cerebral palsy. J Neurophysiol 119(3):1153–1165CrossRefGoogle Scholar
  10. Charles J, Gordon A (2006) Development of hand-arm bimanual intensive training (HABIT) for improving bimanual coordination in children with hemiplegic cerebral palsy. Dev Med Child Neurol 11:931–936CrossRefGoogle Scholar
  11. Coker P, Karakostas T, Dodds C, Hsiang S (2010) Gait characteristics of children with hemiplegic cerebral palsy before and after modified constraint-induced movement therapy. Disabil Rehabil 32(5):402–408CrossRefGoogle Scholar
  12. Delabastita T, Desloovere K, Meyns P (2016) Restricted arm swing affects gait stability and increased walking speed alters trunk movements in children with cerebral palsy. Front Human Neurosci 10(354):1–16Google Scholar
  13. Donker S, Beek P, Wagenaar R, Mulder T (2001) Coordination between arm and leg movements during locomotion. J Mot Behav 33:86–102CrossRefGoogle Scholar
  14. Ferris D, Huang H, Kao P (2006) Moving the arms to activate the legs. Exerc Sport Sci Rev 34(3):113–120CrossRefGoogle Scholar
  15. Gordon A, Charles J, Wolf S (2005) Methods of constraint-induced movement therapy for children with hemiplegic cerebral palsy: development of a child-friendly intervention for improving upper-extremity function. Arch Phys Med Rehabil 86:837–844CrossRefGoogle Scholar
  16. Gordon A, Hung Y, Brandao M, Ferre C, Kuo H, Friel K et al (2011) Bimanual training and constraint-induced movement therapy in children with hemiplegic cerebral palsy: a randomized trial. Neurorehabilit Neural Repair 25(8):692–702CrossRefGoogle Scholar
  17. Hsu A, Tang P, Jan M (2003) Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke. Arch Phys Med Rehabil 84:1185–1193CrossRefGoogle Scholar
  18. Kim CJ, Son SM (2014) Comparison of spatiotemporal gait parameters between children with normal development and children with diplegic cerebral palsy. J Phys Therapy Sci 26(9):1317–1319CrossRefGoogle Scholar
  19. Leys C, Ley C, Klein O, Bernard P, Licata L (2013) Detecting outliers: Do not use standard deviation around the mean, use absolute deviation around the median. J Exp Soc Psychol 49(4):764–766CrossRefGoogle Scholar
  20. Lythgo N, Wilson C, Galea M (2011) Basic gait and symmetry measures for primary school-aged children and young adults. II: Walking at slow, free and fast speed. Gait Posture 33(1):29–35CrossRefGoogle Scholar
  21. Menkveld S, Knipstein E, Quinn J (1988) Analysis of gait patterns in normal school-aged children. J Pediatr Orthop 8:263–267CrossRefGoogle Scholar
  22. Meyns P, van Gestel L, Massaad F, Desloovere K, Molanaers G, Duysens J (2011) Arm swing during walking at different speeds in children with cerebral palsy and typically developing children. Res Dev Disabil 32:1957–1964CrossRefGoogle Scholar
  23. Meyns P, Desloovere K, Van Gestel L, Massaad F, Smits-Engelsman B, Duysens J (2012a) Altered arm posture in children with cerebral palsy is related to instability during walking. Eur J Paediatr Neurol 16:528–535CrossRefGoogle Scholar
  24. Meyns P, van Gestel L, Bruijn S, Desloovere K, Swinnen S, Duysens J (2012b) Is interlimb coordination during walking preserved in children with cerebral palsy? Res Dev Disabil 33:1418–1428CrossRefGoogle Scholar
  25. Meyns P, Molenaers G, Desloovere K, Duysens J (2014) Interlimb coordination during forward walking is largely preserved in backward walking in children with cerebral palsy. Clin Neurophysiol 125(3):552–561CrossRefGoogle Scholar
  26. Novak I, McIntyre S, Morgan C, Campbell L, Dark L, Morton N, Stumbles E, Goldsmith S et al. (2013) A systematic review of interventions for children with cerebral palsy: State of the evidence. Dev Med Child Neurol 55:885–910CrossRefGoogle Scholar
  27. Ortega J, Fehlman L, Farley C (2008) Effects of aging and arm swing on the metabolic cost of stability in human walking. J Biomech 41:3303–3308CrossRefGoogle Scholar
  28. Park J (2008) Synthesis of natural arm swing motion in human bipedal walking. J Biomech 41:1417–1426CrossRefGoogle Scholar
  29. Sutherland D, Olshen R, Cooper L, Woo S (1980) The development of mature gait. J Bone Jt Surg 62:336–353CrossRefGoogle Scholar
  30. Wheelwright E, Minns R, Law H, Elton R (1993) Temporal and spatial parameters of gait in children. I: Normal control data. Dev Med Child Neurol 35:102–113CrossRefGoogle Scholar
  31. Zipp G, Winning S (2012) Effects of constraint-induced movement therapy on gait, balance, and functional locomotor mobility. Pediatr Phys Therapy 24:64–68CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Biobehavioral Sciences, Teachers CollegeColumbia UniversityNew YorkUSA

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