Attias Michael, Bonnefoy-Mazure Alice, Lempereur Mathieu, Lascombes Pierre, De Coulon Geraldo, Armand Stéphane
Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals, Geneva University, Switzerland; School of Health, Geneva University of Applied Sciences Western Switzerland, Switzerland.
Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals, Geneva University, Switzerland.
Clin Biomech (Bristol). 2015 Jan;30(1):28-32. doi: 10.1016/j.clinbiomech.2014.11.009. Epub 2014 Nov 26.
Lower limb deficits have been widely studied during gait in cerebral palsy, deficits in upper body have received little attention. The purpose of this research was to describe the characteristics of trunk movement of cerebral palsy children in terms of type of deficits (diplegia/hemiplegia) and gross motor function classification system (1, 2 or 3).
Data from 92 cerebral palsy children, which corresponds to 141 clinical gait analysis, were retrospectively selected. Kinematic parameters of trunk were extracted from thorax and spine angles in the sagittal, transverse and coronal planes. The range of motion and the mean positions over the gait cycle were analysed. Intra-group differences between the children with diplegia or hemiplegia, gross motor function classification systems 1 to 3 and typically developing participants were analysed with Kruskal-Wallis tests and post hoc tests. Pearson correlation coefficients between the gait profile score normalised walking speed and kinematic parameters of the thorax were assessed.
The results revealed: 1) the range of motion of the thorax and spine exhibited more significant differences between groups than the mean positions; 2) greater levels of impairment were associated with higher thorax range of motion, and 3) the children with diplegia and gross motor function classification system 3 exhibited a greater range of motion for all planes with the exception of spine rotation.
This study confirmed that greater levels of impairment in cerebral palsy are associated with greater thorax range of motion during gait. The thorax plays an important role during gait in cerebral palsy.
在脑瘫患者的步态研究中，下肢缺陷已得到广泛研究，而上半身缺陷却很少受到关注。本研究的目的是根据缺陷类型（双瘫/偏瘫）和粗大运动功能分类系统（1、2或3）描述脑瘫儿童躯干运动的特征。
回顾性选取了92名脑瘫儿童的数据，对应141次临床步态分析。从矢状面、横断面和冠状面的胸部和脊柱角度提取躯干的运动学参数。分析步态周期中的运动范围和平均位置。采用Kruskal-Wallis检验和事后检验分析双瘫或偏瘫儿童、粗大运动功能分类系统1至3的儿童与正常发育儿童之间的组内差异。评估步态轮廓评分标准化步行速度与胸部运动学参数之间的Pearson相关系数。
结果显示：1）胸部和脊柱的运动范围在组间比平均位置表现出更显著的差异；2）更高水平的损伤与更大的胸部运动范围相关，3）除脊柱旋转外，双瘫和粗大运动功能分类系统3的儿童在所有平面上均表现出更大的运动范围。
本研究证实，脑瘫患者更高水平的损伤与步态期间更大的胸部运动范围相关。胸部在脑瘫患者的步态中起着重要作用。
