Malone Ailish, Kiernan Damien, French Helen, Saunders Valerie, O'Brien Timothy
A. Malone, PhD, Gait Laboratory, Central Remedial Clinic, Vernon Avenue, Clontarf, Dublin 3, Ireland.
D. Kiernan, BE, MSc, Gait Laboratory, Central Remedial Clinic.
Phys Ther. 2016 Aug;96(8):1208-15. doi: 10.2522/ptj.20150360. Epub 2016 Feb 18.
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.
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.
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.
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°), and greater sagittal trunk movement as the trail limb crossed (5.1°).
The study was not powered to analyze differences between children with diplegia and those with hemiplegia.
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.
平衡问题在患有脑瘫（CP）但活动自如且能行走的儿童中很常见。在具有挑战性的移动任务（如行走时跨越障碍物）中，控制全身质心对于维持动态稳定性至关重要。
本研究的目的是比较患有CP的儿童和发育正常的儿童在跨越障碍物时的躯干和下肢运动学以及质心控制情况。
这是一项横断面研究。34名年龄在5至17岁之间（17名患有CP，17名发育正常）且年龄和身高匹配的儿童完成了2次涉及跨越10厘米障碍物的步态试验。
使用通用三维运动跟踪系统和测力板采集三维运动学和动力学数据。使用经过验证的模型采集躯干数据。
所有儿童跨越障碍物时的髋部和膝部运动学、步长和单支撑持续时间相似。患有CP的儿童步宽增加了4.81厘米，在领先肢体离地时（0.31米/秒）和领先肢体越过障碍物期间（0.2米/秒）质心速度明显较慢。患有CP的儿童表现出躯干和骨盆运动改变，其特征为在整个任务过程中骨盆倾斜、骨盆倾斜和躯干旋转明显更大，在领先肢体跨越时侧躯干倾斜增加（3.7°），以及在跟随肢体跨越时矢状面躯干运动更大（5.1°）。
该研究没有足够的能力分析双瘫儿童和偏瘫儿童之间的差异。
患有CP的儿童需要在躯干和骨盆处进行更大的调整才能成功跨越障碍物。躯干运动的增加可能是对远端稳定性降低的补偿，或者是反映近端控制不佳的主要问题。研究结果表明，康复应侧重于近端躯干控制和远端稳定性，以改善平衡。
