Movement Analysis Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland; Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin 2, Ireland.
Gait Posture. 2021 May;86:33-37. doi: 10.1016/j.gaitpost.2021.02.032. Epub 2021 Mar 1.
Trunk control during gait in children with cerebral palsy (CP) is known to be impaired. While differentiation of trunk movement between CP subtypes (unilateral/bilateral) has been examined, differentiation of lower lumbar spinal loading has not been considered. Furthermore, the relationship between lower lumbar loading and lower limb pathology has not been reported.
How do lower lumbar spinal kinetics differ during unilateral and bilateral CP gait and what is the relationship between trunk kinematics and L5/S1 kinetics with lower limb pathology?
Three-dimensional thorax kinematics and L5/S1 kinetics were measured during gait with children divided into 3 groups (unilateral CP (n = 21), bilateral CP (n = 31) and typical development (TD) (n = 26)). Differences in thorax kinematics and reactive forces and moments at L5/S1 between groups were analysed using Statistical Parametric Mapping. Correlation coefficients were calculated between Gait Profile Score (GPS) and kinematic measures of the thorax and kinetics at L5/S1.
An increased ipsilateral bending moment was present for unilateral CP in the coronal plane (55-70% Gait Cycle (GC), p < 0.001), while children with bilateral CP demonstrated two distinct increased peaks during mid-stance (10-30 % GC, p < 0.001) and mid-swing (60-80% GC, p = 0.004) compared to TD. RMS and RoM thorax flexion, side flexion and L5/S1 lateral bend moment demonstrated significant moderate correlations with GPS.
This study confirmed an increased involvement at the trunk and of lower lumbar spinal loading for children with bilateral CP compared to unilateral CP. It has been suggested that altered trunk movement in CP gait may be a combination of both a compensation for lower limb pathology and an underlying deficit. Our result of positive yet moderate correlations between GPS and trunk movement and lower spinal loading support this theory.
已知脑瘫（CP）患儿在步态中躯干控制受损。虽然已经研究了 CP 亚型（单侧/双侧）之间的躯干运动差异，但尚未考虑下腰椎脊柱负荷的差异。此外，尚未报道下腰椎负荷与下肢病理之间的关系。
单侧和双侧 CP 步态中，下腰椎脊柱动力学有何不同，以及躯干运动学与 L5/S1 动力学与下肢病理之间有何关系？
在步态中测量了三组儿童（单侧 CP（n=21）、双侧 CP（n=31）和典型发育（TD）（n=26））的三维胸廓运动学和 L5/S1 动力学。使用统计参数映射分析了组间胸廓运动学和 L5/S1 处反作用力和力矩的差异。计算了 Gait Profile Score（GPS）与胸廓运动学测量值和 L5/S1 动力学之间的相关系数。
单侧 CP 在冠状面出现了同侧弯曲力矩增加（55-70%步态周期（GC），p<0.001），而双侧 CP 在中步（10-30%GC，p<0.001）和中摆（60-80%GC，p=0.004）期间表现出两个明显增加的峰值与 TD 相比。RMS 和 RoM 胸廓前屈、侧屈和 L5/S1 侧弯力矩与 GPS 呈显著中度相关。
本研究证实了与单侧 CP 相比，双侧 CP 患儿躯干和下腰椎脊柱负荷的参与度增加。已经提出，CP 步态中躯干运动的改变可能是下肢病理和潜在缺陷的综合补偿。我们关于 GPS 与躯干运动和下脊柱负荷之间存在正相关且为中度相关的结果支持这一理论。
