Salazar-Torres Jose, Church Chris, Miller Freeman, Lennon Nancy, Howard Jason J, Shields Thomas, Owens Laura, Zhang Ran, Shrader M Wade
Department of Orthopedics, Nemours Children's Hospital, 1600 Rockland Rd, Wilmington, DE 19803, USA.
Department of Orthopedics, Nemours Children's Hospital, 1600 Rockland Rd, Wilmington, DE 19803, USA.
Gait Posture. 2025 Jan;115:116-121. doi: 10.1016/j.gaitpost.2024.10.022. Epub 2024 Nov 14.
Children with cerebral palsy (CP) or acquired brain insult (ABI) present with motor disorders affecting movement, muscle tone, and posture. While CP is commonly a consequence of perinatal brain insult (PBI), pediatric ABI can occur between birth and adolescence, with movement patterns that may not be consistent with CP.
Are gait patterns associated with CP different from those with pediatric ABI?
MATERIALS/METHODS: Children with unilateral motor impairment and history of ABI at ≥18 months of age were identified from gait lab records and matched with children with CP having a history of PBI at ≤ 1 year old. Matching was by GMFM-D, age at Instrumented Gait Analysis (IGA), and sex. Kinematic and temporospatial data from the earliest IGA were analyzed. The primary outcome measurement was average knee flexion in stance, as children with CP tend to walk with a more flexed knee and individuals with a brain insult as older children, youth and adults tend to walk with a more extended knee. Secondary variables were temporospatial parameters and lower limb kinematics in stance and swing. Wilcoxon or T-Tests were used.
Twenty-six unilaterally affected children with CP (age: 10.8±3.3 years; f:6/m:20; GMFCS I:14, II:38), and 26 unilateral children with ABI (age:11.1±4.3 years; f:6/m:20) were included in each group. Significantly lower knee flexion angles during stance and swing, and shorter single support duration on the affected side were found in the ABI group as compared to CP (p<0.05). In children with ABI, there was a negative correlation between age of insult and severity of internal hip rotation (p<0.05).
CONCLUSIONS/SIGNIFICANCE: Children with ABI tend to walk with less stability on the affected side as reflected by the more extended knee and reduced single support compared with children with CP. The age at which the brain insult occurs has a significant effect on the hip rotational profile in children with ABI. Further studies on muscle activation patterns, kinetic data and response to treatment are warranted to gain insight on how the stage of brain and musculoskeletal system development at the time of injury affect gait patterns.
脑瘫（CP）患儿或获得性脑损伤（ABI）患儿存在影响运动、肌张力和姿势的运动障碍。虽然CP通常是围产期脑损伤（PBI）的结果，但小儿ABI可发生在出生至青春期之间，其运动模式可能与CP不一致。
与小儿ABI相关的步态模式与CP相关的步态模式是否不同？
材料/方法：从步态实验室记录中识别出年龄≥18个月且有ABI病史的单侧运动障碍儿童，并与1岁及以下有PBI病史的CP患儿进行匹配。匹配依据是粗大运动功能测量量表-发展（GMFM-D）、仪器化步态分析（IGA）时的年龄和性别。对最早一次IGA的运动学和时空数据进行分析。主要结局指标是站立期平均膝关节屈曲度，因为CP患儿行走时膝关节往往更屈曲，而年龄较大的儿童、青少年和成人脑损伤个体行走时膝关节往往更伸展。次要变量是时空参数以及站立期和摆动期下肢运动学。使用Wilcoxon检验或T检验。
每组纳入26例单侧受累的CP患儿（年龄：10.8±3.3岁；女性6例/男性20例；GMFCS I级：14例，II级：38例）和26例单侧ABI患儿（年龄：11.1±4.3岁；女性6例/男性20例）。与CP组相比，ABI组在站立期和摆动期的膝关节屈曲角度显著更低，患侧单支撑持续时间更短（p<0.05）。在ABI患儿中，损伤年龄与内髋旋转严重程度呈负相关（p<0.05）。
结论/意义：与CP患儿相比，ABI患儿患侧行走稳定性较差，表现为膝关节更伸展且单支撑减少。脑损伤发生的年龄对ABI患儿的髋部旋转特征有显著影响。有必要进一步研究肌肉激活模式、动力学数据和对治疗的反应，以深入了解损伤时脑和肌肉骨骼系统的发育阶段如何影响步态模式。
