Restricted Arm Swing Affects Gait Stability and Increased Walking Speed Alters Trunk Movements in Children with Cerebral Palsy

Tijs Delabastita, Kaat Desloovere, Pieter Meyns, Tijs Delabastita, Kaat Desloovere, Pieter Meyns

Abstract

Observational research suggests that in children with cerebral palsy, the altered arm swing is linked to instability during walking. Therefore, the current study investigates whether children with cerebral palsy use their arms more than typically developing children, to enhance gait stability. Evidence also suggests an influence of walking speed on gait stability. Moreover, previous research highlighted a link between walking speed and arm swing. Hence, the experiment aimed to explore differences between typically developing children and children with cerebral palsy taking into account the combined influence of restricting arm swing and increasing walking speed on gait stability. Spatiotemporal gait characteristics, trunk movement parameters and margins of stability were obtained using three dimensional gait analysis to assess gait stability of 26 children with cerebral palsy and 24 typically developing children. Four walking conditions were evaluated: (i) free arm swing and preferred walking speed; (ii) restricted arm swing and preferred walking speed; (iii) free arm swing and high walking speed; and (iv) restricted arm swing and high walking speed. Double support time and trunk acceleration variability increased more when arm swing was restricted in children with bilateral cerebral palsy compared to typically developing children and children with unilateral cerebral palsy. Trunk sway velocity increased more when walking speed was increased in children with unilateral cerebral palsy compared to children with bilateral cerebral palsy and typically developing children and in children with bilateral cerebral palsy compared to typically developing children. Trunk sway velocity increased more when both arm swing was restricted and walking speed was increased in children with bilateral cerebral palsy compared to typically developing children. It is proposed that facilitating arm swing during gait rehabilitation can improve gait stability and decrease trunk movements in children with cerebral palsy. The current results thereby partly support the suggestion that facilitating arm swing in specific situations possibly enhances safety and reduces the risk of falling in children with cerebral palsy.

Keywords: arm swing; cerebral palsy; gait; stability; trunk movements; walking speed.

Figures

Figure 1
Figure 1
Comprehensive illustration of the margin of stability as a measure of dynamic gait stability. (A) schematic representation of the “extrapolated center of mass”-position and the position of the lateral ankle markers. (B) illustration of center of mass' position, “extrapolated center of mass”-vector and margin of stability-calculations.
Figure 2
Figure 2
Influence of restricting arm swing on double support time (A) and trunk sway acceleration variability (B). Bars and error bars represent, correspondingly, mean values and standard deviations of the presented outcome parameter for typically developing children, children with bilateral cerebral palsy and children with unilateral cerebral palsy. White (gray) bars represent the values for the free arm swing conditions, black (gray) bars represent the values for the restricted arm swing conditions. An asterisk indicates a significant within subject group difference (p < 0.05) in the restricted arm swing conditions compared to the free arm swing conditions (Tukey's pairwise comparisons). A horizontal lines indicates a significant between subject group difference (p < 0.05) for the indicated subject groups in the indicated experimental conditions (Tukey's pairwise comparisons).
Figure 3
Figure 3
Influence of increasing walking speed on step length (A) and trunk sway velocity (B). Bars and error bars represent, correspondingly, mean values and standard deviations for of the presented outcome parameter for typically developing children, children with bilateral cerebral palsy and children with unilateral cerebral palsy. White bars represent the values for the preferred walking speed conditions, black bars represent the values for the high walking speed conditions. An asterisk indicates a significant within subject group difference (p < 0.05) in the high walking speed conditions compared to the preferred walking speed conditions (Tukey's pairwise comparisons). A horizontal line indicates a significant between subject group difference (p < 0.05) for the indicated subject groups in the indicated experimental conditions (Tukey's pairwise comparisons).
Figure 4
Figure 4
Influence of restricting arm swing combined with increasing walking speed on trunk sway velocity. Bars and error bars represent, correspondingly, mean values and standard deviations for trunk sway velocity of typically developing children, children with bilateral cerebral palsy and children with unilateral cerebral palsy. White bars represent the values for “free arm swing and preferred walking speed.” Light gray bars represent the values for “restricted arm swing and preferred walking speed.” Dark gray bars represent the values for “free arm swing and high walking speed.” Black bars represent the values for “restricted arm swing and high walking speed.” A double dagger indicates a significant between subject group difference (p < 0.05) in “restricted arm swing and preferred walking speed” compared to “free arm swing and preferred walking speed” (Tukey's pairwise comparisons). A horizontal line indicates a significant between subject group difference (p < 0.05) for the indicated subject groups in the indicated experimental conditions (Tukey's pairwise comparisons).
Figure 5
Figure 5
Influence of restricting arm swing combined with increasing walking speed on trunk rotation velocity. Bars and error bars represent, correspondingly, mean values and standard deviations for trunk rotation velocity of typically developing children, children with bilateral cerebral palsy and children with unilateral cerebral palsy. White bars represent the values for “free arm swing and preferred walking speed.” Light gray bars represent the values for “restricted arm swing and preferred walking speed.” Dark gray bars represent the values for “free arm swing and high walking speed.” Black bars represent the values for “restricted arm swing and high walking speed.” A double dagger indicates a significant between subject group difference (p < 0.05) in “restricted arm swing and preferred walking speed” compared to “free arm swing and preferred walking speed” (Tukey's pairwise comparisons).

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