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Dynamic Resources Used in Ambulation by Children With Spastic Hemiplegic Cerebral Palsy: Relationship to Kinematics, Energetics, and Asymmetries

ST Fonseca, PT, ScD, is Adjunct Professor, Departamento de Fisioterapia, Universidade Federal de Minas Gerais, Av Antõnio Carlos 6627-Unidade Administrativa II, 31270–010, Belo Horizonte, Minas Gerais, Brazil (sfonseca{at}pib.com.br).
KG Holt, PT, PhD, is Associate Professor, Department of Rehabilitation Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Mass, and Center for the Ecological Study of Perception and Action, University of Connecticut, Storrs, Conn
L Fetters, PT, PhD, is Associate Professor, Department of Rehabilitation Sciences, Sargent College of Health and Rehabilitation Sciences
E Saltzman, PhD, is Associate Professor, Department of Rehabilitation Sciences, Sargent College of Health and Rehabilitation Sciences; Center for the Ecological Study of Perception and Action, University of Connecticut; and Haskins Laboratories, New Haven, Conn

Address all correspondence to Dr Fonseca

Background and Purpose. The atypical walking pattern in children with spastic cerebral palsy is assumed to involve kinematic and morphological adaptations that allow them to move. The purpose of this study was to explore how the requirements of the task and the energy-generating and energy-conserving capabilities of children with cerebral palsy relate to kinematic and mechanical energy patterns of walking. Subjects. Six children with hemiplegic cerebral palsy and a matched group of typically developing children participated in the study. Methods. Kinematic data were collected at 5 different walking speeds. Vertical stiffness, mechanical energy parameters, and landing angle were measured during the stance phase. Results. The affected side of the children with cerebral palsy showed greater vertical stiffness, a greater ratio of kinetic forward energy to potential energy, and a smaller landing angle when compared with those of the nonaffected lower extremity and with those of typically developing children. Discussion and Conclusion. Previous research has shown that children with cerebral palsy assumed a gait similar to an inverted pendulum on the nonaffected limb and a pogo stick on the affected limb. Our results indicate that asymmetries between lower extremities and differences from typically developing children in the landing angle of the lower extremity, vertical lower-extremity stiffness, and kinetic and potential energy profiles support the claim that walking patterns in children with spastic hemiplegic cerebral palsy emerge as a function of the resources available to them.

Key Words: Cerebral palsy • Dynamic systems • Locomotion • Oscillatory models

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