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Are Clinical Impairments Related to Kinematic Gait Variability in Children and Young Adults With Cerebral Palsy?

Intrinsic gait variability (GV), i.e., fluctuations in the regularity of gait patterns between repetitive cycles, is inherent to the sensorimotor system and influenced by factors such as age and pathology. Increased GV is associated with gait impairments in individuals with cerebral palsy (CP) and h...

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Autores principales: Tabard-Fougère, Anne, Rutz, Dionys, Pouliot-Laforte, Annie, De Coulon, Geraldo, Newman, Christopher J., Armand, Stéphane, Wegrzyk, Jennifer
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8926298/
https://www.ncbi.nlm.nih.gov/pubmed/35308609
http://dx.doi.org/10.3389/fnhum.2022.816088
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author Tabard-Fougère, Anne
Rutz, Dionys
Pouliot-Laforte, Annie
De Coulon, Geraldo
Newman, Christopher J.
Armand, Stéphane
Wegrzyk, Jennifer
author_facet Tabard-Fougère, Anne
Rutz, Dionys
Pouliot-Laforte, Annie
De Coulon, Geraldo
Newman, Christopher J.
Armand, Stéphane
Wegrzyk, Jennifer
author_sort Tabard-Fougère, Anne
collection PubMed
description Intrinsic gait variability (GV), i.e., fluctuations in the regularity of gait patterns between repetitive cycles, is inherent to the sensorimotor system and influenced by factors such as age and pathology. Increased GV is associated with gait impairments in individuals with cerebral palsy (CP) and has been mainly studied based on spatiotemporal parameters. The present study aimed to describe kinematic GV in young people with CP and its associations with clinical impairments [i.e., passive range of motion (pROM), muscle weakness, reduced selective motor control (selectivity), and spasticity]. This retrospective study included 177 participants with CP (age range 5–25 years; Gross Motor Function Classification System I-III) representing 289 clinical gait analyses [n = 172 for unilateral CP (uCP) vs. 117 for bilateral CP (bCP)]. As variability metrics, Root Mean Square Deviation (RMSD) for nine lower-limb kinematic parameters and Gait Standard Deviation (GaitSD) – as composite score of the kinematic parameters – were computed for the affected (unilateral = uCP) and most affected side (bilateral = bCP), respectively, as defined by clinical scores. GaitSD was then computed for the non/less-affected side for between leg comparisons. Uni- and multivariate linear regressions were subsequently performed on GaitSD of the affected/most affected side with all clinical impairments (composite scores) as independent variables. Highest RMSD were found in the transverse plane (hip, pelvis), for distal joints in the sagittal plane (knee, ankle) and for foot progression. GaitSD was not different between uCP and bCP (affected/most affected side) but higher in the non-affected vs. affected side in uCP. GaitSD was associated with age (p < 0.001), gait deviation index (GDI) (p < 0.05), muscle weakness (p < 0.001), selectivity (p < 0.05), and pROM (p < 0.001). After adjustment for age and GDI, GaitSD remained associated with muscle weakness (uCP: p = 0.003, bCP: p < 0.001) and selectivity (bCP: p = 0.024). Kinematic GV can be expressed as global indicator of variability (GaitSD) in young people with CP given the strong correlation of RMSD for lower-limb kinematic parameters. In terms of asymmetry, increased variability of the non-affected vs. affected side may indicate contralateral compensation mechanisms in uCP. Notably muscle weakness (uCP, bCP) and selectivity (bCP) – but not spasticity – were associated with GaitSD. Further studies need to explore the clinical relevance of kinematic GV in CP to support the interpretation of clinical gait analyses and therapeutic decision-making.
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spelling pubmed-89262982022-03-17 Are Clinical Impairments Related to Kinematic Gait Variability in Children and Young Adults With Cerebral Palsy? Tabard-Fougère, Anne Rutz, Dionys Pouliot-Laforte, Annie De Coulon, Geraldo Newman, Christopher J. Armand, Stéphane Wegrzyk, Jennifer Front Hum Neurosci Neuroscience Intrinsic gait variability (GV), i.e., fluctuations in the regularity of gait patterns between repetitive cycles, is inherent to the sensorimotor system and influenced by factors such as age and pathology. Increased GV is associated with gait impairments in individuals with cerebral palsy (CP) and has been mainly studied based on spatiotemporal parameters. The present study aimed to describe kinematic GV in young people with CP and its associations with clinical impairments [i.e., passive range of motion (pROM), muscle weakness, reduced selective motor control (selectivity), and spasticity]. This retrospective study included 177 participants with CP (age range 5–25 years; Gross Motor Function Classification System I-III) representing 289 clinical gait analyses [n = 172 for unilateral CP (uCP) vs. 117 for bilateral CP (bCP)]. As variability metrics, Root Mean Square Deviation (RMSD) for nine lower-limb kinematic parameters and Gait Standard Deviation (GaitSD) – as composite score of the kinematic parameters – were computed for the affected (unilateral = uCP) and most affected side (bilateral = bCP), respectively, as defined by clinical scores. GaitSD was then computed for the non/less-affected side for between leg comparisons. Uni- and multivariate linear regressions were subsequently performed on GaitSD of the affected/most affected side with all clinical impairments (composite scores) as independent variables. Highest RMSD were found in the transverse plane (hip, pelvis), for distal joints in the sagittal plane (knee, ankle) and for foot progression. GaitSD was not different between uCP and bCP (affected/most affected side) but higher in the non-affected vs. affected side in uCP. GaitSD was associated with age (p < 0.001), gait deviation index (GDI) (p < 0.05), muscle weakness (p < 0.001), selectivity (p < 0.05), and pROM (p < 0.001). After adjustment for age and GDI, GaitSD remained associated with muscle weakness (uCP: p = 0.003, bCP: p < 0.001) and selectivity (bCP: p = 0.024). Kinematic GV can be expressed as global indicator of variability (GaitSD) in young people with CP given the strong correlation of RMSD for lower-limb kinematic parameters. In terms of asymmetry, increased variability of the non-affected vs. affected side may indicate contralateral compensation mechanisms in uCP. Notably muscle weakness (uCP, bCP) and selectivity (bCP) – but not spasticity – were associated with GaitSD. Further studies need to explore the clinical relevance of kinematic GV in CP to support the interpretation of clinical gait analyses and therapeutic decision-making. Frontiers Media S.A. 2022-03-02 /pmc/articles/PMC8926298/ /pubmed/35308609 http://dx.doi.org/10.3389/fnhum.2022.816088 Text en Copyright © 2022 Tabard-Fougère, Rutz, Pouliot-Laforte, De Coulon, Newman, Armand and Wegrzyk. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neuroscience
Tabard-Fougère, Anne
Rutz, Dionys
Pouliot-Laforte, Annie
De Coulon, Geraldo
Newman, Christopher J.
Armand, Stéphane
Wegrzyk, Jennifer
Are Clinical Impairments Related to Kinematic Gait Variability in Children and Young Adults With Cerebral Palsy?
title Are Clinical Impairments Related to Kinematic Gait Variability in Children and Young Adults With Cerebral Palsy?
title_full Are Clinical Impairments Related to Kinematic Gait Variability in Children and Young Adults With Cerebral Palsy?
title_fullStr Are Clinical Impairments Related to Kinematic Gait Variability in Children and Young Adults With Cerebral Palsy?
title_full_unstemmed Are Clinical Impairments Related to Kinematic Gait Variability in Children and Young Adults With Cerebral Palsy?
title_short Are Clinical Impairments Related to Kinematic Gait Variability in Children and Young Adults With Cerebral Palsy?
title_sort are clinical impairments related to kinematic gait variability in children and young adults with cerebral palsy?
topic Neuroscience
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8926298/
https://www.ncbi.nlm.nih.gov/pubmed/35308609
http://dx.doi.org/10.3389/fnhum.2022.816088
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