A cross sectional study investigating dynamic balance when stepping in children with cerebral palsy.

Rachel Rapson; Jos Latour; BERNIE CARTER; Vasiliki Pitsouni; Jonathan  Marsden

doi:10.1016/j.gaitpost.2023.02.006

A cross sectional study investigating dynamic balance when stepping in children with cerebral palsy.

Rachel Rapson^*, Jos Latour, BERNIE CARTER, Vasiliki Pitsouni, Jonathan Marsden

^*Corresponding author for this work

Nursing & Midwifery

University of Plymouth

Research output: Contribution to journal › Article (journal) › peer-review

1 Citation (Scopus)

114 Downloads (Pure)

Abstract

Background
Children with Cerebral Palsy (CP) have altered anticipatory postural adjustments (APAs) during gait initiation. These APAs may affect dynamic balance in tasks such as stepping.

Research Questions
How are APAs in children with CP affected during stepping to precise targets?
How do children with CP modulate APAs when stepping to medial and lateral targets?
What is the association between APAs and symptom severity, movement quality and impairment profile?

Method
Children undertook a stepping task to laterally and medially placed targets with either leg, in a randomised order. Movement of the centre of pressure (COP) and markers at the pelvis and foot were measured via a force plate and 3D motion analysis. Motion of the centre of mass (COM) was estimated via pelvic markers. APAs were assessed prior to leading leg lift-off in medio-lateral and antero-posterior directions. Stepping error was calculated. Baseline characteristics of children with CP included Gross Motor Function Measure (GMFM), Quality Function Measure (QFM), leg muscle hypertonia (Tardieu test) and strength (manual dynamometry).

Results
Sixteen ambulant children with CP (12.2 years ± 2.2) and 14 typically developing (TD) children (11.6 years ± 2.9) were assessed. In children with CP, APAs in the medio-lateral direction were 20-30% smaller. Children with CP were less able to modulate their APAs with steps to medial and laterally placed targets, than TD children. Medio-lateral COP motion was associated with movement quality assessed by QFM subsections, GMFM (correlation coefficient r =0.66-0.80) and hip abductor strength (r=0.75). Antero-posterior APAs were significantly smaller when stepping with the non-paretic leg in children with CP. APA size was positively related to the length of the contralateral, paretic gastrocnemius (r=0.77). Stepping error was higher in children with CP and inversely correlated to the size of the medio-lateral APA.

Discussion
Children with CP show smaller medio-lateral APAs especially when stepping to medially placed targets. APA size may be limited by proximal muscle strength and gastrocnemius length.

Original language	English
Pages (from-to)	154-159
Number of pages	6
Journal	Gait & Posture
Volume	101
Early online date	11 Feb 2023
DOIs	https://doi.org/10.1016/j.gaitpost.2023.02.006
Publication status	Published - 1 Mar 2023

Keywords

Cerebral Palsy
Balance
Anticipatory Postural Adjustment
Stepping

Access to Document

10.1016/j.gaitpost.2023.02.006

Rapson et al 2023 Dynamic Balance Stepping Children CP-accepted 09022023Accepted author manuscript, 224 KBLicence: CC BY-NC-ND
Rapson -Carter 2023 Cross sectional study dynamic balance.... children cerebral palsyFinal published version, 698 KBLicence: CC BY

https://doi.org/10.1016/j.gaitpost.2023.02.006Licence: CC BY

1 Citations
1 Article (journal)

The novel Next Step test is a reliable measure of anticipatory postural adjustments made by children with cerebral palsy prior to taking a step  
Rapson, R., Latour, J., CARTER, B., Pitsouni, V. & Marsden, J., 1 Sept 2023, In: Gait & posture. 105, p. 110-116
Research output: Contribution to journal › Article (journal) › peer-review

Open Access
File

1 Research degree supervision

PhD Supervision: External Student
CARTER, B. (Supervisor), Marsden, J. (Director of Studies) & Latour, J. (Supervisor)
May 2018 → 2023
Activity: Other activity types › Research degree supervision

Cite this

@article{e29f56780fd94c9bb9248dfe32b47fc5,

title = "A cross sectional study investigating dynamic balance when stepping in children with cerebral palsy.",

abstract = "Background Children with Cerebral Palsy (CP) have altered anticipatory postural adjustments (APAs) during gait initiation. These APAs may affect dynamic balance in tasks such as stepping. Research Questions How are APAs in children with CP affected during stepping to precise targets? How do children with CP modulate APAs when stepping to medial and lateral targets? What is the association between APAs and symptom severity, movement quality and impairment profile? Method Children undertook a stepping task to laterally and medially placed targets with either leg, in a randomised order. Movement of the centre of pressure (COP) and markers at the pelvis and foot were measured via a force plate and 3D motion analysis. Motion of the centre of mass (COM) was estimated via pelvic markers. APAs were assessed prior to leading leg lift-off in medio-lateral and antero-posterior directions. Stepping error was calculated. Baseline characteristics of children with CP included Gross Motor Function Measure (GMFM), Quality Function Measure (QFM), leg muscle hypertonia (Tardieu test) and strength (manual dynamometry). Results Sixteen ambulant children with CP (12.2 years ± 2.2) and 14 typically developing (TD) children (11.6 years ± 2.9) were assessed. In children with CP, APAs in the medio-lateral direction were 20-30% smaller. Children with CP were less able to modulate their APAs with steps to medial and laterally placed targets, than TD children. Medio-lateral COP motion was associated with movement quality assessed by QFM subsections, GMFM (correlation coefficient r =0.66-0.80) and hip abductor strength (r=0.75). Antero-posterior APAs were significantly smaller when stepping with the non-paretic leg in children with CP. APA size was positively related to the length of the contralateral, paretic gastrocnemius (r=0.77). Stepping error was higher in children with CP and inversely correlated to the size of the medio-lateral APA. Discussion Children with CP show smaller medio-lateral APAs especially when stepping to medially placed targets. APA size may be limited by proximal muscle strength and gastrocnemius length.",

keywords = "Cerebral Palsy, Balance, Anticipatory Postural Adjustment, Stepping",

author = "Rachel Rapson and Jos Latour and BERNIE CARTER and Vasiliki Pitsouni and Jonathan Marsden",

year = "2023",

month = mar,

day = "1",

doi = "10.1016/j.gaitpost.2023.02.006",

language = "English",

volume = "101",

pages = "154--159",

journal = "Gait & Posture",

issn = "0966-6362",

publisher = "Elsevier",

}

TY - JOUR

T1 - A cross sectional study investigating dynamic balance when stepping in children with cerebral palsy.

AU - Rapson, Rachel

AU - Latour, Jos

AU - CARTER, BERNIE

AU - Pitsouni, Vasiliki

AU - Marsden, Jonathan

PY - 2023/3/1

Y1 - 2023/3/1

N2 - Background Children with Cerebral Palsy (CP) have altered anticipatory postural adjustments (APAs) during gait initiation. These APAs may affect dynamic balance in tasks such as stepping. Research Questions How are APAs in children with CP affected during stepping to precise targets? How do children with CP modulate APAs when stepping to medial and lateral targets? What is the association between APAs and symptom severity, movement quality and impairment profile? Method Children undertook a stepping task to laterally and medially placed targets with either leg, in a randomised order. Movement of the centre of pressure (COP) and markers at the pelvis and foot were measured via a force plate and 3D motion analysis. Motion of the centre of mass (COM) was estimated via pelvic markers. APAs were assessed prior to leading leg lift-off in medio-lateral and antero-posterior directions. Stepping error was calculated. Baseline characteristics of children with CP included Gross Motor Function Measure (GMFM), Quality Function Measure (QFM), leg muscle hypertonia (Tardieu test) and strength (manual dynamometry). Results Sixteen ambulant children with CP (12.2 years ± 2.2) and 14 typically developing (TD) children (11.6 years ± 2.9) were assessed. In children with CP, APAs in the medio-lateral direction were 20-30% smaller. Children with CP were less able to modulate their APAs with steps to medial and laterally placed targets, than TD children. Medio-lateral COP motion was associated with movement quality assessed by QFM subsections, GMFM (correlation coefficient r =0.66-0.80) and hip abductor strength (r=0.75). Antero-posterior APAs were significantly smaller when stepping with the non-paretic leg in children with CP. APA size was positively related to the length of the contralateral, paretic gastrocnemius (r=0.77). Stepping error was higher in children with CP and inversely correlated to the size of the medio-lateral APA. Discussion Children with CP show smaller medio-lateral APAs especially when stepping to medially placed targets. APA size may be limited by proximal muscle strength and gastrocnemius length.

AB - Background Children with Cerebral Palsy (CP) have altered anticipatory postural adjustments (APAs) during gait initiation. These APAs may affect dynamic balance in tasks such as stepping. Research Questions How are APAs in children with CP affected during stepping to precise targets? How do children with CP modulate APAs when stepping to medial and lateral targets? What is the association between APAs and symptom severity, movement quality and impairment profile? Method Children undertook a stepping task to laterally and medially placed targets with either leg, in a randomised order. Movement of the centre of pressure (COP) and markers at the pelvis and foot were measured via a force plate and 3D motion analysis. Motion of the centre of mass (COM) was estimated via pelvic markers. APAs were assessed prior to leading leg lift-off in medio-lateral and antero-posterior directions. Stepping error was calculated. Baseline characteristics of children with CP included Gross Motor Function Measure (GMFM), Quality Function Measure (QFM), leg muscle hypertonia (Tardieu test) and strength (manual dynamometry). Results Sixteen ambulant children with CP (12.2 years ± 2.2) and 14 typically developing (TD) children (11.6 years ± 2.9) were assessed. In children with CP, APAs in the medio-lateral direction were 20-30% smaller. Children with CP were less able to modulate their APAs with steps to medial and laterally placed targets, than TD children. Medio-lateral COP motion was associated with movement quality assessed by QFM subsections, GMFM (correlation coefficient r =0.66-0.80) and hip abductor strength (r=0.75). Antero-posterior APAs were significantly smaller when stepping with the non-paretic leg in children with CP. APA size was positively related to the length of the contralateral, paretic gastrocnemius (r=0.77). Stepping error was higher in children with CP and inversely correlated to the size of the medio-lateral APA. Discussion Children with CP show smaller medio-lateral APAs especially when stepping to medially placed targets. APA size may be limited by proximal muscle strength and gastrocnemius length.

KW - Cerebral Palsy

KW - Balance

KW - Anticipatory Postural Adjustment

KW - Stepping

U2 - 10.1016/j.gaitpost.2023.02.006

DO - 10.1016/j.gaitpost.2023.02.006

M3 - Article (journal)

C2 - 36842256

SN - 0966-6362

VL - 101

SP - 154

EP - 159

JO - Gait & Posture

JF - Gait & Posture

ER -

A cross sectional study investigating dynamic balance when stepping in children with cerebral palsy.

Abstract

Keywords

Access to Document

Fingerprint

Research output

The novel Next Step test is a reliable measure of anticipatory postural adjustments made by children with cerebral palsy prior to taking a step

Activities

PhD Supervision: External Student

Cite this

The novel Next Step test is a reliable measure of anticipatory postural adjustments made by children with cerebral palsy prior to taking a step  