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Arm movements during gait in children with cerebral palsy (CP) are altered compared to typically developing children (TD). We investigated whether these changes in arm movements alter interlimb coordination in CP gait. 3D gait analysis was performed in CP (diplegia [DI]: N = 15 and hemiplegia [HE]: N = 11) and TD (N = 24) children at preferred and fast walking speeds. Mean Relative Phase (MRP, i.e. mean over the gait cycle of the Continuous Relative Phase or CRP) was calculated as a measure of coordination, standard deviation of CRP was used as a measure of coordinative stability, and the sign of MRP indicated which limb was leading (for all pair combinations of the four limbs). In HE, coordination was significantly altered, less stable and a different leading limb was found compared to TD whenever the most affected arm was included in the studied limb pair. In DI, coordination deteriorated significantly when any of the two legs was included in the studied limb pair, and coordinative stability was significantly affected when any of the two arms was included. In almost all limb pair combinations, a different limb was leading in DI compared to TD. Increasing walking speed significantly improved coordination and coordinative stability of several limb pairs in DI. Coordination and limb-leading deficits were mostly linked to the affected limb. The compensating (non-affected) arm primarily affected coordinative stability, which underlines the importance of active arm movements in HE. Increasing walking speed may be used to improve interlimb coordination in DI., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: Toddlers learning to walk adopt specific 'guard' arm postures to maintain their balance during forward progression. In Cerebral Palsy (CP), the cause of the altered arm postures during walking has not been studied., Aim: To investigate whether the altered arm posture in children with CP is a compensation for instability during walking., Methods: Vertical and horizontal hand position, and upper arm elevation angle in the sagittal plane were determined in eleven children with unilateral CP, fifteen children with bilateral CP using 3D gait analysis and compared to twenty-four TD children. A correlation analysis of these measures of arm posture to step width was made to examine the relationship between arm posture and instability., Results: The hand position of children with CP was more elevated and anterior, and their upper arm was rotated more posterior than TD children. Children with unilateral CP held their most affected hand higher than their least affected. Increasing the speed accentuated the differences between groups for hand elevation. Step width correlated positively with horizontal hand position of the least affected arm in children with CP., Conclusion: Children with CP appear to rely on 'guard' arm postures as a compensation strategy to maintain balance while walking comparable to newly walking toddlers. Importantly, this pattern is seen on the least affected side. The substantially altered arm posture on the most affected side in children with unilateral CP, however, suggests that spasticity and associated movements are also important contributing factors., (Copyright © 2012 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.)

The aim of this study was to measure which three-dimensional spatiotemporal and kinematic parameters differentiate upper limb movement characteristics in children with hemiplegic cerebral palsy (HCP) from those in typically developing children (TDC), during various clinically relevant tasks. We used a standardized protocol containing three reach tasks (forwards, upwards, and sideways), two reach-to-grasp tasks (with objects requiring different hand orientations), and three gross motor tasks. Spatiotemporal (movement duration, trajectory straightness, maximum velocity, and timing of maximum velocity), as well as kinematic parameters (discrete angles and waveforms of the trunk, scapula, shoulder, elbow and wrist), were compared between 20 children with HCP (age 10.9 ± 2.9 years) and 20 individually age-matched TDC (age 10.9 ± 3.0 years). Kinematic calculations followed the recommendations from the International Society of Biomechanics. Results showed that children with HCP had longer movement durations, less straight hand trajectories, and lower maximum velocities compared to the TDC. Timing of maximum velocity did not differ between both groups. The movement pathology in children with HCP was highlighted by increased trunk movements and reduced shoulder elevation during reaching and reach-to-grasp. We also measured an increased anterior tilting and protraction of the scapula in children with HCP, although differences were not significant for all tasks. Finally, compared to the TDC, children with HCP used less elbow extension and supination and more wrist flexion to execute all tasks. This study reported distinct 3D upper limb movement characteristics in children with HCP and age-matched TDC, establishing the discriminative ability of the measurement procedure. From a clinical perspective, combining spatiotemporal and kinematic parameters may facilitate the identification of the pathological movement patterns seen in children with HCP and thereby add to a well-targeted upper limb treatment planning., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Children with Cerebral Palsy (CP) have difficulties walking at a normal or high speed. It is known that arm movements play an important role to achieve higher walking speeds in healthy subjects. However, the role played by arm movements while walking at different speeds has received no attention in children with CP. Therefore we investigated the use of arm movements at two walking speeds for children with diplegia (DI) and hemiplegia (HE) as compared to typically developing (TD) children. Arm and leg swing lengths were determined in 11 HE children and 15 DI children and compared to 24 TD children using 3D gait analysis at their preferred and "as fast as possible" walking speeds. We found that TD children increased walking speed more than both CP groups. HE children showed larger arm swings on the non-hemiplegic compared to the hemiplegic side for both walking speeds. In contrast to TD or DI children, the HE group did not show an increase in arm swing length with increasing walking speed. Their leg swing length was larger on the non-hemiplegic than on the hemiplegic side but only at the preferred walking speed. The DI children exhibited smaller leg swings at both walking speeds. Since arm swing is used both by DI (to increase speed) and by HE children (to compensate for the reduced movement on the affected side) it is argued that these movements are important and should be allowed (or even encouraged) in gait training procedures (such as treadmill training)., (Copyright © 2011 Elsevier Ltd. All rights reserved.)