Influence of body weight unloading and support surface during walking of children with cerebral palsy [

Abstract

Introduction: Partial body weight support (BWS) systems have been employed for gait training of children with cerebral palsy (CP). Therefore, it would be important to analyze if the type of walking surface and the amount of body weight unloading over lower limbs change the way these children walk. Objectives: Investigate the influence of walking surface and amount of body weight unloading on the spatial temporal characteristics during walking of children with CP. Materials and methods: Seven children with spastic CP between four and eight years old and GMFCS (Gross Motor Function Classification System) between I and IV, were videotaped walking with 0%, 15% and 30% of BWS on both dynamic (treadmill) and static (ground level) surfaces. Walking spatial temporal variables were calculated. Results: Children walked with similar velocity in all experimental conditions. While stance duration decreased as the percentage of BWS development and, consequently, promotes more autonomy. Biped walking is an acquired motor action (4, 5) and, although it seems a simple motor action, it requires the control of many elements, that transform it on a complex motor action. Walking acquisition is one of the main goal of intervention programs for children with CP. Gait impairment in children with CP are due, mainly, to spasticity or abnormal muscular tonus, motor control diminished and poor balance (6), and in many cases, those children are not able to generate sufficient muscular force to maintain upright posture and ambulate around. In this way, a strategy that could promote upright posture maintenance andhelp in the balance of those children would be body weight unloading on the lower limb during the locomotion. This strategy is named body weight support or partial body weight support (BWS), and it increased, no differences were found for stance and swing periods and cadence. Children walked with longer steps and strides and with faster strides on static surface compared to dynamic surface. Conclusion: Children with CP presenting different levels of motor impairment presented some alterations in the spatial temporal walking parameters as they walked with body unloading. However, such alterations might be due mainly to the type of walking surface than the percentage of body weight unloading on lower limbs.