Influence of crouch angle on lower-extremity kinetic gait profile and walk distance in children with cerebral palsy: a cross-sectional study.

Abstract

Background: Gait kinetics explains dynamics of gait deviations, which inform surgical and non-surgical clinical-decision-making to enhance walking performance of children with cerebral palsy. Kinetic gait profile of children with lesser crouch angle is known; however lower-extremity gait kinetics of ambulatory children at a further continuum of the spectrum with greater crouch angle is unclear. Therefore, present cross-sectional study evaluated influence of varying crouch angle on gait kinetics and walk distance.

Method: Following ethical approval and signed informed consent of parents, 3-D gait of 33 ambulatory children with CP(10.4 year) and 31 age-matched typically-developing children was studied to compute the magnitude and timing of lower-extremity external net joint moments and power during stance phase. An average of 3gait trials walked bare-feet at self-selected pace was considered for analyses. Walk distance was measured with 2-min walk test. Typically developing children were classified as Group I, children with mild crouch-angle (mean knee flexion angle during stance)[Formula: see text]16.8⁰and ≤ 25⁰ were classified as Group II(n = 17), whereas children with severe crouch-angle i.e.[Formula: see text] 25⁰ throughout stance phase were classified as Group III(n = 16). Three groups were compared with one-way-ANOVA(p ≤ 0.05). Bonferroni adjustment was made for post-hoc analyses (p ≤ 0.01).

Results: Gait speed, cadence and 2-minute walk distance decreased from Group I to II to III(p ≤ 0.01). Hip flexion, extension and adduction; knee flexion and ankle dorsiflexion moments were significantly different between three groups(p ≤ 0.01)). Rise in crouch-angle was associated with an increase in peak hip flexion moment and increase in power generated at hip and decrease in power generated at knee and ankle (p ≤ 0.01). The timing of peak hip and knee moments during stance phase also differed across the 3 groups (p ≤ 0.01) indicating a delay in the occurrence of peak hip flexion-extension; abduction-adduction and knee flexion moment with a rise in crouch angle.

Conclusion: Present findings inform lower-extremity joint kinetics during gait across the spectrum of mild to severe crouch angle with reference to typically-developing children. Precise knowledge of magnitude and pattern of net joint moments and power along with the timing of moments and decline in walking distance in children with severe crouch, can guide therapeutic interventions to restore the optimum dynamic lever arm function for improved walking performance.

Trial registration: CTRI registration no. CTRI/22/12/048524/27/12/2022.

Trial registry: CTRI/22/12.

Trial registration number: 048524. Trial registration date: 27th December 2022.