The biomechanics of turning gait in children with cerebral palsy

Abstract

Turning while walking is a crucial component of locomotion; yet, little is known about how the biomechanics of turning gait differ from those of straight walking. Moreover, it is unclear how populations with restricted gait ability, such as children with cerebral palsy (CP) adapt to turning, compared to their typically developing (TD) peers. Thus, the aims of this thesis were to quantify the biomechanical differences between turning gait and straight walking in TD children and to explore if further, pathology specific, changes present during turning in children with CP. Biomechanical data, including three-dimensional body motion, ground reaction forces, and muscle activity from both groups were collected during straight walking and 90 degree turning gait using motion capture technology. Experimental data were used to compute joint kinematics (angles) and joint kinetics (moments and power) as well as more novel measures to quantify turning fluency and dynamic stability. These data were also used to derive walking simulations using a musculo-skeletal model of the human body in order to quantify muscle contributions to medio-lateral center of mass (COM) acceleration. The results show that both groups preferred to redirect their body during turning about the inside, rather than the outside, limb (with respect to the turn center). For TD children, substantial biomechanical adaptations occurred during turning, compared to straight walking. Furthermore, turning gait simulations reveal that proximal (hip abductors) and distal (ankle plantarflexors) leg muscles were mainly responsible for the redirection of the COM towards the new walking direction during turning. For children with CP, the results suggest that turning gait may be better able to reveal gait abnormalities than straight walking for a number of kinematic and kinetic gait variables. Potentially, analysis of turning gait could improve the identification and management of gait abnormalities in children with CP.This thesis is not currently available in OR