title: Altered trunk movements during gait in children with spastic diplegia: compensatory or underlying trunk control deficit?
abstract: Altered trunk movements during gait in children with CP are considered compensatory due to lower limb impairments, although scientific evidence for this assumption has not yet been provided. This study aimed to study the functional relation between trunk and lower limb movement deficits during gait in children with spastic diplegia. Therefore, the relationship between trunk control in sitting, and trunk and lower limb movements during gait was explored in 20 children with spastic diplegia (age 9.2 ± 3 yrs; GMFCS level I n=10, level II n=10). Trunk control in sitting was assessed with the Trunk Control Measurement Scale (TCMS), a clinical measure that reflects the presence of an underlying trunk control deficit. Trunk movements during gait were measured with a recently developed trunk model including the pelvis, thorax, head, shoulder line and spine. Lower limb movements were assessed with the Plug-in-Gait model (Vicon(®)). Range of motion (ROM) of the different trunk segments was calculated, as well as the Trunk Profile Score (TPS) and Trunk Variable Scores (TVSs). Similarly, the Gait Profile Score (GPS) and Gait Variable Scores (GVSs) were calculated to describe altered lower limb movements during gait. Correlation analyses were performed between the presence of impaired trunk control in sitting (TCMS) and altered trunk movements during gait (ROM, TPS/TVSs) and between these altered trunk movements and lower limb movements (GPS/GVSs) during gait. A poorer performance on the TCMS correlated with increased ROM and TPS/TVSs, particularly for the thorax, indicating the presence of an underlying trunk control deficit. No significant correlation was found between the TPS and GPS, suggesting that overall trunk and lower limb movement deficits were not strongly associated. Only few correlations between specific lower limb deficits (GVSs for hip ab/adduction, knee flexion/extension and ankle flexion/extension) and TVSs for thorax lateral bending and rotation were found. This study provided first evidence that the altered trunk movements observed during gait should not be solely considered compensatory due to lower limb impairments, but that these may also partially reflect an underlying trunk control deficit. A better understanding of underlying trunk control deficits in children with CP may facilitate targeted therapy planning and ultimately can optimize a child's functionality.
authors.affiliation: KU Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Department of Rehabilitation Sciences, Tervuursevest 101, 3001 Heverlee, Belgium. Electronic address: lieve.heyrman@faber.kuleuven.be.
authors.forename: Lieve
authors.initials: L
authors.lastname: Heyrman
authors.affiliation: KU Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Department of Rehabilitation Sciences, Tervuursevest 101, 3001 Heverlee, Belgium. Electronic address: hilde.feys@faber.kuleuven.be.
authors.forename: Hilde
authors.initials: H
authors.lastname: Feys
authors.affiliation: University Hospital of Pellenberg, Clinical Motion Analysis Laboratory, Weligerveld 1, 3212 Pellenberg, Belgium; KU Leuven, Faculty of Medicine, Department of Development and Regeneration, Herestraat 49, 3000 Leuven, Belgium. Electronic address: guy.molenaers@uzleuven.be.
authors.forename: Guy
authors.initials: G
authors.lastname: Molenaers
authors.affiliation: ETH, Department of Health Sciences and Technology, Neural Control of Movement Lab, Rämistrasse 101, 8006 Zurich, Switzerland. Electronic address: ellen.jaspers@hest.ethz.ch.
authors.forename: Ellen
authors.initials: E
authors.lastname: Jaspers
authors.affiliation: KU Leuven, Science, Engineering and Technology Group, Department of Mechanical Engineering, Celestijnenlaan 300, 3001 Heverlee, Belgium. Electronic address: davide.monari@mech.kuleuven.be.
authors.forename: Davide
authors.initials: D
authors.lastname: Monari
authors.affiliation: KU Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Department of Rehabilitation Sciences, Tervuursevest 101, 3001 Heverlee, Belgium. Electronic address: angela.nieuwenhuys@faber.kuleuven.be.
authors.forename: Angela
authors.initials: A
authors.lastname: Nieuwenhuys
authors.affiliation: KU Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Department of Rehabilitation Sciences, Tervuursevest 101, 3001 Heverlee, Belgium; University Hospital of Pellenberg, Clinical Motion Analysis Laboratory, Weligerveld 1, 3212 Pellenberg, Belgium. Electronic address: kaat.desloovere@uzleuven.be.
authors.forename: Kaat
authors.initials: K
authors.lastname: Desloovere
mesh_terms: D001696:Biomechanical Phenomena; D002547:Cerebral Palsy / Q000503:physiopathology*; D002648:Child; D005260:Female; D020233:Gait Disorders, Neurologic / Q000503:physiopathology*; D006801:Humans; D008297:Male; D004856:Postural Balance / Q000502:physiology*; D016059:Range of Motion, Articular; D060726:Torso / Q000503:physiopathology*
keywords: Cerebral palsy; Clinical measurement scale; Three-dimensional gait analysis; Trunk control