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This longitudinal study investigated the impact of the first independent steps on harmonic gait development in unilateral cerebral palsy (CP) and typically developing (TD) children. We analysed the gait ratio values (GR) by comparing the duration of stride/stance, stance/swing and swing/double support phases. Our investigation focused on identifying a potential trend towards the golden ratio value of 1.618, which has been observed in the locomotion of healthy adults as a characteristic of harmonic walking. Locomotor ability was assessed in both groups at different developmental stages: before and after the emergence of independent walking. Results revealed that an exponential fit was observed only after the first unsupported steps were taken. TD children achieved harmonic walking within a relatively short period (approximately one month) compared to children with CP, who took about seven months to develop harmonic walking. Converging values for stride/stance and stance/swing gait ratios, averaged on the two legs, closely approached the golden ratio in TD children (R 2  = 0.9) with no difference in the analysis of the left vs right leg separately. In contrast, children with CP exhibited a trend for stride/stance and stance/swing (R 2  = 0.7), with distinct trends observed for the most affected leg which did not reach the golden ratio value for the stride/stance ratio (GR = 1.5), while the least affected leg exceeded it (GR = 1.7). On the contrary, the opposite trend was observed for the stance/swing ratio. These findings indicate an overall harmonic walking in children with CP despite the presence of asymmetry between the two legs. These results underscore the crucial role of the first independent steps in the progressive development of harmonic gait over time., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2023. Published by Elsevier B.V.)

Background: This paper presents the preliminary results of a novel rehabilitation therapy for cervical and trunk control of children with cerebral palsy (CP) based on serious videogames and physical exercise., Materials: The therapy is based on the use of the ENLAZA Interface, a head mouse based on inertial technology that will be used to control a set of serious videogames with movements of the head., Methods: Ten users with CP participated in the study. Whereas the control group (n = 5) followed traditional therapies, the experimental group (n = 5) complemented these therapies with a series of ten sessions of gaming with ENLAZA to exercise cervical flexion-extensions, rotations and inclinations in a controlled, engaging environment., Results: The ten work sessions yielded improvements in head and trunk control that were higher in the experimental group for Visual Analogue Scale, Goal Attainment Scaling and Trunk Control Measurement Scale (TCMS). Significant differences (27% vs. 2% of percentage improvement) were found between the experimental and control groups for TCMS (p < 0.05). The kinematic assessment shows that there were some improvements in the active and the passive range of motion. However, no significant differences were found pre- and post-intervention., Conclusions: Physical therapy that combines serious games with traditional rehabilitation could allow children with CP to achieve larger function improvements in the trunk and cervical regions. However, given the limited scope of this trial (n = 10) additional studies are needed to corroborate this hypothesis.

Background: Cerebral palsy (CP) has been defined as a nonprogressive disease of movement and posture development. Physical therapy techniques use different forms of sensory stimulation to improve neuromotor development., Aim: The aim of this study was to assess the efficacy of a vestibular stimulation training in improving motor functions in cerebral palsy., Population: Fourteen children with CP were randomly separated into two different groups in a cross-over trial., Methods: Over a period of 10 weeks, each group performed 10 sessions of 50 min of neurodevelopmental treatment (NDT) and 10 sessions of vestibular training (VR). Children were evaluated with the Gross Motor Function Measurement-88 scale, the Goal Attainment Scale and the root mean square of head accelerations., Results: A significant improvement in the GAS-score (p = .003) was noted after NDT+VR., Conclusions: Vestibular stimulation integrated with NDT proved to be an effective complementary strategy for facilitating motor functioning.

Background: Dual task paradigm is a common mechanism of daily life, and it is often used for investigating the effect on cognitive processing of motor behavior., Aim: In the present study we investigate the dual task interference during walking on upright gait stability., Design: Cross-sectional study., Setting: Inpatient neurorehabilitation unit and children neurorehabilitation unit., Population: Eighty-five subjects were enrolled, divided into five groups: healthy young, healthy elderly, children with typical development, children with cerebral palsy and adults with stroke in subacute phase., Methods: All subjects had to walk through a pathway during which they had to hear a sound, turn the head to watch a number and verbalize it. Subjects wore an accelerometer on their lumbar spine to measure upright gait stability have been assessed by means of the Root Mean Square (RMS) of the trunk acceleration., Results: All subjects showed a reduced speed when performing a dual task with respect to single task. This reduction was significantly different among groups (F(4,81)=12.253, P<0.001, effect size 0.377). The RMS appeared to be increased along the latero-lateral axis, and reduced along the anterio-posterior and the cranio-caudal axes during the dual task walking., Conclusions: These accelerations were significantly related to the changes in speed that were managed in a different way in subjects affected by cerebral palsy and stroke., Clinical Rehabilitation Impact: The information obtained in this study may be used to support specific rehabilitation techniques in subjects with poor balance ability.

Upper body movements during walking provide information about balance control and gait stability. Typically developing (TD) children normally present a progressive decrease of accelerations from the pelvis to the head, whereas children with cerebral palsy (CP) exhibit a general increase of upper body accelerations. However, the literature describing how they are transmitted from the pelvis to the head is lacking. This study proposes a multilevel motion sensor approach to characterize upper body accelerations and how they propagate from pelvis to head in children with CP, comparing with their TD peers. Two age- and gender-matched groups of 20 children performed a 10m walking test at self-selected speed while wearing three magneto-inertial sensors located at pelvis, sternum, and head levels. The root mean square value of the accelerations at each level was computed in a local anatomical frame and its variation from lower to upper levels was described using attenuation coefficients. Between-group differences were assessed performing an ANCOVA, while the mutual dependence between acceleration components and the relationship between biomechanical parameters and typical clinical scores were investigated using Regression Analysis and Spearman's Correlation, respectively (α = 0.05). New insights were obtained on how the CP group managed the transmission of accelerations through the upper body. Despite a significant reduction of the acceleration from pelvis to sternum, children with CP do not compensate for large accelerations, which are greater than in TD children. Furthermore, those with CP showed negative sternum-to-head attenuations, in agreement with the documented rigidity of the head-trunk system observed in this population. In addition, the estimated parameters proved to correlate with the scores used in daily clinical practice. The proposed multilevel approach was fruitful in highlighting CP-TD gait differences, supported the in-field quantitative gait assessment in children with CP and might prove beneficial to designing innovative intervention protocols based on pelvis stabilization.

Background: Previous studies reported controversial results about the efficacy of video-game based therapy (VGT) in improving neurorehabilitation outcomes in children with cerebral palsy (CP)., Aim: Primary aim was to investigate the effectiveness of VGT with respect to conventional therapy (CT) in improving upper limb motor outcomes in a group of children with CP. Secondary aim was to quantify if VGT leads children to perform a higher number of movements., Design: A cross-over randomized controlled trial (RCT) for investigating the primary aim and a cross-sectional study for investigating the secondary aim of this study., Settings: Outpatients., Inclusion Criteria: clinical diagnosis of CP, age between 4 and 14 years, level of GMFC between I and IV., Exclusion Criteria: QI<35, severe comorbidities, incapacity to stand even with an external support., Methods: Twenty-two children with CP (6.89±1.91-year old) were enrolled in a cross-over RCT with 16 sessions of VGT (using Xbox with Kinect device) and then 16 of CT or vice versa. Upper limb functioning was assessed using the Quality of Upper Extremities Skills Test (QUEST) and hand abilities using Abilhand-kids score. According to the secondary aim of this study a secondary cross-sectional study has been performed. Eight children with CP (6.50±1.60-year old) were enrolled into a trial in which five wireless triaxial accelerometers were positioned on their forearms, legs and trunk for quantifying the physical activity during VGT vs. CT., Results: QUEST scores significantly improved only after VGT (P=0.003), and not after CT (P=0.056). The reverse occurred for Abilhand-kids scores (P=0.165 vs. P=0.013, respectively). Quantity of performed movements was three times higher in VGT than in CT (+198%, P=0.027)., Conclusion: VGT resulted effective in improving the motor functions of upper limb extremities in children with CP, conceivably for the increased quantity of limb movements, but failed in improving the manual abilities for performing activities of daily living which benefited more from CT., Clinical Rehabilitation Impact: VGT performed using the X-Box with Kinect device could enhance the number of upper limb movements in children with CP during rehabilitation and in turn improving upper limb motor skills, but CT remained superior for improving performances in manual activities of daily living.

Objectives: Many studies have examined how children with cerebral palsy (CP) manage to walk, but few have investigated running, yielding controversial results. The aim of this study was to quantitatively assess gait ability and its stability in children with hemiplegic CP while running and walking., Methods: A group of 20 children with spastic hemiplegia due to CP (CPG, 5.1 ± 2.3 years old), and a group of 20 children with typical development (TDG, 5.9 ± 2.6 years old) underwent a 10-m walking/running test with a wearable triaxial accelerometer fixed to their lower trunk. Spatiotemporal gait parameters, root mean squares of upper body acceleration, and related harmonic and symmetry ratios were computed., Results: Differences in gait speed were significantly higher during running ( - 19% for CPG with respect of TDG) than during walking ( - 14%, p = 0.028). Conversely, no significant changes were observed in terms of gait stability, and the differences in terms of gait harmony along anteroposterior axis recorded during walking ( - 43%, p < 0.001) disappeared during running ( + 3%, p = 0.834)., Conclusions: During running, children with CP are slower than children with TD, but their gait was not less stable, and the harmony of their anteroposterior movements was even more similar to TDG than during walking., (Georg Thieme Verlag KG Stuttgart · New York.)

The aim of this study was to quantitatively assess the stability and harmony of gait in children with cerebral palsy. Seventeen children with spastic hemiplegia due to cerebral palsy (5.0±2.3 years old) who were able to walk autonomously and seventeen age-matched children with typical development (5.7±2.5 years old, p=0.391) performed a 10-m walking test with a wearable device fixed to their lower trunk and included a triaxial accelerometer and three gyroscopes. Three parameters related to gait stability and three related to gait harmony were computed; all of these yielded significant differences between children with cerebral palsy and those with typical development (p<0.020 for all the computed parameters). In the latter group of children, trunk accelerations were found to be negatively correlated with age (partial correlation controlled for walking speed: R(p)<-0.58, p>0.020). Conversely, in children with cerebral palsy, the upper body accelerations were proportionally correlated with their gait speed (R=0.548, p=0.023 in the antero-posterior direction) but not with their age (p>0.05). This finding can be related both to difficulties in managing the higher upper body accelerations involved in rapid walking and to compensation strategies., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Functional taping with elastic bandages and adhesive tapes could limit the action of upper limb spastic muscles and sustain that of weaker muscles in children with hemiplegic cerebral palsy (CP). 16 young children with CP (3±2 years old) were enrolled in this pilot study including 5 months of taping in conjunction with conventional physical therapy, followed by 7 months of physical therapy alone (taping wash-out), and other 5 months of taping plus therapy. Large improvements in the Melbourne assessment score were found in the first period in which taping was used (+15.4%, p<0.001) and also in the second one despite 8 drop-outs (+8.4%, p=0.012), but not during the taping wash-out (- 4.6%; p=0.093). These results suggest that children with CP could benefit from the continuous correction provided by taping in order to limit the development of improper upper limb motor schemas and to favour that of proper ones., (© Georg Thieme Verlag KG Stuttgart · New York.)