Gait Parameters in Children with Cerebral Palsy and Healthy Children

The sample consists of two groups of children. The first group involves 10 children (four male and six female) with a previous clinical diagnosis of spastic CP aged (9.2±3.2) years. The second group contains 12 children with normal development (seven male and five female) aged 8.2±2.2 years mentioned in the paper as control subjects. For the CP group, the inclusion criteria were: (1) have a clinical diagnosis of spastic CP; (2) independent walking without use of assistive devices (i.e., walker, cane, and ankle-foot orthosis); (3) have not undergone orthopedic surgery within at least two years prior to the experiment; and (4) cognitive ability to understand instructions and efficiently take part in the experimentation protocol. For the control group (ND), the inclusion criteria were: (1) age matched to the CP group; (2) absence of motor impairments or chronic disease with mobility limitations; (3) normal walking; and (4) cognitive ability to understand instructions and efficiently take part in the experimentation protocol. All parents consented, and the children agreed to participate in the experiment; they provided written informed consent prior to their participation in the study. All patients had undergone SEMLS (Single Event Multilevel Surgery). A total of 37 procedures were performed for 17 limbs of the patients (13 Achilles tendon lengthening, 5 Hamstring lengthening, 6 rectus femoris recession, 6 Psoas lengthening, 6 Adductors, and one Femoral derotation osteotomy). The patients were tested at the gait analysis laboratory two times, the first (1.22±1) month before surgery (PrS) and the second (12.3±4.6) month after the surgery (PoS). Gait analysis was performed in the Biomechanics Laboratory at Damascus University, Syria, using a six-camera (BTS Bioengineering, Italy) and BTS software (BTS SMART Clinic, BTS Bioengineering, Italy). Twenty-two reflective markers were placed on the two lower extremities, pelvis, and trunk, according to the Davis-Heel protocol. The subjects walked along a 10-meter, carpeted walkway at a freely selected speed as data were collected barefoot. A minimum of three representative trials were processed with the subject's anthropometric data and averaged to get the final result for CP and ND children.

In this study, a set of 20 kinematic features (Table 2) serves as a comprehensive representation of the walking features exhibited across the hip, knee, and ankle joints during the gait cycle (Figures 4A and 4B). For the hip joint, three primary features are identified: H1, H2, and H3. H1 denotes the angular displacement during the initial maximum phase of hip movement, with corresponding temporal information represented by HT1. Subsequently, H2 characterizes the minimum angle achieved during the gait cycle, accompanied by its temporal counterpart, HT2. Finally, H3 encapsulates the angular value corresponding to the secondary maximum phase of hip motion, alongside its temporal occurrence, denoted by HT3.

Similarly, the knee joint features an analogous triad of parameters denoted as K1, K2, and K3. These parameters encapsulate the angular dynamics during key phases of knee motion, analogous to their hip counterparts. The temporal occurrences of these features are represented by KT1, KT2, and KT3, respectively. Finally, the ankle joint is examined with a more detailed focus, accounting for four distinctive phases of low, high, low, and high amplitude. These phases correspond to specific points within the gait cycle where the ankle joint shows notable angular displacements. The associated temporal information for these features is denoted by AT1, AT2, AT3, and AT4, respectively.