The arm posture in children with unilateral Cerebral Palsy is mainly related to antero-posterior gait instability

Abstract

In this observational case-control study we aimed to determine whether altered arm postures in children with unilateral CP (uniCP) are related to gait instability in a specific direction. Antero-posterior and medio-lateral Foot Placement Estimator instability measures and arm posture measures (vertical and antero-posterior hand position, sagittal and frontal upper arm elevation angle) were determined in eleven uniCP (7 years-10 months) and twenty-four typically developing children (9 years-6 months) at two walking speeds. Spearman-rank correlation analyses were made to examine the relationship between antero-posterior and medio-lateral arm posture and gait instability. Arm posture in both planes was related to antero-posterior instability (e.g. sagittal and frontal upper arm elevation angle correlated moderately with antero-posterior instability; R=0.41, p<0.001, R=-0.47, p<0.001). In uniCP, increased antero-posterior instability was associated with a higher (R=-0.62, p=0.002) and more frontal position of the hemiplegic hand (R=-0.58, p=0.005), while the non-hemiplegic upper arm was rotated more backward (R=0.63, p=0.002) and both upper arms rotated more sideways (hemiplegic: R=-0.58, p=0.004; non-hemiplegic: R=-0.55, p=0.008). The altered non-hemiplegic (sagittal and frontal) arm posture in uniCP may be a compensation to reduce antero-posterior gait instability.

Keywords: Arm posture; Cerebral Palsy; Foot placement estimator; Gait instability; Guard position.