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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Bioeng. Biotechnol. | doi: 10.3389/fbioe.2019.00345

Excessive lateral trunk lean in patients with cerebral palsy: is it based on a kinematic compensatory mechanism?

 Roman Rethwilm1, 2*, Harald Böhm1, Chakravarthy U. Dussa1 and  Peter A. Federolf2
  • 1Orthopädische Kinderklinik Aschau, Germany
  • 2Department of Sport Science, Faculty of Psychology and Sport Science, University of Innsbruck, Austria

Introduction
Excessive lateral trunk lean is a commonly observed gait deviation in children with cerebral palsy (CP), with implications for energy expenditure and the development of back pain. While the trunk lean towards the stance leg is widely interpreted as a compensatory strategy to unload the hip, in CP the relation to hip abductor muscle strength is only weak. Therefore, other mechanisms may play a role in the prevalence of excessive trunk lean in CP, or it could be a primary motor function deficit.
Research Question
Is the excessive lateral trunk lean in patients with CP part of an underlying biomechanical mechanism?
Materials and Methods
Patients with bilateral CP (N=255; age 13.6±6.6 years) were retrospectively included and divided into a group with (n=174) and without (n=81) excessive lateral trunk lean. Ten lower-extremity joint angle waveforms were analyzed using a principal component analysis (PCA) to identify patterns of correlated deviations from average angle waveforms. Binary logistic regressions were performed to determine the discriminative capacity of the identified patterns.
Results
The PCA identified correlated kinematic patterns, with lower-order patterns showing more common gait pathologies, such as torsional malalignments and crouch gait pattern. Within five patterns, significant (p< .0025) group differences were identified. Interestingly, the trunk lean was not always distinctive in these patterns and despite the significant differences their effect sizes were small. The logistic regression was unable to reliably classify patients based on their trunk lean patterns.
Discussion
The current study identified multiple trunk lean-related patterns, however, excessive trunk lean was not attributable to a distinctive CP related gait pathology or to a specific compensatory strategy. Overall, the results do not support the hypothesis that excessive trunk lean is part of a biomechanical mechanism. Therefore, it seems more likely that excessive lateral trunk lean is based on other disease specific dysfunctions, influenced by the severity of the disease.

Keywords: 3D Gait Analysis, Gait pattern, Principal component analysis ( PCA), Trunk control, Duchenne gait, Motor function, compensatory strategy, Cerebral Palsy

Received: 03 Jul 2019; Accepted: 06 Nov 2019.

Copyright: © 2019 Rethwilm, Böhm, Dussa and Federolf. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Mx. Roman Rethwilm, Orthopädische Kinderklinik Aschau, Aschau im Chiemgau, 83229, Germany, r.rethwilm@bz-aschau.de