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The purpose of this study is to investigate lower limb impairments in children with bilateral cerebral palsy during stepping tasks.
Individuals with bilateral cerebral palsy (BCP) sustain a neonatal brain injury that leads to altered neuromuscular control to the lower limbs. One commonly observed motor impairment from this altered control is loss of selective voluntary motor control (SVMC), defined as the ability to independently move the joints intentionally. Loss of SVMC typically manifests as knee and ankle joint impairment and abnormal coupling between the hip adductors and lower limb extensors. This can make stepping up or down a curb or stair challenging, but quantitative investigation in these closed-chain activities has been limited. This is especially important as performance in stair-climbing is associated with limitations to overall mobility and community participation in cerebral palsy.
The overall aim of this proposal is to investigate the altered neuromuscular control that challenges stair walking in individuals with BCP. Participants who consent to the study will be instructed to perform multiple step-ups and step-downs on a single raised platform. The parameters of the stepping task may change by adding weight to the body or subtracting weight from the body. Using standard gait analysis techniques, biomechanical metrics such as joint kinematics and kinetics will be analyzed.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| load modulation | Experimental | Participants will experience different body weight loading conditions - with body weight added by a weighted vest or removed using the ZeroG overhead harness. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| load modulation | Other | Adding body weight (BW) up to 20% BW and subtracting body weight down to -20% BW |
|
| Measure | Description | Time Frame |
|---|---|---|
| Joint biomechanics (support moment) | Sum of the joint kinetics from the hip, knee and ankle, termed the "support moment" and measured in Nm. | At baseline and each loading level; During entirety of the stepping trial, from initial lift-off to final contact onto the single platform. |
| Joint biomechanics (hip) | hip torque (measured in Nm) will be identified for the hip, knee, and ankle during the duration of the task. | At baseline and each loading level; During entirety of the stepping trial, from initial lift-off to final contact onto the single platform. |
| Joint biomechanics (knee) | Knee angle (between the thigh and shank measured in degrees) will be identified during the duration of the task. | At baseline and each loading level; During entirety of the stepping trial, from initial lift-off to final contact onto the single platform. |
| Joint biomechanics (ankle) | Ankle angle (between the shank and foot measured in degrees) will be identified during the duration of the task. | At baseline and each loading level; During entirety of the stepping trial, from initial lift-off to final contact onto the single platform. |
| Measure | Description | Time Frame |
|---|---|---|
| Muscle activations (hip) | EMG data will be identified for underlying muscles of the hip during the stance phases of the task. | At baseline and each loading level; During entirety of the stepping trial, from initial lift-off to final contact onto the single platform. |
| Muscle activations (knee) |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Northwestern University | Chicago | Illinois | 60611 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 19627331 | Background | Rose J. Selective motor control in spastic cerebral palsy. Dev Med Child Neurol. 2009 Aug;51(8):578-9. doi: 10.1111/j.1469-8749.2009.03401.x. No abstract available. | |
| 20089048 | Background | Fowler EG, Staudt LA, Greenberg MB. Lower-extremity selective voluntary motor control in patients with spastic cerebral palsy: increased distal motor impairment. Dev Med Child Neurol. 2010 Mar;52(3):264-9. doi: 10.1111/j.1469-8749.2009.03586.x. |
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Raw data files underlying publications will be shared
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Upon publication
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| ID | Term |
|---|---|
| D002547 | Cerebral Palsy |
| D020233 | Gait Disorders, Neurologic |
| ID | Term |
|---|---|
| D001925 | Brain Damage, Chronic |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
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All participants are exposed to all conditions in a randomized order.
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EMG data will be identified for underlying muscles of the knee during the stance phases of the task. |
| At baseline and each loading level; During entirety of the stepping trial, from initial lift-off to final contact onto the single platform. |
| Muscle activations (ankle) | EMG data will be identified for underlying muscles of the ankle during the stance phases of the task. | At baseline and each loading level; During entirety of the stepping trial, from initial lift-off to final contact onto the single platform. |
| 21036615 | Background | Novak AC, Brouwer B. Sagittal and frontal lower limb joint moments during stair ascent and descent in young and older adults. Gait Posture. 2011 Jan;33(1):54-60. doi: 10.1016/j.gaitpost.2010.09.024. Epub 2010 Oct 30. |
| 9597060 | Background | Lepage C, Noreau L, Bernard PM. Association between characteristics of locomotion and accomplishment of life habits in children with cerebral palsy. Phys Ther. 1998 May;78(5):458-69. doi: 10.1093/ptj/78.5.458. |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |