Walking Environment and Speed Differentially Change More Affected Limb Dynamic Motor Control in Children With Cerebral Palsy
Stephanie N. Mace, Joseph W. Harrington, Vivek Dutt, Brian A. Knarr, David C. KingstonBackground:
Children with cerebral palsy (CP) have impaired motor and simplified neuromuscular control during walking. Surgical interventions, conventional therapies, and real-time biofeedback result in minimal improvements in muscle synergies, highlighting the need for new strategies to enhance motor control.
Objective:
To assess how neuromuscular control of the more-affected limb is acutely affected across walking environments and speeds for children with CP.
Method:
Eight children with CP (5 males and 3 females; age: 12.58 ± 3.91 years; height: 1.52 ± 0.20 m; and weight: 54.55 ± 30.83 kg) and 15 typically developing children had 8 surface EMG sensors on the lower limbs. Muscle synergies were calculated with non-negative matrix factorization to define dynamic motor control during walking (walk-DMC) for overground, conventional treadmill, and aquatic treadmill walking. We compared walk-DMC across environment and speed conditions (slow, normal, and fast) for the more-affected limb.
Results:
Main effects of the aquatic environment and the slow walking speed acutely increased walk-DMC in children with CP, indicating increased neuromuscular complexity. Neither conventional treadmill nor overground environments significantly impacted walk-DMC scores.
Conclusions:
Walk-DMC was sensitive to acute changes in the walking environment and speed in children with CP. These findings offer new perspectives on walking rehabilitation by accounting for the interplay between task demands and motor function. However, future studies should investigate repeated exposures to aquatic gait rehabilitation environments, particularly aquatic treadmill training and slow walking speeds.