Cinemática da marcha de crianças com desenvolvimento típico e com paralisia cerebral diplégica espástica nível I e II do GMFCS: um estudo comparativo

Abstract

The objective of the study is compare, using PCA, the kinematics of thepelvis, hip, knee and ankle during gait between typical and spastic diplegic cerebral palsy GMFCS I and II children. Cross-sectional observational study was realized with 56 children, aged 6 to 12 years (9.0±SD), divided into three groups: children level I of the GMFCS; children level II of the GMFCS and children with typical development were studied. Kinematic data was obtained using a motion analysis system Qualisys Pro-Reflex - MCU 240, with eight cameras synchronized with two force platforms, to determine the gait events, as the participants walked on a platform of 7 meters. Landmarks over specific anatomic points were used for the construction of the pelvis, thigh, leg and foot segments. The data were processed using the software acquisition Qualisys Track Manager 1.6.0.x - QTM, and transferred to the Visual 3D software to obtain the kinematic data. PCA was applied in order to reduce thedimensionality of the data, the time dependence and temporal variabilitybetween the gait curves. A 90% of total data variability was the cut off pointfor data explanation. To determine which component was statisticallysignificant between the groups a 95% CI was applied. The componentsinterpretations were performed by reading loads of vector graphics. Therewere differences in speed and stride length among the three groups. Thecycle time was statistically smaller in the typical group and time of support was higher in the GMFCS II group (p <0.05). In the pelvis and hip, the factors that most contributed to differentiate children GMFCS I from typical were decreased pelvic elevation, increased ROM of hip flexion and smaller ROM of internal/external rotation, with greater internal rotation in children GMFCS I. In relation to GMFCS groups I and II, children GMFCS II showed less hip extension and adduction during the stance phase of gait At the hip joint, the main components observed were excess of hip flexion and loss of extension ROM in children GMFCS I and II in relation to typical. At the knee joint, the main differences were the smaller knee flexion/extension ROM of the GMFCS I and II groups in relation to typical. In addition, the range of knee external rotation was lower in children GMFCS I and II compared to typical. At the ankle, children GMFCS I and II had lower range of plantar flexion and adduction and abduction ROM than typical children. Kinematic gait analysis through PCA was effective in differentiating characteristics of gait in spastic diplegic cerebral palsy children from level I and II and from typical children. Our results might help physiotherapists on treatment planning.