Slip avoidance strategies in children with bilateral spastic cerebral palsy and crouch gait

Abstract

Background: A slip occurs when the required friction (RCOF) to prevent slipping at the foot/floor interfaces exceeds the available friction. The RCOF is dependent upon the biomechanics features of individuals and their gait. On the other hand, the available friction depends on environmental features. Once individuals with crouch gait have their biomechanics of gait completely altered, how do they interact with a supporting surface? The aim was to quantify the RCOF in children with bilateral spastic cerebral palsy (BSCP) and crouch gait.

Methods: 11 children with crouch gait and 11 healthy age-matched children were instructed to walk barefoot at self-selected speed over a force platform. The RCOF curve was obtained as the ratio between the tangential forces (FT), and the vertical ground reaction force (FZ). Three points were extracted by the RCOF, FT and FZ curves at the loading response, midstance and push-off phases.

Findings: Children with BSCP presented higher values of RCOF in all support phase and lower gait velocity relative to the healthy controls. For BSCP group no correlation between FT and FZ were found, indicating that this group is not able to negotiate the forces during the support phase.

Interpretation: Children with BSCP and crouch gait are not able to negotiate the forces applied on the ground in support phase, so to avoid the fall, their strategy is to reduce the gait velocity.

Keywords: Bilateral spastic cerebral palsy; Cerebral palsy; Crouch gait; Ground reaction force; Required coefficient of friction.