Three-dimensional head and trunk movement characteristics during gait in children with spastic diplegia

- Children with CP showed increased head and trunk movements compared to TD children.
- Impairments were multidimensional in more disabled children (GMFCS II).
- Both GMFCS I and II showed increased thorax lateral bending.
- Differences between GMFCS levels were found in the control of sagittal movements.
- A new index for overall trunk pathology, the TPS, showed additional value.

This study uses a recently developed trunk model to determine which head and trunk kinematic parameters differentiate children with spastic diplegia from typically developing (TD) children while walking. Differences in head and trunk parameters in relation to the severity of the motor involvement (GMFCS levels) were additionally examined. The trunk model consisted of five segments (pelvis, thorax, head, shoulder line, spine). Discrete kinematic parameters (ROM, mean position) and angular waveforms were compared between 20 children with spastic diplegia (age 9.8 years ± 2.9 years; GMFCS I: n = 10, GMFCS II: n = 10) and 20 individually age-matched TD children (9.7 years ± 3 years). A new measure for overall trunk pathology, the trunk profile score (TPS), was proposed and included in the comparative analysis. Compared to TD children, children with GMFCS II showed a significantly higher TPS and increased ROM for pelvis tilt, for thorax and head in nearly all planes, and the angle of kyphosis. In children with GMFCS I, only ROM of thorax lateral bending was significantly increased. Sagittal ROM differentiated best between GMFCS levels, with higher ROM found in children with GMFCS II. Current results provide new insights into head and trunk kinematics during gait in children with spastic diplegia.