Altered trunk movements during gait in children with spastic diplegia: compensatory or underlying trunk control deficit?
Poor seated trunk control, not just leg weakness, drives extra trunk motion during gait in spastic diplegia.
01Research in Context
What this study did
Heyrman et al. (2014) watched kids with spastic diplegia walk. They also tested the same kids while they sat still.
The seated test is called the Trunk Control Measurement Scale (TCMS). It checks if the child can hold and move their trunk without falling.
By pairing the seated score with motion-capture data from walking, the team asked: does the trunk wobble during gait come from weak legs only, or also from a trunk-control problem?
What they found
Kids who scored low on the seated trunk test showed more thorax motion while walking.
The link stayed even when leg weakness was accounted for. This points to an independent trunk-control deficit, not just compensation for leg problems.
How this fits with other research
Saether et al. (2014) used a trunk-worn accelerometer on similar children. They also saw high trunk accelerations and asymmetry, but they blamed poor balance rather than rating seated control. The two studies agree: the trunk is a problem zone.
Bigham et al. (2013) found that weak hip abductors cause only a small trunk lean. Lieve’s team now shows that seated trunk scores predict gait motion better than hip strength. Together they tell you to look above the pelvis, not just at the hips.
Ballaz et al. (2014) saw less coordinated trunk-hip action during a Wii Fit skiing game. Their visual weight-shifting task and Lieve’s TCMS both flag medio-lateral trunk control as a separate issue, strengthening the case for trunk-focused goals.
Why it matters
Before you write a gait goal, run the five-minute TCMS. If the score is low, add trunk-stability drills to your plan. Targeting the trunk early may cut down compensations and save leg strength work for later.
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02At a glance
03Original abstract
Altered trunk movements during gait in children with CP are considered compensatory due to lower limb impairments, although scientific evidence for this assumption has not yet been provided. This study aimed to study the functional relation between trunk and lower limb movement deficits during gait in children with spastic diplegia. Therefore, the relationship between trunk control in sitting, and trunk and lower limb movements during gait was explored in 20 children with spastic diplegia (age 9.2 ± 3 yrs; GMFCS level I n=10, level II n=10). Trunk control in sitting was assessed with the Trunk Control Measurement Scale (TCMS), a clinical measure that reflects the presence of an underlying trunk control deficit. Trunk movements during gait were measured with a recently developed trunk model including the pelvis, thorax, head, shoulder line and spine. Lower limb movements were assessed with the Plug-in-Gait model (Vicon(®)). Range of motion (ROM) of the different trunk segments was calculated, as well as the Trunk Profile Score (TPS) and Trunk Variable Scores (TVSs). Similarly, the Gait Profile Score (GPS) and Gait Variable Scores (GVSs) were calculated to describe altered lower limb movements during gait. Correlation analyses were performed between the presence of impaired trunk control in sitting (TCMS) and altered trunk movements during gait (ROM, TPS/TVSs) and between these altered trunk movements and lower limb movements (GPS/GVSs) during gait. A poorer performance on the TCMS correlated with increased ROM and TPS/TVSs, particularly for the thorax, indicating the presence of an underlying trunk control deficit. No significant correlation was found between the TPS and GPS, suggesting that overall trunk and lower limb movement deficits were not strongly associated. Only few correlations between specific lower limb deficits (GVSs for hip ab/adduction, knee flexion/extension and ankle flexion/extension) and TVSs for thorax lateral bending and rotation were found. This study provided first evidence that the altered trunk movements observed during gait should not be solely considered compensatory due to lower limb impairments, but that these may also partially reflect an underlying trunk control deficit. A better understanding of underlying trunk control deficits in children with CP may facilitate targeted therapy planning and ultimately can optimize a child's functionality.
Research in developmental disabilities, 2014 · doi:10.1016/j.ridd.2014.04.031