The lower limb coordination, brain activation during walking and their correlation in adolescents with spastic cerebral palsy: A pilot cross-sectional fNIRS study.
Teens with spastic CP walk with jerkier hip-knee-ankle coordination and burn more parietal fuel—share these data with the PT when gait goals stall.
01Research in Context
What this study did
Zhou et al. (2026) watched teens with spastic CP walk on a treadmill while wearing a light cap that shines near-infrared light on the brain. The cap, called fNIRS, shows which parts of the brain work harder during each step.
They also tracked how the hip, knee, and ankle joints moved. The goal was to see if messy joint patterns link up with extra brain activity.
What they found
The teens with CP showed jerkier hip-knee and knee-ankle motion from step to step. Their brain used more parietal sensorimotor fuel to keep the legs going.
The more the parietal area lit up, the more variable the leg joints swung. Typical teens kept tight, steady patterns with less brain effort.
How this fits with other research
Vitiello et al. (2016) showed that just 15 minutes of walking tires the knee and wrecks balance in the same group. Fenyan adds the brain view: the knee may tire because the cortex is stuck in over-drive.
Amore et al. (2011) found that kids with hemiparetic CP cleverly swing the good arm to keep body spin normal. Fenyan’s teens could not hide the extra brain work; their fix happens inside the head, not with arm tricks.
Osório et al. (2025) saw high step-to-step variability in autistic toddlers. The pattern looks similar, but the cause differs: CP teens battle spasticity and weakness, while ASD toddlers struggle with motor planning.
Why it matters
When gait goals stall, share these brain data with the PT. If the parietal area is burning extra fuel, short bursts of walking or added rest may keep the knee from failing. You can also track progress with simple fNIRS caps in clinic—less variability plus lower brain light equals real improvement.
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Join Free →After a five-minute treadmill warm-up, note knee wobble; if it worsens, insert a seated break before the next walking trial.
02At a glance
03Original abstract
BACKGROUND: This study aimed to explore the lower limb coordination and brain activation in adolescents with cerebral palsy (CP) during walking, and to investigate their relationship. METHODS: 8 adolescents with spastic CP were recruited as the CP group and 8 typically developing (TD) adolescents as the control group. Functional near-infrared spectroscopy (fNIRS) and the Vicon motion capture system were used to collect hemodynamic signals and kinematic data during walking, respectively. RESULTS: The mean absolute value of the continuous relative phase (MACRP) values of hip-knee joint was lower but deviation phase (DP) values of hip-knee and knee-ankle joints was higher. The activation levels of the supplementary motor area (SMA), the pre-central gyrus (PRG), the post-central gyrus (POG), and the superior parietal lobe (SPL) were higher. The DP of hip-knee joint was positively correlated with the SPL (channels 9,18) and right POG (channel 17), whereas the DP of the knee-ankle joint was positively correlated with the right POG (channel 17). In the control group, the MACRP of knee-ankle joint was positively correlated with the right PRG and POG (channel 15). The DP of hip-knee joint was positively correlated with the right SMA (channel 12) but negatively correlated with the left SPL (channel 9). CONCLUSION: Adolescents with CP exhibit a higher variability in hip-knee and knee-ankle joints in the coordination patterns and greater demand for activation of the sensorimotor cortex during walking. The over-activation of the parietal cortex may lead to increased variability in the coordination patterns of individuals with CP.
Research in developmental disabilities, 2026 · doi:10.1016/j.ridd.2025.105197