How do children with bilateral spastic cerebral palsy manage walking on inclines

Abstract Background Walking on inclined surfaces is an everyday task, which challenges stability and propulsion even in healthy adults. Children with cerebral palsy adapt similarly to inclines as healthy children. However, how stability and propulsion in these subjects are influenced by different inclines remained unaddressed as of yet. Research question Aim was to examine the feeling of safety, stability and propulsion in children with cerebral palsy on inclines to gain insight into the challenges they might face in these conditions. Methods Eighteen children with bilateral spastic cerebral palsy with gross motor function classification scale-level I and II and nineteen healthy children underwent instrumented 3D gait analysis on level ground and on 5° and 10° slopes. A mixed linear model was used to draw between and within group comparisons. Results Reduced lateral trunk sway, a relative lengthening of the lower limb at initial contact and a controlled walking speed were employed during downhill gait compared to level walking. Patients showed an increased ROM of trunk (3-4°) and pelvis (2°) and decreased sagittal knee ROM (13°) compared to the typical developed children. During uphill gait, an insufficient increase of push-off power at the ankle (0.48 W/kg) was noted, which appeared to lead to particularly shorter strides (about 0.1 m) in patients compared to healthy children (1.32 W/kg). The sagittal ROM of trunk (3-4°) and pelvis (2-3°) are increased compared to typical developed children. Significance Depending on inclination angle, children with cerebral palsy manage to in a controlled manner. The steeper the incline, the more the gait appeared to be affected: Decreased feeling of safety, increased need for stabilising mechanisms for downhill gait and less sufficient uphill propulsion were seen. Helping these patients to attain better control during downhill gait and strengthening uphill gait mechanisms may support their participation in everyday life.