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Differences in the dynamic gait stability of children with cerebral palsy and typically developing children
Abstract
The aim of this investigation was to evaluate the differences in the dynamic gait stability of children with cerebral palsy (CP) and typically developing (TD) children. The participants walked on a treadmill for 2 min as a motion capture system assessed the walking kinematics. Floquet analysis was used to quantify the rate of dissipation of disturbances that were present in the walking kinematics, and the variability measures were used to assess the magnitude of the disturbances present in the step length and width. The Floquet multipliers, step width and length values were correlated with Sections D and E of the Gross Motor Function Measure (GMFM). The children with CP had a larger Floquet multiplier and used a wider step width than the TD children. The magnitude of the maximum Floquet multiplier was positively correlated with the step width. Furthermore, the magnitude of the maximum Floquet multiplier and the step width were negatively correlated with the score on Section E of the GMFM. Lastly, the children with CP used a more variable step length than the TD children. These results suggest that children with CP have poor dynamic gait stability because they require more strides to dissipate the disturbances that are present in their walking pattern. In effort to stabilize these disturbances, the children with CP appear to utilize a wider step width and modulate their step length. Overall the inability to effectively dissipate the gait disturbances may be correlated with the child's ability to perform a wide range of gross motor skills (e.g., step over obstacles, jump, walk up stairs).
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Postural control dysfunction in children with CP contributes to limitations in gross motor skills requiring balance, especially gait, upper limb activities, and oral motor activities.
“This dysfunction is known to contribute to limitations in gross motor skills that require balance, 16 especially gait, 17,18 during upper limb activities such as reaching, 19 and during oral motor activities such as eating, swallowing, and speaking. 20”
From Exercise interventions improve postural control in children with cerebral palsy: a systematic review (2015) · cites this paper as [18]
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Exercise interventions improve postural control in children with cerebral palsy: a systematic review
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“Over 90% of these children present motor impairments that result in a gait pattern that is slower, less coordinated, and has a greater amount of variability or errors in the temporal kinematics [1,2].”
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“This finding is in agreement with earlier studies reporting increased variability in gait characteristics in children with CP (Hsue et al., 2009a; Katz-Leurer, Rotem, Keren, & Meyer, 2009; Kurz et al., 2012; Prosser et al., 2010).”
ResultEvaluation of postural stability in children with hemiplegic cerebral palsy
Keniş-Coşkun, Ö., Giray, E., Eren, B., Özkök, Ö., & Karadağ‐Saygı, E. (2016) · Journal of Physical Therapy Science · doi:10.1589/jpts.28.1398 · Cited by 44
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Kurz, M. J., Bergwell, H., Spooner, R. K., Baker, S. E., Heinrichs‐Graham, E., & Wilson, T. W. (2020) · Annals of Clinical and Translational Neurology · doi:10.1002/acn3.51246 · Cited by 26
“Our biomechanical results were aligned with the current literature that has overwhelmingly showed that youth with CP have slower walking speeds, shorter step lengths and a reduced cadence compared with the controls.(9,41-43) However, our correlation results provide insight on the possible neurological mechanisms that…”
ResultSelf-citationWalking dynamics are symmetric (enough)
Ankaralı, M. M., Sefati, S., Madhav, M. S., Long, A., Bastian, A. J., & Cowan, N. J. (2015) · Journal of The Royal Society Interface · doi:10.1098/rsif.2015.0209 · Cited by 30
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1 Walking dynamics are symmetric (enough)Preprint
Ankaralı, M. M., Sefati, S., Madhav, M. S., Long, A., Bastian, A. J., & Cowan, N. J. (2016) · Cited by 25
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“Marker positions and ground reaction forces were low-pass filtered by 4th order Butterworth filters with cutoff frequencies of 6 Hz and 20 Hz, respectively based on previous literature (Kurz et al., 2012; Reisman et al., 2009; Winter, 2009).”
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“…children with CP were compared to normal children, the step widths of children with CP were found to be larger than those of normal children; the reason being that children with CP widened the bearing surface to maintain the stability of the center of mass due to their poor trunk stability [10,32].”
A New Perspective on the Walking Margin of Stability
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Self-citationEinstein relation and hydrodynamics of nonequilibrium mass transport processes
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“These methods include tracking the variability of the center of mass (COM) trajectory [1,2,3,4], calculating a margin of stability [5,6], using non-linear dynamics such as Lyapunov exponents or Floquet multipliers to compare stability [7,8], and tracking standing balance with the presumption that it correlates with dy…”
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“In addition, they have poor dynamic gait stability, as they require more strides to dissipate these gait disturbances, and, to compensate for these alterations, they show a greater stride width [10,11], modulating the length of their stride [12].”
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“Since it is conceivable that disturbances in the motor system of children with CP result from spasticity [27] and that the output variability is a product of input disturbances [32], we hypothesised that reducing the volume of afferent input through SDR might be an effective treatment not only to reduce spasticity but…”
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Leizerowitz, G. M., & Leurer, M. K. (2017) · Brain Injury · doi:10.1080/02699052.2017.1332384 · Cited by 13
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“The larger step width broadens the support base during the double support phase, and highlights the balance difficulties encountered by children with CP during gait.(36,37,83)”
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“Considering that the variability in CP gait is higher compared to TD gait (Kurz et al., 2012; Davies and Kurz, 2013), we hypothesized that the intra-subject variability in the OI is higher in children with CP compared to TD children.”
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“The different responses between our healthy older adult and CP cohorts may be attributed to the fact that people with CP typically already walk with wider steps compared to the unimpaired population [23], potentially leaving limited room for change.”
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“We selected the type of filter and cut-off frequency based on previous literature [3,26,27].”
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“Such variability is considered to be a key contributor to dynamic instability during walking [27–29].”
Flux, E., van der Krogt, M. M., Harlaar, J., Buizer, A. I., & Sloot, L. H. (2021) · Journal of NeuroEngineering and Rehabilitation · doi:10.1186/s12984-021-00940-1 · Cited by 9
“Children with cerebral palsy often present with abnormal gait patterns, and the altered ankle kinematics and lower gait stability [32] could interfere with the feasibility of the protocol and the effectiveness of evoking reflexes.”
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“…populations who commonly demonstrate stiff-knee gait (e.g., individuals post-stroke or with cerebral palsy) often walk with increased step widths (Kurz et al., 2012; Roerdink et al., 2007) and exhibit poorer balance control (Kurz et al., 2012; Nott et al., 2014) compared to healthy individuals.”
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“Previous studies demonstrated a wider step width in CP compared to TD (Chang et al., 2011; Kurz et al., 2012), as shown here.”
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Dussault-Picard, C., Cherni, Y., & Dixon, P. C. (2025) · Scientific Reports · doi:10.1038/s41598-025-89280-x · Cited by 6
“3a) suggests dynamic stability impairments and, consequently, the need for greater adaptation to maintain stability in response to the balance perturbation 45 .”
Generalizability of foot placement control strategies during unperturbed and perturbed gait
Liu, C., Valero‐Cuevas, F. J., & Finley, J. M. (2024) · Royal Society Open Science · doi:10.1098/rsos.231210 · Cited by 6
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“walking or difficulty in climbing stairs [11].”
Assessing Dynamic Balance in Children with Cerebral Palsy
Niiler, T. (2018) · Springer eBooks · doi:10.1007/978-3-319-50592-3_49-1 · Cited by 7
“A related analysis which makes use of Floquet multipliers (FM) does not require so many cycles for valid results and has shown some promise in the assessment of balance in children with CP (Kurz 2012).”
Method[Retracted] Simulation Analysis and Study of Gait Stability Related to Motion Joints
Lei, Y., & Yang, F. (2022) · BioMed Research International · doi:10.1155/2022/8417089 · Cited by 5
“found that children with cerebral palsy had poor gait stability because they needed more stride length to eliminate the disturbances present [8].”
BackgroundRetractedWeight distribution asymmetry in relation to walking speed in children with spastic cerebral palsy
Ibrahim, N. M., & Abbass, M. E. (2022) · African Health Sciences · doi:10.4314/ahs.v22i2.65 · Cited by 5
“Correlation between speed and weight on the most affected side in children with diplegia is represented in figure (2).”
BackgroundGómez-Pérez, C., Vidal, J., Puig-Diví, A., Medina-Casanovas, J., Font-Llagunes, J. M., & Martori, J. C. (2022) · Journal of Orthopaedic Science · doi:10.1016/j.jos.2022.08.011 · Cited by 4
“However, most of them only studied cadence, stride length and/or gait speed [22,24–27], and specific types of clinical outcomes at body functions and structures level, or activities and participation level [23–25 ,27,28].”
BackgroundResultHegazy, R. G., & Abdel-aziem, A. A. (2022) · Journal of Manipulative and Physiological Therapeutics · doi:10.1016/j.jmpt.2023.04.011 · Cited by 4
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“In terms of biomechanics, the stability of the human body during walking primarily depends on the ability to regulate the movement of the center of mass (COM) 49 , typically situated at the junction of the waist and pelvis of the human body 50 .”
Rovnováha a možnosti jejího hodnocení
Bizovská, L., Janura, M., Míková, M., & Svoboda, Z. (2017) · doi:10.5507/ftk.17.24452593 · Cited by 4
Assessing Dynamic Balance in Children with Cerebral Palsy
Niiler, T. (2020) · Springer eBooks · doi:10.1007/978-3-319-74558-9_49 · Cited by 4
Mousa, R. A., Elhadidy, E. E., & Ali, W. M. (2024) · Bulletin of Faculty of Physical Therapy · doi:10.1186/s43161-024-00203-9 · Cited by 3
“Impaired motor control is one of the most common neuromuscular deficits in children with spastic CP and often occurs in combination with muscle weakness and spasticity [4].”
BackgroundAziz, H. G. A. E., Khatib, A. E., & Hamada, H. A. (2019) · Journal of Chiropractic Medicine · doi:10.1016/j.jcm.2019.01.005 · Cited by 3
“Children with spastic diplegia frequently have problems with motor control, spasticity, and balance that lead to gait abnormalities and problems.(1) Evaluation of lower limb dysfunction in children with CP is a complex process.”
BackgroundAssociation between pelvic inclination and balance in children with spastic diplegia
Allah, N. E. A., Kamal, H. M., & El-Nabie, W. A. E.-H. A. (2023) · Bulletin of Faculty of Physical Therapy · doi:10.1186/s43161-022-00115-6 · Cited by 3
“Children with spastic diplegia experience gait abnormalities and problems caused by deficits in balance, motor control, and spasticity [4].”
BackgroundReal-time detection of reaction forces during gait on a ground equipped with a large force platform
Samadi, B., Raison, M., Detrembleur, C., & Ballaz, L. (2014) · Global Information Infrastructure and Networking Symposium · doi:10.1109/giis.2014.6934268 · Cited by 3
Flux, E., Mooijekind, B., Bar‐On, L., van Asseldonk, E. H. F., Buizer, A. I., & van der Krogt, M. M. (2024) · Journal of Electromyography and Kinesiology · doi:10.1016/j.jelekin.2024.102921 · Cited by 2
Lohss, R., Sangeux, M., Visscher, R. M. S., Winter, R., Gwerder, M., Zentai, N., Cattin, P. C., & Viehweger, E. (2025) · Human Movement Science · doi:10.1016/j.humov.2025.103359 · Cited by 2
Ayoub, H. S., Tawfik, R. M., Draz, A. H., Habib, D. A. A., & Said, S. M. (2025) · Neurorehabilitation · doi:10.1177/10538135251399216 · Cited by 2
“Children with spastic diplegia often experience severe gait abnormalities and postural instability because of de fi - cits in motor control, spasticity, and coordination (Kurz et al., 2012).”
Zhou, F., Qi, L., Sun, W., & Wang, J. (2025) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2025.105197 · Cited by 2
Dissipation of disturbances seen in the knee joint kinematics of children with cerebral palsy
Kurz, M. J., Arpin, D. J., Davies, B. L., & Gehringer, J. E. (2015) · PubMed · doi:10.5277/abb-00207-2014-04 · Cited by 2
“Assessing how disturbances in the movement pattern influence the ability to return back to the limit cycle trajectory has proven to be rewarding in the assessment of the stability of movement patterns seen in humans, animals, and walking robots [7], [9], [10], [13], [14].”
BackgroundMethodSelf-citationKimoto, M., Okada, K., Mitobe, K., Saito, M., & Sakamoto, H. (2024) · Journal of Biomechanics · doi:10.1016/j.jbiomech.2024.112349 · Cited by 2
Association Between Two Methods of Spinal and Pelvic Analysis Among Children With Cerebral Palsy.
Ali, M. S., & Usama, M. (2024) · PubMed Central · Cited by 1
Holistic Evaluation of Gait Development in Children by Principal Component Analysis
Sawatome, A., Tada, M., Takemura, H., Kouchi, M., & Mochimaru, M. (2016) · Journal of the Society of Biomechanisms · doi:10.3951/sobim.40.1_43 · Cited by 1
Mohamed, R. A., & Elnaggar, R. K. (2015) · British Journal of Applied Science & Technology · doi:10.9734/bjast/2015/16313
“Because of motor weakness and poor voluntary motor control, children with CP use a wider step width than normal children [39], suggesting that children with CP may choose a wider base of support in order to stabilize the center of mass.”
BackgroundTratamiento combinado aplicado en parálisis cerebral infantil: presentación de un caso
Sanz-Terrades, P., Espí‐López, G. V., Sánchez-Sánchez, M. L., Ruescas-Nicolau, M. A., & Romero-Ávila, J. L. (2014)
Vasudeva, A., Laisram, N., & Chanu, A. R. (2018) · Journal of Medical Society · doi:10.4103/jms.jms_76_17
Bailey, H. G. B., O’Brien, T. D., Walker, R. L., Barton, G., Bass, A., Wright, D. M., Pinzone, O., Greaves, H., & Foster, R. J. (2021) · Gait & Posture · doi:10.1016/j.gaitpost.2021.09.170
YUMOTO, R., Kazunori, H. A. S. E., Yoshikawa, A., & Kim, S. (2021) · Transactions of the JSME (in Japanese) · doi:10.1299/transjsme.21-00111
Effectiveness of Physiotherapy Interventions in CP Child-Systematic Review
Alhumaidan, I. A., Tawhari, F. Y. A., & Aldawhn, I. S. (2024) · International Journal of Recent Innovations in Medicine and Clinical Research · doi:10.18231/j.ijrimcr.2020.009
“Declerck reported significant improvement in motor function following 10 weeks of aquatic training in 14 youths with CP, which was found to translate into functional independence and improved selfcare30.”
MethodFiltering walking actigraphy data in children with unilateral cerebral palsy: A preliminary study
Hwang, Y., & Kwon, J. (2024) · PLoS ONE · doi:10.1371/journal.pone.0303090
Quach, P. T. M., Fisher, G., Lai, B. W., Modlesky, C. M., Hurt, C. P., Bowersock, C. D., Boolani, A., & Singh, H. (2025) · Healthcare · doi:10.3390/healthcare13243251
Flux, E., van der Krogt, M. M., Harlaar, J., Buizer, A. I., & Sloot, L. H. (2021) · Figshare · doi:10.6084/m9.figshare.16829836
Flux, E., van der Krogt, M. M., Harlaar, J., Buizer, A. I., & Sloot, L. H. (2021) · Figshare · doi:10.6084/m9.figshare.16829833
Flux, E., van der Krogt, M. M., Harlaar, J., Buizer, A. I., & Sloot, L. H. (2021) · Figshare · doi:10.6084/m9.figshare.16829830
Zografou, S., Pierret, J., Vasa, R., Paysant, J., & Beyaert, C. (2026) · PLoS ONE · doi:10.1371/journal.pone.0334195
“Indeed, this variable reflects a strategy for reducing the risk of falls in unstable gait and is usually high in children with CP [70].”
Pierret, J. (2020) · theses.fr (ABES) · doi:10.70675/c1f96f78z36eaz4034z887eza866ad138c7f
“C’est pourquoi les protocoles de rééducation doivent proposer des activités motrices permettant d’améliorer le contrôle de l’équilibre dynamique (Kurz et al., 2012) et en particulier celui du tronc (Barbado et al., 2018).”
Background
Metadata
- Authors
- Kurz, M. J., Arpin, D. J., & Corr, B.
- Affiliations
- University of Nebraska Medical Center (US)
- Corresponding author
- Kurz, Max J.
- Venue
- Gait & Posture
- Publisher
- Elsevier BV
- Published
- 2012-07
- Volume
- 36
- Issue
- 3
- Pages
- 600-604
- ISSN
- 0966-6362 (ISSN-L)
- OpenAlex
- W1985641200
- Cited by
- 87
- References
- 31
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 8 · 2023: 6 · 2022: 11 · 2021: 10 · 2020: 6 · 2019: 5 · 2018: 6 · 2017: 4 · 2016: 7 · 2015: 5 · 2014: 9 · 2013: 4
- FWCI
- 4.11
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Gait & Posture (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rehabilitation › Cerebral Palsy and Movement Disorders
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Social Sciences › Psychology › Developmental and Educational Psychology › Children's Physical and Motor Development
- Keywords
- cerebral palsy, Floquet theory, step width, step length variability, gait kinematics, Gross Motor Function Measure, children, gait disturbance, gross motor function
- MeSH terms
- Adaptation, Physiological, Age Factors, Cerebral Palsy, Child, Child, Preschool, Cross-Sectional Studies, Disability Evaluation, Postural Balance, Female, Follow-Up Studies, Gait, Humans, Male, Posture, Reference Values, Risk Assessment, Disabled Children, Children with Disabilities, Gait Disorders, Neurologic
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