Mechanics of overground, dry, and aquatic treadmill walking in children & adolescents with cerebral palsy

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Abstract This project will determine biomechanical mechanisms to optimize walking rehabilitation in overground, dry treadmill, and wet treadmill environments for children with cerebral palsy (CP). Cerebral palsy is a neurological disorder caused by brain damage in early development that impairs motor control and overall mobility. Common gait issues in children with CP are excessive knee flexion, excessive hip flexion/adduction, and high muscular demand. Additionally, children with CP have lower-limb muscle weakness and low joint ranges of motion (ROM). These are speculated as key mechanisms decreasing walking endurance, independence, and quality of life. Less understood is how lower limb kinematics and muscle activity are modified amongst different walking environments commonly used in rehabilitation. In addition, post-operative tolerance to various walking speeds has not been rigorously examined in children with CP. Through descriptive studies, we will perturb walking speed amongst diverse walking environments, characterize within-subject changes to spatiotemporal walking parameters, and establish a fulsome evidence base to design future clinical trials. We hypothesize that walking environment will impact lower limb kinematics and muscle activity due to hydrodynamic drag and altered walking strategies. Furthermore, we hypothesize that the impact of walking environment will vary base on speed. Aim 1: Determine the effects of walking speed and environment on lower body kinematics and muscular demand in children with CP. Aim 2: Link overground walking function with lower body kinematics and muscular demand in diverse walking rehabilitation conditions. Aim 3: Establish post-operative functional differences for walking rehabilitation in children with CP that receive Distal Femoral Extension Osteotomy (DFEO) or Anterior Distal Femoral Hemiepiphysiodesis (ADFH). Considering the ubiquity of post-operative rehabilitation, the clinical importance of data-driven interventions for children with CP is difficult to overstate.