Obstacle Crossing as an Indicator of Dynamic Balance in Children with CP

Obstacle crossing is a part of daily life. A child may be walking and has to step over a stick or manipulate around objects, like desks or toys. This requires dynamic balance. Obstacle crossing requires trunk control and stability in the lower limbs to maintain a center of mass.

Children with CP are often tested over level ground with minimal obstructions, which does not allow for the most accurate results in terms of dynamic balance. A child with CP who can move around freely may have relatively good static balance or decent dynamic balance around minimal obstacles. Still, when their dynamic balance is tested over a relatively significant obstacle, this is a better indicator of what areas an intervention needs to address. It also establishes if the child has a high risk of falling.

Study

A 2016 study titled “Obstacle Crossing During Gait in Children With Cerebral Palsy: Cross-Sectional Study With Kinematic Analysis of Dynamic Balance and Trunk Control” aimed to evaluate and compare trunk and lower limb control as well as kinematics in children with CP (Malone et al.) The study concluded that interventions should address trunk control and stability in the lower limbs for dynamic balance.

When crossing over the obstacle, a child must have ankle and trunk stability and strength to maintain their balance. Impaired movement of the lower limbs leads to compensation by the overexaggerating movement of the trunk to stabilize balance. This is not the most effective strategy for maintaining the center of mass, but it is often utilized by children with CP.

A child with CP approaches the obstacle at a lower speed, shows excessive movements of the limbs and trunk, has a high foot clearance, and tries to gain momentum by swinging their limb. In addition, the muscles in the lower limbs are slower to activate as a symptom of CP. All of this significantly affects a child’s ability to effectively cross obstacles.

Conclusion

·      When evaluating a child with CP who is ambulant, observing their trunk control and lower limb stability while crossing over and manipulating around obstacles is recommended in addition to typical evaluation strategies.

·      Interventions for improving balance in children with CP should target the control, stability, and strength of the trunk and lower limbs.  

• Source

  Malone, Ailish et al. “Obstacle Crossing During Gait in Children with Cerebal Palsy: A Cross-Sectional Study with Kinematic Analysis of Dynamic Balance and Trunk Control, Physical Therapy. Vol. 98, no. 8 (2016): 1208-1215. 10.2522/ptj.20150360.