基于矢量编码技术痉挛型脑性瘫痪儿童平地行走时的下肢协调性和变异性特征

doi:10.3969/j.issn.1006-9771.2025.05.015

Abstract

Abstract:

Objective To quantify the lower limb coordination and coordination variability of children with spastic cerebral palsy (CP) during flat ground walking using vector coding technology.
Methods From September to December, 2023, eight children with spastic CP (patients) from Ji'nan Rehabilitation Hospital and Ji'nan Special Education School, and eight healthy children (controls) from communities walked on a treadmill at a speed of 0.45 m/s. Lower limb kinematic data were collected using Vicon, a three-dimensional motion capture system. Vector coding technology was used to quantify the temporal and spatial parameters of ipsilateral lower limb joints to calculate joint coupling angles and coupling angle variability (CAV).
Results In the first and second double support phase, the hip-knee coupling angle was significantly larger in the patients than in the controls (|t| > 2.317, P < 0.05). In the swing phase, the hip-ankle and knee-ankle coupling angles were significantly larger in the patients (|t| > 2.346, P < 0.05). In the first double support phase and the single support phase, CAV of the hip-knee and hip-ankle were significantly larger in the patients (|t| > 2.454, P < 0.05), and they were smaller in the swing phase (t > 2.560, P < 0.05). In the second double support phase and the swing phase, CAV of the knee-ankle was significantly larger in the patients (|t| > 2.909, P < 0.05).
Conclusion Coordination among hip, knee and ankle joints is poor for children with spastic CP during both the stance and swing phases of walking, and variability is more during the stance phase.

Key words: spastic cerebral palsy, gait, coordination, vector coding

CLC Number:

R742.3

CHEN Chuanyi, QI Liuxin, LI Aihua, NI Yan, SUN Wei, WANG Jiangna. Lower limb coordination and variability in children with spastic cerebral palsy during flat ground walking: a vector coding technique study[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(5): 613-620.

Figures/Tables 10

Table 1

Figure 1

Figure 2

Figure 3

Table 2

Comparison of hip-knee coupling angles between two groups 单位：°"

分期	组别	n	$x - ± s$	t值	P值
第一双支撑期	对照组	8	180.39±0.60	-2.606	0.021
	脑瘫组	8	194.72±15.50
单支撑期	对照组	8	183.13±8.80	0.092	0.928
	脑瘫组	8	182.83±3.15
第二双支撑期	对照组	8	262.57±27.29	-2.317	0.036
	脑瘫组	8	294.79±28.31
摆动期	对照组	8	163.03±21.66	-0.929	0.369
	脑瘫组	8	174.21±26.27

Table 2

Table 3

Comparison of hip-ankle coupling angle between two groups 单位：°"

分期	组别	n	$x - ± s$	t值	P值
第一双支撑期	对照组	8	179.94±0.45	0.610	0.550
	脑瘫组	8	176.25±17.10
单支撑期	对照组	8	176.71±9.11	-0.627	0.545
	脑瘫组	8	178.91±3.93
第二双支撑期	对照组	8	264.76±25.80	-0.691	0.503
	脑瘫组	8	276.82±42.17
摆动期	对照组	8	140.64±21.23	-2.346	0.037
	脑瘫组	8	161.81±14.15

Table 3

Table 4

Comparison of knee-ankle coupling angles between two groups 单位：°"

分期	组别	n	$x - ± s$	t值	P值
第一双支撑期	对照组	8	178.77±37.47	11.698	0.255
	脑瘫组	8	148.73±60.35
单支撑期	对照组	8	117.58±22.71	0.032	0.975
	脑瘫组	8	116.98±47.73
第二双支撑期	对照组	8	179.88±9.18	0.204	0.844
	脑瘫组	8	176.63±44.06
摆动期	对照组	8	162.24±15.04	-2.730	0.017
	脑瘫组	8	181.00±12.32

Table 4

Table 5

Comparison of CAV of hip-knee coupling angles between two groups 单位：°"

分期	组别	n	$x - ± s$	t值	P值
第一双支撑期	对照组	8	10.99±2.08	-6.717	< 0.001
	脑瘫组	8	35.45±14.49
单支撑期	对照组	8	0.72±0.25	-2.454	0.028
	脑瘫组	8	11.65±12.59
第二双支撑期	对照组	8	67.24±6.31	1.426	0.180
	脑瘫组	8	58.77±8.15
摆动期	对照组	8	66.34±7.46	2.560	0.019
	脑瘫组	8	52.46±14.03

Table 5

Table 6

Comparison of CAV of hip-ankle coupling angles between two groups 单位：°"

分期	组别	n	$x - ± s$	t值	P值
第一双支撑期	对照组	8	0.87±0.37	-6.832	< 0.001
	脑瘫组	8	35.41±14.29
单支撑期	对照组	8	0.99±0.45	-2.205	0.045
	脑瘫组	8	11.07±12.93
第二双支撑期	对照组	8	68.15±6.87	1.805	0.098
	脑瘫组	8	59.35±11.95
摆动期	对照组	8	66.62±5.08	2.720	0.022
	脑瘫组	8	54.47±11.57

Table 6

Table 7

Comparison of CAV of knee-ankle coupling angles between two groups 单位：°"

分期	组别	n	$x - ± s$	t值	P值
第一双支撑期	对照组	8	65.83±4.74	1.187	0.258
	脑瘫组	8	62.25±7.10
单支撑期	对照组	8	67.30±8.74	9.151	0.233
	脑瘫组	8	58.49±10.63
第二双支撑期	对照组	8	28.98±4.71	-4.331	0.002
	脑瘫组	8	46.32±10.3
摆动期	对照组	8	61.37±8.41	-2.909	0.015
	脑瘫组	8	71.10±4.35

Table 7

References 40

[1]	梁艳华, 张琦, 胡晓诗, 等. 深层肌肉刺激对痉挛型脑瘫儿童肌肉结构和功能的效果[J]. 中国康复理论与实践, 2024, 30(12): 1452-1460. doi: 10.3969/j.issn.1006-9771.2024.12.011
	LIANG Y H, ZHANG Q, HU X S, et al. Effect of deep muscle stimulation on muscle structure and function in children with spastic cerebral palsy[J]. Chin J Rehabil Theory Pract, 2024, 30(12): 1452-1460.
[2]	ALBRIGHT A L. Spasticity and movement disorders in cerebral palsy[J]. Childs Nerv Syst, 2023, 39(10): 2877-2886.
[3]	SHEKARI Z, SADEGHIAN AFARANI R, FATOREHCHY S, et al. Relationship between postural asymmetry, balance, and pain in children with spastic cerebral palsy[J]. Pediatr Neurol, 2024, 155: 84-90. doi: 10.1016/j.pediatrneurol.2024.03.018 pmid: 38608553
[4]	SURANA B K, FERRE C L, DEW A P, et al. Effectiveness of lower-extremity functional training (LIFT) in young children with unilateral spastic cerebral palsy: a randomized controlled trial[J]. Neurorehabil Neural Repair, 2019, 33(10): 862-872. doi: 10.1177/1545968319868719 pmid: 31434537
[5]	祝莉洁, 贠国俊, 张伟云, 等. 超声成像技术在痉挛型脑性瘫痪患儿腓肠肌定量评定中的应用[J]. 中国康复理论与实践, 2022, 28(9): 1079-1083. doi: 10.3969/j.issn.1006-9771.2022.09.011
	ZHU L J, YUN G J, ZHANG W Y, et al. Application of ultrasonography in quantitative evaluation of gastrocnemius muscles in children with spastic cerebral palsy[J]. Chin J Rehabil Theory Pract, 2022, 28(9): 1079-1083.
[6]	SARASWAT P, CARSON L T, SHULL E R, et al. Does use of ankle foot orthoses affect the dynamic motor control index during walking in cerebral palsy and idiopathic toe walking populations?[J]. Gait Posture, 2023, 102: 100-105. doi: 10.1016/j.gaitpost.2023.03.007 pmid: 36958157
[7]	AHN Y, HONG J, SHIM D, et al. Comparing the lower-limb muscle activation patterns of simulated walking using an end-effector-type robot with real level and stair walking in children with spastic bilateral cerebral palsy[J]. Sensors (Basel), 2023, 23(14): 6579.
[8]	SIDIROPOULOS A, MAGILL R, GORDON A. Coordination of the upper and lower extremities during walking in children with cerebral palsy[J]. Gait Posture, 2021, 86: 251-255. doi: 10.1016/j.gaitpost.2021.03.028 pmid: 33812293
[9]	王佳伟, 刘晔. 运动协调理论模型与量化方法的演进[J]. 中国组织工程研究, 2022, 26(20): 3256-3264.
	WANG J W, LIU Y. Motor coordination: evolution of theoretical model and quantitative method[J]. Chin J Tissue Eng Res, 2022, 26(20): 3256-3264.
[10]	STEBBINS J, HARRINGTON M, STEWART C. Clinical gait analysis 1973-2023: evaluating progress to guide the future[J]. J Biomech, 2023, 160: 111827.
[11]	IPPERSIEL P, ROBBINS S M, DIXON P C. Lower-limb coordination and variability during gait: the effects of age and walking surface[J]. Gait Posture, 2021, 85: 251-257. doi: 10.1016/j.gaitpost.2021.02.009 pmid: 33626449
[12]	马乾峰, 丁健, 李立, 等. 基于矢量编码技术研究功能性踝关节不稳者下肢协调性和变异性[J]. 医用生物力学, 2023, 38(6): 1086-1092.
	MA Q F, DING J, LI L, et al. Lower limb coordination and variability in patients functional ankle instability based on vector coding analysis[J]. J Med Biomech, 2023, 38(6): 1086-1092.
[13]	王佳伟, 刘晔. 不同高度跳深时髋、膝关节协调模式与下肢肌肉活动的关系[J]. 中国组织工程研究, 2023, 27(2): 276-281.
	WANG J W, LIU Y. Hip and knee coordination patterns in relation to lower limb muscle activity during drop jumps at different heights[J]. Chin J Tissue Eng Res, 2023, 27(2): 276-281.
[14]	SAKUMA K, TATEUCHI H, NISHISHITA S, et al. Gait kinematics and physical function that most affect intralimb coordination in patients with stroke[J]. NeuroRehabilitation, 2019, 45(4): 493-499. doi: 10.3233/NRE-192923 pmid: 31868698
[15]	CELESTINO M L, VAN EMMERIK R, BARELA J A, et al. Intralimb gait coordination of individuals with stroke using vector coding[J]. Hum Mov Sci, 2019, 68: 102522.
[16]	胡晓诗, 张琦, 岳青, 等. 矫形弹力绷带对痉挛性偏瘫脑性瘫痪患儿步态对称性和步行能力的效果[J]. 中国康复理论与实践, 2023, 29(9): 1083-1089. doi: 10.3969/j.issn.1006-9771.2023.09.012
	HU X S, ZHANG Q, YUE Q, et al. Effect of orthopedic elastic bandages on gait symmetry and walking ability in children with spastic hemiplegic cerebral palsy[J]. Chin J Rehabil Theory Pract, 2023, 29(9): 1083-1089.
[17]	CARCREFF L, GERBER C N, PARASCHIV-IONESCU A, et al. Comparison of gait characteristics between clinical and daily life settings in children with cerebral palsy[J]. Sci Rep, 2020, 10(1): 2091. doi: 10.1038/s41598-020-59002-6 pmid: 32034244
[18]	中国康复医学会儿童康复专业委员会, 中国残疾人康复协会小儿脑性瘫痪康复专业委员会, 中国医师协会康复医师分会儿童康复专业委员会, 等. 中国脑性瘫痪康复指南(2022)第一章:概论[J]. 中华实用儿科临床杂志, 2022, 37(12): 887-892.
	Chinese Association of Rehabilitation Medicine Pediatric Rehabilitation Committee, Chinese Association of Rehabilitation of Disabled Persons Rehabilitation Committee for Cerebral Palsy, Chinese Medical Doctor Association Pediatric Rehabilitation Committee, et al. Chapter I: Introduction of Chinese Cerebral Palsy Rehabilitation Guide (2022)[J]. Chin J Prac Pediatr Clin Prac, 2022, 37(12): 887-892.
[19]	王立端, 曲峰. 运动水平对不同跑速条件下的下肢关节协调性特征的影响[J]. 天津体育学院学报, 2023, 38(6): 740-744.
	WANG L D, QU F. Effect of skill level on the coordination of lower limb joints in running at different speeds[J]. J Tianjin Univ Sport, 2023, 38(6): 740-744.
[20]	ROGERS-BRADLEY E, YEON S H, LANDIS C, et al. Variable-stiffness prosthesis improves biomechanics of walking across speeds compared to a passive device[J]. Sci Rep, 2024, 14(1): 16521.
[21]	LABONTE D, BISHOP P J, DICK T J M, et al. Dynamic similarity and the peculiar allometry of maximum running speed[J]. Nat Commun, 2024, 15(1): 2181. doi: 10.1038/s41467-024-46269-w pmid: 38467620
[22]	CHEN Y, WAN A, MAO M, et al. Tai Chi practice enables prefrontal cortex bilateral activation and gait performance prioritization during dual-task negotiating obstacle in older adults[J]. Front Aging Neurosci, 2022, 14: 1000427.
[23]	VITRIKAS K, DALTON H, BREISH D. Cerebral palsy: an overview[J]. Am Fam Physician, 2020, 101(4): 213-220. pmid: 32053326
[24]	DUSSAULT-PICARD C, IPPERSIEL P, BöHM H, et al. Lower-limb joint-coordination and coordination variability during gait in children with cerebral palsy[J]. Clin Biomech (Bristol, Avon), 2022, 98: 105740.
[25]	CEN X, YU P, SONG Y, et al. Influence of medial longitudinal arch flexibility on lower limb joint coupling coordination and gait impulse[J]. Gait Posture, 2024, 114: 208-214. doi: 10.1016/j.gaitpost.2024.10.002 pmid: 39369652
[26]	DESAI G A, GRUBER A H. Bilateral differences in coordination variability among injured and uninjured runners: a prospective study[J]. J Biomech, 2022, 132: 110938.
[27]	BEITTER J, KWON Y H, TULCHIN-FRANCIS K. A combined method for binning coupling angles to define coordination patterns[J]. J Biomech, 2020, 103: 109598.
[28]	何艳, 张琦, 胡晓诗, 等. 功能性电刺激康复踏车训练对痉挛型脑性瘫痪儿童下肢运动功能的效果[J]. 中国康复理论与实践, 2021, 27(12): 1464-1469. doi: 10.3969/j.issn.1006-9771.2021.12.013
	HE Y, ZHANG Q, HU X S, et al. Effect of functional electrical stimulation rehabilitation cycling on lower limb motor function in children with spastic cerebral palsy[J]. Chin J Rehabil Theory Pract, 2021, 27(12): 1464-1469.
[29]	JIANG W, ZHANG L, WEI M, et al. A preliminary study on the spasticity reduction of quadriceps after selective dorsal rhizotomy in pediatric cases of spastic cerebral palsy[J]. Acta Neurochir (Wien), 2024, 166(1): 108. doi: 10.1007/s00701-024-06010-4 pmid: 38409557
[30]	LI H, CHEN Y, DU Q, et al. Abnormal gait partitioning and real-time recognition of gait phases in children with cerebral palsy[J]. Biomed Sig Proc Control, 2023, 86: 105085.
[31]	GONÇALVES R V, MENDES M B, FIGUEIREDO P R P, et al. Gait profiles of children and adolescents with cerebral palsy according to their gross motor levels[J]. J Bodyw Mov Ther, 2025, 42: 313-318.
[32]	SANGEUX M, VIEHWEGER E, ROMKES J, et al. On the clinical interpretation of overground gait stability indices in children with cerebral palsy[J]. Sci Rep, 2024, 14(1): 26363. doi: 10.1038/s41598-024-76598-1 pmid: 39487202
[33]	LI L, ZHANG L, CUI H, et al. Gait and sEMG characteristics of lower limbs in children with unilateral spastic cerebral palsy during walking[J]. Gait Posture, 2024, 108: 177-182. doi: 10.1016/j.gaitpost.2023.12.007 pmid: 38100956
[34]	ZHAO J, HAN W, TANG H. Lower limbs inter-joint coordination and variability during typical Tai Chi movement in older female adults[J]. Front Physiol, 2023, 14: 1164923.
[35]	IPPERSIEL P, DUSSAULT-PICARD C, MOHAMMADYARI S G, et al. Muscle coactivation during gait in children with and without cerebral palsy[J]. Gait Posture, 2024, 108: 110-116. doi: 10.1016/j.gaitpost.2023.11.012 pmid: 38029482
[36]	SUKAL-MOULTON T, DE CAMPOS A C, ALTER K E, et al. Relationship between sensorimotor cortical activation as assessed by functional near infrared spectroscopy and lower extremity motor coordination in bilateral cerebral palsy[J]. Neuroimage Clin, 2018, 20: 275-285.
[37]	LARSON S C, SMITH A E, ARAVAMUTHAN B R, et al. Pediatric constraint-induced movement therapy: current practices and implementation barriers[J]. [ahead of print]. OTJR (Thorofare N J), 2024. doi: 10.1177/15394492241300607.
[38]	CORTÉS-PÉREZ I, GONZÁLEZ-GONZÁLEZ N, PEINADO-RUBIA A B, et al. Efficacy of robot-assisted gait therapy compared to conventional therapy or treadmill training in children with cerebral palsy: a systematic review with meta-analysis[J]. Sensors (Basel), 2022, 22(24): 9910.
[39]	GARCIA-DEL PINO-RAMOS S, ROMERO-GALISTEO R P, PINERO-PINTO E, et al. Effectiveness of treadmill training on the motor development of children with cerebral palsy and Down syndrome[J]. Medicina (B Aires), 2021, 81(3): 367-374.
[40]	TORO I S, WEIR G, AMADO A, et al. Is coordination variability using vector coding different in overground and treadmill walking and running?[J]. Gait Posture, 2022, 92: 413-420.

项目	对照组(n = 8)	脑瘫组(n = 8)	t值	P值
性别(男/女)/n	5/3	5/3	-	-
年龄/岁	13.75±1.49	13.88±1.25	0.182	0.858
身高/m	1.57±0.08	1.55±0.08	-0.491	0.631
体质量/kg	49.38±6.39	45.50±5.04	-1.346	0.200

Lower limb coordination and variability in children with spastic cerebral palsy during flat ground walking: a vector coding technique study

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 10

References 40

Related Articles 15

Metrics

Comments

Recommended 0

[1]	LIU Fangchao, ZHANG Yuanmingfei, WU Meiqi, ZHOU Mouwang, LI Tao. Validity of key points detection technology of artificial intelligence in gait kinematics analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(3): 249-253.
[2]	LI Dong, ZHANG Hao, LIU Nan, WANG Xinyue, XU Miao. Effect of cognitive-motor dual-task training on balance function and gait in convalescent stroke patients: a randomized contolled trial [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(9): 1082-1091.
[3]	ZHOU Yiwen, ZHONG Yaping, WEI Mengli, WANG Haifeng, YU Shaohua, GUI Huixian. Risk assessment of return to sport based on gait data of athletes after anterior cruciate ligament reconstruction [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(8): 948-956.
[4]	WEN Nana, ZHANG Xinhui, LONG Qing, WANG Yuhao, YU Qunping, ZHANG Hanchun, ZHENG Guohua. Predictive value of gait and balance on frailty in community-dwelling older adults in Shanghai, China [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(6): 731-736.
[5]	ZHENG Jianling, LIU Huilin, ZHU Lin, GU Bin, YAN Ruxiu, ZHAO Qi, SONG Luping. Effect of early intelligent assisted walking under suspension protection on motor and walking function for stroke patients [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 431-436.
[6]	YU Chunyang, LIU Ran, ZHAO Yishuang, GUO Shuai, ZHOU Ya'nan, LI Li, ZHANG Hao. Effect of virtual reality treadmill training on balance and gait in stroke patients [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(3): 310-315.
[7]	GE Ying, ZHAO Wowa, ZHANG Lu, SHU Xuan, LI Jiawei, LIU Ying. Motor function and quality of life in Parkinson's disease patients with freezing of gait [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(3): 339-344.
[8]	MA Qianfeng, LI Li, ZHANG Wei, DING Jian, XU Yilin, MAO Wenhui. Influence of different hardness surfaces on gait coordination in functional ankle instability [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(3): 345-351.
[9]	WU Liang, XU Xiu, LUO Liang. Effect of exercise rehabilitation and adapted physical activity on psychomotor skills, motor abilities and motor development in children and adolescents with spastic cerebral palsy: an evidence-based research using ICF [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(2): 148-156.
[10]	LIU Hua, JIA Mingyue, DU Xiaoxia, YANG Yaru, LI Jing, LÜ Jihui. Physical fitness and characteristics of cognitive function among people aged 55 to 75 years with high and low risk of dementia in communities in Beijing [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(2): 195-201.
[11]	YANG Ping, CHEN Haoyuan, GAO Ruixin, WANG Xinping, Philip ROWE. Three-dimensional modeling of foot motion based on low-cost inertial measurement unit and force sensing resistor [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(10): 1224-1231.
[12]	WEI Mengli, ZHONG Yaping, ZHOU Yiwen, GUI Huixian, GUAN Yeming, YU Tingting. Difference in bilateral lower limb muscle synergy mode for gait in patients after unilateral anterior cruciate ligament reconstruction [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 95-104.
[13]	BI Xiaoyu, ZHU Xiaotong, ZHU Feilong, KUANG Dongqing, SONG Yiling, FAN Biyao, REN Yuanchun. Sex difference of fine motor skills of school-age children with attention deficit hyperactivity disorder [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(9): 1029-1034.
[14]	ZHAO Panchao, JI Zhongqiu, JIANG Guiping, WEN Ruixiang. Influence of different tasks on gait characteristics and task cost in early childhood [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(9): 1072-1082.
[15]	HU Xiaoshi, ZHANG Qi, YUE Qing, LIANG Yanhua, LI Xiaosong, FENG Amei, ZHANG Yanqing. Effect of orthopedic elastic bandages on gait symmetry and walking ability in children with spastic hemiplegic cerebral palsy [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(9): 1083-1089.