Kinematic and electromyographic studies on unaided, unilateral and bilateral crutch walking in adolescents with spastic diplegia

Background: Back pain and ambulation deterioration among ambulatory individuals with cerebral palsy (CP) are common as they grow older and walking aids are often prescribed to improve stability and promote maximal weight-bear on lower limbs during gait. Objective: To investigate the effects of walking aids on back muscle activity and whole body kinematics among adolescents with spastic diplegia. Study Design: A repeated-measures design was adopted with participants tested under different walking conditions. Methods: Ten participants were recruited and Lofstrand forearm crutches were selected. Both the activity of lumbar erector spinae and the kinematics of head, trunk, pelvis and lower limbs during walking were monitored using telemetric electromyography and motion analysis system respectively. Results: Comparisons between walking unaided and walking with unilateral and bilateral crutch(es) were made. Significant decreases in speed, cadence, erector spinae activity and lower trunk extension were observed during crutch walking together with significantly increased stride time and anterior pelvic tilt. Conclusions: These findings suggested that Lofstrand crutch(es) reduced muscular demands and lumbar lordosis with increased lower back mobility. The results shed light on the prescription of walking aid in the management and prevention of chronic back pain for ambulatory individuals with CP from a life span perspective. Clinical relevance This study revealed that four-point reciprocal crutch walking can be prescribed to reduce muscle activity, and hence decrease stress at back, during gait among ambulatory individuals with CP that may serve as an adjunct to back pain management in this population group.