Coordination of the upper and lower extremities during walking in children with cerebral palsy

Background: Children with cerebral palsy indicate poor continuous gait inter-limb coordination compared to typically developing children. Limited research exists in the understanding of the coordinative relationship between the arms and legs of these children and if the phasing relationships between limbs can be improved. Research Question: Which motor control factors impact coordination in children with cerebral palsy and can coordination improve with intervention? Methods: This literature review provides a comprehensive overview of the current knowledge of continuous coordination in a pediatric, pathologic population with an emphasis on inter-limb coordination. Peer-reviewed research articles related to inter-limb coordination, with a focus on gait, were reviewed to identify relevant research and any gaps in the literature which could inform future study design. Consideration of the most appropriate analysis for evaluation of such movement is also presented. Results: The coordinative difficulties experienced by children with cerebral palsy may originate from the deficits in motor control, muscle tone, and weakness caused by damage to the central nervous system, which is vital in motor control of inter-limb coordination. Continuous inter-limb coordination in children with cerebral palsy may be improved with enhanced function of the upper extremities through intensive motor-learning based rehabilitation or botulinum toxin injection of the more-affected arm. Importantly, analysis of limb movements should include continuous measures of relative phase, as it provides a more detailed description of coordination compared to discrete measures. Significance: Improved upper extremity function may produce a positive change in the phasing relationship between the arms and legs. This type of coordination should be analyzed using relative phase analysis, as this type of analysis can provide more information compared to traditional spatiotemporal parameters. However, more research is required to fully understand the connection between improved upper extremity function and its positive impact on gait coordination in children with cerebral palsy.