Gait synergetic neuromuscular control in children with cerebral palsy at different gross motor function classification system levels

Cerebral palsy (CP) is a neural developmental disease featured with gait abnormalities. CP gait assessment is usually performed with the Gross Motor Function Classification System (GMFCS) in clinics, which does not involve a thorough assessment of neuromuscular control. To understand how the neuromuscular control disorders lead to gait abnormalities, we explored the relationship between GMFCS levels and the gait synergetic control characteristics in this study. In total, 18 children with CP at different GMFCS levels (mean age: 4.41±1.30 yr) and 8 age-matched typically developing (TD) children (mean age: 4.43±1.36 yr) were recruited to perform a straight walking task, and the surface electromyographic (sEMG) signals from eight lower limb muscles on each side and accelerometer data were collected. A nonnegative matrix factorization method was applied to obtain the muscle synergies from the sEMG signals. Next, synergy structures were projected onto the basic gait synergies to test the completeness of those structures. Subsequently, synergy activation parameters, including total activation duration and coactivation index, were compared across the participants. This study showed that children with CP at GMFCS levels I and II and the TD children had similar synergy structures, but the synergy activations of these children with CP were different from those of TD children. In addition, similar to previous research, we also found that children with CP at GMFCS level III could not access all four basic synergies on both sides. Based on the synergy analysis results, a gait assessment paradigm was proposed to facilitate the clinical CP gait evaluation. NEW & NOTEWORTHY Understanding the mechanism of gait abnormality has important clinical significance for the diagnosis, prognosis, and possible treatment of motor dysfunction in children with cerebral palsy (CP). In this study, the comparisons of the lower limb muscle synergies among different groups of children with CP at different Gross Motor Function Classification System levels might provide some new insight into the mechanism underlying the gait disorder. In particular, the discrepancies of gait synergy structure and activation patterns across the study groups may indicate different neurophysiological and pathological attributes in different groups of patients.