Do children with cerebral palsy walk with reduced dynamic stability compared to their typically developing peers? A systematic review

Stability is a prerequisite for functional gait but not routinely quantified in clinical practice for children and adolescents with cerebral palsy (CP), for whom improved mobility is a frequent and crucial target for intervention. Recent advances in technology and the development of appropriate modelling means that such evaluations are viable, but belied by the wide range of approaches employed. This review sought to compile the available literature using instrumented techniques to quantify the stability of children and adolescents with CP compared to their typically developing (TD) peers. 18 of 4971 studies from the initial search were included for quality appraisal and further analysis. A narrative synthesis found that compared to TD, children with CP were likely to demonstrate a reduced capacity for dynamically stable gait, which may be appreciated either as a reduction in stability due to increased displacement of the centre of mass from the centre of pressure with increased excursion and acceleration at the level of the pelvis and trunk, or by virtue of more conservative strategies that effectively increase stability in one or more planes of movement. Further research is required to integrate the wide variety of outcome measures with other gait parameters, and to validate these measures against current clinical standards.