Locomotion in Children with Cerebral Palsy: a Review with Special Reference to the Displacement of the Center of Mass and Energy Cost



Clarissa Schuch1 & Leonardo A. P. Tartaruga2


Abstract: The aim of the study was to review aspects of the displacement of the center of mass and energy cost of walking in children with cerebral palsy. The methodology used was a bibliographical review, whose articles had been chosen using the database PubMed and Google Scholar. There is unanimity from the studies that describe the locomotion of the hemiplegic children with increased vertical displacement of center of mass, ineffi cient exchange between kinetic and potential energy and elevated energy cost when compared with normal children. The mechanisms that explain these fi ndings seem to have strong relation with the muscular co-contraction and the deformity in plantarfl exion. Therefore, evaluation of the locomotion through cinematography and energy expenditure index is effi cient to detect the effects of medical and therapeutic interventions.

Key words: Cerebral palsy - Hemiplegia - Gait


Resumo: O objetivo do estudo foi revisar aspectos relacionados ao deslocamento do centro de massa e gasto energético na caminhada de criancas hemiplegicas decorrentes da Paralisia Cerebral (PC). A metodologia empregada foi uma revisao bibliografica, cujos artigos foram escolhidos utilizando a base de dados PubMed e Google Scholar. Ha uma unanimidade entre os estudos, que descrevem a locomocao das criancas hemiplegicas com maior deslocamento vertical do centro de massa (CM), inefi ciente troca entre energia cinetica e potencial e maior gasto energetico quando comparadas as criancas saudaveis. Os mecanismos que explicam esses achados nao estao bem definidos, mas parecem ter forte relacao com a co-contracao muscular e a deformidade em flexao plantar presentes nos pacientes hemiplegicos. Portanto, meios de avaliacao da locomocao como a cinemetria e indice de gasto energetico sao eficazes para acompanhar a trajetoria dos resultados das intervenções terapeuticas.

Palavras-chave: Paralisia cerebral – Hemiplegia - Marcha


1 Universidade Federal do Rio Grande do Sul - Laboratorio de Pesquisa do Exercicio, Porto Alegre, RS, Brasil, e-mail:
2 Universidade Federal do Rio Grande do Sul - Laboratorio de Pesquisa do Exercicio, Porto Alegre, RS, Brasil, e-mail:


Literatura Citada

AYCICEK, A.; ISCAN, A. Oxidative and antioxidative capacity in children with cerebral palsy. Brain Research Bulletin, v. 69, p. 666–668, 2006. doi

BENNETT, BC; ABEL, MF; WOLOVICK, A; FRANKLIN, T; ALLAIRE, PE; KERRIGAN, DC. Center of mass movement and energy transfer during walking in children with cerebral palsy. Arch Phys Med Rehabil, v. 86, n. 11, p. 2184-2189, nov. 2005.

BOWEN, TRBS; LENNON, NMS; CASTAGNO, PMS; MILLER, FMD; RICHARDS, J. Variability of energy-consumption measures in children with cerebral palsy. Journalof Pediatric Orthopaedics, v. 18, p. 738-742, 1998. doi

BURTNER, PA; WOOLLACOTT, MH; QUALLS, C. Stance balance control with orthoses in a group of children with spastic cerebral palsy. Dev Med Child Neuro, v.41, p. 748-757, 1999. doi

CAVAGNA, GA; FRANZETTI, P; FUCHIMOTO, T. The mechanics of walking in children. J Physiol, v. 343, p. 323-339, 1983. doi

CAVAGNA, GA; KANEKO, M. Mechanical work and effi ciency in level walking and running. J Physiol, v. 2,n. 268, p. 467- 481, 1977.

CAVAGNA, GA; SAIBENE, FP; MARGARIA, R. External work in walking. J Appl Physiol, v.18, p. 1-9, 1963.

CAVAGNA, GA; SAIBENE, FP; MARGARIA, R. Mechanical Work in Running. J Appl Physiol, v. 19, p. 249-256, 1964.

CAVAGNA, GA; WILLEMS, PA; LEGRAMANDI, MA; HEGLUND, NC. Pendular energy transduction within the step in human walking. J Exp Biol, v. 21, p. 3413-3422, 2002.

CHAMBERS, HG; SUTHERLAND, DH. A practical guide to gait analysis. Journal of the American Academy of Orthopaedic Surgeons, v. 10, n. 3, p. 222-231, 2002.

CROCE, UD; RILEY, PO; LELAS, JL; KERRIGAN, DC. A refi ned view of the determinants of gait. Gait Posture, v. 14, p. 79–84, 2001. doi

DAMIANO, DL; MARTELLOTTA, TL; SULLIVAN, DJ; GRANATA, KP; ABEL, MF. Muscle force production and functional performance in spastic cerebral palsy: relationship of cocontraction. Arch Phys Med Rehabil, v. 81, p. 895-900, 2000. doi

FENN, WO. Work against gravity and work due to velocity changes in running. Am J Physiol, v. 93, p. 433-462, 1930.

FONSECA, ST; HOLT, KG; SALTZMAN, E; FETTERS, L. A dynamical model of locomotion in spastic hemiplegic cerebral palsy: infl uence of walking speed. Clin Biomech v. 16, p. 793–805, 2001. doi

FORMENTI, F; ARDIGO, LP; MINETTI, AE. Human locomotion on snow: determinants of economy and speed of skiing across the ages. Proc Biol Sci, v. 272, p. 1561-1569, 2005. doi

FORMENTI, F; MINETTI, AE. Human locomotion on ice: the evolution of ice-skating energetics through history. J Exp Biol, v. 210, p. 1825-1833, 2007. doi

GRABOWSKI, A; FARLEY, CT; KRAM, R. Independent metabolic costs of supporting body weight and accelerating body mass during walking. J Appl Physiol, v. 98, p. 579–583, 2005. doi

HECKE, A; MALGHEM, C; RENDERS, A; DETREMBLEUR, C; PALUMBO, S; LEJEUNE, TM. Mechanical work, energetic cost, and gait effi ciency in children with cerebral palsy. J Pediatr Orthop, v.27, n. 6, p. 643-647, 2007. doi

HOLT, KG; FONSECA, ST; LAFIANDRA, ME. The dynamics of gait in children with spastic hemiplegic cerebral palsy: Theoretical and clinical implications. Human Movement Science. v. 19, p. 375- 405, 2000. doi

ISHIKAWA, M; KOMI, PV; GREY, MJ; LEPOLA, V; BRUGGEMANN, GP. Muscle-tendon interaction and elastic energy usage in human walking. J Appl Physiol, v. 99, p. 603–608, 2005. doi

JOHNSTON, TE; MOORE, SE; QUINN, LT; SMITH, BT. Energy cost of walking in children with cerebral palsy: relation to the Gross Motor Function Classifi cation System. Developmental Medicine & Child Neurology, v. 46, p. 34–38, 2004.

KEEFER, DJ; TSEH, W; CAPUTO, JL; APPERSON, K; MCGREAL, S; MORGAN, DW. Comparison of direct and indirect measures of walking energy expenditure in children with hemiplegic cerebral palsy. Developmental Medicine & Child Neurology, v. 46, p. 320 324, 2004.

MASSAAD, F; DIERICK, F; HECK, A; DETREMBLEUR, C. Infl uence of gait pattern on the body’s centre of mass displacement in children with cerebral palsy. Developmental Medicine & Child Neurology, v.46, p. 674–680, 2004. doi

MASSAAD, F; HECKE, A; RENDERS, A; DETREMBLEUR, C. Infl uence of equinus treatments on the vertical displacement of the body’s centre of mass in children with cerebral palsy. Developmental Medicine & Child Neurology, v. 48, p. 813–818, 2006. doi

MAURITZ, KH. Gait training in hemiplegia. European Journal of Neurology, v. 9, (Suppl. 1), p. 23–29, 2002. doi

MIAN, OS; THOM, JM; ARDIGO, LP; NARICI, MV; MINETTI, AE. Metabolic cost, mechanical work, and efficiency during walking in young and older men. Acta Physiol, v. 186, p. 127–139, 2006. doi

MINETTI, AE. A model equation for the prediction of mechanical internal work of terrestrial locomotion. J Biomech, v. 31, n. 5, p. 463- 468, 1998. doi

OLNEY, SJ; COSTIGAN, PA; HEDDEN, DM. Mechanical energy patterns in gait of cerebral palsied children with hemiplegia. Physical Therapy, v. 67, p. 1348-1354, 1987.

ORTEGA, JD; FARLEY, CT. Minimizing center of mass vertical movement increases metabolic cost in walking. J Appl Physiol, v. 99, p. 2099–2107, 2005. doi

PEYRE-TARTARUGA, LA. Energetica e mecanica da caminhada e corrida humana com especial referencia a locomocao em plano inclinado e efeitos da idade. Tese (Doutorado Educacao Fisica), UFRGS, Porto Alegre, 136p, 2008.

PICCININI, L; CIMOLIN, V; GALLI, M; BERTI, M; CRIVELLINI, M; TURCONI, AC. Quantifi cation of energy expenditure during gait in children affected by cerebral palsy. Eura Medicophis, v. 43, p. 7-12, 2007.

ROMKES, J; BRUNNER, R. An electromyographic analysis of obligatory (hemiplegic cerebral palsy) and voluntary (normal) unilateral toe-walking. Gait & Posture, v. 26, p. 577–586, 2007. doi

ROSE, J; GAMBLE, JG; BURGOS, A; MEDEIROS, J; HASKELL, WL. Energy expenditure index of walking for normal children and for children with cerebral palsy. Dev Med Child Neurol, v. 32, p. 333-340, 1990. doi

RUSSELL, SD; BENNETT, BC; KERRIGAN, DC; ABEL, MF. Determinants of gait as applied to children with cerebral palsy. Gait & Posture, v. 26, p. 295–300, 2007. doi

SAIBENE, F; MINETTI, AE. Biomechanical and physiological aspects of legged locomotion in humans. Eur J Appl Physiol, v. 88, p. 297–316, 2003. doi

SAUNDERS, JB; INMAN, VT; EBERHART, HD. The major determinants in normal and pathological gait. J Bone Joint Surg Am, v. 35, p. 543–558, 1953.

SCHEPENS, B; WILLEMS, PA; CAVAGNA, GA. The mechanics of running in children. J Physiol, v. 509, p. 927-940, 1998. doi

VANDERPOOL, MT; COLLINS, SH; KUO, AD. Ankle fi xation need not increase the energetic cost of human walking. Gait Posture, v. 28, p. 427-33, 2008. doi

WATERS, RL; MULROY, S. The energy expenditure of normal and pathologic gait. Gait and Posture, v. 9, p. 207–231, 1999. doi

WILLEMS, PA; CAVAGNA, GA; HEGLUND, NC. External, internal and total work in human locomotion. The Journalof Experimental Biology, v. 198, p. 379–393, 1995.