The effects of dual tasks on gait in children with cerebral palsy

Abstract

Aim: To assess the gait and cognitive performances of children with cerebral palsy (CP) during dual tasks (DT) in comparison to typically developing (TD) children.

Method: This prospective, observational, case-control study included 18 children with CP (7 girls, 11 boys; median age 12 [10:13] years and 19 controls (9 girls, 10 boys; median age 12 [10:13y6mo] years). Performances were recorded during a simple walking task, 5 DT (walking + cognitive tasks with increasing cognitive load), and 5 simple cognitive tasks (while sitting). Gait parameters were computed using an optoelectronic system during walking tasks. Six parameters were selected for analysis by a principal component analysis. Cognitive performance was measured for each cognitive task. The dual-task cost (DTC) was calculated for each DT.

Results: Gait performance decreased in both groups as DT cognitive load increased (e.g., walking speed normalized by leg length, in simple task: 1.25 [1.15:1.46] s^-1 for CP, 1.53 [1.38:1.62] s^-1 for TD; DT with highest load: 0.64 [0.53:0.80] s^-1 for CP, 0.95 [0.75:1.08] s^-1 for TD). The CP group performed significantly worse than TD group in every task (including the simple task), but DTC were similar in both groups. A task effect was found for the majority of the gait parameters.

Interpretation: The reduced gait performance induced by DT may generate underestimated difficulties for children with CP in daily-life situations, where DT are common. This should be considered in clinical assessments.

Keywords: Cerebral palsy; Cognitive-motor interference; Dual tasks; Gait.