A1 Journal article (refereed)
The gait is less stable in children with cerebral palsy in normal and dual-task gait compared to typically developed peers (2021)

Piitulainen, H., Kulmala, J.-P., Mäenpää, H., & Rantalainen, T. (2021). The gait is less stable in children with cerebral palsy in normal and dual-task gait compared to typically developed peers. Journal of Biomechanics, 117, Article 110244. https://doi.org/10.1016/j.jbiomech.2021.110244

JYU authors or editors

Publication details

All authors or editorsPiitulainen, Harri; Kulmala, Juha-Pekka; Mäenpää, Helena; Rantalainen, Timo

Journal or seriesJournal of Biomechanics



Publication year2021


Article number110244


Publication countryUnited Kingdom

Publication languageEnglish


Publication open accessOpenly available

Publication channel open accessPartially open access channel

Publication is parallel published (JYX)https://jyx.jyu.fi/handle/123456789/73835


There is limited evidence about gait stability and its alteration by concurrent motor and cognitive tasks in children with cerebral palsy (CP). We examined gait stability and how it is altered by constrained cognitive or motor task in CP and their typically developed (TD) controls.
Gait kinematics were recorded using inertial-measurement units (IMU) from 18 patients with hemiplegia (13.5±2.4 years), 12 with diplegia (13.0±2.1 years), and 31 TD controls (13.5±2.2 years) during unconstrained gait, and motor (carrying a tray) and cognitive (word naming) task constrained gait at preferred speed (∼400 steps/task). Step duration, its standard deviation and refined-compound-multiscale entropy (RCME) were computed independently for vertical and resultant horizontal accelerations.
Gait complexity was higher for patients with CP than TD in all tasks and directions (p<0.001–0.01), being pronounced in vertical direction, cognitive task and for diplegic patients (p<0.05–0.001). The gait complexity increased more (i.e. higher dual-task cost) from the unconstrained to the constrained gait in CP compared to TD (p<0.05). Step duration was similar in all groups (p>0.586), but its variation was higher in CP than TD (p<0.001–0.05), and during the constrained than unconstrained gait in all groups (p<0.01–0.001).
The gait in children with CP was more complex and the dual-task cost was higher primarily for children with diplegic CP than TD during cognitive task, indicating that attentional load hinders their gait more. This raises the hypothesis that more attention and cortical resources are needed to compensate for the impaired gait in children with CP.

Keywordsbiomechanicskinematicsstability (physics)balancewalking (motion)children (age groups)cerebral palsycerebral palsied

Free keywordsgait variability; inertial measurement unit; kinematics; stability; walking; attention

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Ministry reportingYes

Reporting Year2021

JUFO rating2

Last updated on 2024-03-04 at 19:57