GAIPOS-2558; No of Pages 8 Comparison of upper extremity kinematics in children with spastic diplegic cerebral palsy using anterior and posterior walkers Kelly M.B. Strifling a, * , Na Lu b , Mei Wang a , Kevin Cao a , Jeffrey D. Ackman d , John P. Klein b , Jeffrey P. Schwab c , Gerald F. Harris a a Orthopaedic and Rehabilitation Engineering Center (OREC), Marquette University, Academic Support Facility Room 105, 734 N 17th Street, Milwaukee, WI 53201, United States b Department of Biostatistics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, United States c Department of Orthopedic Surgery, Medical College of Wisconsin, P.O. Box 26099, Milwaukee, WI 53226, United States d Shriners Hospital for Children, 2211 N Oak Park Avenue, Chicago, IL 60707, United States Received 2 April 2007; received in revised form 7 January 2008; accepted 29 January 2008 Abstract This prospective study analyzes the upper extremity kinematics of 10 children with spastic diplegic cerebral palsy using anterior and posterior walkers. Although both types of walkers are commonly prescribed by clinicians, no quantitative data comparing the two in regards to upper extremity motion has been published. The study methodology included testing of each subject with both types of walkers in a motion analysis laboratory after an acclimation period of at least 1 month. Overall results showed that statistically, both walkers are relatively similar. With both anterior and posterior walkers, the shoulders were extended, elbows flexed, and wrists extended. Energy expenditure, walking speed and stride length was also similar with both walker types. Several differences were also noted although not statistically significant. Anterior torso tilt was reduced with the posterior walker and shoulder extension and elbow flexion were increased. Outcomes analysis indicated that differences in upper extremity torso and joint motion were not dependent on spasticity or hand dominance. These findings may help to build an understanding of upper extremity motion in walker-assisted gait and potentially to improve walker prescription. # 2008 Elsevier B.V. All rights reserved. Keywords: Cerebral palsy; Gait; Kinematics; Upper extremity; Walker 1. Introduction Spastic diplegic cerebral palsy (CP) affects many children and results from developmental and acquired abnormalities of the brain [1,2]. Many children with CP have difficulty ambulating and are commonly prescribed anterior or posterior walkers. However, no comprehensive reports on walker types or quantitative guidelines for walker prescription exist. There are few reports comparing lower extremity (LE) motion in children with spastic diplegic CP using different walkers [3–6]. Reports are limited to spatiotemporal parameters, energy expenditure, and some preliminary analyses on LE kinematics. Levangie et al. reported no significant gait temporal and stride parameter (GTSP) differences between anterior and posterior walkers [3]. Logan et al. [4] and Greiner et al. [5] concluded that posterior walkers facilitate an overall decrease in pelvic tilt and hip flexion and increase in walking velocity. Greiner also reported that patients felt more stable with posterior walkers [5]. Park et al. [6] and Bachschmidt et al. [7] reported that posterior walkers helped with energy conservation. Recently, our group published more detailed findings of LE kinematics in children with CP using posterior and anterior walkers [8]. While informative, these earlier studies did not include a detailed kinematic analysis of the upper extremities (UEs). There is an underlying perception that walker placement creates dissimilar postures which affect the motion of the body [3–7,9]. One well-known theory supporting posterior www.elsevier.com/locate/gaitpost Available online at www.sciencedirect.com Gait & Posture xxx (2008) xxx–xxx * Corresponding author. Tel.: +1 414 288 6003; fax: +1 414 288 0713. E-mail address: kelly.strifling@mu.edu (K.M.B. Strifling). 0966-6362/$ – see front matter # 2008 Elsevier B.V. All rights reserved. doi:10.1016/j.gaitpost.2008.01.018 Please cite this article in press as: Strifling KMB, et al., Comparison of upper extremity kinematics in children with spastic diplegic cerebral palsy using anterior and posterior walkers, Gait Posture (2008), doi:10.1016/j.gaitpost.2008.01.018