Gait patterns in hemiplegic children with Cerebral Palsy: Comparison of right and left hemiplegia Manuela Galli a,b , Veronica Cimolin a, *, Chiara Rigoldi a , Nunzio Tenore b , Giorgio Albertini b a Bioengineering Department, Politecnico di Milano, p.zza Leonardo Da Vinci 32, via Golgi 39, 20133 Milano, Italy b IRCCS ‘‘San Raffaele Pisana’’, Tosinvest Sanita `, via della Pisana 235, 00163 Roma, Italy 1. Introduction Hemiplegia is a form of spastic Cerebral Palsy (CP) in which one arm and leg on either the right or left side of the body is affected. It is the most common syndrome in children born at term and is second in frequency only to spastic diplegia among preterm infants (Kulak & Sobaniec, 2004). Patients with spastic hemiplegia have unilateral prehensile dysfunction as a consequence of lesions in the sensorimotor cortex and corticospinal tract. Children whose hemiparesis involves the upper limb to a greater extent than the lower (arm-dominant hemiparesis) are much more likely to experience learning difficulties than whose clinical pattern is leg-dominant. They more often develop recurrent unprovoked seizures. Those whose clinical pattern affects the upper and lower limbs to an approximately equal extent (‘‘proportional’’ hemiparesis) appear to fall between the arm-dominant and leg-dominant groups. Research in Developmental Disabilities 31 (2010) 1340–1345 ARTICLE INFO Article history: Received 7 June 2010 Received in revised form 15 June 2010 Accepted 6 July 2010 Keywords: Hemiplegia Cerebral Palsy Gait analysis ABSTRACT The aims of this study are to compare quantitatively the gait strategy of the right and left hemiplegic children with Cerebral Palsy (CP) using gait analysis. The gait strategy of 28 right hemiparetic CP (RHG) and 23 left hemiparetic CP (LHG) was compared using gait analysis (spatio-temporal and kinematic parameters) and considering the hemiplegic classification based on four gait strategies. Our results demonstrated that velocity was a significant parameter to differentiate RHG and LHG: all hemiplegic types revealed in fact that RHG walked with higher velocity than LHG. The ankle strategy displayed an increased number of differences between RHG and LHG from hemiplegia of Type I to Type III. In all the comparison, the LHG showed the less physiological gait pattern. As for knee kinematics, differences between right and left hemiplegic gait pattern were evidenced only in children with hemiplegia Type II: the LHG walked with a more flexed knee at initial contact, marked hyperextension in midstance and reduced knee flexion ability in the swing phase. The hip strategy was quite normal in both groups in hemiplegia Type I. In the other two types, LHG showed a limited extension ability in midstance in comparison to RHG. In conclusion, our data revealed that RHG and LHG were in general characterised by different gait patterns, evidencing a general a progression of involvement in the different types of hemiplegia; in particular in all the hemiplegic types the LHG patients revealed a more severe involvement than the RHG individuals and the differences were more evident at the distal joints, especially at the ankle joint. ß 2010 Elsevier Ltd. All rights reserved. * Corresponding author. Tel.: +39 02 2399 3359; fax: +39 02 2399 3360. E-mail address: veronica.cimolin@polimi.it (V. Cimolin). Contents lists available at ScienceDirect Research in Developmental Disabilities 0891-4222/$ – see front matter ß 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.ridd.2010.07.007