Development of postural control during gait in typically developing children and children with cerebral palsy: The effects of dual task conditions
Boonyong, Sujitra, 1973-
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Boonyong, Sujitra, 1973-
The purpose of this dissertation was (1) to investigate the effects of dual task conditions on the development of postural control during gait in typically developing children while walking and obstacle crossing, and (2) to investigate the attentional requirements of gait in children with cerebral palsy (CP). Forty younger and older typically developing (YTD and OTD) children and 10 children with CP performed a gait task with and without a concurrently auditory Stroop task. Gait and cognitive performance were measured. In study 1, dual task interference with gait performance was found in YTD and OTD children, but not in healthy young adults (HYA). In general, gait performance decrements under dual task contexts were greater in YTD than OTD children, whereas cognitive performance decrements during dual tasking were not different between the two groups of children. Dual task interference was lowest in HYA and highest in YTD children when compared among groups. As the difficulty of the gait task was increased, dual task affects on cognitive performance were now found in YTD and OTD children, but not HYA. In study 2, there were significant differences in dual task interference affecting gait performance in all groups of children. When performing the gait task with a concurrent auditory Stroop task, OTD children showed greater dual-task costs than children with CP for accuracy, but children with CP demonstrated greater dual-task costs than OTD and YTD children for medial Center of Mass-Ankle-joint-center inclination angle. This increased medio-lateral inclination angle in dual task situations has also been seen in older adults with balance deficits and may be associated with an increased risk for falls. YTD children showed dual-task costs in a slowing of gait velocity and stride time, a safer strategy than that used by children with CP. The lower cognitive performance during dual tasking for OTD children suggests that they allocate greater attention to maintain gait stability, whereas YTD children and children with CP do not. In addition, children with CP use a behavior that may increase their risk of falls in complex environments. This dissertation includes unpublished co-authored material.