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perturbation to examine stability of walking in individuals with and without cerebral palsy. This tripping perturbation is a forward-dynamics analysis, and it works so that in a subject-specific muscle-driven simulation of walking, created from experimental gait data, a force is applied to the swing-foot, and resulting changes in the kinematics are observed. Here, changes in the fore-aft position of the trunk were analyzed. Subjects were 10 children with spastic diplegic cerebral palsy and eight unimpaired children walking at their self-selected speed. Several tripping perturbations throughout the swing phase were performed, and each perturbation was used to analyze stability at a respective instant of time. At a given instant of time, walking was defined as stable if after initially deviating from its unperturbed position, because of the perturbation, the trunk then approached and stayed close to that position. Walking was in turn defined as unstable if the trunk moved away from its unperturbed position. All unimpaired subjects were stable at some point of their swing phases, whereas six out of the ten CP subjects were never stable. The unimpaired subjects were statistically significantly stable for a larger percentage of the swing phase than the CP subjects (p < 0.05). On the average, unimpaired subjects were stable for 8.5% of the swing phase while CP subjects were stable for 1.5% of the swing phase. These findings demonstrate that a tripping perturbation is capable of detecting a balance impairment. Thus, it shows promise as a tool for rehabilitation.

Deteriorated stabilization of walking in individuals with spastic cerebral palsy revealed by a simulated tripping perturbation