The Interlimb Asymmetry-Locomotor Capacity Nexus: A Two-Year Longitudinal Investigation in Ambulatory Children With Unilateral Cerebral Palsy.

Abstract

To investigate the longitudinal relationship between spatial-temporal gait asymmetries and locomotor capacity in ambulatory children with unilateral cerebral palsy (UCP). A prospective longitudinal study with assessments at baseline, 6, 12, 18, and 24 months. Twenty-seven children with UCP (GMFCS levels I-II, aged 8-15 years) were evaluated for spatial (SAI) and temporal (TAI) gait asymmetry indices and locomotor capacity measures (community balance & mobility: CB&M, functional walking test: FWT, 10-meter Shuttle Run Test: 10m-SRT, and 6-Minute Walk Test: 6mWT). Mixed-effects models analyses indicated that higher SAI was significantly associated with lower CB&M scores (β=-124.73, P<0.001), reduced FWT performance (β=-48.79, P<0.001), increased 10m-SRT times (β=32.14, P<0.001), and shorter 6mWT distances (β=-774.86, P<0.001). Similar associations were found with TAI (β=-118.47, β=-43.93, β=35.18, β=-719.46, respectively; all P<0.001). Trajectory analysis revealed gradual improvements in asymmetry indices over 24 months. Children with lower baseline asymmetry demonstrated faster rates of locomotor improvement compared to those with higher baseline asymmetry. Longitudinal data establish that spatial-temporal gait asymmetries are significantly associated with locomotor capacity in children with UCP, with these relationships persisting over time. This supports the value of gait asymmetry metrics as clinical biomarkers for monitoring heterogeneous functional mobility trajectories within this specific population.