Stop Tip-toeing Around Toe-walking
Condition: Spastic Cerebral Palsy (sCP)
MeSH terms: Cerebral Palsy
Study type: Interventional

Summary: 
      The purpose of this study is to explore the interplay among nervous-, musculoskeletal-, and
      psychological systems and how they impact toe-walking behavior, and vice versa.

      Sub-Project 1 is to analyze the feasibility of the developed virtual reality (VR)
      environment, in 10 TD and sCP children respectively. It is assess the effects of VR immersion
      on predefined static and dynamic stability parameters.

      Sub-Project 2: After adjustments have been made following Sub-Project 1 regarding the study
      procedure, technical factors or the parameters of interest etc., the optimized study
      procedure is implemented in Sub-Project 2 (20 to 25 TD will be included).

      Sub-Project 3: After adjustments have been made following Sub-Project 1 regarding the study
      procedure, technical factors or the parameters of interest etc., the optimized study
      procedure is implemented in Sub-Project3 (20 to 25 sCP will be included)
    

Detailed description: 
      The interplay between the nervous-, musculoskeletal-, and psychological systems and their
      impact on resulting walking patterns are poorly understood. Children that toe-walk often show
      poorer levels of static and dynamic stability, leading to a lower quality of life compared to
      typically develop-ing children (TD). Current research suggests multifactorial adaptations in
      central and/or peripheral nervous as well as the musculoskeletal system contribute to and
      result from toe-walk-ing. The purpose of this study is to explore the interplay among
      nervous-, musculoskeletal-, and psychological systems and how they impact toe-walking
      behavior, and vice versa. The effect of psychological factors (via the use of a
      custom-designed virtual reality environment) on static vs. dynamic stability, motor control,
      coordination (indirect assessment of central nervous system function) as well as reflex
      control (Hoffmann-reflex, H-reflex, performance of peripheral nervous system) is
      investigated.
    

Intervention name(s): Static stability measurement; Dynamic stability measurement
Intervention type(s): Diagnostic Test; Diagnostic Test
Intervention description(s): The child stands barefoot on dual force platforms in two (CP: three) different conditions: barefoot and with shoes (CP: and with orthosis). Each condition is recorded three times each lasting for 30s, and 30s rest between them. Both conditions are recorded with and without wearing a headset. The order of conditions (within each Virtual Reality ("VR)-condition") is randomized. For each condition, the child rests in a comfortable position for 20s with the heels on the same level and arms hanging at their sides. Between both "VR-conditions", the child rests for 120 s.; The child walks at their normal walking speed on a 10-m walkway in two (CP: three) different conditions: barefoot and with shoes (CP: and with orthosis). For each condition, at least six error-free trials are recorded. Errors in data may occur due to hidden or lost markers during walking or software interruptions. Both conditions are recorded with and without wearing a headset. The order of conditions (within each "VR-condition") is randomized.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Intervention model description: Cross sectional, age-matched-controlled and monocentric study with an exploratory approach.
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: tip-toeing; toe-walking; gait cycle; heel-strike; Static stability; Dynamic stability; Virtual Reality; Cerebral Palsy (CP)