Stop Tip-toeing Around Toe-walking

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.

Inclusion criteria

for TD children:

• between the age of 7 and 18 years
• who are typically developing
• able to stand and walk alone without using assistance or assistive devices
• able to place their feet flat on the force platforms
• with enough German language skills to follow the instructions

Inclusion criteria

for sCP children:

• between the age of 7 and 18 years
• with the diagnosis of spastic CP or CP similar (both unilateral and bilateral), functionally classified level I or II according to the Gross Motor Function Classification System (GMFCS)
• being able to stand and walk alone without assistance or assistive devices
• able to place their feet flat on the force platforms
• with enough German language skills to follow the instructions

Exclusion criteria

for TD children:

• severe visual, cognitive, or auditory impairments that would interfere with the study instructions and the VR immersion
• any vestibular problems (e.g. severe motion sickness)
• history of epilepsy, pace-marker or/and electrical pumps (due to possible interference with electrical stimulation)
• prior experience of VR to ensure a comparable baseline between subjects

Exclusion criteria

for sCP children:

• severe visual, cognitive, or auditory impairments that would interfere with the study instructions and the VR immersion
• severe knee flexion gait (>45°)
• walking capacity <50m
• botulinum toxin type A treatment (past 6 months)
• orthopedic surgery of upper or lower extremities (past 12 months)
• any vestibular problems (e.g. severe motion sickness or dizziness)
• history of epilepsy, pace-marker or/and electrical pumps (due to possible interference with electrical stimulation)
• prior experience of VR as they may already be adapted to VR.