Comparison of compensatory strategies and gait deviations in unclassified and type 1 unilateral cerebral palsy.

Different classification systems were described in the past for unilateral Cerebral Palsy (CP) focusing on gait deviations of the involved limbs mainly in the sagittal plane. However, there is a high percentage of patients that remain unclassified. Particularly in unilateral CP due to the naturally given asymmetry, the gait deviation causes compensatory movement patterns, thus affecting the sound limb. The objective of this work was a comprehensive assessment of gait deviations (involved and sound limb) in patients with unilateral CP, particularly in comparison between unclassified patients, type 1 hemiplegia and typically developing individuals. 47 individuals with unilateral CP (15 unclassified, 32 type 1) were included. Differences between those two groups and particularly compared to typically developing individuals, including pelvis and trunk and all planes/degrees of freedom, were analyzed using instrumented 3D gait analysis (IGA). Most remarkably, gait deviations due to anatomical and functional leg length discrepancies (LLD) and pelvic rotation were found in all participants, still not considered for classification of patients with unilateral CP. Alterations due to LLD and transversal asymmetry are additional predominant and highly significant modulations with respect to compensatory movement strategies in all patients with unilateral CP and should be considered for classification and treatment recommendations.