Gait Variability in Children with Periventricular Leukomalacia and Perinatal Stroke: A Comparison of Between-Subject Variability.

AIM: This study aimed to (1) compare gait patterns between children with periventricular leukomalacia (PVL) and those with perinatal stroke and (2) assess between-subject gait variability within each group to quantify differences in the heterogeneity of gait patterns associated with distinct brain lesion types.

METHODS

A total of 43 children with cerebral palsy (CP) (32 PVL, 11 perinatal stroke) underwent three-dimensional gait analysis. Kinematic waveforms of the more affected leg and temporospatial gait parameters were compared between groups. Furthermore, between-subject gait variability in gait kinematics was evaluated. Differences in discrete kinematic parameters were assessed with Levene's tests. Dynamic time warping (DTW) quantified deviations from group mean trajectories, and principal component analysis (PCA) evaluated the number of components required to explain cumulative variance in gait patterns.

RESULTS

Children with PVL and stroke did not differ significantly in temporospatial gait parameters or overall kinematic profiles, except for greater hip adduction during mid-stance in PVL. However, gait variability was consistently higher in the PVL group across analytical methods. PVL was associated with greater variability in knee flexion at initial contact (p = 0.040) and a trend during swing (p = 0.069). DTW distances were larger for PVL in sagittal knee kinematics (p = 0.002), and PCA indicated that more components were needed to explain 90% of variance.

CONCLUSION

Children with PVL exhibited greater between-subject gait variability than those with stroke, reflecting the diffuse nature of white matter injury. These findings highlight the importance of considering lesion type and gait variability when designing individualized rehabilitation strategies for children with CP.