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James C Galloway, Invited Commentary, Physical Therapy, Volume 84, Issue 4, 1 April 2004, Pages 355–356, https://doi.org/10.1093/ptj/84.4.355
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Let me first congratulate Fonseca and colleagues on an article that advances our understanding of important features of gait in children with cerebral palsy (CP). Moreover, this article highlights the question of how these features emerge during development, which is, of course, a central issue to pediatric neurorehabilitation.
In summary, the authors found that children with hemiplegic CP produced greater vertical stiffness, greater potential energy (K/P energy, also called “PE” in the article), and a decreased landing angle during stance on their more affected extremity compared with the less affected extremity as well as with age-matched, typically developing children. The authors suggest that their data and their previous work1 are compatible with a novel view of the underlying process by which children with CP develop independent locomotion, namely that these “impairments” are, in part, adaptations by the child to the mechanical and energetic requirements of walking.
I have focused my comments first on the authors' “selection theory,” as I call it, followed by a few points on the method and results, several of which were touched on in the article's “Discussion” section.
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