The characteristics of cortical activation during gait in children with spastic diplegic cerebral palsy

Introduction Cerebral palsy (CP) is a common movement disorder caused by abnormalities or injury to the developing brain. It affects more than 17 million people worldwide and is associated with substantial impairments in postural balance and gait control, particularly in children with spastic diplegic CP. This study aimed to examine differences in cortical activation during walking between children with spastic diplegic CP and children with typical development (CTD), and to explore the relationship between cortical activation and gross motor performance. Methods Functional near-infrared spectroscopy (fNIRS) was used to monitor cortical activity during walking in 15 children with spastic diplegic CP and 15 age-matched CTD participants. All participants walked at a self-selected pace while cortical hemodynamic responses were recorded. Cortical activation patterns were compared between groups, and correlation analyses were conducted to evaluate associations between cortical activation, gross motor function, and walking speed. Results Compared with CTD, children with spastic diplegic CP showed significantly greater cortical activation in the right prefrontal cortex (RPFC), left prefrontal cortex (LPFC), and right premotor cortex (RPMC) during walking. In addition, activation in the RPMC was negatively correlated with gross motor function and walking speed. Discussion These findings indicate that children with spastic diplegic CP exhibit cortical over-activation during walking, particularly in the prefrontal and premotor cortices. The observed negative association between RPMC activation and motor performance suggests that greater cortical recruitment may reflect increased compensatory demands during motor planning and gait control. Overall, the results support the notion that children with spastic diplegic CP rely more heavily on cortical compensatory mechanisms to maintain walking performance.