A child carefully balances a tray while walking, symbolizing the challenges of cerebral palsy.

Balancing Act: How Accuracy Impacts Movement in Children with Cerebral Palsy

Jordan Keane in Health & Wellness July 2025 • 4 min read.

"Uncover the surprising ways accuracy demands affect walking and coordination in children with unilateral spastic cerebral palsy and what it means for their development."

Children with unilateral spastic cerebral palsy (USCP) face motor challenges that affect both their upper and lower body movements, impacting everyday activities. While many studies examine upper or lower body impairments independently, a recent study investigates how accuracy demands during a combined task—walking while carrying an object—affect their movement and coordination.

The study aimed to understand how accuracy constraints influence gait (walking pattern) and bimanual coordination in children with USCP during a whole-body task. Ten children with USCP (ages 7-12, GMFCS levels I-II) and ten typically-developed children (TDC) participated. They walked while carrying a water bottle on a tray, both with and without a cap, allowing researchers to observe their movements under different accuracy demands.

Researchers analyzed various aspects of the participants' movements, including walking speed, stride length, hand movements, and joint angles. The goal was to determine how the need for greater accuracy affected their ability to walk and coordinate their hand movements effectively.

Key Findings: Accuracy Affects Both Groups, But Differently

A child carefully balances a tray while walking, symbolizing the challenges of cerebral palsy.

The study revealed that increased accuracy demands—carrying the water bottle without a cap—affected both groups, but in distinct ways. Typically developed children (TDC) responded by:

Slowing down their walking speed.
Shortening their stride length.
Decreasing height differences between the hands (improved levelness).
Reducing vertical hand movement.
Limiting elbow joint excursion.

Children with USCP, on the other hand, demonstrated the following adjustments:

Significant decrease in walking speed.
Significant decrease in vertical hand movement.
Significant decrease in elbow joint excursion.
Significantly decreased walking deviation.

Implications for Treatment and Assessment

The finding that children with USCP (GMFCS levels I and II) could maintain bimanual coordination and modify their gait under higher accuracy constraints is promising. It suggests that treatments and assessments could incorporate accuracy challenges, even during complex, whole-body tasks.

By understanding how accuracy demands affect movement strategies, therapists and educators can create more effective interventions to improve coordination and walking ability in children with USCP. This might involve practicing tasks that require precise movements while walking, helping them develop better control and stability.

Future research should continue to explore the effects of various task constraints on movement in children with USCP, leading to more tailored and effective rehabilitation approaches. Considering external cues and attention focus may also offer additional avenues for improving motor skills in this population.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/j.gaitpost.2018.11.012, Alternate LINK

Title: Influence Of Accuracy Constraints On Bimanual Coordination And Gait Performance In Children With Unilateral Spastic Cerebral Palsy

Subject: Rehabilitation

Journal: Gait & Posture

Publisher: Elsevier BV

Authors: Hung Ya-Ching

Published: 2019-02-01

Everything You Need To Know

What was the primary goal of the study?

The study investigated how accuracy constraints affect walking and bimanual coordination in children with unilateral spastic cerebral palsy (USCP). This involved observing how children walked while carrying a water bottle on a tray, both with and without a cap. The presence or absence of the cap created different levels of accuracy demand, influencing the children's gait and hand movements.

Why is understanding how accuracy impacts movement in children with unilateral spastic cerebral palsy (USCP) important?

Children with unilateral spastic cerebral palsy (USCP) experience motor challenges affecting both upper and lower body movements. These challenges impact daily activities. The study's significance lies in understanding how accuracy demands, such as carrying an uncapped water bottle, influence their gait and bimanual coordination. This understanding can shape future treatments and assessments, suggesting that incorporating accuracy challenges into therapies might be beneficial.

Who were the participants in the study, and what were they asked to do?

The study used two groups: children with unilateral spastic cerebral palsy (USCP) and typically developed children (TDC). Both groups were asked to walk while carrying a water bottle on a tray, once with a cap (less accuracy demand) and once without a cap (more accuracy demand). Researchers analyzed various aspects of their movements, including walking speed, stride length, hand movements, and joint angles to understand how the accuracy demands influenced their movements.

How did children with unilateral spastic cerebral palsy (USCP) adjust their movements when accuracy demands increased?

When faced with increased accuracy demands, such as carrying the uncapped water bottle, children with unilateral spastic cerebral palsy (USCP) significantly decreased their walking speed and vertical hand movement, and reduced elbow joint excursion, while showing significantly decreased walking deviation. This indicates they adjusted their movements to maintain control and stability under the accuracy constraint.

What are the potential implications of these findings for the treatment and assessment of children with unilateral spastic cerebral palsy (USCP)?

The findings suggest that treatments and assessments could incorporate accuracy challenges, even during complex, whole-body tasks for children with unilateral spastic cerebral palsy (USCP). This is promising because the children in the study (GMFCS levels I and II) were able to maintain bimanual coordination while adapting their gait, indicating a capacity to improve with targeted interventions focusing on accuracy in functional movements.