Volume 12, Issue 3 (11-2026)                   J Sport Biomech 2026, 12(3): 394-404 | Back to browse issues page

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Elhami M, Yazdani S, Eskandar Nezhad M. Comparative Analysis of Dual-Task Effects on EMG Activity During Walking in Individuals with Hemiplegic Cerebral Palsy and Healthy Controls. J Sport Biomech 2026; 12 (3) :394-404
URL: http://biomechanics.iauh.ac.ir/article-1-471-en.html
Comparative Analysis of Dual-Task Effects on EMG Activity During Walking in Individuals with Hemiplegic Cerebral Palsy and Healthy Controls
Mobarake Elhami1 , Shirin Yazdani *1 , Mahta Eskandar Nezhad1
1- Department of Motor Behavior, Faculty of Physical Education and Sports Sciences, University of Tabriz, Tabriz, Iran.
Abstract:   (95 Views)
Objective The present study aimed to investigate the electromyographic (EMG) activity of lower limb and trunk muscles in individuals with cerebral palsy (CP) and healthy controls during normal and dual-task walking.
Methods Twelve CP patients and twelve age-matched healthy volunteers participated in this study. Surface EMG signals from the erector spinae (ES), biceps femoris (BF), and rectus femoris (RF) muscles were recorded during normal walking and motor, cognitive, and visual dual-tasks using a bipolar EMG USB2+ system. Acquired signals were processed using OT Biolab software. Statistical analysis was performed using repeated measures ANOVA in SPSS 22, with significance set at p<0.05.
Results Significant differences were observed in normalized EMG of L3, BF, and RF muscles between CP and healthy groups (p<0.001). Motor and visual dual tasks differentially affected muscle activation intensity in both groups (p=0.020). While dual tasks produced symmetrical muscle activation increases in healthy participants, CP patients demonstrated significantly greater left-side activation (p=0.010).
Conclusion CP patients exhibited significantly higher EMG activity in L3, BF, and RF muscles across all conditions except normal walking and motor dual-task (where right BF showed no difference). Notably, motor and visual dual-tasks elicited greater muscle activity than cognitive tasks in CP patients, suggesting preferential reliance on visual over proprioceptive feedback due to sensory integration deficits. So, these information, can serve as a useful guide for assessing and designing appropriate exercise and rehabilitation programs for individuals with CP.
Keywords: Electromyography, Cerebral palsy, Gait, Dual-task
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Type of Study: Research | Subject: Special
Received: 2025/11/23 | Accepted: 2026/06/16 | Published: 2026/06/18
References
1. Winter DA. Biomechanics and motor control of human movement. Hoboken (NJ): John Wiley & Sons; 2009. [DOI:10.1002/9780470549148]
2. Carvalho JP, Bento-Torres J, da Silva DJ, et al. Cognitive and visual interactions in the decline of postural stability in healthy older adults. Brazilian Journal of Physical Therapy. 2024;28:100806. [DOI:10.1016/j.bjpt.2024.100806]
3. Stavsky M, Mor O, Mastrolia SA, Greenbaum S, Than NG, Erez O. Cerebral palsy-trends in epidemiology and recent development in prenatal mechanisms of disease, treatment, and prevention. Frontiers in Pediatrics. 2017;5:21. [DOI:10.3389/fped.2017.00021]
4. Kulak W, Sobaniec W. Comparisons of right and left hemiparetic cerebral palsy. Pediatric Neurology. 2004;31(2):101-108. [DOI:10.1016/j.pediatrneurol.2004.01.009]
5. Gordon AM, Charles J, Wolf SL. Efficacy of constraint-induced movement therapy on involved upper-extremity use in children with hemiplegic cerebral palsy is not age-dependent. Pediatrics. 2006;117(3):e363-e373. [DOI:10.1542/peds.2005-1009]
6. Galli M, Cimolin V, Rigoldi C, Tenore N, Albertini G. Gait patterns in hemiplegic children with cerebral palsy: comparison of right and left hemiplegia. Research in Developmental Disabilities. 2010;31(6):1340-1345. [DOI:10.1016/j.ridd.2010.07.007]
7. Carcreff L, Bonnefoy-Mazure A, Valenza N, Allali G, Fluss J, Armand S. Influence of cognitive-motor interference on gait spatiotemporal parameters in children and adolescents with cerebral palsy: a preliminary study. Gait & Posture. 2016;49:1-5. [DOI:10.1016/j.gaitpost.2016.07.084]
8. Cimolin V, Galli MA, Tenore NU, Albertini GI, Crivellini M. Gait strategy of uninvolved limb in children with spastic hemiplegia. European Journal of Physical and Rehabilitation Medicine. 2007;43(3):303-310.
9. Hoon AH Jr, Stashinko EE, Nagae LM, Lin DD, Keller J, Bastian AM, et al. Sensory and motor deficits in children with cerebral palsy born preterm correlate with diffusion tensor imaging abnormalities in thalamocortical pathways. Developmental Medicine & Child Neurology. 2009;51(9):697-704. [DOI:10.1111/j.1469-8749.2009.03306.x]
10. Kurz MJ, Heinrichs-Graham E, Becker KM, Wilson TW. The magnitude of somatosensory cortical activity is related to mobility and strength impairments in children with cerebral palsy. Journal of Neurophysiology. 2015;113(9):3143-3150. [DOI:10.1152/jn.00602.2014]
11. Sharma A, Saxena A, Thakur K. The effect of single and dual task on spatiotemporal gait parameters in children with spastic cerebral palsy. Journal of Society of Indian Physiotherapists. 2024;8(1):14-19. [DOI:10.4103/jsip.jsip_95_23]
12. Houwink A, Aarts PB, Geurts AC, Steenbergen B. A neurocognitive perspective on developmental disregard in children with hemiplegic cerebral palsy. Research in Developmental Disabilities. 2011;32(6):2157-2163. [DOI:10.1016/j.ridd.2011.07.012]
13. Yu Y, Tucker CA, Lauer RT, Keshner EA. Influence of visual dependence on intersegmental coordination during upright stance in cerebral palsy. Journal of Motor Behavior. 2020;52(3):249-261. [DOI:10.1080/00222895.2019.1610860]
14. Sonksen PM, Dale N. Visual impairment in infancy: impact on neurodevelopmental and neurobiological processes. Developmental Medicine & Child Neurology. 2002;44(11):782-791. [DOI:10.1111/j.1469-8749.2002.tb00287.x]
15. Lidbeck C, Bartonek Å, Yadav P, et al. The role of visual stimuli on standing posture in children with bilateral cerebral palsy. BMC Neurology. 2016;16:1-9. [DOI:10.1186/s12883-016-0676-2]
16. Sansare A, Reimann H, Bodt B, et al. Reliance on vision for walking balance is related to somatosensory deficits in individuals with cerebral palsy. medRxiv. 2024. [DOI:10.1101/2024.02.07.24302467]
17. Hallemans A, Ortibus E, Meire F, Aerts P. Low vision affects dynamic stability of gait. Gait & Posture. 2010;32(4):547-551. [DOI:10.1016/j.gaitpost.2010.07.018]
18. Afzal MT, Tariq S, Khan MS, et al. Effects of additional functional strength training on mobility in children with hemiplegic cerebral palsy. Rehabilitation Journal. 2023;7(4):14-19. [DOI:10.52567/trehabj.v7i04.8]
19. Uysal İ, Özden F, Tümtürk İ, İmerci A. The effectiveness of dual-task exercise training on balance, mobility, physical performance, and quality of life in children with cerebral palsy: a single-blind randomized controlled trial. Irish Journal of Medical Science. 2024;193(2):813-821. [DOI:10.1007/s11845-023-03530-3]
20. Hall JB, Chole D, Thomas J, Guess T. A novel multimodal platform detects gait and balance dual-task interference in unilateral cerebral palsy. Proceedings of the Combined Sections Meeting (CSM), USA; 2025.
21. Sansare A, Arcodia M, Lee SC, Jeka J, Reimann H. Individuals with cerebral palsy show altered responses to visual perturbations during walking. Frontiers in Human Neuroscience. 2022;16:977032. [DOI:10.3389/fnhum.2022.977032]
22. de Sèze MP, Cazalets JR. Anatomical optimization of skin electrode placement to record electromyographic activity of erector spinae muscles. Surgical and Radiologic Anatomy. 2008;30(2):137-143. [DOI:10.1007/s00276-007-0289-y]
23. Maffiuletti NA, Lepers R. Quadriceps femoris torque and EMG activity in seated versus supine position. Medicine & Science in Sports & Exercise. 2003;35(9):1511-1516. [DOI:10.1249/01.MSS.0000084426.03247.93]
24. Padulo J, Tiloca A, Powell D, et al. EMG amplitude of the biceps femoris during jumping compared to landing movements. SpringerPlus. 2013;2:1-7. [DOI:10.1186/2193-1801-2-520]
25. Hermens HJ, Freriks B, Disselhorst-Klug C, Rau G. Development of recommendations for SEMG sensors and sensor placement procedures. Journal of Electromyography and Kinesiology. 2000;10(5):361-375. [DOI:10.1016/S1050-6411(00)00027-4]
26. Haakana P, Nurminen J, Kulmala JP, et al. Effects of cognitive and motor dual-task on gait parameters in children and adolescents with cerebral palsy. Gait & Posture. 2020;81:130-135. [DOI:10.1016/j.gaitpost.2020.07.099]
27. Schmid AB, Dyer L, Böni T, et al. Paraspinal muscle activity during symmetrical and asymmetrical weight training in idiopathic scoliosis. Journal of Sport Rehabilitation. 2010;19(3):315-327. [DOI:10.1123/jsr.19.3.315]
28. Konrad P. The ABC of EMG: a practical introduction to kinesiological electromyography. Scottsdale (AZ): Noraxon Inc.; 2005.
29. Prosser LA, Lee SC, Barbe MF, et al. Trunk and hip muscle activity in early walkers with and without cerebral palsy: a frequency analysis. Journal of Electromyography and Kinesiology. 2010;20(5):851-859. [DOI:10.1016/j.jelekin.2010.04.005]
30. Romkes J, Brunner R. An electromyographic analysis of obligatory and voluntary unilateral toe-walking. Gait & Posture. 2007;26(4):577-586. [DOI:10.1016/j.gaitpost.2006.12.010]
31. Patikas D, Wolf SI, Döderlein L. Electromyographic evaluation of the sound and involved side during gait of spastic hemiplegic children with cerebral palsy. European Journal of Neurology. 2005;12(9):691-699. [DOI:10.1111/j.1468-1331.2005.01047.x]
32. Adjenti SK, Louw G, Jelsma J, Unger M. Electromyographic study of abdominal muscle activity in children with spastic cerebral palsy. South African Journal of Physiotherapy. 2017;73(1):341. [DOI:10.4102/sajp.v73i1.341]
33. Sharifmoradi K, Farahpour N. Range of motion and lower limb muscle activity in Parkinson's disease and elderly individuals. Journal of Sport Biomechanics. 2017;3(1):25-36.
34. Bruijn SM, Millard M, Van Gestel L, et al. Gait stability in children with cerebral palsy. Research in Developmental Disabilities. 2013;34(5):1689-1699. [DOI:10.1016/j.ridd.2013.02.011]
35. Armand S, Decoulon G, Bonnefoy-Mazure A. Gait analysis in children with cerebral palsy. EFORT Open Reviews. 2016;1(12):448-460. [DOI:10.1302/2058-5241.1.000052]
36. Gharib NM, Abd-El Maksoud GM, Eldin S, Elsayed B. Efficacy of concurrent cognitive-motor training on gait in hemiparetic cerebral palsy: a randomized controlled trial. International Journal of Physiotherapy and Research. 2017;5(1):1852-1862. [DOI:10.16965/ijpr.2016.206]
37. Winters TF, Gage JR, Hicks R. Gait patterns in spastic hemiplegia in children and young adults. Journal of Bone and Joint Surgery (American Volume). 1987;69(3):437-441. [DOI:10.2106/00004623-198769030-00016]
38. Ferdjallah M, Harris GF, Smith P, Wertsch JJ. Analysis of postural control synergies during quiet standing in healthy children and children with cerebral palsy. Clinical Biomechanics. 2002;17(3):203-210. [DOI:10.1016/S0268-0033(01)00121-8]
39. Charles J, Gordon AM. A critical review of constraint-induced movement therapy and forced use in children with hemiplegia. Neural Plasticity. 2005;12(2-3):245-261. [DOI:10.1155/NP.2005.245]
40. Zehr EP, Fujita K, Stein RB. Reflexes from the superficial peroneal nerve during walking in stroke subjects. Journal of Neurophysiology. 1998;79(2):848-858. [DOI:10.1152/jn.1998.79.2.848]
41. Kahneman D. Attention and effort. Englewood Cliffs (NJ): Prentice-Hall; 1973.
42. Azadian E, Taheri Torbati H. Muscle activity during dual-task walking in elderly with balance impairments. Journal of Sport Biomechanics. 2016;2(2):5-15.
43. Lima CR, Pavão SL, da Silva BR, et al. Cognitive-motor dual-task costs on postural sway during sit-to-stand movement in children with cerebral palsy. Physiotherapy. 2023;103(4):pzad016. [DOI:10.1093/ptj/pzad016]
44. Piitulainen H, Kulmala JP, Mäenpää H, et al. Gait is less stable in children with cerebral palsy in dual-task conditions. Journal of Biomechanics. 2021;117:110244. [DOI:10.1016/j.jbiomech.2021.110244]
45. Yazdani S, Farahpour N, Delavar A, Farahmand F. Electromyographical activity of erector spinae and gluteus medius muscles in patients with adolescent idiopathic scoliosis during gait. Medical Journal of Tabriz University of Medical Sciences. 2016;38(6):84-92.
46. Hung YC, Meredith GS. Influence of dual-task constraints on gait performance and bimanual coordination during walking in children with unilateral cerebral palsy. Research in Developmental Disabilities. 2014;35(4):755-760. [DOI:10.1016/j.ridd.2014.01.024]
47. Johnson-Frey SH (ed.). Taking action: cognitive neuroscience perspectives on intentional acts. Cambridge (MA): MIT Press; 2003. [DOI:10.7551/mitpress/6614.001.0001]
48. Syczewska M, Święcicka A. Electromyographic patterns during gait in spastic cerebral palsy. Acta of Bioengineering and Biomechanics. 2016;18(3):-.
49. Kulmala JP, Haakana P, Nurminen J, et al. Effort equalization hypothesis in children with cerebral palsy. PLoS One. 2022;17(1):e0262042. [DOI:10.1371/journal.pone.0262042]
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