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Comparison of compensatory strategies and gait deviations in unclassified and type 1 unilateral cerebral palsy
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  • Published: 20 February 2026

Comparison of compensatory strategies and gait deviations in unclassified and type 1 unilateral cerebral palsy

  • Stefanos Tsitlakidis1,
  • Nicholas A. Beckmann1,
  • Johannes Weishorn1,
  • Sebastian I. Wolf1,
  • Pit Hetto1 &
  • …
  • Paul Mick1 

Scientific Reports , Article number:  (2026) Cite this article

We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Subjects

  • Outcomes research
  • Paediatric research

Abstract

Different classification systems were described in the past for unilateral Cerebral Palsy (CP) focusing on gait deviations of the involved limbs mainly in the sagittal plane. However, there is a high percentage of patients that remain unclassified. Particularly in unilateral CP due to the naturally given asymmetry, the gait deviation causes compensatory movement patterns, thus affecting the sound limb. The objective of this work was a comprehensive assessment of gait deviations (involved and sound limb) in patients with unilateral CP, particularly in comparison between unclassified patients, type 1 hemiplegia and typically developing individuals. 47 individuals with unilateral CP (15 unclassified, 32 type 1) were included. Differences between those two groups and particularly compared to typically developing individuals, including pelvis and trunk and all planes/degrees of freedom, were analyzed using instrumented 3D gait analysis (IGA). Most remarkably, gait deviations due to anatomical and functional leg length discrepancies (LLD) and pelvic rotation were found in all participants, still not considered for classification of patients with unilateral CP. Alterations due to LLD and transversal asymmetry are additional predominant and highly significant modulations with respect to compensatory movement strategies in all patients with unilateral CP and should be considered for classification and treatment recommendations.

Data availability

All data generated or analyzed during this study are included in this article. Supplementary data are available on reasonable request.

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Acknowledgements

Essential participation in the conception and design of the study as well as acquisition, analysis and interpretation of data were done by all authors. The manuscript was edited and approved by all mentioned authors. This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

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Open Access funding enabled and organized by Projekt DEAL. This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany

    Stefanos Tsitlakidis, Nicholas A. Beckmann, Johannes Weishorn, Sebastian I. Wolf, Pit Hetto & Paul Mick

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  1. Stefanos Tsitlakidis
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  2. Nicholas A. Beckmann
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  3. Johannes Weishorn
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All individuals listed as authors meet the appropriate authorship criteria and nobody who qualifies for authorship has been omitted from the list. All the authors have read the manuscript and agreed to it being submitted for publication.- Stefanos Tsitlakidis:- Conception and design; acquisition of data; analysis and interpretation of data; drafting the article; final approval of the version to be published- Nicholas A Beckmann:- analysis and interpretation of data; revising the article critically for important intellectual content; final approval of the version to be published- Johannes Weishorn:- analysis and interpretation of data; revising the article critically for important intellectual content; final approval of the version to be published- Sebastian I Wolf:- acquisition of data; analysis and interpretation of data; revising the article critically for important intellectual content; final approval of the version to be published- Pit Hetto:- acquisition of data; revising the article critically for important intellectual content; final approval of the version to be published- Paul Mick:- analysis and interpretation of data; drafting and revising the article critically for important intellectual content; final approval of the version to be published.

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Correspondence to Paul Mick.

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All authors have participated in the research. The paper has not been submitted for simultaneous consideration to any other journal. Institutional Review Board (IRB): An IRB approval was given by the local ethics committee (S-198/2019).

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Tsitlakidis, S., Beckmann, N.A., Weishorn, J. et al. Comparison of compensatory strategies and gait deviations in unclassified and type 1 unilateral cerebral palsy. Sci Rep (2026). https://doi.org/10.1038/s41598-026-40523-5

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  • Received: 11 February 2025

  • Accepted: 13 February 2026

  • Published: 20 February 2026

  • DOI: https://doi.org/10.1038/s41598-026-40523-5

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Keywords

  • 3D-instrumented gait analysis
  • unilateral cerebral palsy
  • compensatory strategies
  • transversal asymmetry
  • Winters classification
  • sound/uninvolved limb
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