Are spasticity, weakness, selectivity, and passive range of motion related to gait deviations in children with spastic cerebral palsy? A statistical parametric mapping study

Abstract

This study aimed to identify the relationships between clinical impairments and gait deviations in children with cerebral palsy (CP). A retrospective convenience sample of 367 children with CP was selected (3–18 years old) and divided in two groups based on clinical symptomatology [unilateral (uCP) / bilateral CP (bCP), (n = 167/200)]. All children underwent a three-dimensional gait analysis and a standardized clinical examination. Gait was inspected on a vector level (all sagittal motions combined), and an individual joint level (pelvis, hip, knee and ankle joint motions). Statistical non-parametric mapping was applied to identify specific parts of the gait cycle displaying relationships between the gait deviations of both groups and the impairment scores of spasticity, weakness, selectivity, and passive range of motion. Impairment scores were summarized in two ways: a) composite impairment scores (e.g. combined spasticity of all assessed muscles acting around the hip, knee and ankle joints) and b) joint specific impairment scores (e.g. spasticity of the muscles acting around the knee joint). Results showed that the vector and most of the individual motions were related to the composite scores. Direct and carry-over relationships were found between certain individual motions and joint impairment scores (around the same or neighboring joints, respectively). All correlations were more prominent for children with bCP compared to uCP, especially regarding the relationships of gait deviations with weakness and reduced selectivity. In conclusion, this study enabled the mapping of relationships between clinical impairments and gait deviations in children with CP, by identifying specific parts of the gait cycle that are related to each of these impairments. These results provide a comprehensive description of these relationships, while simultaneously highlighting the differences between the two CP groups. Integration of these findings could lead to a better understanding of the pathophysiology of gait deviations and, eventually, support individualized treatment planning.

Concurrent Validity and Reliability of an Inertial Measurement Unit for the Assessment of Craniocervical Range of Motion in Subjects with Cerebral Palsy

“…Currently, CP is recognized as being the most common cause of serious permanent physical disability in childhood, although the prospect of survival in children with severe disability has increased in recent years. Cerebral palsy is associated with sensory deficits, cognitive deficits, communication and motor disabilities, behavioral problems, seizure disorders, pain and secondary musculoskeletal problems, with spastic paresis being one of the most common forms of presentation [5,6], affecting the magnitude of movement and motor control [7,8], including the craniocervical region. Thus, head movement alterations can impair temporomandibular joint functions [9], and increase the risk of falls [10].…”

Structural Brain Lesions and Gait Pathology in Children With Spastic Cerebral Palsy

“…Additional data were collected and reported for all patients regarding commonly measured clinical impairments and comorbidities. Clinical impairments of the muscles acting in the sagittal plane were summed to form composite scores for spasticity, weakness, selectivity and passive range of motion (ROM) (Papageorgiou et al, 2019b). Comorbidities included visual, hearing and intellectual impairments, as well as a history of epilepsy.…”

“…Children with bCP and uCP display differences in brain lesions ( Krägeloh-Mann and Horber, 2007 ; Zhou et al, 2017 ), gross motor function ( Himmelmann and Uvebrant, 2011 ; Holmes et al, 2018 ; Papageorgiou et al, 2019b ), and gait ( Meyns et al, 2016 ; Holmes et al, 2018 ). These population-based differences necessitate in-depth exploration of the possible interactions between the brain lesions of each group and their function or gait characteristics.…”

Movement History Influences Pendulum Test Kinematics in Children With Spastic Cerebral Palsy

“…In this paper, we will use the terms spasticity and joint hyper-resistance against movement interchangeable. These clinical tests give little insight in the underlying mechanisms of increased resistance to movement, which might explain why the contribution of spasticity to walking impairments is only poorly understood ( Papageorgiou et al, 2019 ). There is growing consensus that it is important to distinguish different contributions to joint hyper-resistance, i.e., non-neural originating from passive tissue properties, and neural originating from background muscle activity and stretch hyperreflexia ( van den Noort et al, 2017 ).…”