Contractile behavior of the medial gastrocnemius in children with bilateral spastic cerebral palsy during forward, uphill and backward-downhill gait

Medial gastrocnemius and soleus muscle‐tendon unit, fascicle, and tendon interaction during walking in children with cerebral palsy

“…Repeated eccentric contractions from toe walking could potentially result in muscle damage; however, it remains to be seen whether this stimulus is sufficient in children with CP. These muscle actions and resultant tissue responses may not, however, be experienced in children with CP walking with crouch gait as medial gastrocnemius fascicle behaviour more closely follows the isometric contractions reported in typically developing children …”

“…The findings are not generalizable to all speeds of walking or to walking on gradients. MTU, fascicle, and tendon behaviour of the medial gastrocnemius and soleus may vary with different conditions, as reported in typically developing individuals and children with CP walking with a crouch gait pattern, and needs to be examined in future studies. Conclusions about the contribution of the lengthening fascicles to passive force generation within the MTU and the specific contractile conditions of both the medial gastrocnemius and soleus cannot yet be established without further investigation.…”

“…In the first study, children with diplegic CP, walking supported on a treadmill with crouch gait pattern, had medial gastrocnemius muscle fascicles that maintained a relatively constant length during mid-stance. 22 In contrast, the second study found the medial gastrocnemius muscle belly lengthened during the same gait phase in a group of children with hemiplegic and diplegic CP with a more toe-walking gait pattern and during overground independent walking. 23 The contrasting calf muscle behaviour may be a function of crouch versus toe-walking gait pattern or variability of muscle measurement and walking methodologies.…”

“…Two recent studies investigating the calf muscle during walking in children with spastic type CP have provided differing findings. In the first study, children with diplegic CP, walking supported on a treadmill with crouch gait pattern, had medial gastrocnemius muscle fascicles that maintained a relatively constant length during mid‐stance . In contrast, the second study found the medial gastrocnemius muscle belly lengthened during the same gait phase in a group of children with hemiplegic and diplegic CP with a more toe‐walking gait pattern and during overground independent walking .…”

In vivo muscle behaviour in cerebral palsy with an equinus gait: are we on track?

“…There remain concerns regarding the validity of estimating fascicle lengths using ultrasound, further compounded in dynamic situations when both ultrasound probe pressure and out‐of‐plane fascicle movement may lead to the introduction of extrinsic errors. Hösl et al . introduced a novel ultrasound probe‐fixation that may reduce these errors, but a comprehensive reliability analysis is yet to be established.…”