Impaired gait function in adults with cerebral palsy is associated with reduced rapid force generation and increased passive stiffness

Geertsen, Svend Sparre; Kirk, Henrik; Lorentzen, Jakob; Jorsal, Martin; Johansson, Claus Bo; Nielsen, Jens Bo

doi:10.1016/j.clinph.2015.02.005

Cited by 59 publications

(65 citation statements)

References 52 publications

(84 reference statements)

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“…Similar findings have been described for the lower limb, specifically the ankle flexors. Previous reports have estimated the passive tension to be 22–120% higher in CP for the ankle flexor muscles (Ross et al, 2011; de Gooijer-van de Groep et al, 2013; Geertsen et al, 2015). Thus, our finding of a 2-fold increase in skeletal muscle stiffness of the forearm flexors is comparable to data on weight bearing muscles of the lower limb.…”

Section: Discussionmentioning

confidence: 94%

“…Recent reports have highlighted stunted growth in the lower limb as a contributing factor to contracture development (Gough and Shortland, 2012) and slowed growth rate has been detected as early as 15-months of age (Herskind et al, 2015). Several investigators have described increased passive stiffness of the calf muscle in children with CP and different tests have shown that the calf muscle is 22–120% stiffer in CP children compared to TD (Ross et al, 2011; de Gooijer-van de Groep et al, 2013; Geertsen et al, 2015). The process starts early and increased whole muscle passive stiffness in the calf has been described as early as 3 years of age (Willerslev-Olsen et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

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Forearm Flexor Muscles in Children with Cerebral Palsy Are Weak, Thin and Stiff

Walden

Jalaleddini

Evertsson

et al. 2017

Front. Comput. Neurosci.

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Children with cerebral palsy (CP) often develop reduced passive range of motion with age. The determining factor underlying this process is believed to be progressive development of contracture in skeletal muscle that likely changes the biomechanics of the joints. Consequently, to identify the underlying mechanisms, we modeled the mechanical characteristics of the forearm flexors acting across the wrist joint. We investigated skeletal muscle strength (Grippit®) and passive stiffness and viscosity of the forearm flexors in 15 typically developing (TD) children (10 boys/5 girls, mean age 12 years, range 8–18 yrs) and nine children with CP Nine children (6 boys/3 girls, mean age 11 ± 3 years (yrs), range 7–15 yrs) using the NeuroFlexor® apparatus. The muscle stiffness we estimate and report is the instantaneous mechanical response of the tissue that is independent of reflex activity. Furthermore, we assessed cross-sectional area of the flexor carpi radialis (FCR) muscle using ultrasound. Age and body weight did not differ significantly between the two groups. Children with CP had a significantly weaker (−65%, p < 0.01) grip and had smaller cross-sectional area (−43%, p < 0.01) of the FCR muscle. Passive stiffness of the forearm muscles in children with CP was increased 2-fold (p < 0.05) whereas viscosity did not differ significantly between CP and TD children. FCR cross-sectional area correlated to age (R2 = 0.58, p < 0.01), body weight (R2 = 0.92, p < 0.0001) and grip strength (R2 = 0.82, p < 0.0001) in TD children but only to grip strength (R2 = 0.60, p < 0.05) in children with CP. We conclude that children with CP have weaker, thinner, and stiffer forearm flexors as compared to typically developing children.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Forearm Flexor Muscles in Children with Cerebral Palsy Are Weak, Thin and Stiff

Walden

Jalaleddini

Evertsson

et al. 2017

Front. Comput. Neurosci.

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“…[26] Since increased reflex stiffness also appears to play only a small role for the gait disability in the population of adults with CP, this finding is probably of little significance in any case. [9,27,28] The lack of correlation between the reduced passive stiffness and improved gait ability in the training group suggests that other mechanisms contributed to the improvement in gait and may have obscured the contribution from the changes in passive stiffness. Chief among these are changes in the neural drive to the muscles and improved coordination of the muscle activity during gait.…”

Section: Discussionmentioning

confidence: 99%

“…Spasticity in the form of hyperactive reflex activity in contrast likely causes little functional problems in this patient group. [9,10] Gait has been shown to develop in children for a considerable time and a mature walking pattern is not observed until the age of 10-12 years. [11,12] Prior to this age, the gait pattern appears to be flexible and may also in children with CP be changed relatively easily through training.…”

Section: Introductionmentioning

confidence: 99%

Treadmill training with an incline reduces ankle joint stiffness and improves active range of movement during gait in adults with cerebral palsy

Lorentzen

Kirk

Fernández‐Lago

et al. 2016

Disability and Rehabilitation

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Daily treadmill training with an incline for 6 weeks reduces ankle joint stiffness and increases active ROM during gait in adults with CP. Intensive gait training may thus be beneficial in preventing and reducing contractures and help to maintain functional gait ability in adults with CP. Implications for rehabilitation Uphill gait training is an effective way to reduce ankle joint stiffness in adult with contractures. 6 weeks of daily uphill gait training improves functional gait parameters such as gait speed and dorsal flexion during gait in adults with cerebral palsy.

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“…The main muscles affected by spasticity are the muscles of the lower extremities, such as the plantar and dorsal flexor muscles of the ankle. Spasticity of these muscles has a significant impact on the gait performance (Geertsen et al, 2015). One of the objectives of the BTX treatment in patients with spasticity is to improve the functionality of the motor task.…”

Section: Introductionmentioning

confidence: 99%