Influence of impaired selective motor control on gait in children with cerebral palsy

Abstract

Purpose Spastic cerebral palsy (CP) is characterized by four neuromuscular deficits: weakness, short muscle-tendon unit, muscle spasticity and impaired selective motor control (SMC). We examined the influence of impaired SMC on gait in children with bilateral spastic CP. Delineating the influence of neuromuscular deficits on gait abnormalities can guide surgical and therapeutic interventions to reduce long-term debilitating effects of CP. Methods The relationship between impaired SMC and gait was assessed using multivariate linear regression analysis of Selective Control Assessment of the Lower Extremity (SCALE) in relation to stance phase knee flexion and temporal-spatial gait parameters calculated using 3D kinematics for 57 children with bilateral spastic CP, ages seven to 11 years. Results Mean SCALE values were 5.8 (0 to 10, sd 3.0) and 5.7 (0 to 10, sd 2.9) for right and left legs, respectively. Multivariate linear regression models, including right and left SCALE and height, significantly predicted right and left knee flexion at initial contact (R = 0.479, p = 0.003; R = 0.452, p = 0.007, respectively) and right and left knee flexion in midstance (R = 0.428, p = 0.013; R = 0.407, p = 0.022, respectively). The model significantly predicted right and left step length (R = 0.645, p = 0.000; R = 0.523, p = 0.001, respectively) and predicted gait velocity (R = 0.444, p = 0.008). The model including SCALE did not predict step width. Conclusion Results indicate impaired SMC predicts increased knee flexion at initial contact, and reduces step length and velocity. Understanding the influence of impaired SMC on gait can inform decisions regarding therapy and surgery, such as hamstring lengthening. Level of evidence Level II Retrospective Study

The Pediatric Temporal‐spatial Deviation Index: quantifying gait impairment for children with cerebral palsy

“…The physician rating score, a clinical physical examination assessment for children with CP, was also found to have high intraobserver but poor interobserver reliability. 4 Gait temporal-spatial parameters are readily measured in clinics, and studies have identified characteristic temporal-spatial parameters associated with neuromuscular deficits in spastic CP including: impaired selective motor control, 6 spasticity, 7 and muscle stretch characteristics. 8 In the last decade, the emergence of magneto-inertial units have been developed for the step-by-step estimation of the gait temporal-spatial parameters to assess gait and are increasingly being used in the clinical setting.…”

“…The physician rating score, a clinical physical examination assessment for children with CP, was also found to have high intraobserver but poor interobserver reliability . Gait temporal‐spatial parameters are readily measured in clinics, and studies have identified characteristic temporal‐spatial parameters associated with neuromuscular deficits in spastic CP including: impaired selective motor control, spasticity, and muscle stretch characteristics …”

Walking in the Hibbot, an innovative walking aid improves gait characteristics in children with cerebral palsy: a cross-sectional study

“…(5)(6)(7)(8) A significant correlation between scores on the Selective Control Assessment of the Lower Extremities (SCALE) (9) and impaired gait has been found in children with CP. (2,9) These findings suggest that a crouch gait pattern may be related to impaired neuromuscular control and this might play a crucial role in the persistence of a flexed gait pattern.…”

“…2.5/1000. (1) The damage in the central nervous system causes muscle weakness, shortening of muscle-tendon units, muscle spasticity and impaired selective motor control (SMC) (2,3) which results in gait limitations to a varying degree, as classified by the GMFCS-level. (4) One of the major gait difficulties is crouch gait.…”

Walking in the Hibbot, an innovative walking aid improves gait characteristics in children with cerebral palsy: a cross-sectional study

“…2.5/1000. (1) The damage in the central nervous system causes muscle weakness, shortening of muscle-tendon units, muscle spasticity and impaired selective motor control (SMC) (2,3) which results in gait limitations to a varying degree, as classified by the GMFCS-level. (4) One of the major gait difficulties is crouch gait.…”