Plantar flexor muscle weakness may cause stiff-knee gait

Apti, Adnan; Akalan, N.E.; Kuchimov, Shavkat; Özdinçler, Arzu Razak; Temelli, Yener; Nene, A.V.

doi:10.1016/j.gaitpost.2016.03.010

Cited by 21 publications

(6 citation statements)

References 23 publications

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“…Further, dorsiflexion angle in swing in CP was not significantly different from the TD children. Stronger plantar flexors are known to promote a better push off and subsequently a fluent knee flexion motion during swing [ 42 , 43 ]. The children with CP had indeed a lower maximal plantar flexion torque and ankle power generation during push-off, but this was not associated to weakness in the plantar flexors nor to reduced plantar flexor RFD.…”

Section: Discussionmentioning

confidence: 99%

A new strength assessment to evaluate the association between muscle weakness and gait pathology in children with cerebral palsy

et al. 2018

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AimThe main goal of this validation study was to evaluate whether lower limb muscle weakness and plantar flexor rate of force development (RFD) related to altered gait parameters in children with cerebral palsy (CP), when weakness was assessed with maximal voluntary isometric contractions (MVICs) in a gait related test position. As a subgoal, we analyzed intra- and intertester reliability of this new strength measurement method.MethodsPart 1 –Intra- and intertester reliability were determined with the intra-class correlation coefficient (ICC2,1) in 10 typical developing (TD) children (age: 5–15). We collected MVICs in four lower limb muscle groups to define maximum joint torques, as well as plantar flexor RFD.Part 2 –Validity of the strength assessment was explored by analyzing the relations of lower limb joint torques and RFD to a series of kinematic- and kinetic gait features, the GDI (gait deviation index), and the GDI-kinetic in 23 children with CP (GMFCS I-II; age: 5–15) and 23 TD children (age: 5–15) with Spearman’s rank correlation coefficients.ResultsPart 1 –The best reliability was found for the torque data (Nm), with the highest ICC2,1 (0.951) for knee extension strength (inter) and the lowest (0.693) for dorsiflexion strength (intra). For plantar flexor RFD, the most reliable window size was 300 milliseconds (ICC2,1: 0.828 (inter) and 0.692 (intra)).Part 2 –The children with CP were significantly weaker than the TD children (p <0.001). Weakness of the dorsiflexors and plantar flexors associated with delayed and decreased knee flexion angle during swing, respectively. No other significant correlations were found.ConclusionWhile our new strength assessment was reliable, intra-joint correlations between weakness, RFD, and gait deviations were low. However, we found inter-joint associations, reflected by a strong association between plantar- and dorsiflexor weakness, and decreased and delayed knee flexion angle during swing.

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Section: Discussionmentioning

confidence: 99%

A new strength assessment to evaluate the association between muscle weakness and gait pathology in children with cerebral palsy

et al. 2018

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“…Lack of eccentric contraction of ankle plantar flexor causes ground reaction force vector (GRFV) to pass behind the knee, thus creating a knee flexion moment with excess tibial motion over talus during mid to late stance. To prevent knee buckling, increased quadriceps contraction is needed, which may lead to stiff-knee gait [6] and reduced gait speed [7]. Excessive dorsiflexion allows the load to transfer through the heel, causing calcaneal gait pattern, which is one of the hallmarks of CES [8].…”

Section: Introductionmentioning

confidence: 99%

Heel lift improves walking ability of persons with traumatic cauda equina syndrome—a pilot experimental study

Kurien

Senthilvelkumar

George

et al. 2020

Spinal Cord Ser Cases

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“…In healthy subjects and children with cerebral palsy, relationships between knee flexion angle during Sw and knee flexion velocity at toe-off has been reported [22,27,28]. Similarly, in stroke patients, knee flexion angle during Sw was shown to be associated with knee flexion velocity at toe-off and ankle plantarflexor moment [21,29]. In addition, sufficient leg extension angle during late stance would be expected to allow hip flexion using elastic energy accumulated by extended hip flexors and the joint capsule.…”

Section: Discussionmentioning

confidence: 95%

“…Therefore, knee flexion angle during Sw would be a critical indicator of kinematics in post-stroke gait. Factors reported to result in a decrease in knee flexion angle during Sw include the large breaking forces during late stance [19], the excessive activity of the rectus femoris during late stance [20], the lack of push-off power at the ankle [21], and the insufficient hip pull-off during Sw [22]. Consequently, reduced knee flexion during Sw is affected by the gait kinematics during late stance.…”

Section: Introductionmentioning

confidence: 99%

Effect of Leg Extension Angle on Knee Flexion Angle during Swing Phase in Post-Stroke Gait

et al. 2021

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Background and Objectives: Leg extension angle is important for increasing the propulsion force during gait and is a meaningful indicator for evaluating gait quality in stroke patients. Although leg extension angle during late stance might potentially also affect lower limb kinematics during the swing phase, the relationship between these two remains unclear. This study aimed to investigate the relationship between leg extension angle and knee flexion angle during pre-swing and swing phase in post-stroke gait. Materials and Methods: Twenty-nine stroke patients walked along a 16 m walkway at a self-selected speed. Tilt angles and acceleration of pelvis and paretic lower limb segments were measured using inertial measurement units. Leg extension angle, consisting of a line connecting the hip joint with the ankle joint, hip and knee angles, and increments of velocity during pre-swing and swing phase were calculated. Correlation analysis was conducted to examine the relationships between these parameters. Partial correlation analysis adjusted by the Fugl-Meyer assessment-lower limb (FMA-LL) was also performed. Results: On the paretic side, leg extension angle was positively correlated with knee flexion angle during the swing phase (r = 0.721, p < 0.001) and knee flexion angle and increments of velocity during the pre-swing phase (r = 0.740–0.846, p < 0.001). Partial correlation analysis adjusted by the FMA-LL showed significant correlation between leg extension angle and knee flexion angle during the swing phase (r = 0.602, p = 0.001) and knee flexion angle and increments of velocity during the pre-swing phase (r = 0.655–0.886, p < 0.001). Conclusions: Leg extension angle affected kinematics during the swing phase in post-stroke gait regardless of the severity of paralysis, and was similar during the pre-swing phase. These results would guide the development of effective gait training programs that enable a safe and efficient gait for stroke patients.

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Plantar flexor muscle weakness may cause stiff-knee gait

Cited by 21 publications

References 23 publications

A new strength assessment to evaluate the association between muscle weakness and gait pathology in children with cerebral palsy

A new strength assessment to evaluate the association between muscle weakness and gait pathology in children with cerebral palsy

Heel lift improves walking ability of persons with traumatic cauda equina syndrome—a pilot experimental study

Effect of Leg Extension Angle on Knee Flexion Angle during Swing Phase in Post-Stroke Gait

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