Selective motor control correlates with gait abnormality in children with cerebral palsy

Chruscikowski, Emily; Fry, Nicola; Noble, Jonathan J; Gough, Martin; Shortland, Adam P

doi:10.1016/j.gaitpost.2016.11.031

Cited by 45 publications

(35 citation statements)

References 16 publications

(20 reference statements)

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“…On the other hand, reduced motor selectivity might also impact on UL movement pathology in children with uCP. The importance of selective motor control for gait performance was recently reported [24], though this area remains unexplored for the UL. Future studies incorporating the assessment of selective motor control, as measured with e.g.…”

Section: Discussionmentioning

confidence: 99%

Clinical assessment and three-dimensional movement analysis: An integrated approach for upper limb evaluation in children with unilateral cerebral palsy

et al. 2017

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IntroductionThe clinical application of upper limb (UL) three-dimensional movement analysis (3DMA) in children with unilateral cerebral palsy (uCP) remains challenging, despite its benefits compared to conventional clinical scales. Moreover, knowledge on UL movement pathology and how this relates to clinical parameters remains scarce. Therefore, we investigated UL kinematics across different manual ability classification system (MACS) levels and explored the relation between clinical and kinematic parameters in children with uCP.Patients and methodsFifty children (MACS: I = 15, II = 26, III = 9) underwent an UL evaluation of sensorimotor impairments (grip force, muscle strength, muscle tone, two-point discrimination, stereognosis), bimanual performance (Assisting Hand Assessment, AHA), unimanual capacity (Melbourne Assessment 2, MA2) and UL-3DMA during hand-to-head, hand-to-mouth and reach-to-grasp tasks. Global parameters (Arm Profile Score (APS), duration, (timing of) maximum velocity, trajectory straightness) and joint specific parameters (angles at task endpoint, ROM and Arm Variable Scores (AVS)) were extracted. The APS and AVS refer respectively to the total amount of movement pathology and movement deviations of wrist, elbow, shoulder, scapula and trunk.ResultsLonger movement durations and increased APS were found with higher MACS-levels (p<0.001). Increased APS was also associated with more severe sensorimotor impairments (r = -0.30-(-0.73)) and with lower AHA and MA2-scores (r = -0.50-(-0.86)). For the joint specific parameters, stronger movement deviations distally were significantly associated with increased muscle weakness (r = -0.32-(-0.74)) and muscle tone (r = 0.33-(-0.61)); proximal movement deviations correlated only with muscle weakness (r = -0.35–0.59). Regression analysis exposed grip force as the most important predictor for the variability in APS (p<0.002).ConclusionWe found increased movement pathology with increasing MACS-levels and demonstrated the adverse impact of especially muscle weakness. The lower correlations suggest that 3DMA provides additional information regarding UL motor function, particularly for the proximal joints. Integrating both methods seems clinically meaningful to obtain a comprehensive representation of all aspects of a child’s UL functioning.

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Section: Discussionmentioning

confidence: 99%

Clinical assessment and three-dimensional movement analysis: An integrated approach for upper limb evaluation in children with unilateral cerebral palsy

et al. 2017

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“…In addition, a slow transition from hip and knee extension in terminal stance to hip and knee flexion in initial swing leads reduced foot clearance in swing due to reduced hip and knee flexion. Chruscikowski et al (2017) studied 194 patients with bilateral CP and found a significant, negative correlation between SMC measured using SCALE and gait impairment, as measured by Gait Profile Score, suggesting that impaired SMC negatively affects gait function.…”

Section: Influence Of Neuromuscular Deficits On Gait In Cerebral Palsmentioning

confidence: 99%

Neurologic Correlates of Gait Abnormalities in Cerebral Palsy: Implications for Treatment

Zhou

Butler

Rose

2017

Front. Hum. Neurosci.

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Cerebral palsy (CP) is the most common movement disorder in children. A diagnosis of CP is often made based on abnormal muscle tone or posture, a delay in reaching motor milestones, or the presence of gait abnormalities in young children. Neuroimaging of high-risk neonates and of children diagnosed with CP have identified patterns of neurologic injury associated with CP, however, the neural underpinnings of common gait abnormalities remain largely uncharacterized. Here, we review the nature of the brain injury in CP, as well as the neuromuscular deficits and subsequent gait abnormalities common among children with CP. We first discuss brain injury in terms of mechanism, pattern, and time of injury during the prenatal, perinatal, or postnatal period in preterm and term-born children. Second, we outline neuromuscular deficits of CP with a focus on spastic CP, characterized by muscle weakness, shortened muscle-tendon unit, spasticity, and impaired selective motor control, on both a microscopic and functional level. Third, we examine the influence of neuromuscular deficits on gait abnormalities in CP, while considering emerging information on neural correlates of gait abnormalities and the implications for strategic treatment. This review of the neural basis of gait abnormalities in CP discusses what is known about links between the location and extent of brain injury and the type and severity of CP, in relation to the associated neuromuscular deficits, and subsequent gait abnormalities. Targeted treatment opportunities are identified that may improve functional outcomes for children with CP. By providing this context on the neural basis of gait abnormalities in CP, we hope to highlight areas of further research that can reduce the long-term, debilitating effects of CP.

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“…As the lower extremities and the trunk are involved during walking, knowledge about their individual and combined impact on gait is essential for developing optimal gait-trainingstrategies [3]. Studies exploring the impact of different lower extremity impairments such as spasticity, contractures, muscle weakness, selective voluntary motor control (SVMC)) on functional ambulation and gross motor function in children with CP found that a lack of muscle strength and SVMC were the strongest predictors [4][5][6][7][8][9][10][11]. Spasticity and a decreased range of motion (contractures) of the lower extremities were found to have smaller effect on gait [5,8,10].…”

Section: Main Text Introductionmentioning

confidence: 99%

Influence of trunk control and lower extremity impairments on gait capacity in children with cerebral palsy

Balzer

Marsico

Mitteregger

et al. 2017

Disability and Rehabilitation

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The interconnection between trunk control, leg muscle strength and selectivity for gait capacity in children with CP was shown. It indicates the significance of these impairments in gait assessment and, potentially, rehabilitation. Implications for Rehabilitation Trunk control was the strongest predictor for gait capacity in a regression model with lower extremity spasticity, muscle strength and selectivity and age as independent variables. Lower extremity muscle strength, selectivity, and trunk control explained a similar amount of gait capacity variance which is higher than that explained by lower extremity spasticity. Lower extremity muscle strength and selectivity correlated strongly with trunk control. Therefore, we cautiously suggest that a combined trunk control and lower extremity training might be promising for improving gait capacity in children with CP (Gross Motor Function Classification System level I-III), which needed to be tested in future intervention-studies.

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Selective motor control correlates with gait abnormality in children with cerebral palsy

Cited by 45 publications

References 16 publications

Clinical assessment and three-dimensional movement analysis: An integrated approach for upper limb evaluation in children with unilateral cerebral palsy

Clinical assessment and three-dimensional movement analysis: An integrated approach for upper limb evaluation in children with unilateral cerebral palsy

Neurologic Correlates of Gait Abnormalities in Cerebral Palsy: Implications for Treatment

Influence of trunk control and lower extremity impairments on gait capacity in children with cerebral palsy

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