Spasticity and `Spastic' Gait in Children with Cerebral palsy

Crenna, P.

doi:10.1016/s0149-7634(97)00046-8

Cited by 162 publications

(114 citation statements)

References 47 publications

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“…Failure to extend the knee in swing is problematic, often resulting in a "crouched" posture at initial contact and an abnormally short stride. Tight hamstrings, resulting from an exaggerated reflex response or from excessive passive forces, are thought to cause the diminished knee extension in most cases (e.g., Baumann et al, 1980;Crenna, 1998;Sutherland and Davids, 1993;Tuzson et al, 2003). Thus, children with a crouched gait often undergo hamstrings lengthening surgery.…”

Section: Introductionmentioning

confidence: 99%

Muscular coordination of knee motion during the terminal-swing phase of normal gait

Arnold

Thelen

Schwartz

et al. 2007

Journal of Biomechanics

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Children with cerebral palsy often walk with diminished knee extension during the terminal swing phase, resulting in a troublesome "crouched" posture at initial contact and a shortened stride. Treatment of this gait abnormality is challenging because the factors that extend the knee during normal walking are not well understood, and because the potential of individual muscles to limit terminal-swing knee extension is unknown. This study analyzed a series of three-dimensional, muscle-driven dynamic simulations to quantify the angular accelerations of the knee induced by muscles and other factors during swing. Simulations were generated that reproduced the measured gait dynamics and muscle excitation patterns of six typically-developing children walking at self-10 selected speeds. The knee was accelerated toward extension in the simulations by velocity-related forces (i.e., Coriolis and centrifugal forces) and by a number of muscles, notably the vasti in mid-12 swing (passive), the hip extensors in terminal swing, and the stance-limb hip abductors, which accelerated the pelvis upward. Knee extension was slowed in terminal swing by the stance-limb hip flexors, which accelerated the pelvis backward. The hamstrings decelerated the forward motion of the swing-limb shank, but did not contribute substantially to angular motions of the knee. Based on these data, we hypothesize that the diminished knee extension in terminal swing exhibited by children with cerebral palsy may, in part, be caused by weak hip extensors or by impaired hip muscles on the stance limb that result in abnormal accelerations of the pelvis.

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Section: Introductionmentioning

confidence: 99%

Muscular coordination of knee motion during the terminal-swing phase of normal gait

Arnold

Thelen

Schwartz

et al. 2007

Journal of Biomechanics

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“…There is, however, no direct evidence that this is the case. Crenna (1998) found abnormal EMG activity when muscles were lengthened during gait in children with CP and argued that this reflected increased stretch reflex activity. However, as the author also discussed, it is not possible to dissociate descending motor commands and sensory feedback mechanisms when measuring overall EMG activity.…”

mentioning

confidence: 99%

Sensory feedback to ankle plantar flexors is not exaggerated during gait in spastic hemiplegic children with cerebral palsy

Willerslev-Olsen

Andersen

Sinkjær

et al. 2014

Journal of Neurophysiology

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Willerslev-Olsen M, Andersen JB, Sinkjaer T, Nielsen JB. Sensory feedback to ankle plantar flexors is not exaggerated during gait in spastic hemiplegic children with cerebral palsy. J Neurophysiol 111: 746 -754, 2014. First published November 13, 2013 doi:10.1152/jn.00372.2013.-It is still widely believed that exaggerated stretch reflexes and increased muscle tone in ankle plantar flexors contribute to reduced ankle joint movement during gait in children with cerebral palsy (CP). However, no study has directly measured stretch reflex activity during gait in these children. We investigated sensory feedback mechanisms during walking in 20 CP children and 41 control children. Stretch responses in plantar flexor muscles evoked in stance showed an age-related decline in control but not CP children. In swing the responses were abolished in control children, but significant responses were observed in 14 CP children. This was related to reduced activation of dorsiflexors in swing. Removal of sensory feedback in stance produced a drop in soleus activity of a similar size in control and CP children. Soleus activity was observed in swing to the same extent in control and CP children. Removal of sensory feedback in swing caused a larger drop in soleus activity in control children than in CP children. The lack of age-related decline in stretch reflexes and the inability to suppress reflexes in swing is likely related to lack of maturation of corticospinal control in CP children. Since soleus activity was not seen more frequently than in control children in swing and since sensory feedback did not contribute more to their soleus activity, spasticity is unlikely to contribute to foot drop and toe walking. We propose that altered central drive to the ankle muscles and increased passive muscle stiffness are the main causes of foot drop and toe walking. age-dependent changes; stretch reflex; biomechanical evaluation; cerebral palsy; electrophysiology; spasticity THE MAJORITY OF CHILDREN with cerebral palsy (CP) have gait problems, which impact their quality of life (af Klint et al.

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“…, 7), lateral tibial plate (9, 10), external malleolus (11,12), and fifth metatarsus joint (13,14). The two last markers were placed on the top of the head (1) and on the sacrum (8).…”

Section: Locomotor Parametersmentioning

confidence: 99%

“…Many developmental studies have addressed this problem studying balance control during various natural locomotor activities [1][2][3][4][5][6] or treadmill locomotion 7 in healthy children or using classic motor disorder models, such as cerebral palsy. [8][9][10][11] Maintaining balance during locomotion is a complex task because it involves achieving a compromise between the forward propulsion of the body, which involves horizontal as well as vertical highly destabilizing forces and the need to maintain lateral stability of the body. 12 With autonomous bipedal walking, new problems of balance arise for the young child.…”

Section: Introductionmentioning

confidence: 99%

Locomotor skills and balance strategies in children with internal rotations of the lower limbs

Mallau

Mesure

Viehweger

et al. 2007

Journal Orthopaedic Research

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The purpose of this study was to investigate the functional effects of a structural deformation, internal rotations (IR) of the lower limbs, on upper body balance strategies used during locomotion in 5-6 year-old and 7-10 year-old children. Balance control was examined in terms of rotation around the longitudinal axis in horizontal plane (yaw) and around the sagittal axis in a frontal plane (roll). Kinematics of foot, pelvis, shoulder, and head rotations were measured with an automatic optical TV image processor and used to calculate angular dispersions and segmental stabilizations. Older children with IR showed a lower gait velocity, particularly in difficult balance conditions than typically developing (TD) children. In younger children, the effect of the local biomechanical deficit remained limited to the lower limbs and did not affect upper body coordination. By contrast, in older children with IR, the development of head stabilization in space was affected. This was demonstrated by an ''en bloc'' instead of an articulated mode of head-trunk unit systematically adopted by the control group. As pelvic stabilization remains the main reference frame to organize balance control in older children with IR, we conclude that the structural deformity of the legs affect and possibly delay the acquisition of the head stabilization in space strategy. ß

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Spasticity and `Spastic' Gait in Children with Cerebral palsy

Cited by 162 publications

References 47 publications

Muscular coordination of knee motion during the terminal-swing phase of normal gait

Muscular coordination of knee motion during the terminal-swing phase of normal gait

Sensory feedback to ankle plantar flexors is not exaggerated during gait in spastic hemiplegic children with cerebral palsy

Locomotor skills and balance strategies in children with internal rotations of the lower limbs

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