Objective Measurement of Muscle Strength In Children With Spastic Diplegia After Selective Dorsal Rhizotomy* 1 (original) (raw)
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Cocontraction during passive movements of the knee joint in children with cerebral palsy
Clinical Biomechanics, 2007
Background. Co-contraction is an impairment commonly reported in children with cerebral palsy. However, co-contraction has not been investigated during passive movements which may be used to assess spasticity in children with cerebral palsy. The purpose of this study was to examine the frequency of co-contraction and the relationship between reflex activity and co-contraction during passive movements of the knee joint in children with cerebral palsy.
Journal of Electromyography and Kinesiology, 2001
Cerebral palsy is a condition that results in varying degrees of functional deficits. The goal of this study was to develop an objective measure of muscle activity during a prescribed voluntary motor task in non-ambulatory children with spastic cerebral palsy. While performing a simultaneous hip/knee flexion task from the supine position, followed by return to the starting position, electromyographic and kinematic data were obtained from the right leg of eight children before and after selective dorsal rhizotomy and compared with eight age-matched controls. The electromyographic and kinematic data were combined to determine for each muscle of interest (tibialis anterior, soleus, vastus lateralis, biceps femoris) the percentage of the movement cycle for which the muscle was acting concentrically, eccentrically, isometrically or was considered inactive. Averaged over the four muscles, isometric activity decreased by 38% post-op and the time the muscles were inactive increased by 37% following surgery. The percentages of concentric and eccentric activity did not differ significantly between pre-and post-op conditions. Post-operatively, the percentage muscle activity patterns of the children with cerebral palsy more closely resembled that of the control children: averaged across all muscles and contraction types, the difference between the control children and the children with cerebral palsy was reduced by 50% following surgery. This measurement technique indicates promise as a method for quantifying muscle activity during voluntary motor tasks in non-ambulatory children with cerebral palsy.
A Descriptive Study of Lower Limb Torsional Kinematic Profiles in Children With Spastic Diplegia
Journal of Pediatric Orthopaedics, 2015
Sit-to-stand movement changes in preschool-aged children with spastic diplegia following one neurodevelopmental treatment sessiona pilot Yonetsu R1, Iwata A, Surya J, Unase K, Shimizu J. Purpose: This study was designed to provide a better understanding of how a single neurodevelopmental treatment (NDT) session affects sit-to-stand (STS) movements in children with cerebral palsy (CP). Methods: Eight children with spastic diplegia and five typically developing children, aged 4-6 years, participated in this study. The CP participants performed STS movements immediately before and after a 40-min NDT session. Using a threedimensional, four-camera analysis system, angular movements involving the hip, knee and ankle joints of the participants were obtained. Results: During forward tilt of the trunk, the maximum and final angles after the NDT session significantly decreased compared with those before the session (p < 0.05, p < 0.01). Moreover, the final hip flexion after the session also significantly decreased compared with that before the session (p < 0.01). On the other hand, the initial, maximum and final ankle dorsiflexion angles after the session were significantly greater (p < 0.05, p < 0.01 and p < 0.05, respectively) than before the session. Conclusions: These findings suggest that a single NDT session enables children with CP to stand from a seated position without using some atypical movement patterns. Implications for Rehabilitation Preschool-aged children with spastic diplegia, with limited ability to independently transfer from a sitting position, and dependent on a wheelchair for mobility experience obstacles to enhanced activities of daily life and social participation. A single neurodevelopmental treatment session would enable children with spastic diplegia to perform sit-to-stand movements more efficiently, with selective muscle control. Understanding how a single neurodevelopmental treatment session affects sit-to-stand movements in children with spastic diplegia is invaluable for therapists planning more efficient therapeutic programs and may enable children with spastic diplegia to develop improved mobility.
Physical & Occupational Therapy in Pediatrics, 2013
Children with cerebral palsy (CP) are likely to experience decreased participation in activities and less competence in activities of daily living. Studies of children with spastic CP have shown that strengthening programs produce positive results in strength, gait, and functional outcomes (measured by the Gross Motor Function Measure). No investigations have analyzed electromyography (EMG) activity before and after strength training to determine whether any changes occur in the GMFM. This feasibility case report quantified dorsiflexor and plantarflexor muscle activation changes during performance of 3-5 selected GMFM items following a plantarflexor strength training in two children with cerebral palsy. Increased plantarflexor strength and increased ability to selectively activate muscles were found. Little carryover to performance on GMFM items was observed. It is feasible to use EMG during performance on selected GMFM items to evaluate motor control changes following strength training in children with CP.
Fisioterapia em Movimento, 2015
Objective The aims of this study were to evaluate the reliability of three range of motion tests (Straight Leg Raise, Modified Thomas, and Duncan-Ely) using photographic measurements in children with spastic diplegic cerebral palsy (SD) and with typical development (TD). Methods A cross-sectional test-retest design was applied to compare muscle-tendon unit shortening tests between groups. Results The tests showed reliability that ranged from good to excellent (ICC > 0.8), except for the Thomas Test for the bi-articular hip flexor muscle-tendon unit of the TD group (ICC = 0.7). Differences between groups were found in all tests (p < 0.05), except when the range of motion of the bi-articular hip flexor muscles was assessed using the Thomas test (p > 0.05). Conclusion Children with SD presents a smaller range of motion than the TD group. However, the Thomas Test for the bi-articular hip flexor muscles was unable to determine differences between children with spastic diplegic c...
Pediatric Physical Therapy, 2006
ELECTIVE dorsal rhizotomy is a surgical procedure used in patients with CP that involves partial sensory deafferentation at the levels of the L-1 through S-2 nerve rootlets. The selection of rootlets for cutting is based on the lower-extremity muscular response to electrical stimulation of the rootlets. The operation is performed in children with CP to reduce spasticity and thereby improve motor function. In several of the most recent investigations in which the effectiveness of SDR was evaluated, three groups of researchers used the GMFM as the primary means of assessing outcome. The results of two of these three recent randomized trials indicated that SDR followed by intensive PT was more effective than intensive PT alone in bringing about an increase in gross motor function. According to the results of the third trial, SDR followed by intensive PT was not any more effective in improving gross motor function than intensive PT alone. 24 A metaanalysis of the combined results of the three investigations indicated that SDR followed by intensive PT was more effective in improving gross motor function than intensive PT only. 23
Measures of muscle and joint performance in the lower limb of children with cerebral palsy
Developmental Medicine and Child Neurology, 2003
The aim of this study was to determine the reliability and magnitude of error of three lower-limb clinical measures for children with cerebral palsy (CP): the Modified Ashworth Scale of Spasticity (MAS), passive range of movement (PROM) and the modified Tardieu scale (MTS). Six physiotherapists measured 11 females and seven males (mean age 6 years 4 months, SD 2 years 4 months; age range 2 years 4 months to 10 years) on two occasions using a repeated measures design, collecting all data over 6 days. The severity of CP spanned all five levels of the Gross Motor Function Classification System and all children demonstrated varying degrees of spasticity. Exclusion criteria included botulinum toxin injections, inhibitory plasters, and orthopaedic surgery within the 6 months before study entry. For PROM and the MTS interrater reliability was acceptable with an intraclass correlation coefficient of 0.7, but results for MAS were lower. Standard error of measurement for repeated measures of PROM and MTS was about five degrees, but 95% confidence interval ranges were considerably higher. Test-retest results varied widely, particularly for the MAS. These measurement tools should be used with caution when evaluating changes in young children with CP.