Article

OBJECTIVE: To identify clinical and biomechanical parameters that influence
swing-phase knee flexion and contribute to stiff-knee gait in individuals with
spastic cerebral palsy (CP) and flexed-knee gait. DESIGN: Retrospective analysis
of clinical data and gait kinematics collected from 2010 to 2013. SETTING: Motion
and gait analysis laboratory at a children's hospital. PARTICIPANTS: Individuals
with spastic CP (N=34; 20 boys, 14 girls; mean age +/- SD, 10.1+/-4.1y [range,
5-20y]; Gross Motor Function Classification System I-III) who walked with
flexed-knee gait >/=20 degrees at initial contact and had no prior surgery were
included; the more-involved limb was analyzed. INTERVENTION: Not applicable. MAIN
OUTCOME MEASURES: The magnitude and timing of peak knee flexion (PKF) during
swing were analyzed with respect to clinical data, including passive range of
motion and Selective Control Assessment of the Lower Extremity, and biomechanical
data, including joint kinematics and hamstring, rectus femoris, and gastrocnemius
muscle-tendon length during gait. RESULTS: Data from participants demonstrated
that achieving a higher magnitude of PKF during swing correlated with a higher
maximum knee flexion velocity in swing (rho=.582, P<0.001) and a longer maximum
length of the rectus femoris (rho=.491, P=.003). In contrast, attaining earlier
timing of PKF during swing correlated with a higher knee flexion velocity at
toe-off (rho=-.576, P<.001), a longer maximum length of the gastrocnemius
(rho=-.355, P=.039), and a greater peak knee extension during single-limb support
phase (rho=-.354, P=.040). CONCLUSIONS: Results indicate that the magnitude and
timing of PKF during swing were independent, and their biomechanical correlates
differed, suggesting important treatment implications for both stiff-knee and
flexed-knee gait.
CI - Copyright (c) 2015 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS