Article

OBJECTIVE: To identify biomechanical and clinical parameters that influence knee
flexion (KF) angle at initial contact (IC) and during single limb stance phase of
gait in children with spastic cerebral palsy (CP) who walk with flexed-knee gait.
DESIGN: Retrospective analysis of gait kinematics and clinical data collected
from 2010-2013. SETTING: Motion & Gait Analysis Laboratory at Lucile Packard
Children's Hospital, Stanford, CA. PARTICIPANTS: Gait analysis data from persons
with spastic CP (Gross Motor Function Classification System [GMFCS] I-III) who
had no prior surgery were analyzed. Participants exhibiting KF >/=20 degrees at
IC were included; the more-involved limb was analyzed. METHODS: Outcome measures
were analyzed with respect to clinical findings, including passive range of
motion, Selective Motor Control Assessment for the Lower Extremity (SCALE), gait
kinematics, and musculoskeletal models of muscle-tendon lengths during gait. MAIN
OUTCOME MEASURES: KF at IC (KFIC) and minimum KF during single-limb support
(KFSLS) were investigated. RESULTS: Thirty-four participants met the inclusion
criteria, and their data were analyzed (20 males and 14 females, mean age 10.1
years, range 5-20 years). Mean KFIC was 34.4 +/- 8.4 degrees and correlated with
lower SCALE score (rho = -0.530, P = .004), later peak KF during swing (rho =
0.614, P < .001), and shorter maximal muscle length of the semimembranosus (rho =
-0.359, P = .037). Mean KFSLS was 18.7 +/- 14.9 and correlated to KF contracture
(rho = 0.605, P < .001) and shorter maximal muscle length of the semimembranosus
(rho = -0.572, P < .001) and medial gastrocnemius (rho = -0.386, P = .024). GMFCS
correlated more strongly to KFIC (rho = 0.502, P = .002) than to KFSLS (rho =
0.371, P = .031). Linear regression found that both the SCALE score (P = .001)
and delayed timing of peak KF during swing (P = .001) independently predicted
KFIC. KF contracture (P = .026) and maximal length of the semimembranosus (P =
.043) independently predicted KFSLS. CONCLUSION: Correlates of KFIC differed from
those for KFSLS and suggest that impaired selective motor control and later
timing of swing-phase KF influence knee position at IC, whereas KF contracture
and muscle lengths influence minimal KF in single-limb support, findings with
important treatment implications.
CI - Copyright (c) 2016 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS