Article

We compared the outcomes of manual and motorized instrumented ankle
spasticity assessments in children with cerebral palsy (CP). METHOD: Ten children
with spastic CP (three males, seven females; mean age 11y [standard deviation
3y], range 6-14y ; Gross Motor Function Classification System levels I-III) were
included. During motorized assessments, fast (100 degrees /s) rotations were
imposed around the ankle joint by a motor-driven footplate; during manual
assessments, rotations of comparable speed were applied by a therapist using a
foot orthotic. Angular range of motion, maximum velocity, acceleration, work, and
muscle activity (electromyography [EMG]) of the triceps surae and tibialis
anterior were compared during passive muscle stretch between motorized and manual
assessments. Both movement profiles were also compared to CP gait ankle movement
profile. RESULTS: The imposed movement profile differed between methods, with the
motorized assessment reaching higher maximum acceleration. Despite equal maximum
velocity, the triceps surae were more often activated in motorized assessments,
with low agreement of 44% to 72% (kappa</=0) for EMG onset occurrence between
methods. The manually applied ankle velocity profile matched more closely with the gait profile. INTERPRETATION: The differences in acceleration possibly
account for the different muscle responses, which may suggest acceleration,
rather than velocity-dependency of the stretch reflex.
Future prototypes of
instrumented spasticity assessments should standardize movement profiles,
preferably by developing profiles that mimic functional tasks such as walking.
CI - (c) 2016 The Authors. Developmental Medicine & Child Neurology published by John
Wiley & Sons Ltd on behalf of Mac Keith Press.

Langue : ANGLAIS