Abstract
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° 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 (ρ=.582, P<0.001) and a longer maximum length of the rectus femoris (ρ=.491, P=.003). In contrast, attaining earlier timing of PKF during swing correlated with
a higher knee flexion velocity at toe-off (ρ=−.576, P<.001), a longer maximum length of the gastrocnemius (ρ=−.355, P=.039), and a greater peak knee extension during single-limb support phase (ρ=−.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.
Keywords
List of abbreviations:
CP (cerebral palsy), PKF (peak knee flexion), SCALE (Selective Control Assessment of the Lower Extremity), SLS (single-limb support)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 30, 2014
Footnotes
Supported by the National Science Foundation Graduate Research Fellowship (grant no. DGE-1147470).
Disclosures: none.
Identification
Copyright
© 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
