- •Synergies were associated with posttreatment gait outcomes.
- •This association was independent of treatment group at both centers.
- •Less impaired motor control was associated with faster walking posttreatment.
- •Less impaired motor control was associated with greater improvements in kinematics.
- •Associations were similar across 2 commonly used clinical muscle sets.
To determine whether patient-specific differences in motor control quantified using muscle synergy analysis were associated with changes in gait after treatment of cerebral palsy (CP) across 2 clinical centers with different treatments and clinical protocols.
Retrospective cohort study.
Clinical medical center.
Center 1: children with CP (n=473) and typically developing (TD) children (n=84). Center 2: children with CP (n=163) and TD children (n=12).
Standard clinical care at each center.
Main Outcome Measures
The Dynamic Motor Control Index During Walking (walk-DMC) was computed from electromyographic data during gait using muscle synergy analysis. Regression analysis was used to evaluate whether pretreatment walking speed or kinematics, muscle synergies, treatment group, prior treatment, or age were associated with posttreatment changes in gait at both clinical centers.
Walk-DMC was significantly associated with changes in speed and kinematics after treatment with similar regression models at both centers. Children with less impaired motor control were more likely to have improvements in walking speed and gait kinematics after treatment, independent of treatment group.
Dynamic motor control evaluated with synergy analysis was associated with changes in gait after treatment at both centers, despite differences in treatments and clinical protocols. This study further supports the finding that walk-DMC provides additional information, not captured in traditional gait analysis, that may be useful for treatment planning.
List of abbreviations:BTA (botulinum toxin type A), CP (cerebral palsy), GDI (Gait Deviation Index), SDR (selective dorsal rhizotomy), SEMLS (single-event multilevel orthopedic surgery), TD (typically developing), tVAF (total variance accounted for), walk-DMC (Dynamic Motor Control Index During Walking)
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Published online: April 10, 2018
Supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health (award no. R01NS091056), and by graduate student funding from the Washington Research Foundation Funds for Innovation in Neuroengineering.
© 2018 by the American Congress of Rehabilitation Medicine