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Query: UMLS:C0026838 (spasticity)
 6,471 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study investigated the effects of spasticity in the hamstrings and quadriceps muscles on gait parameters including temporal spatial measures, knee position, excursion and angular velocity in 25 children with spastic diplegic cerebral palsy (CP) as compared to 17 age-matched peers. While subjects were instructed to relax, an isokinetic device alternately flexed and extended the left knee at one of the three constant velocities 30 degrees/s, 60 degrees/s and 120 degrees/s, while surface electromyography (EMG) electrodes over the biceps femoris and the rectus femoris recorded muscle activity. Patients then participated in 3D gait analysis at a self-selected speed. Results showed that, those with CP who exhibited heightened stretch responses (spasticity) in both muscles, had significantly slower knee angular velocities during the swing phase of gait as compared to those with and without CP who did not exhibit stretch responses at the joint and the tested speeds. The measured amount (torque) of the resistance to passive flexion or extension was not related to gait parameters in subjects with CP; however, the rate of change in resistance torque per unit angle change (stiffness) at the fastest test speed of 120 degrees/s showed weak to moderate relationships with knee angular velocity and motion during gait. For the subset of seven patients with CP who subsequently underwent a selective dorsal rhizotomy, knee angular extension and flexion velocity increased post-operatively, suggesting some degree of causality between spasticity and movement speed.
Gait Posture 2006 Jan
PMID:Relationship of spasticity to knee angular velocity and motion during gait in cerebral palsy. 1631 Nov 88

Inappropriate activity of M. rectus femoris (RF) during swing is believed to contribute to stiff knee gait in cerebral palsy. This study used musculoskeletal modeling techniques to analyze rectus femoris musculo-tendon (MT) length and lengthening velocity during stiff knee gait in 35 children with diplegic cerebral palsy (CP). Duncan Ely test scores were used to categorize the patients into four groups with increasing levels of rectus femoris spasticity. Knee kinematics confirmed a significant reduction and delay of maximal peak knee flexion during swing in the patient groups compared to reference values. Maximal musculo-tendon length of M. rectus femoris was reduced and occurred prematurely in swing. Musculo-tendon lengthening velocity was significantly reduced and the timing of the maximal lengthening velocity was shifted into stance phase. The present study demonstrates altered dynamic behavior of the M. rectus femoris in stiff knee gait and the results indicate that maximal knee flexion in swing was not a valid reference for the MT length of the M. rectus femoris. Furthermore, in the patient group maximal musculo-tendon lengthening velocity of the muscle related to the stance phase rather than the stance-swing transition.
Gait Posture 2006 Feb
PMID:Musculo-tendon length and lengthening velocity of rectus femoris in stiff knee gait. 1639 19

Toe-walking is one of the most prevalent gait deviations and has been linked to many diseases. Three major ankle kinematic patterns have been identified in toe-walkers, but the relationships between the causes of toe-walking and these patterns remain unknown. This study aims to identify these relationships. Clearly, such knowledge would increase our understanding of this gait deviation, and could help clinicians plan treatment. The large quantity of data provided by gait analysis often makes interpretation a difficult task. Artificial intelligence techniques were used in this study to facilitate interpretation as well as to decrease subjective interpretation. Of the 716 limbs evaluated, 240 showed signs of toe-walking and met inclusion criteria. The ankle kinematic pattern of the evaluated limbs during gait was assigned to one of three toe-walking pattern groups to build the training data set. Toe-walker clinical measurements (range of movement, muscle spasticity and muscle strength) were coded in fuzzy modalities, and fuzzy decision trees were induced to create intelligible rules allowing toe-walkers to be assigned to one of the three groups. A stratified 10-fold cross validation situated the classification accuracy at 81%. Twelve rules depicting the causes of toe-walking were selected, discussed and characterized using kinematic, kinetic and EMG charts. This study proposes an original approach to linking the possible causes of toe-walking with gait patterns.
Gait Posture 2007 Mar
PMID:Linking clinical measurements and kinematic gait patterns of toe-walking using fuzzy decision trees. 1683 98

This prospective study compared the test-retest reliability of thirteen variables calculated from the pendulum test in able-bodied children to those of children diagnosed with cerebral palsy. Ten healthy children and 10 children with a primary diagnosis of cerebral palsy (CP) (mean age 13 years) participated in the study. Data were collected using a three-dimensional motion analysis system on two separate occasions 73+/-28 days apart. The between day reliability ICC scores of all variables were moderate to very high (0.60-0.98) for children with CP and high to very high (0.71-0.98) for able-bodied children. The children with CP demonstrated slower maximum angular velocity compared to the able-bodied children (202 degrees /s versus 293 degrees /s, p<0.01). The time to maximum angular velocity occurred sooner for children with CP compared to able-bodied children (0.22s versus 0.34s, p<0.001). For some children with CP, the knee motions demonstrated were not oscillations of decreasing magnitude. Therefore the integrals of knee motion in each plane were calculated. For both groups of subjects the largest integrals of motion were in the sagittal plane (knee flexion/extension). The able-bodied subject's integrals were twice as large compared to subjects diagnosed with CP (p<0.01). High test-retest reliability of the variables suggests that the pendulum test provides an objective and reliable method to assess quadriceps spasticity in children with cerebral palsy.
Gait Posture 2007 Jun
PMID:Reliability of the three-dimensional pendulum test for able-bodied children and children diagnosed with cerebral palsy. 1696 81

The purpose of this study was to explore how origin-insertion length and lengthening velocity of hamstring and psoas muscle change as a result of crouch gait. The second purpose was to study the effect of changes in walking speed, in crouch, on muscle lengths and velocities. Eight healthy female subjects walked on a treadmill both normally and in crouch. In the crouch condition, subjects walked at three different walking speeds. 3D kinematic data were collected and muscle lengths and velocities were calculated using musculoskeletal modeling. It was found that voluntary walking in crouch resulted in shorter psoas length compared to normal, but not in shorter hamstrings length. Moreover, crouch gait did not result in slower muscle lengthening velocities compared to normal gait. These results do not support the role of hamstrings shortness or spasticity in causing crouch gait. Decreasing walking speed clearly reduced muscle lengths and lengthening velocities. Therefore, patients with short or spastic muscles are more likely to respond by walking slower than by walking in crouch. Also, differences in walking speed should be avoided as a confounding factor when comparing patient groups with controls.
Gait Posture 2007 Oct
PMID:Muscle length and lengthening velocity in voluntary crouch gait. 1720

This prospective study analyzes the upper extremity kinematics of 10 children with spastic diplegic cerebral palsy using anterior and posterior walkers. Although both types of walkers are commonly prescribed by clinicians, no quantitative data comparing the two in regards to upper extremity motion has been published. The study methodology included testing of each subject with both types of walkers in a motion analysis laboratory after an acclimation period of at least 1 month. Overall results showed that statistically, both walkers are relatively similar. With both anterior and posterior walkers, the shoulders were extended, elbows flexed, and wrists extended. Energy expenditure, walking speed and stride length was also similar with both walker types. Several differences were also noted although not statistically significant. Anterior torso tilt was reduced with the posterior walker and shoulder extension and elbow flexion were increased. Outcomes analysis indicated that differences in upper extremity torso and joint motion were not dependent on spasticity or hand dominance. These findings may help to build an understanding of upper extremity motion in walker-assisted gait and potentially to improve walker prescription.
Gait Posture 2008 Oct
PMID:Comparison of upper extremity kinematics in children with spastic diplegic cerebral palsy using anterior and posterior walkers. 1840 38

Stiff knee gait (SKG) is common in hemiplegic patients. The main focus of treatment is rectus femoris (RF) spasticity. The aims of this study were to evaluate the effect of botulinum toxin injection (BTI) in the RF muscle on peak knee flexion during swing phase and its quantitative and functional impact on gait. We also wished to evaluate the correlation between the effects of nerve block and BTI on peak knee flexion. 10 adult hemiplegic subjects (>6 months post stroke or traumatic brain injury) with SKG and inappropriate RF EMG activity during mid-swing phase were included. 3D gait analysis, clinical and functional assessments (Timed Up and Go test, 10 m walk test, 6 min walk test and the time taken to ascend and descend a flight of stairs) were performed initially, 30 min after anaesthetic block of the RF nerve and one month post BTI. After BTI, there was a significant increase in knee flexion (8 degrees average) and a tendency towards improvement in gait and functional parameters. The effect of the nerve block on peak knee flexion was significantly correlated with the effect of BTI (11 degrees average increase in peak knee flexion after nerve block). We challenge the relevance of RF nerve blocks in this population when EMG and kinematic data are available. Our results indicate that BTI is an effective treatment for SKG in adult hemiplegic subjects, with a significant increase in peak knee flexion, no reduction in hip flexion and a tendency towards functional improvements.
Gait Posture 2009 Jan
PMID:Relevance of botulinum toxin injection and nerve block of rectus femoris to kinematic and functional parameters of stiff knee gait in hemiplegic adults. 1877 25

Children with cerebral palsy often walk with reduced knee extension in terminal swing, which can be associated with short length or slow lengthening velocity of hamstrings muscles during gait. This study investigated the role of two factors that may contribute to such short and slow hamstrings: walking speed and spasticity. 17 children with spastic cerebral palsy and 11 matched typically developing children walked at comfortable, slow, and fast walking speed. Semitendinosus muscle-tendon length and velocity during gait were calculated using musculoskeletal modeling. Spasticity of the hamstrings was tested in physical examination. Peak hamstrings length increased only slightly with walking speed, while peak hamstrings lengthening velocity increased strongly. After controlling for these effects of walking speed, spastic hamstrings acted at considerably shorter length and slower velocity during gait than normal, while non-spastic hamstrings did not (all P<0.001). These data are important as a reference for valid interpretation of hamstrings length and velocity data in gait analyses at different walking speeds. The results indicate that the presence of spasticity is associated with reduced hamstrings length and lengthening velocity during gait, even at constant walking speed.
Gait Posture 2009 Jun
PMID:The effect of walking speed on hamstrings length and lengthening velocity in children with spastic cerebral palsy. 1923 Jun 72

Spasticity is clinically assessed using goniometry to measure the joint angle of the catch (AOC) during fast passive muscle stretch. The precision and accuracy of the goniometric AOC measurements are questionable, because of the inevitable joint repositioning after occurrence of the catch. This study aims to evaluate the use of goniometry in estimating the AOC in spasticity assessment of the medial hamstrings, soleus and gastrocnemius in twenty children with Cerebral palsy (CP), using inertial sensors (IS) as reference system. The IS were initially validated with an optoelectronic system to measure 3d-orientation and proved to be accurate within 1 degree. To evaluate the precision and accuracy of the goniometry, the joint angle measured with the goniometer after repositioning was compared to the joint angle measured simultaneously with the IS, and to the true AOC, detected and measured with the IS during the fast muscle stretch. Results showed that goniometry is an imprecise method to measure the true AOC in spasticity assessment. The error is mainly due to joint repositioning after the fast muscle stretch. For spasticity assessment, it is advised to apply inertial sensors when a precise measurement of the angle of catch is required.
Gait Posture 2009 Aug
PMID:Evaluation of clinical spasticity assessment in cerebral palsy using inertial sensors. 1952 13

In this study a gait classification method was developed and applied to subjects with Cerebral palsy who walk with excessive knee flexion at initial contact. Sagittal plane gait data, simplified using the gait features method, is used as input into a k-means cluster analysis to determine homogeneous groups. Several clinical domains were explored to determine if the clusters are related to underlying pathology. These domains included age, joint range-of-motion, strength, selective motor control, and spasticity. Principal component analysis is used to determine one overall score for each of the multi-joint domains (strength, selective motor control, and spasticity). The current study shows that there are five clusters among children with excessive knee flexion at initial contact. These clusters were labeled, in order of increasing gait pathology: (1) mild crouch with mild equinus, (2) moderate crouch, (3) moderate crouch with anterior pelvic tilt, (4) moderate crouch with equinus, and (5) severe crouch. Further analysis showed that age, range-of-motion, strength, selective motor control, and spasticity were significantly different between the clusters (p<0.001). The general tendency was for the clinical domains to worsen as gait pathology increased. This new classification tool can be used to define homogeneous groups of subjects in crouch gait, which can help guide treatment decisions and outcomes assessment.
Gait Posture 2009 Aug
PMID:Crouch gait patterns defined using k-means cluster analysis are related to underlying clinical pathology. 1953 49


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