Article

The mechanisms contributing to swing phase knee acceleration in individuals with
spastic diplegic cerebral palsy (CP) are not well understood, but evidence
suggests that selective voluntary motor control (SVMC) may play a role. The
purpose of this study was to examine the relationship between lower limb SVMC,
measured using Selective Control Assessment of the Lower Extremity (SCALE), and
joint moment contributions to swing knee extension acceleration in participants
with spastic diplegic CP. Eighteen participants were recruited (mean age=13.8
years, range=6-30 years, Gross Motor Function Classification System Levels
I-III). Induced acceleration analysis was performed during the swing phase of
gait. Average joint moment contributions to swing knee extension acceleration
were calculated. Contributions from stance limb and swing limb joint moments were
correlated with SCALE scores using Pearson's correlations. A strong correlation
was found (p<0.0001, r=0.85) between SCALE score and the total swing joint moment
contributions to swing knee extension acceleration. As SCALE score increased,
swing joint moments provided less resistance to knee extension acceleration. No
relationship (p=0.18) was found between stance moment contributions to swing knee
acceleration and stance limb SCALE scores. Excessive contributions from swing
limb joint moments appear to be the factor limiting swing knee extension in
spastic diplegic CP gait. Interventions that address negative contributions due
to spasticity may not be effective in patients who cannot generate adequate knee
extension due to poor SVMC.
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Langue : ANGLAIS