Article

Clinical determination of spasticity is confounded by the difficulty in
distinguishing reflex from passive contributions to muscle stiffness. There is,
therefore, a risk that children with cerebral palsy (CP) receive antispasticity
treatment unnecessarily. To investigate this, we aimed to determine the
contribution of reflex mechanisms to changes in the passive elastic properties of
muscles and tendons in children with CP. METHOD: Biomechanical and
electrophysiological measures were used to determine the relative contribution of
reflex and passive mechanisms to ankle muscle stiffness in 35 children with
spastic CP (21 males, 14 females; mean age 9 y, SD 3 y 4 mo; range 3-15 y) and 28
control children without CP (19 males, nine females; mean age 8 y 11 mo, SD 2 y
10 mo; range 3-15 y). Twenty-seven children were diagnosed as having spastic
hemiplegia, six with spastic diplegia, and two with spastic tetraplegia.
According to the Gross Motor Function Classification System, 31 children were
classified in level I, two in level II, and two in level III. RESULTS: Only seven
children with spastic CP showed reflex stiffness outside the range of the control
children. In contrast, 20 children with spastic CP showed abnormal passive muscle
stiffness (p<0.001). No correlation between increased reflex or increased passive
muscle stiffness and age was observed within the age range studied.
INTERPRETATION: These data suggest that increased reflex-mediated muscle
stiffness is difficult to distinguish clinically from changes in passive muscle
stiffness and that signs of changes in muscle properties are already present from
the age of 3 years in children with CP. This emphasizes the importance of
accurately distinguishing different contributions to muscle stiffness to avoid
unnecessary antispasticity treatment.
CI - (c) The Authors. Developmental Medicine & Child Neurology (c) 2013 Mac Keith
Press.

Langue : ANGLAIS