Article

Patients with cerebral palsy frequently experience foot dragging and tripping
during walking due to reduced toe clearance mostly caused by a lack of adequate
knee flexion in swing (stiff-knee gait). The aim of this study was to investigate
adaptive mechanism to an uneven surface in stiff-knee walkers with cerebral
palsy. Sixteen patients with bilateral cerebral palsy, GMFCS I-II and stiff-knee
gait, mean age 14.1 (SD=6.2) years, were compared to 13 healthy controls with
mean age 13.5 (SD=4.8) years. Gait analysis including EMG was performed under
even and uneven surface conditions. Similar strategies to improve leg clearance
were found in patients as well as in controls. Both adapted with significantly
reduced speed and cadence, increased outward foot rotation, knee and hip flexion
as well as anterior pelvic tilt. Therefore cerebral palsy and stiff-knee gait did
not affect the adaptation capacity on the uneven surface. On the uneven surface
an average increase in knee flexion of 7 degrees (SD=3 degrees ) and 12 degrees
(SD=5 degrees ) was observed in controls and patients with cerebral palsy,
respectively. Although rectus femoris activity was increased in patients with
cerebral palsy, they were able to increase their knee flexion during swing. The
results of this study suggest that walking on uneven surface has the potential to
improve knee flexion in stiff-knee walkers. Therefore training on uneven surface
could be used as a conservative treatment regime alone, in combination with
Botulinum neurotoxin or in the rehabilitation of surgery.
CI - Copyright (c) 2014 Elsevier B.V. All rights reserved.

Langue : ANGLAIS