Article

In children with hemiplegia, it is important to distinguish between equinus with
hindfoot varus (equinovarus) or valgus (equinovalgus).
Premature onset of medial
gastrocnemius (GM) EMG in individuals with equinus is well documented. Premature
onset of Peroneus longus (PL) EMG has been described in neurologically impaired
adults with equinovalgus, but not in children. Our aim was to record the onset of
PL and GM activity on the hemiplegic side of children with equinovalgus
deformity. Fifteen children GMFCS 1 (3.8 yrs +/- 2) with hemiplegia had a
goniometric assessment of passive ankle range of motion and assessment of ankle
function from video and surface EMG recording during gait.
The clinical and video
observations were used to determine the equinovalgus, as defined by Wren, at
initial contact (IC). The premature onset of muscle activity was normalised as a
swing (SW) percentage prior to IC of the following stance (ST).
A paired T-test
compared the onset of muscle activity between PL and GM. The ankle passive
dorsiflexion was 13 degrees +/- 12 degrees (hemiplegic side) versus 18 degrees
+/- 10 degrees (non-involved side) (p<0.05). For the non-involved limb, the onset
of GM activity was at 14% of the gait cycle (midstance), the onset of PL activity
was at 19% (p<0.05). For the hemiplegic limb with equinovalgus, there was a
premature onset activity of PL
(-24%) and GM(-8%) (p<0.001). On the non involved
side, the onset of PL activity occurred, as in adults, after the onset of GM
activity, during ST. On the hemiplegic side, there was no triceps surae
contracture and the onset of PL activity occurred prior to the onset of GM
activity, during terminal SW. This study confirmed the overactivity of PL in
hemiplegic children with equinovalgus.
CI - Copyright (c) 2012 Elsevier B.V. All rights reserved.

Langue : ANGLAIS