Comparison of 3 Different Methods to Analyze Ankle Plantarflexor Stiffness in Children with Spastic Diplegia Cerebral Palsy

Overview

Journal Arch Phys Med Rehabil

Specialty Rehabilitation Medicine

Date 2011 Dec 3

PMID 22133254

Citations 3

Authors

Sandy A Ross

Matthew Foreman

Jack R Engsberg

Affiliations

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Abstract

Objective: To compare 3 different methods of measuring plantarflexor stiffness in children with spastic diplegia cerebral palsy (CP) and children without disability.

Design: Case-control study.

Setting: Human performance laboratory.

Participants: A retrospective analysis was conducted with children with spastic diplegia (n=121; mean age, 8.4y) and children with typical development (TD) (n=48; mean age, 9.7y).

Interventions: Not applicable.

Main Outcome Measures: An isokinetic dynamometer was used to measure ankle plantarflexor stiffness at 10°/s using 3 methods: (1) end-range method, which applied a linear slope to the end of the torque-angle curve; (2) set-range method, which applied a linear slope from 30° to 10° plantarflexion; and (3) a linear method, which applied a slope only to the linear portion of the curve.

Results: Two-way analysis of variance revealed significant main effects for group and stiffness method. The end-range method showed no significant difference between groups for plantarflexor stiffness (P=.62), the set-range method showed the CP group with 120% greater stiffness than the TD group (P<.046), and the linear method showed the CP group with 35% greater stiffness than the TD group (P<.001).

Conclusions: The linear method appeared to resolve the issues with the previous methods; applying a linear slope to a nonlinear curve or applying a linear slope to the same range of motion for each child regardless of their range limitations. It is clear that children with CP have limited range of motion; therefore, stiffness occurs earlier in the range than would be expected for a typically developing child. Using the linear method, children with CP were 35% stiffer in the ankle plantarflexors than typically developing peers.

Citing Articles

What causes increased passive stiffness of plantarflexor muscle-tendon unit in children with spastic cerebral palsy?.

Boulard C, Gross R, Gautheron V, Lapole T Eur J Appl Physiol. 2019; 119(10):2151-2165.

PMID: 31468174 DOI: 10.1007/s00421-019-04208-4.

Forearm Flexor Muscles in Children with Cerebral Palsy Are Weak, Thin and Stiff.

von Walden F, Jalaleddini K, Evertsson B, Friberg J, Valero-Cuevas F, Ponten E Front Comput Neurosci. 2017; 11:30.

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Clinical application of a robotic ankle training program for cerebral palsy compared to the research laboratory application: does it translate to practice?.

Sukal-Moulton T, Clancy T, Zhang L, Gaebler-Spira D Arch Phys Med Rehabil. 2014; 95(8):1433-40.

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