Influence of gait analysis on decision-marketing for lower extremity surgery

Stretching improves ankle biomechanics in children with cerebral palsy


  1. 1. Biodynamics Laboratory, Rehabilitation Institute of Chicago;
  2. 2. College of Medicine, University of Illinois at Chicago;
  3. 3. Department of Pediatrics and Physical Medicine & Rehabilitation, Rehabilitation  Institute of Chicago;
  4. 4. Department of Biomedical Engineering and Physical Medicine & Rehabilitation, Northwestern University, Chicago, II, USA

Objectives: To investigate the null hypothesis that controlled stretching will not induce changes in ankle biomechanical properties in children with spastic cerebral palsy (CP).

Design: Prospective nonrandomized before-after trial.

Particiapnts/Setting: Twenty-one children with CP, aged 6 to 19, with modified Ashworth scores > 1 in plantarflexors and no fixed contractures were assessed in a freestanding rehabilitation hospital.

Methods: Each participant’s modified Ashworth score was manually assessed before testing. A custom manual spasticity evaluator (MSE) was used to measure joint torque and position before and after stretching. Participants underwent a 30-minute stretching session; the ankle was stretched slowly into extreme dorsi/plantarflexion using velocity under intelligent control and terminal resitance torque limits. Torque limits were set lower for palantarflexor so as no to overstretch in palantarflexion. Measurements mad by the MSE were compared for the same participant before and after stretching and were compared to manual Ashworth scores for each participant. Paired comparisons were made using a student’s t-test. Relationships between the MSE and Ashworth measures were assessed using the Pearson correlation coefficient ®.

Results: Fourteen males and seven females (mean age 11y 6mo) were assessed. Mean ankle joint dorsiflexion range of motion (ROM) and stiffness are presented in Table SP:62. The ankle joints of children with CP were capable of reaching a significantly larger range of dorsiflexion after stretching when compared with dorsiflexion prior to stretching (p=0.005). In addition, the ankle joints of children with CP were significantly less stiff after stretching when compared with prior to stretching (p=0.036). No significant relationship was identified between Ashworth score prior to stretching and any of the quantitative measures of the ankle joint either before or after stgretching (p>0.05).

Conclusions: Stiffness and decreased ROM are major components of body structure /function, impose limitations during function in children with CP, and are directly related to spasticity. This study demonstrated that stretching treatment can decrease ankle stiffness and increase ROM in children with CP.
Although the modified Ashworth scale is commonly used to assess the severity of spasticity in the clinical setting, it has been shown to be highly dependent on the examiner’s judgment and to have poor reliability. This study demonstrated that the modified Ashworth scale is also a poor predictor of changes in body structure /function.

Acknowlegements: The support of the NIH and NIDRR.

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