Vol 8, No 4 (2022)
Research paper
Published online: 2022-09-26

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Impairments restricted knee flexion during gait in a child with cerebral palsy

Faustyna Manikowska1, Sabina Brazeviс1, Marek Jóźwiak1, Maria Lebiedowska2
Rheumatology Forum 2022;8(4):178-184.

Abstract

Introduction: A child with cerebral palsy has multiple coexisting deficits that limit functional abilities such as walking. Their interaction shapes the kinematic gait pattern by modulating both the range and shape of the knee flexion movement during the swing phase. The significance of the effect of specific impairments on knee joint flexion range-of-motion is not clear.
Aim: The aim of this study is to comprehensively analyse the effect of coexisting deficits on the range and speed of flexion at the knee joint in the sagittal plane in a child with cerebral palsy.
Material and methods: In 132 patients (M = 76; F = 56; age: 11 ± 4) with spastic cerebral palsy, lower limb joint range-of-motion, selective motor control, strength and spasticity were assessed during the clinical examination. The range of knee flexion in the terminal stance phase, pre-swing and initial swing (TSt-ISw) was assessed during the laboratory three-dimensional gait analysis.
Results: The TSt-ISw knee flexion movement was most strongly (RS = –0.28) dependent on knee extensor hypertonia, similarly as in the KSt stance phase (RS = –0.22) and in the KSw swing phase (RS = –0.22). The velocity of flexion (V) was most strongly correlated with knee extensor muscle hypertonia (RS = –0.32) and successively with selective control of hip flexor movement (RS = –0.28), knee extensor strength (RS = –0.23) and plantar flexor hypertonia (RS = –0.21).
Conclusions: The range-of-motion of knee flexion in the sagittal plane depends on the hypertonia of the knee extensor muscles in both the TSt-ISw and KSt and KSw phases.
Velocity increase depends on the occurrence of knee extensor muscle hypertonia, selective control of hip flexor movement, knee extensor strength and plantar flexor hypertonia.

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