Are Muscle Volume Differences Related to Concentric Muscle Work During Walking in Spastic Hemiplegic Cerebral Palsy?
2012 (English)In: Clinical Orthopaedics and Related Research, ISSN 0009-921X, E-ISSN 1528-1132, Vol. 470, no 5, 1278-1285 p.Article in journal (Refereed) Published
Background: Individuals with spastic hemiplegic cerebral palsy are typically high functioning and walk without assistive devices. The involved limb is usually smaller and shorter, although it is not clear whether the difference in muscle volume has an impact on walking capacity. Questions/purposes: We determined the volume of muscles important for propulsion and related that volume to concentric muscle work during walking on the hemiplegic and noninvolved sides in patients with cerebral palsy. Patients and Methods: We studied 46 patients (mean age, 17.6 years; range, 13-24 years) with spastic hemiplegic cerebral palsy. We assessed muscle volume using MRI and concentric muscle work in the sagittal plane from the hip, knee, and ankle using three-dimensional gait analysis. Patients were classified by Winters' criteria to assess the involvement of cerebral palsy and movement pattern during walking. Results: On the hemiplegic side, muscles were smaller, except for the gracilis muscle, and concentric muscle work from the ankle plantar flexors, knee extensors, and hip flexors and extensors was lower compared to the noninvolved side. Hip extensor work was higher on the hemiplegic and the noninvolved sides compared to a control group of 14 subjects without cerebral palsy. Hemiplegic to noninvolved volume ratios correlated with work ratios (r = 0.40-0.66). The Winters classification and previous calf muscle surgery predicted work ratios. Conclusions: Our observations of smaller muscles on the hemiplegic side and changes in muscle work on both sides can help us distinguish between primary deviations that may potentially be treatable and compensatory mechanisms that should not be treated.
Place, publisher, year, edition, pages
2012. Vol. 470, no 5, 1278-1285 p.
Adolescent, Cerebral Palsy, Cross-Sectional Studies, Female, Functional Laterality, Hemiplegia, Humans, Magnetic Resonance Imaging, Male, Muscle Contraction, Muscle Spasticity, Muscle, Skeletal, Walking, Young Adult
IdentifiersURN: urn:nbn:se:kth:diva-74929DOI: 10.1007/s11999-011-2093-6ISI: 000304094400006ScopusID: 2-s2.0-84859810541OAI: oai:DiVA.org:kth-74929DiVA: diva2:490208
QC 201206112012-02-042012-02-042012-06-11Bibliographically approved