Dynamic spasticity of plantar flexor muscles in cerebral palsy gait

Objective: To quantify dynamic spasticity, i.e. the coupling between muscle-tendon stretch velocity and muscle activity during gait, of the gastrocnemius and soleus muscles in children with spastic cerebral palsy. Design: Prospective, cross-sectional study. Subjects: Seventeen ambulatory children with cerebral palsy with spastic calf muscles, and H matched typically developing children. Methods: The children walked at 3 different speeds. Threedimensional kinematic and electromyographic data were collected. Muscle-tendon velocities of the gastrocnemius medialis and soleus were calculated using musculoskeletal modelling. Results: In typically developing children, muscles were stretched fast in swing without subsequent muscle activity, while spastic muscles were stretched more slowly for the same walking speed, followed by an increase in muscle activity. The mean ratio between peak activity and peak stretch velocity in swing was approximately 4 times higher in spastic muscles, and increased with walking speed. In stance, the stretch of muscles in typically developing children was followed by an increase in muscle activity. Spastic muscles were stretched fast in loading response, but since muscle activity was already built up in swing, no clear dynamic spasticity effect was present. Conclusion: Spastic calf muscles showed increased coupling between muscle-tendon stretch velocity and muscle activity, especially during the swing phase of gait. © 2010 Foundation of Rehabilitation Information

How Crouch Gait Can Dynamically Induce Stiff-Knee Gait

Children with cerebral palsy frequently experience foot dragging and tripping during walking due to a lack of adequate knee flexion in swing (stiff-knee gait). Stiff-knee gait is often accompanied by an overly flexed knee during stance (crouch gait). Studies on stiff-knee gait have mostly focused on excessive knee muscle activity during (pre)swing, but the passive dynamics of the limbs may also have an important effect. To examine the effects of a crouched posture on swing knee flexion, we developed a forward-dynamic model of human walking with a passive swing knee, capable of stable cyclic walking for a range of stance knee crouch angles. As crouch angle during stance was increased, the knee naturally flexed much less during swing, resulting in a 'stiff-knee' gait pattern and reduced foot clearance. Reduced swing knee flexion was primarily due to altered gravitational moments around the joints during initial swing. We also considered the effects of increased push-off strength and swing hip flexion torque, which both increased swing knee flexion, but the effect of crouch angle was dominant. These findings demonstrate that decreased knee flexion during swing can occur purely as the dynamical result of crouch, rather than from altered muscle function or pathoneurological control alone. © 2010 The Author(s)

The globe system: An unambiguous description of shoulder positions in daily life movements

Positions of the shoulder joint are commonly described in terms of degrees of humeral elevation in the principal planes. This approach is inadequate for an accurate and unambiguous description of functional arm movements that are not confined to these planes. In this paper, a general unambiguous method for describing shoulder positions is adopted and visualized in globe graphs. This facilitates the use and interpretation of the method in clinical practice. To illustrate this globe system of description, a healthy subject participated in the experiments. The shoulder position is described for several functional and standardized tasks for the upper limb with three angles: (1) the angle of the plane of elevation, (2) the angle of elevation within the plane of elevation, and (3) the angle of axial rotation. With these parameters, the position of the upper arm can be visualized as a position on a “globe” about the shoulder joint. Although not perfect, the globe system provides the most unambiguous description of functional thoracohumeral positions, which is easy to apply in clinical practice.Mechanical EngineeringMechanical, Maritime and Materials Engineerin

Calibration of EMG to force for knee muscles is applicable with submaximal voluntary contractions

Purpose: In this study, the influence of using submaximal isokinetic contractions about the knee compared to maximal voluntary contractions as input to obtain the calibration of an EMG-force model for knee muscles is investigated. Methods: Isokinetic knee flexion and extension contractions were performed by healthy subjects at five different velocities and at three contraction levels (100%, 75% and 50% of MVC). Joint angle, angular velocity, joint moment and surface EMG of five knee muscles were recorded. Individual calibration values were calculated according to [C.A.M. Doorenbosch, J. Harlaar, A clinically applicable EMG-force model to quantify active stabilization of the knee after a lesion of the anterior cruciate ligament, Clinical Biomechanics 18 (2003) 142-149] for each contraction level. Results: First, the output of the model, calibrated with the 100% MVC was compared to the actually exerted net knee moment at the dynamometer. Normalized root mean square errors were calculated [A.L. Hof, C.A.N. Pronk, J.A. van Best, Comparison between EMG to force processing and kinetic analysis for the calf muscle moment in walking and stepping, Journal of Biomechanics 20 (1987) 167-187] to compare the estimated moments with the actually exerted moments. Mean RMSD errors ranged from 0.06 to 0.21 for extension and from 0.12 to 0.29 for flexion at the 100% trials. Subsequently, the calibration results of the 50% and 75% MVC calibration procedures were used. A standard signal, representing a random EMG level was used as input in the EMG force model, to compare the three models. Paired samples t-tests between the 100% MVC and the 75% MVC and 50% MVC, respectively, showed no significant differences (p > 0.05). Conclusion: The application of submaximal contractions of larger than 50% MVC is suitable to calibrate a simple EMG to force model for knee extension and flexion. This means that in clinical practice, the EMG to force model can be applied by patients who cannot exert maximal force. © 2004 Elsevier Ltd. All rights reserved

Muscle fatigue during repetitive voluntary contractions: a comparison between children with cerebral palsy, typically developing children and young healthy adults.

Aim: To combine peak torque and EMG analyses to investigate the hypothesis that 1) children with cerebral palsy (CP) have lower muscle fatigability than typically developing children (TD) and whether 2) muscle fatigue correlates with muscle strength. Methods: Seven CP children, eight TD children and ten young healthy adults (YHA) performed an all-out fatigue test of 35 maximal concentric knee extension and flexion contractions on an isokinetic dynamometer. Angular velocity was set at 60°/s. Peak torque (PT) was determined per repetition and either normalized to bodyweight or maximum voluntary torque. Surface-EMG of quadriceps and hamstring muscles was measured to obtain changes in median frequency (EMG- mf) and smooth rectified EMG amplitude per contraction. Results: Decline in PT differed between all groups for extensors and flexors, where YHA showed the largest decline and CP children the smallest decline over the course of the test. YHA showed a larger decline in EMG- mf of all quadriceps and hamstrings than TD and CP children, while TD children showed a larger decline in EMG- mf of m.rectus femoris and m.vastus lateralis than CP children. Interpretation: Results confirm that children with CP show lower fatigability than TD children and that the lower fatigability coincides with lower maximal muscle strength. © 2013 Elsevier B.V

The effect of walking speed on hamstrings length and lengthening velocity in children with spastic cerebral palsy

Children with cerebral palsy often walk with reduced knee extension in terminal swing, which can be associated with short length or slow lengthening velocity of hamstrings muscles during gait. This study investigated the role of two factors that may contribute to such short and slow hamstrings: walking speed and spasticity. 17 children with spastic cerebral palsy and 11 matched typically developing children walked at comfortable, slow, and fast walking speed. Semitendinosus muscle-tendon length and velocity during gait were calculated using musculoskeletal modeling. Spasticity of the hamstrings was tested in physical examination. Peak hamstrings length increased only slightly with walking speed, while peak hamstrings lengthening velocity increased strongly. After controlling for these effects of walking speed, spastic hamstrings acted at considerably shorter length and slower velocity during gait than normal, while non-spastic hamstrings did not (all

Validation of hamstrings musculoskeletal modeling by calculating peak hamstrings length at different hip angles

Accurate estimates of hamstrings lengths are useful, for example, to facilitate planning for surgical lengthening of the hamstrings in patients with cerebral palsy. In this study, three models used to estimate hamstrings length (M1: Delp, M2: Klein Horsman, M3: Hawkins and Hull) were evaluated. This was done by determining whether the estimated peak semitendinosus, semimembranosus and biceps femoris long head lengths, as measured in eight healthy subjects, were constant over a range of hip and knee angles. The estimated peak hamstrings length depended on the model that was used, even with length normalized to length in anatomical position. M3 estimated shorter peak lengths than M1 and M2, showing that more advanced models (M1 and M2) are more similar. Peak hamstrings length showed a systematic dependence on hip angle for biceps femoris in M2 and for semitendinosus in M3, indicating that either the length was not correctly estimated, or that the specific muscle did not limit the movement. Considerable differences were found between subjects. Large inter-individual differences indicate that modeling results for individual subjects should be interpreted with caution. Testing the accuracy of modeling techniques using in vivo data, as performed in this study, can provide important insights into the value and limitations of musculoskeletal models. © 2008 Elsevier Ltd. All rights reserved

Intermuscular co-ordination during fast contact control leg tasks in man

From previous inverse dynamic analyses of human leg extensions, it was hypothesized that the underlying processes for the activation of mono- and biarticular muscles are different; the mono-articular muscles being activated when they shortened, whereas the biarticular muscles appeared responsible for the control of the external force direction. In the present study, experiments were performed on a dynamometer which was especially developed to test this hypothesis. Subjects had to exert different prescribed force vectors on a moving force-plate during leg extension, which they had intensively practised prior to the actual experiments. Of each trial, position, force and EMG activity were recorded. Net joint torques were calculated by the method of inverse dynamics and related to the EMG-patterns of the mono- and biarticular upper leg muscles to reveal whether the previously observed different roles in contact tasks might constitute a general principle in motor control. The results showed that although the action of the biarticular m. rectus femoris and hamstrings muscles was consistent in controlling the direction of the external force, the actions of the mono-articular muscles did not agree with their hypothesized role as simple work generators. The generalizability of a different control for mono-and biarticular muscles could thus not be confirmed for these tasks. They might rather reflect one out of more available strategies the CNS can use to control different contact control tasks