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The effect of walking speed on hamstrings length and lengthening velocity in children with spastic cerebral palsy
Marjolein M van der Krogt1, Caroline A M Doorenbosch, Jaap Harlaar
1Department of Rehabilitation Medicine, Research Institute MOVE, VU University Medical Center, Amsterdam, The Netherlands. m.vanderkrogt@vumc.nl
Insights
Children with spastic cerebral palsy have shorter and slower hamstring muscles during walking. This study found spasticity, not just walking speed, significantly impacts hamstring muscle function in gait.
Area of Science:
- Biomedical Engineering
- Orthopedics
- Pediatric Rehabilitation
Background:
- Children with cerebral palsy (CP) often exhibit reduced knee extension during the terminal swing phase of gait.
- This gait abnormality is frequently linked to inadequate hamstring muscle length or slow lengthening velocity.
- Understanding factors influencing hamstring mechanics is crucial for targeted interventions in CP.
Purpose of the Study:
- To investigate the independent contributions of walking speed and hamstring spasticity to altered hamstring muscle-tendon dynamics during gait in children with CP.
- To establish reference data for interpreting hamstring length and velocity in gait analyses across various walking speeds.
Main Methods:
- Utilized musculoskeletal modeling to calculate semitendinosus muscle-tendon length and velocity during gait.
- Collected gait data from 17 children with spastic CP and 11 typically developing children across comfortable, slow, and fast walking speeds.
- Assessed hamstring spasticity through standardized physical examination.
Main Results:
- Peak hamstring lengthening velocity increased significantly with walking speed.
- After accounting for walking speed effects, spastic hamstrings demonstrated significantly shorter muscle-tendon lengths and slower lengthening velocities compared to non-spastic hamstrings.
- Non-spastic hamstrings in children with CP did not show these alterations when compared to controls.
Conclusions:
- Spasticity in the hamstrings is a key factor associated with reduced muscle-tendon length and lengthening velocity during gait in children with CP.
- These findings provide essential reference data for gait analysis in children with CP, highlighting the impact of spasticity independent of walking speed.
Abstract:
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 P<0.001). These data are important as a reference for valid interpretation of hamstrings length and velocity data in gait analyses at different walking speeds. The results indicate that the presence of spasticity is associated with reduced hamstrings length and lengthening velocity during gait, even at constant walking speed.
