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Spontaneous decrease in gastrocnemius spasticity after correction of knee flexion gait in children with cerebral
Winson Min-Teng Low1, Sue-Mei Wang1,2, Kuo-Kuang Yeh3
1Department of Pediatric Orthopedics, Chang Gung Memorial Hospital, Taoyuan.
Insights
Spasticity in children with cerebral palsy may decrease spontaneously after correcting knee flexion gait. This is particularly true for patients with worse knee flexion contracture, suggesting gastrocnemius preservation is beneficial.
Area of Science:
- Neurology
- Orthopedics
- Pediatrics
Background:
- Synergistic neuro-excitability in lower extremities can lead to gait disorders.
- Cerebral palsy (CP) often involves spasticity and gait abnormalities.
Purpose of the Study:
- To investigate spontaneous changes in gastrocnemius spasticity after correcting knee flexion gait in children with CP.
- To explore the underlying mechanisms, particularly the role of knee flexion contracture.
Main Methods:
- A prospective study involving 23 children with CP.
- Assessment of gross motor function, joint range of motion (ROM), and spasticity (Modified Ashworth Scale).
- Evaluation of limb characteristics associated with spontaneous gastrocnemius spasticity reduction.
Main Results:
- In 19 limbs without gastrocnemius release, spasticity decreased spontaneously in 6 limbs by 3 months and 10 limbs by 6 months.
- Limbs with spontaneous spasticity reduction showed worse preoperative knee flexion contracture (knee ROM limitation score 5.4 vs. 3.7, p=0.026).
Conclusions:
- Patients with knee flexion contracture utilize a greater plantar flexion-knee extension couple to compensate for knee flexion gait.
- This compensatory mechanism enhances synergistic neuro-excitability of the gastrocnemius.
- Preserving the gastrocnemius muscle may be a beneficial strategy in treating knee flexion gait, especially in CP patients with knee flexion contracture.
Purpose:
Synergistic neuro-excitability in the lower extremities may be related to gait disorders. This study aimed to report spontaneous changes after correcting knee flexion gait and discuss the underlying mechanisms.
Methods:
A prospective study of 23 children with cerebral palsy was conducted to assess postoperative changes in gross motor function, joint range of motion (ROM), and spasticity. Characteristics of children/limbs with spontaneous decrease in gastrocnemius spasticity were assessed.
Results:
In 10 patients (19 limbs) without gastrocnemius release, the Modified Ashworth scores in the gastrocnemius decreased in 6 limbs after 3 months and in 10 limbs after 6 months. Those limbs with spontaneous changes had worse preoperative knee flexion contracture than the limbs without spasticity changes (knee ROM limitation score 5.4 vs. 3.7, p = 0.026).
Conclusions:
Patients with knee flexion contracture recruited greater plantar flexion-knee extension couple to balance knee flexion gait, and synergistic neuro-excitability of the gastrocnemius was enhanced. Our early results suggest preservation of the gastrocnemius in treating knee flexion gait, especially for patients with knee flexion contracture.
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