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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.

Journal of Orthopaedic Surgery (Hong Kong)
|December 27, 2019
PubMed
Summary

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.

Keywords:
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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.