Related Experiment Video
Updated: Nov 21, 2025
Author Spotlight: Repetitive Transcranial Magnetic Stimulation Combined with Movement Observation in Cerebral Palsy
Published on: August 9, 2024
Tendon release reduced joint stiffness with unaltered leg stiffness during gait in spastic diplegic cerebral palsy
Chien-Chung Kuo1,2, Hsing-Po Huang3, Ting-Ming Wang4,5
1Department of Orthopedics, China Medical University Hospital, Taiwan, R.O.C.
Insights
Tendon release surgery improved gait stiffness control in children with spastic diplegic cerebral palsy (CP). While some deficits persist, including altered joint stiffness and reduced muscular demand, the procedure enhances overall leg stiffness during walking.
Area of Science:
- Biomechanics
- Pediatric Orthopedics
- Neurology
Background:
- Cerebral palsy (CP) often presents with biomechanical joint deviations during gait.
- Understanding joint and leg stiffness control in children with spastic diplegic CP is crucial, but pre- and post-surgical differences are not well-documented.
Purpose of the Study:
- To compare leg stiffness (skeletal and muscular components) and joint stiffness during gait in children with spastic diplegic CP before and after tendon release surgery (TRS).
- To evaluate the impact of TRS on gait control strategies in this patient population.
Main Methods:
- Gait analysis was performed on 12 healthy controls and 12 children with spastic diplegic CP.
- Kinematic and forceplate data were collected during self-selected walking on a 10-meter walkway.
- Stiffness-related variables were calculated for specific gait phases: loading response, mid-stance, terminal stance, and pre-swing.
Main Results:
- Children with CP exhibited altered lower limb joint stiffness and reduced demand on muscular components post-TRS.
- Leg stiffness during the stance phase remained unaltered after tendon release surgery.
- Tendon release surgery demonstrated improvements in joint and leg stiffness control during gait, though residual deficits persisted.
Conclusions:
- Tendon release surgery positively impacts gait stiffness control in children with spastic diplegic CP.
- Inclusion of stiffness-related variables in clinical gait analysis is recommended for a comprehensive assessment of CP.
- Further research may explore strategies to address remaining gait deviations post-surgery.
Abstract:
Biomechanical deviations at individual joints are often identified by gait analysis of patients with cerebral palsy (CP). Analysis of the control of joint and leg stiffness of the locomotor system during gait in children with spastic diplegic CP has been used to reveal their control strategy, but the differences between before and after surgery remain unknown. The current study aimed to bridge the gap by comparing the leg stiffness-both skeletal and muscular components-and associated joint stiffness during gait in 12 healthy controls and 12 children with spastic diplegic CP before and after tendon release surgery (TRS). Each subject walked at a self-selected pace on a 10-meter walkway while their kinematic and forceplate data were measured to calculate the stiffness-related variables during loading response, mid-stance, terminal stance, and pre-swing. The CP group altered the stiffness of the lower limb joints and decreased the demand on the muscular components while maintaining an unaltered leg stiffness during stance phase after the TRS. The TRS surgery improved the joint and leg stiffness control during gait, although residual deficits and associated deviations still remained. It is suggested that the stiffness-related variables be included in future clinical gait analysis for a more complete assessment of gait in children with CP.
