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Association Between Calf Muscle Tone, Plantar Surface Area, and Gross Motor Function in Children with Spastic
Hisham Mohamed Hussein1,2, Amsha Alhumaidi Alshammari3, Hand Zamel M Alshammari4
1Department of Physical Therapy, College of Applied Medical Sciences, University of Ha'il, Ha'il, Saudi Arabia.
Insights
Children with spastic diplegic Cerebral Palsy (CP) show better standing and walking abilities with increased plantar surface area and higher foot pressure. This highlights key factors for improving gross motor function in CP. Keywords: Cerebral Palsy, spastic diplegic CP, gross motor function, standing, walking, plantar surface area, foot pressure.
Area of Science:
- Pediatric Rehabilitation
- Neurology
- Biomechanics
Background:
- Spastic diplegic Cerebral Palsy (CP) often involves lower limb hypertonicity, impacting foot alignment and weight-bearing.
- These impairments can limit gross motor functions like standing and walking in affected children.
- Understanding these relationships is crucial for developing effective rehabilitation strategies.
Purpose of the Study:
- To investigate the relationship between plantar surface area, weight distribution, and gross motor function in children with spastic diplegic CP.
- To explore how foot biomechanics correlate with standing and walking abilities in this population.
Main Methods:
- Cross-sectional study involving 71 children (aged 8-14) with spastic diplegic CP.
- Assessed Gross Motor Function (GMFM-88), Calf Muscle Tone (Modified Ashworth scale), Plantar Surface Area (PSA), and Peak Pressure on mid and hind feet (PPMF, PPHF) using a foot scan system.
- Employed Person's correlation coefficient and regression analyses to examine variable relationships.
Main Results:
- Strong to moderate positive correlations were found between PSA, PPMF, PPHF, and GMFM-D and GMFM-E scores.
- Regression models predicted GMFM-D with 0.791 accuracy and GMFM-E with 0.720 accuracy.
- Higher plantar surface area and peak foot pressure were associated with better standing and walking abilities.
Conclusions:
- Standing and walking abilities in spastic diplegic CP are positively correlated with increased plantar surface area and higher peak foot pressure.
- Findings suggest that interventions targeting these foot parameters may improve gross motor function.
- Future longitudinal studies are recommended to track changes in gross motor function alongside improvements in plantar surface area and peak pressure.
Background:
Children diagnosed with spastic diplegic Cerebral Palsy (CP) usually demonstrate hypertonicity of the lower limb muscles which affects the normal alignments and weight reception by the feet. These impairments could be correlated to the limitations in gross motor function such as standing and walking abilities. Understanding these relationships can contribute to developing more effective rehabilitation strategies and improving overall motor outcomes for affected children.
Objective:
The current study was designed to explore the relationship between plantar surface area, weight distribution on the plantar surface, and gross motor function (namely, standing and walking abilities) in spastic diplegic CP children.
Methods:
Seventy-one spastic diplegic CP children aged 8-14 years joined this cross-sectional study. The Person's correlation coefficient and regression tests were used to assess the correlation between variables, namely, Gross Motor Function (GMFM), Calf Muscle Tone, Plantar surface area (PSA), and Peak pressure on mid and hind feet (PPMF, PPHF, respectively). These variables were assessed using the GMFM-88 scale, Modified Ashworth scale, and foot scan plantar pressure detection system, respectively.
Results:
The correlation analysis demonstrated a strong to moderate positive correlation between PSA, PPMF, PPHF, and GMFM-D and GMFM-E. Additionally, regression model showed prediction levels equal to 0.791 for the GMFM-D and 0.720 for the GMFM-E categories, respectively.
Conclusion:
Standing and walking abilities were positively correlated (r ≥.6) with the increased plantar surface area and higher peak pressure on mid and hind feet in spastic diplegic CP. Future longitudinal studies should investigate changes in gross motor function in relation to improvement in plantar surface area and peak pressure values.
