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Muscle Tone and Stiffness Comparison in Ambulatory Children With Unilateral Spastic Cerebral Palsy: Implications for
Melisa Akdıkan1, İlke Kara2,3, Tülay Çevik Saldıran3
1Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Okan University, Istanbul,Turkey.
Insights
Muscle symmetry, especially in calf muscles, is key for functional mobility in children with unilateral spastic cerebral palsy (UCP). Trunk control also plays a vital role in their rehabilitation.
Area of Science:
- Pediatric Rehabilitation
- Neuromuscular Biomechanics
- Movement Science
Background:
- Unilateral spastic cerebral palsy (UCP) affects muscle tone and stiffness.
- Understanding these biomechanical factors is crucial for improving function in affected children.
Purpose of the Study:
- Compare muscle tone and stiffness in ambulatory children with UCP versus typically developing peers.
- Investigate the relationship between muscle tone/stiffness and postural balance/functional mobility in UCP.
Main Methods:
- Assessed muscle tone and stiffness in lumbar extensors, gastrocnemius, and hamstrings using a myotonometer.
- Evaluated functional mobility with the 2-Minute Walk Test and Timed Up and Go Test.
- Assessed postural balance using the Pediatric Balance Scale and Trunk Control Measurement Scale (TCMS).
Main Results:
- Higher gastrocnemius muscle tone and stiffness were observed on the affected side in UCP children compared to controls.
- Lumbar spinal extensor tone positively correlated with improved TCMS scores.
- Gastrocnemius and hamstring tone/stiffness did not significantly impact functional mobility in UCP.
Conclusions:
- Muscle symmetry, particularly in plantar flexors, is important for functional mobility in UCP.
- While ankle and knee biomechanics differed, they did not significantly impact balance or mobility.
- Symmetry in lumbar spinal extensors correlated with better outcomes, highlighting trunk control's importance in UCP rehabilitation.
Objectives:
To compare muscle tone and stiffness in ambulatory children with unilateral spastic cerebral palsy (UCP) with typically developing peers and explore their relationship with postural balance and functional mobility.
Methods:
Forty ambulatory children with UCP and age-matched typically developing peers were assessed for tone and stiffness of lumbar spinal extensors, gastrocnemius, and hamstring muscles using a myotonometer. Functional mobility was evaluated with the 2-Minute Walk Test, and the Timed Up and Go Test, while postural balance was evaluated using the Pediatric Balance Scale and the Trunk Control Measurement Scale (TCMS).
Results:
The gastrocnemius muscle tone and stiffness were higher on the affected side in UCP compared with the less affected side and typically developing peers (P < .05). Lumbar spinal extensor tone correlated with improved Trunk Control Measurement Scale scores (P = .003). The gastrocnemius and hamstring muscles' tone and stiffness did not significantly affect functional mobility measures in UCP (P > .05).
Conclusions:
Our study highlights the importance of achieving muscle symmetry, particularly in the plantar flexors, for functional mobility in UCP children. While differences in ankle and knee muscle biomechanics were observed, they didn't significantly impact functional mobility or postural balance. Symmetry in lumbar spinal extensor biomechanics correlated with better outcomes, emphasizing the crucial role of trunk control in rehabilitation strategies for ambulatory children with UCP.
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