Assessment of spasticity in hemiplegic cerebral palsy. II: Distal lower-limb reflex excitability and function

A clinical method for measuring the stretch reflex threshold and gain of muscles acting across the ankle joint in children with congenital hemiplegia is described. The stretch reflexes of all limbs were velocity-dependent. Hemiparetic limbs were not necessarily spastic compared with non-paretic limbs, suggesting that the term 'spastic hemiplegia' should be used more selectively and emphasis be placed on the heterogeneity of the hemisyndromes of childhood. Abnormal motor control, planning and dexterity, the hemipostures and plastic (non-electrical) muscle changes may be more important measures of impairment than reflex excitability. A general scheme for assessing reflex excitability and available treatments applicable to all types of cerebral palsy is proposed.