Concepts in spasticity and selective motor control in children with spastic cerebral palsy

Abstract

Multiple impairments contribute to motor deficits seen in children with spastic cerebral palsy (CP). Impairments should be identified and quantified to individualize treatment plans. Spasticity and reduced selective voluntary motor control (SVMC) are two primary impairments. Spasticity is one of the most obvious and is the focus of many current interventions. The pendulum test is a sensitive measure of quadriceps spasticity than can be easily used with children. Our research has shown that the most sensitive pendulum test outcome is the first swing excursion. Using the pendulum test, the clinical premise that effortful exercise increases spasticity was disproven. Standardized tools have been available for evaluating spasticity, balance, strength and contractures, but not for the assessment of SVMC for patients with CP. We developed a new comprehensive assessment for lower extremity SVMC. Its validity and reliability have been established. The relationships between SVMC and gait as well as the clinical applications of SVMC assessment are presented.