Abstract
Impaired motor control and musculotendon tightness in the lower extremities are characteristic features of patients with diplegic cerebral palsy (CP). Tendon release surgery (TRS) helps improve joint and leg stiffness, but the effects of TRS on inter-limb coordination in terms of the total leg stiffness, and the bilateral symmetry in leg stiffness during gait, remain unknown. Ten children with spastic diplegic CP scheduled for TRS and ten healthy controls participated in this study. The inter-limb sharing of total leg stiffness during double-limb support phase and bilateral leg stiffness symmetry during stance phase of gait were calculated using the kinematic and ground reaction force data measured by a motion analysis system. Before TRS, the patients with diplegic CP walked with a decreased share of total leg stiffness during weight-acceptance (p < 0.05) and with increased bilateral leg stiffness asymmetry during single-limb support and weight-transfer during gait (p < 0.05) when compared to healthy controls. After TRS, the bilateral leg stiffness asymmetry was significantly reduced in the CP group, especially in the terminal stance phase, with inter-limb sharing of total leg stiffness becoming similar to that in controls (p > 0.05). The surgery seemed to improve the lower limb control and increased the bilateral limb symmetry during gait.
Highlights
Tendon release surgery (TRS), the children with diplegic cerebral palsy (CP) walked with a decreased share of total leg stiffness during weight-acceptance and increased bilateral leg stiffness asymmetry during singlelimb support and weight-transfer during gait when compared to healthy Controls
The tightness of the musculotendinous units in the CP group led them to walk with more flexed lower limbs, and with an increased muscular effort [15], which appeared to contribute to the decrease in the total leg stiffness sharing in the weight-acceptance limb
doublelimb support (DLS) and the bilateral symmetry in leg stiffness throughout the gait cycle in children with diplegic CP who had undergone TRS was revealed in the current study
Summary
Spastic diplegic cerebral palsy (CP) is characterized by impaired motor control on both sides of the body with shortened or improperly developed muscles, and impaired joint movement in both lower extremities [1,2,3,4,5,6]. These impairments impact directly on the body’s mobility and stability throughout the gait cycle [7], for body-weight support during single-limb support (SLS), and for body-weight transfer during doublelimb support (DLS). Well-coordinated joint controls, both intra- and inter-limb, are needed for smooth and stable body-weight transfer and balance control during gait
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