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. 2018 Jan 11;13(1):e0191097.
doi: 10.1371/journal.pone.0191097. eCollection 2018.

A new strength assessment to evaluate the association between muscle weakness and gait pathology in children with cerebral palsy

Marije Goudriaan  1 , Angela Nieuwenhuys  1 , Simon-Henri Schless  1 , Nathalie Goemans  2   3 , Guy Molenaers  2   4 , Kaat Desloovere  1   4
Affiliations

A new strength assessment to evaluate the association between muscle weakness and gait pathology in children with cerebral palsy

Marije Goudriaan et al. PLoS One. .

Abstract

Aim: The main goal of this validation study was to evaluate whether lower limb muscle weakness and plantar flexor rate of force development (RFD) related to altered gait parameters in children with cerebral palsy (CP), when weakness was assessed with maximal voluntary isometric contractions (MVICs) in a gait related test position. As a subgoal, we analyzed intra- and intertester reliability of this new strength measurement method.

Methods: Part 1 -Intra- and intertester reliability were determined with the intra-class correlation coefficient (ICC2,1) in 10 typical developing (TD) children (age: 5-15). We collected MVICs in four lower limb muscle groups to define maximum joint torques, as well as plantar flexor RFD. Part 2 -Validity of the strength assessment was explored by analyzing the relations of lower limb joint torques and RFD to a series of kinematic- and kinetic gait features, the GDI (gait deviation index), and the GDI-kinetic in 23 children with CP (GMFCS I-II; age: 5-15) and 23 TD children (age: 5-15) with Spearman's rank correlation coefficients.

Results: Part 1 -The best reliability was found for the torque data (Nm), with the highest ICC2,1 (0.951) for knee extension strength (inter) and the lowest (0.693) for dorsiflexion strength (intra). For plantar flexor RFD, the most reliable window size was 300 milliseconds (ICC2,1: 0.828 (inter) and 0.692 (intra)). Part 2 -The children with CP were significantly weaker than the TD children (p <0.001). Weakness of the dorsiflexors and plantar flexors associated with delayed and decreased knee flexion angle during swing, respectively. No other significant correlations were found.

Conclusion: While our new strength assessment was reliable, intra-joint correlations between weakness, RFD, and gait deviations were low. However, we found inter-joint associations, reflected by a strong association between plantar- and dorsiflexor weakness, and decreased and delayed knee flexion angle during swing.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

References

    1. Aisen ML, Kerkovich D, Mast J, Mulroy S, Wren T Al, Kay RM, et al. Cerebral palsy: clinical care and neurological rehabilitation. Lancet Neurol. 2011;10:844–52. doi: 10.1016/S1474-4422(11)70176-4 - DOI - PubMed
    1. Odding E, Roebroeck ME, Stam HJ. The epidemiology of cerebral palsy: incidence, impairments and risk factors. Disabil Rehabil [Internet]. 2006. February 28 [cited 2013 Sep 22];28(4):183–91. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16467053 doi: 10.1080/09638280500158422 - DOI - PubMed
    1. Gage JR, Schwartz MH, Koop SE, Novacheck TF. The identification and treatment of gait problems in cerebral palsy. 2nd ed John Wiley & Sons; 2009.
    1. Lieber RL. Skeletal muscle structure, function and plasticity. Wolters Kluwer, Lipincot Williams and Wilkins,Philidelphia & Baltimore;
    1. van der Krogt MM, Delp SL, Schwartz MH. How robust is human gait to muscle weakness? Gait Posture [Internet]. 2012. May [cited 2014 Jul 10];36(1):113–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22386624 doi: 10.1016/j.gaitpost.2012.01.017 - DOI - PMC - PubMed

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