Leg and Joint Stiffness in Children with Spastic Diplegic Cerebral Palsy during Level Walking. 2015

Ting-Ming Wang, and Hsing-Po Huang, and Jia-Da Li, and Shih-Wun Hong, and Wei-Ching Lo, and Tung-Wu Lu
Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan, R.O.C.

Individual joint deviations are often identified in the analysis of cerebral palsy (CP) gait. However, knowledge is limited as to how these deviations affect the control of the locomotor system as a whole when striving to meet the demands of walking. The current study aimed to bridge the gap by describing the control of the locomotor system in children with diplegic CP in terms of their leg stiffness, both skeletal and muscular components, and associated joint stiffness during gait. Twelve children with spastic diplegia CP and 12 healthy controls walked at a self-selected pace in a gait laboratory while their kinematic and forceplate data were measured and analyzed during loading response, mid-stance, terminal stance and pre-swing. For calculating the leg stiffness, each of the lower limbs was modeled as a non-linear spring, connecting the hip joint center and the corresponding center of pressure, with varying stiffness that was calculated as the slope (gradient) of the axial force vs. the deformation curve. The leg stiffness was further decomposed into skeletal and muscular components considering the alignment of the lower limb. The ankle, knee and hip of the limb were modeled as revolute joints with torsional springs whose stiffness was calculated as the slope of the moment vs. the angle curve of the joint. Independent t-tests were performed for between-group comparisons of all the variables. The CP group significantly decreased the leg stiffness but increased the joint stiffness during stance phase, except during terminal stance where the leg stiffness was increased. They appeared to rely more on muscular contributions to achieve the required leg stiffness, increasing the muscular demands in maintaining the body posture against collapse. Leg stiffness plays a critical role in modulating the kinematics and kinetics of the locomotor system during gait in the diplegic CP.

UI MeSH Term Description Entries
D007596 Joints Also known as articulations, these are points of connection between the ends of certain separate bones, or where the borders of other bones are juxtaposed. Joint
D007866 Leg The inferior part of the lower extremity between the KNEE and the ANKLE. Legs
D009132 Muscles Contractile tissue that produces movement in animals. Muscle Tissue,Muscle,Muscle Tissues,Tissue, Muscle,Tissues, Muscle
D002547 Cerebral Palsy A heterogeneous group of nonprogressive motor disorders caused by chronic brain injuries that originate in the prenatal period, perinatal period, or first few years of life. The four major subtypes are spastic, athetoid, ataxic, and mixed cerebral palsy, with spastic forms being the most common. The motor disorder may range from difficulties with fine motor control to severe spasticity (see MUSCLE SPASTICITY) in all limbs. Spastic diplegia (Little disease) is the most common subtype, and is characterized by spasticity that is more prominent in the legs than in the arms. Pathologically, this condition may be associated with LEUKOMALACIA, PERIVENTRICULAR. (From Dev Med Child Neurol 1998 Aug;40(8):520-7) Diplegic Infantile Cerebral Palsy,Little Disease,Monoplegic Cerebral Palsy,Quadriplegic Infantile Cerebral Palsy,Spastic Diplegia,CP (Cerebral Palsy),Cerebral Palsy, Athetoid,Cerebral Palsy, Atonic,Cerebral Palsy, Congenital,Cerebral Palsy, Diplegic, Infantile,Cerebral Palsy, Dyskinetic,Cerebral Palsy, Dystonic-Rigid,Cerebral Palsy, Hypotonic,Cerebral Palsy, Mixed,Cerebral Palsy, Monoplegic, Infantile,Cerebral Palsy, Quadriplegic, Infantile,Cerebral Palsy, Rolandic Type,Cerebral Palsy, Spastic,Congenital Cerebral Palsy,Diplegia, Spastic,Infantile Cerebral Palsy, Diplegic,Infantile Cerebral Palsy, Monoplegic,Infantile Cerebral Palsy, Quadriplegic,Little's Disease,Monoplegic Infantile Cerebral Palsy,Rolandic Type Cerebral Palsy,Athetoid Cerebral Palsy,Atonic Cerebral Palsy,Cerebral Palsies, Athetoid,Cerebral Palsies, Dyskinetic,Cerebral Palsies, Dystonic-Rigid,Cerebral Palsies, Monoplegic,Cerebral Palsy, Dystonic Rigid,Cerebral Palsy, Monoplegic,Diplegias, Spastic,Dyskinetic Cerebral Palsy,Dystonic-Rigid Cerebral Palsies,Dystonic-Rigid Cerebral Palsy,Hypotonic Cerebral Palsies,Hypotonic Cerebral Palsy,Mixed Cerebral Palsies,Mixed Cerebral Palsy,Monoplegic Cerebral Palsies,Spastic Cerebral Palsies,Spastic Cerebral Palsy,Spastic Diplegias
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D005684 Gait Manner or style of walking. Gaits
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001696 Biomechanical Phenomena The properties, processes, and behavior of biological systems under the action of mechanical forces. Biomechanics,Kinematics,Biomechanic Phenomena,Mechanobiological Phenomena,Biomechanic,Biomechanic Phenomenas,Phenomena, Biomechanic,Phenomena, Biomechanical,Phenomena, Mechanobiological,Phenomenas, Biomechanic
D016022 Case-Control Studies Comparisons that start with the identification of persons with the disease or outcome of interest and a control (comparison, referent) group without the disease or outcome of interest. The relationship of an attribute is examined by comparing both groups with regard to the frequency or levels of outcome over time. Case-Base Studies,Case-Comparison Studies,Case-Referent Studies,Matched Case-Control Studies,Nested Case-Control Studies,Case Control Studies,Case-Compeer Studies,Case-Referrent Studies,Case Base Studies,Case Comparison Studies,Case Control Study,Case Referent Studies,Case Referrent Studies,Case-Comparison Study,Case-Control Studies, Matched,Case-Control Studies, Nested,Case-Control Study,Case-Control Study, Matched,Case-Control Study, Nested,Case-Referent Study,Case-Referrent Study,Matched Case Control Studies,Matched Case-Control Study,Nested Case Control Studies,Nested Case-Control Study,Studies, Case Control,Studies, Case-Base,Studies, Case-Comparison,Studies, Case-Compeer,Studies, Case-Control,Studies, Case-Referent,Studies, Case-Referrent,Studies, Matched Case-Control,Studies, Nested Case-Control,Study, Case Control,Study, Case-Comparison,Study, Case-Control,Study, Case-Referent,Study, Case-Referrent,Study, Matched Case-Control,Study, Nested Case-Control
D016138 Walking An activity in which the body advances at a slow to moderate pace by moving the feet in a coordinated fashion. This includes recreational walking, walking for fitness, and competitive race-walking. Ambulation

Related Publications

Ting-Ming Wang, and Hsing-Po Huang, and Jia-Da Li, and Shih-Wun Hong, and Wei-Ching Lo, and Tung-Wu Lu
October 2019, Journal of pediatric orthopedics,
Ting-Ming Wang, and Hsing-Po Huang, and Jia-Da Li, and Shih-Wun Hong, and Wei-Ching Lo, and Tung-Wu Lu
February 1997, Developmental medicine and child neurology,
Ting-Ming Wang, and Hsing-Po Huang, and Jia-Da Li, and Shih-Wun Hong, and Wei-Ching Lo, and Tung-Wu Lu
June 1989, Archives of physical medicine and rehabilitation,
Ting-Ming Wang, and Hsing-Po Huang, and Jia-Da Li, and Shih-Wun Hong, and Wei-Ching Lo, and Tung-Wu Lu
January 2000, Developmental medicine and child neurology,
Ting-Ming Wang, and Hsing-Po Huang, and Jia-Da Li, and Shih-Wun Hong, and Wei-Ching Lo, and Tung-Wu Lu
March 2014, European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society,
Ting-Ming Wang, and Hsing-Po Huang, and Jia-Da Li, and Shih-Wun Hong, and Wei-Ching Lo, and Tung-Wu Lu
October 2004, Gait & posture,
Ting-Ming Wang, and Hsing-Po Huang, and Jia-Da Li, and Shih-Wun Hong, and Wei-Ching Lo, and Tung-Wu Lu
January 2011, NeuroRehabilitation,
Ting-Ming Wang, and Hsing-Po Huang, and Jia-Da Li, and Shih-Wun Hong, and Wei-Ching Lo, and Tung-Wu Lu
March 2007, Journal of pediatric orthopedics,
Ting-Ming Wang, and Hsing-Po Huang, and Jia-Da Li, and Shih-Wun Hong, and Wei-Ching Lo, and Tung-Wu Lu
January 2023, Iranian journal of child neurology,
Ting-Ming Wang, and Hsing-Po Huang, and Jia-Da Li, and Shih-Wun Hong, and Wei-Ching Lo, and Tung-Wu Lu
July 2010, The Kaohsiung journal of medical sciences,
Copied contents to your clipboard!