scholarly journals Development of Lower Extremity Strength in Ambulatory Children With Bilateral Spastic Cerebral Palsy in Comparison With Typically Developing Controls Using Absolute and Normalized to Body Weight Force Values

2021 ◽  
Vol 12 ◽  
Author(s):  
Nicolaos Darras ◽  
Eirini Nikaina ◽  
Magda Tziomaki ◽  
Georgios Gkrimas ◽  
Antigone Papavasiliou ◽  
...  
Keyword(s):  
Body Weight ◽  
Cerebral Palsy ◽  
Muscle Strength ◽  
Lower Limb ◽  
Age Groups ◽  
Knee Extensors ◽  
Spastic Cerebral Palsy ◽  
Typically Developing ◽  
Antagonist Muscles ◽  
Muscle Groups

This cross-sectional study aimed to examine the development of lower limb voluntary strength in 160 ambulatory patients with bilateral spastic cerebral palsy (CP) (106 diplegics/54 quadriplegics) and 86 typically developing (TD) controls, aged 7–16 years. Handheld dynamometry was used to measure isometric strength of seven muscle groups (hip adductors and abductors, hip extensors and flexors, knee extensors and flexors, and ankle dorsiflexors); absolute force (AF) values in pounds were collected, which were then normalized to body weight (NF). AF values increased with increasing age (p < 0.001 for all muscle groups), whereas NF values decreased through adolescence (p < 0.001 for all muscle groups except for hip abduction where p = 0.022), indicating that increases in weight through adolescence led to decreases in relative force. Both AF and NF values were significantly greater in TD subjects when compared with children with CP in all muscle and all age groups (p < 0.001). Diplegics and quadriplegics demonstrated consistently lower force values than TD subjects for all muscle groups, except for the hip extensors where TD children had similar values with diplegics (p = 0.726) but higher than quadriplegics (p = 0.001). Diplegic patients also exhibited higher values than quadriplegics in all muscles, except for the knee extensors where their difference was only indicative (p = 0.056). The conversion of CP subjects' force values as a percentage of the TD subjects' mean value revealed a pattern of significant muscle strength imbalance between the CP antagonist muscles, documented from the following deficit differences for the CP muscle couples: (hip extensors 13%) / (hip flexors 32%), (adductors 27%) / (abductors 52%), and (knee extensors 37%) / (knee flexors 53%). This pattern was evident in all age groups. Similarly, significant force deficiencies were identified in GMFCS III/IV patients when compared with TD children and GMFCS I/II patients. In this study, we demonstrated that children and adolescents with bilateral CP exhibited lower strength values in lower limb muscles when compared with their TD counterparts. This difference was more prevalent in quadriplegic patients and those with a more severe impairment. An important pattern of muscle strength imbalance between the antagonist muscles of the CP subjects was revealed.

Reliability and validity of hand-held dynamometry for assessing lower limb muscle strength

2021 ◽  
pp. 1-10
Author(s):  
Tjaša Lipovšek ◽  
Alan Kacin ◽  
Urška Puh
Keyword(s):  
Muscle Strength ◽  
Lower Limb ◽  
Reliability And Validity ◽  
Knee Extensors ◽  
Lower Limb Muscle ◽  
Limb Muscle ◽  
Rater Reliability ◽  
Extensor Muscles ◽  
Good For ◽  
Muscle Groups

BACKGROUND: Hand-held dynamometry (HHD) is used to assess muscle strength in various patient populations, but many variations in protocols exist. OBJECTIVE: First, to systematically develop a protocol of HHD for all lower limb muscle groups and evaluate intra-rater reliability; second, to validate HHD with fixed dynamometry for the knee flexor and extensor muscles. METHODS: Thirty healthy young adults (women: men – 15:15) participated in two testing sessions. HHD of 12 lower limb muscle groups was performed in both sessions, while fixed dynamometry of knee muscle groups was performed only in the second session. RESULTS: The intra-rater reliability of HHD was good for five muscle groups and excellent for seven muscle groups (ICC3, k= 0.80–0.96). The criterion validity of HHD ranged from very good to excellent for the knee flexors (r= 0.77–0.89) and from good to very good for the knee extensors (r= 0.65–0.78). However, peak moment values for the knee extensor muscles were underestimated by 32% (p< 0.001). CONCLUSIONS: The proposed HHD protocol provides reliable and valid measurements of lower limb muscle isometric strength in healthy adults, which may also be used to test patients with mild muscle strength deficits. However, possible underestimation of absolute strength must be considered when interpreting the results of knee extensors or other large muscles.

Antagonist muscle strength development, of the lower extremities of ambulatory children with bilateral spastic cerebral palsy, in comparison to typically developing controls

2013 ◽  
Vol 38 ◽  
pp. S12-S13
Author(s):  
Nikolaos Darras ◽  
Dimitris Pasparakis ◽  
Magda Tziomaki ◽  
Christos Nestoridis ◽  
Manoussos Pentarakis ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Muscle Strength ◽  
Lower Extremities ◽  
Spastic Cerebral Palsy ◽  
Strength Development ◽  
Typically Developing ◽  
Antagonist Muscle

Effects of the use neuromuscular electrical stimulation of the lower extremities in the prehabilitation of patients in a before cardiac surgery

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
P Oleinik ◽  
AN Sumin ◽  
AV Bezdenezhnykh
Keyword(s):  
Cardiac Surgery ◽  
Handgrip Strength ◽  
Lower Extremities ◽  
Left Knee ◽  
Knee Extensors ◽  
Control Group ◽  
Elective Cardiac Surgery ◽  
Antagonist Muscles ◽  
Muscle Groups ◽  
Knee Flexors

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Research Institute for Complex Issues of Cardiovascular Diseases Aim To evaluate the effects of neuromuscular electrostimulation in the prehabilitation and prevention of muscle weakness in patients awaiting cardiac surgery. Materials and methods 122 patients waiting for elective cardiac surgery were included. Exclusion criteria: age less than 25 and more than 80 years; emergency and urgent surgical interventions; arthropathies; low pain threshold; rhabdomyolysis and other myopathies; cognitive dysfunction. Routine laboratory and instrumental examinations were performed in all patients upon admission to the hospital, as part of a standard examination. 62 patients were randomly selected for the preoperative NMES group, in addition to the standard preoperative preparation and treatment program. The standard program included 60 control patients. Patients of the NMES group underwent quadriceps stimulation for at least 5 sessions, lasting 90 minutes, daily before surgery. Results. The groups were comparable and did not have significant differences in gender and age characteristics, according to the main clinical and anamnestic data and types of operations. Initially, there were no differences in the state of the muscles of the lower extremities, the distance of the six-minute walking test (6MWT), and the strength of the hand grip. After NMES, there was an increase in muscle strength relative to the control group, both stimulated muscle groups and unstimulated antagonist muscles, as well as a greater 6MWT distance and hand compression force. All the differences were significant. Conclusions The course of pre-rehabilitation of NMES before surgery, allowed to maintain, and in some cases improve the condition of the muscle frame of the lower extremities. A positive effect was observed not only in stimulated muscle groups, but also in antagonist muscles Indicators of muscle status NMES (n = 62) Control group (n = 60) Baseline Discharge Baseline Discharge P-level Right knee extensors strength (kg) 24,4 [18,3; 31,4] 30,4 [23,8; 36,2]* 24,7 [20,1; 33,2] 22,25 [18,9; 30,4] &lt;0,001 Left knee extensors strength (kg) 23,8 [19,3; 31,3] 29,2 [23,6; 35,4]* 25,75 [19,2; 31,3] 22,9 [18,9; 27,8] &lt;0,001 Right knee flexors strength (kg) 18,9 [13,3; 24,0] 21,7 [16,6; 25,1] 19,55 [13,1; 26,0] 16,7 [12,1; 23,3] 0,006 Left knee flexors strength (kg) 19,3 [14,3; 24,5] 21,9 [17,3; 26,7] 19,5 [13,0; 24,3] 18,2 [13,4; 22,2] 0,005 6-MWT (m) 300,0 [261,0; 371,0] 331,0 [280,0; 375,0] 304,5 [253,0; 380,0] 285,5 [246,0; 342,0] 0,006 Right handgrip strength (kg) 28,5 [20,5; 34,0] 31,5 [22,0; 34,0] 29,0 [19,0; 34,0] 27,0 [19,0; 33,0] 0,054 Left handgrip strength (kg) 25,0 [18,0; 31,0] 25,0 [18,0; 32,0] 24,0 [15,0; 31,0] 22,0 [14,0; 28,0] 0,062 * - p-level from baseline data &lt; 0,05 Abstract Figure. dynamics of stimulated muscles

Improving gait and lower-limb muscle strength in children with cerebral palsy following Selective Percutaneous Myofascial Lengthening and functional physiotherapy

2019 ◽  
Vol 43 (4) ◽  
pp. 361-368 ◽  
Author(s):  
Vasileios C. Skoutelis ◽  
Anastasios Kanellopoulos ◽  
Stamatis Vrettos ◽  
Georgios Gkrimas ◽  
Vasileios Kontogeorgakos
Keyword(s):  
Cerebral Palsy ◽  
Muscle Strength ◽  
Lower Limb ◽  
Lower Limb Muscle ◽  
Limb Muscle ◽  
Children With Cerebral Palsy

Interventions and lower‐limb macroscopic muscle morphology in children with spastic cerebral palsy: a scoping review

2020 ◽  
Author(s):  
Fenna Walhain ◽  
Kaat Desloovere ◽  
Marlies Declerck ◽  
Anja Van Campenhout ◽  
Lynn Bar‐On
Keyword(s):  
Cerebral Palsy ◽  
Scoping Review ◽  
Lower Limb ◽  
Spastic Cerebral Palsy ◽  
Muscle Morphology

Ambulant adults with spastic cerebral palsy: The validity of lower limb joint angle measurements from sagittal video recordings

2012 ◽  
Vol 35 (2) ◽  
pp. 186-191 ◽  
Author(s):  
Kerstin L. Larsen ◽  
Grethe Maanum ◽  
Kathrine F. Frøslie ◽  
Reidun Jahnsen
Keyword(s):  
Cerebral Palsy ◽  
Lower Limb ◽  
Joint Angle ◽  
Spastic Cerebral Palsy ◽  
Video Recordings ◽  
Angle Measurements

A Study of Effects of Intervention of Botulinum Toxin- A on Lower Limb in Children with Spastic Cerebral Palsy

2015 ◽  
Vol 26 (4) ◽  
pp. 94-101
Author(s):  
U Singh ◽  
Raj Kumar ◽  
Sanjay Wadhwa ◽  
SL Yadav
Keyword(s):  
Cerebral Palsy ◽  
Botulinum Toxin ◽  
Range Of Motion ◽  
Lower Limb ◽  
Stride Length ◽  
Botulinum Toxin A ◽  
Step Length ◽  
Spastic Cerebral Palsy ◽  
Toxin A ◽  
Base Of Support

Abstract Objective Analysis of clinical gait pattern, change in spasticity and range of motion (ROM) in cerebral palsy patient (CP) with spastic lower limb muscle after injecting botulinum toxin- A. Study Design Prospective study Methods 28 children (18 male and 10 female) with spastic CP had problems in normal walking, aged 2–9 years (mean age 4.65 years), consecutively treated in the PMR department over a 2-year period, were prospectively followed-up and clinically assessed pre- and post-treatment (at 2 weeks and 2 months) both objectively and subjectively. Objective assessment included gait parameters -- stride length, cadence, velocity, step length, base of support; active and passive range of motion (ROM), (measured by goniometry) and spasticity on modified Ashworth scale. Subjective assessment was done by asking questionnaire in terms of comfort, ease of care, perineal hygiene, walking. Injections were given using clinical palpatory method on OPD basis. All patients received botulinum toxin-A injections, followed with exercises and activities and orthosis as needed. Results Significant improvement was achieved for spasticity reduction in gastrocnemius (p< 0.001), hamstring and adductor (p=0.050), ankle AROM & PROM (p< 0.001), active knee extension (p=0.009), popliteal angle (p=0.015) and percentage left and right foot contact (p< 0.001), whereas non-significant change was observed in step length, cadence, velocity, stride length, and base of support. Parents felt subjective improvement in most of the cases (>90%). Conclusions Botulinum toxin- A injection is effective in the treatment of spastic lower limb muscles for equinus/ crouching/scissoring gait in cerebral palsy children. The treatment was feasible and easily implemented. Botulinum toxin- A injections were well tolerated, yielded no serious treatment-related adverse events.

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