Department of Physical Therapy, Toyohashi SOZO University, Toyohashi, Japan.
Disabil Rehabil. 2010;32(15):1232-41. doi: 10.3109/09638280903464455.
We investigated body alignment and muscle activity at quiet standing and anteroposterior stability limits in children with spastic diplegic cerebral palsy (SDCP).
Body alignment and electromyographic (EMG) activity of ventral and dorsal lower limb muscles at three different standing positions were compared between seven children with SDCP (SDCP(group)) and seven controls [typically developing (TD(group))]. We also compared these measurements in a child with SDCP before and after a 3-week training in which the child leant forward and maintained the forward-leaning posture with the help of a physiotherapist who manually held her lower limbs fixed in position.
In TD(group), EMG activity of the dorsal muscles increased at the extreme forward-leaning position, whereas that of the ventral muscles increased at the extreme backward-leaning position. In SDCP(group), such direction-specific increases were observed in lower leg muscles but not in thigh muscles. As a result of training, direction-specific activity in the dorsal muscles improved, and crouch posture was also improved.
Our findings suggest that children with SDCP have difficulty modulating muscle activity while standing and that the quadriceps plays a critical role in maintaining couch posture. In addition, crouch posture may be improved by the training which focuses on control of the dorsal muscles.
我们研究了痉挛性双瘫脑瘫（SDCP）患儿在安静站立和前后稳定性极限时的身体姿势和肌肉活动。
将 7 名 SDCP 患儿（SDCP 组）与 7 名对照组（正常发育 TD 组）在三种不同的站立姿势下的下肢前、后向肌肉的肌电图（EMG）活动进行了比较。我们还比较了一名 SDCP 患儿在接受 3 周训练前后的这些测量值，在训练中，患儿在治疗师的帮助下向前倾斜，并通过治疗师手动固定下肢的位置来保持前倾姿势。
在 TD 组中，在极度前倾的位置时，背侧肌肉的 EMG 活动增加，而在极度后倾的位置时，腹侧肌肉的 EMG 活动增加。在 SDCP 组中，小腿肌肉出现了这种方向特异性的增加，但大腿肌肉没有。经过训练，背侧肌肉的方向特异性活动得到了改善，并且蹲伏姿势也得到了改善。
我们的发现表明，SDCP 患儿在站立时难以调节肌肉活动，股四头肌在维持蹲伏姿势中起着关键作用。此外，通过专注于控制背侧肌肉的训练，可以改善蹲伏姿势。
