UCLA/Orthopaedic Hospital Center for Cerebral Palsy, David Geffen School of Medicine at UCLA, 22-64 Rehabilitation Center, 1000 Veteran Avenue, Los Angeles, CA 90095-1795, USA.
Clin Orthop Relat Res. 2012 May;470(5):1320-6. doi: 10.1007/s11999-011-2028-2.
Preliminary evidence suggests selective voluntary motor control (SVMC), defined as performance of isolated voluntary joint movement on request, may be an important factor affecting functional movement tasks. Individuals with poor SVMC are unable to dissociate hip and knee synergistic movement during the swing phase of gait and have difficulty extending their knee while the hip is flexing during terminal swing regardless of hamstring length. This pattern may limit their ability to take advantage of hamstring-lengthening surgery (HLS) and may explain a lack of improved stride length postoperatively.
QUESTIONS/PURPOSES: Provide a preliminary clinical and conceptual framework for using SVMC to predict swing phase parameters of gait after HLS.
We contrasted two patients with spastic diplegia of similar age, gross motor function, and spasticity but with different SVMC scores using the Selective Control Assessment of the Lower Extremity (SCALE). The patients underwent bilateral HLS. Popliteal angles, joint kinematics, step length, stride length, and walking velocity were assessed pre- and postoperatively.
Popliteal angles, terminal knee extension, and knee range of motion improved for both patients. However, only the patient with higher SCALE scores improved stride length postoperatively.
Although preliminary, the data suggest that SVMC, as measured by SCALE, may be a prognostic factor for improved stride length after HLS in patients with spastic diplegia.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
初步证据表明，选择性自主运动控制（SVMC），即根据要求进行孤立的自主关节运动，可能是影响功能性运动任务的一个重要因素。SVMC 较差的个体在步态摆动相时无法分离髋关节和膝关节协同运动，并且在终末摆动时髋关节弯曲时难以伸展膝关节，无论腘绳肌长度如何。这种模式可能限制了他们利用腘绳肌延长术（HLS）的能力，并可能解释了术后跨步长度没有改善的原因。
问题/目的：提供使用 SVMC 预测 HLS 后步态摆动相参数的初步临床和概念框架。
我们对比了两名年龄、粗大运动功能和痉挛程度相似但 SVMC 评分不同的痉挛性双瘫患者，使用选择性下肢控制评估（SCALE）进行评估。患者均接受双侧 HLS。术前和术后评估腘窝角、关节运动学、步长、跨步长度和行走速度。
两名患者的腘窝角、终末膝关节伸展和膝关节活动范围均得到改善。然而，只有 SCALE 评分较高的患者术后跨步长度得到改善。
尽管初步，但数据表明，SCALE 测量的 SVMC 可能是痉挛性双瘫患者 HLS 后改善跨步长度的预后因素。
IV 级，治疗研究。有关证据水平的完整描述，请参见作者指南。
