Department of Sports Medicine, China Medical University, 91 Hsueh-Shih Road, Taichung 40402, Taiwan.
Res Dev Disabil. 2012 Nov-Dec;33(6):2308-16. doi: 10.1016/j.ridd.2012.07.010. Epub 2012 Jul 31.
The aim of this study was to evaluate the relationships of muscle strength at different angular velocities and gross motor functions in ambulatory children with cerebral palsy (CP). This study included 33 ambulatory children with spastic CP aged 6-15 years and 15 children with normal development. Children with CP were categorized into level I (n=17) or level II (n=16) according to Gross Motor Function Classification System (GMFCS) levels. All children underwent curl-up test and isokinetic tests of the knee extensor and flexor muscle. Children with CP underwent the gross motor function assessments, including the Gross Motor Function Measure (GMFM-66) and the gross motor subtests of Bruininks-Oseretsky Test of Motor Proficiency (BOTMP). The hamstring-quadriceps ratio (HQ ratio) was calculated as 100%×(isokinetic peak torque of hamstring (knee flexor)/isokinetic peak torque of quadriceps (knee extensor)). Children with GMFCS level II had lower BOTMP and GMFM-66 scores, curl-up scores, HQ ratio, and knee muscle strength, especially knee flexor, compared to those with GMFCS level I. The regression analysis showed that knee flexor torques at 60 and 90°/s are mainly related to balance (r(2)=0.167, p=0.011) and strength (r(2)=0.243, p=0.002) while knee flexor torques at 120°/s mainly contribute to running speed and agility (r(2)=0.372, p<0.001). These findings suggest that children with CP had knee strength deficits, especially knee flexor. Postural muscle (knee flexor) strength dominated gross motor function than antigravity muscle strength (knee extensor). The knee flexor strength at different angular velocities was associated with various gross motor tasks. The HQ ratio may be used as a potential biomarker to probe the therapeutic effectiveness for muscle strengthening in these children. These data may allow clinician for formulating effective muscle strengthening strategies for these children.
本研究旨在评估不同角速度下肌肉力量与脑瘫（CP）患儿步行能力之间的关系。本研究纳入了 33 名 6-15 岁痉挛型 CP 患儿和 15 名正常发育儿童。根据粗大运动功能分类系统（GMFCS）水平，CP 患儿分为 1 级（n=17）或 2 级（n=16）。所有儿童均行卷腹试验和膝关节伸肌、屈肌等速测试。CP 患儿还接受粗大运动功能评估，包括粗大运动功能测量（GMFM-66）和 Bruininks-Oseretsky 运动能力测试（BOTMP）的粗大运动子测试。腘绳肌/四头肌比率（HQ 比）计算为 100%×（膝关节屈肌等速峰值扭矩/膝关节伸肌等速峰值扭矩）。与 GMFCS 1 级患儿相比，GMFCS 2 级患儿的 BOTMP 和 GMFM-66 评分、卷腹评分、HQ 比以及膝关节肌肉力量（尤其是膝关节屈肌）均较低。回归分析显示，60°/s 和 90°/s 时膝关节屈肌扭矩主要与平衡（r(2)=0.167，p=0.011）和力量（r(2)=0.243，p=0.002）相关，而 120°/s 时膝关节屈肌扭矩主要与跑步速度和敏捷性相关（r(2)=0.372，p<0.001）。这些发现表明 CP 患儿存在膝关节力量缺陷，尤其是膝关节屈肌。姿势肌（膝关节屈肌）力量比抗重力肌力量（膝关节伸肌）更能主导粗大运动功能。不同角速度下的膝关节屈肌力量与各种粗大运动任务相关。HQ 比可能作为一种潜在的生物标志物，用于探究这些患儿肌肉强化治疗的效果。这些数据可能有助于临床医生为这些患儿制定有效的肌肉强化策略。
