College of Health Professions, Medical University of South Carolina, 77 President St, Charleston, SC, USA.
Institute of Human Movement Science, Sport and Health, Department of Biomechanics, Training and Movement Science, University of Graz, Mozartgasse 14, Graz, A-8010, Austria.
Gait Posture. 2021 Mar;85:14-19. doi: 10.1016/j.gaitpost.2021.01.009. Epub 2021 Jan 14.
Cerebral palsy (CP) is the most common motor and movement disability in childhood. The mechano-morphological alterations of the spastic muscle itself as well as the functional limitations in CP are well documented. However, the relationship between muscle tendon properties and functional tests in CP remains unknown.
The aim of this study was to explore the relationship between spastic muscle mechano-morphological properties and functional performance in children with CP.
This study included retrospective data from 22 children with spastic cerebral palsy with a mean age of 12.8 years (19 GMFCS I/3 GMFC II, 15 male/7 female, 8 unilateral involved/14 bilateral). Mechano-morphological properties of gastrocnemius (GM) and Achilles tendon (AT) were correlated with a variety of functional measures, maximal isometric strength, the Muscle Power Sprint test (MPST), 6-minute walk test (6MWT) and 3D-gait analysis using the Pearson Coefficient.
Muscle-tendon properties were normalized to remove anthropometric dimensions because of strong associations with anthropometric data. Higher isometric muscle strength was related to longer normalized GM fascicle lengths (r = 0.67, p < 0.01). The distance reached in the 6MWT positively correlated with normalized GM fascicle lengths (r = 0.61, p < 0.01). Higher AT stiffness was associated with faster performance in the MPST (r = 0.77, p < 0.01). Finally, there was an association between ankle power and both longer normalized AT length and shorter muscle belly (r = 0.60 and r = 0.54, p < 0.01).
The findings of this study give more insight into the function specific adaptations of a spastic muscle-tendon unit. While walking, assessed through the 6MWT, was related to normalized gastrocnemius fascicle length, sprint performance was associated with an increased AT stiffness. These results provide a better understanding of the relationship between functional tasks and spastic muscle-tendon properties, which offers potential for improved and targeted interventions in CP.
脑瘫（CP）是儿童中最常见的运动和运动障碍。痉挛肌肉本身的力学形态改变以及 CP 中的功能限制已得到充分记录。然而，CP 中肌肉肌腱特性与功能测试之间的关系尚不清楚。
本研究旨在探讨痉挛性肌肉力学形态特性与 CP 儿童功能表现之间的关系。
本研究包括 22 名痉挛性脑瘫儿童的回顾性数据，平均年龄为 12.8 岁（19 名 GMFCS I/3 GMFC II，15 名男性/7 名女性，8 名单侧受累/14 名双侧受累）。跟腱（AT）和腓肠肌（GM）的力学形态特性与各种功能测量、最大等长肌力、肌肉力量短跑测试（MPST）、6 分钟步行测试（6MWT）和 3D 步态分析进行了相关分析，使用 Pearson 相关系数。
由于与人体测量数据有很强的关联，肌肉肌腱特性被归一化以去除人体测量尺寸。较高的等长肌肉力量与较长的 GM 束长度归一化值呈正相关（r = 0.67，p < 0.01）。6MWT 中达到的距离与 GM 束长度归一化值呈正相关（r = 0.61，p < 0.01）。较高的 AT 硬度与 MPST 中更快的表现相关（r = 0.77，p < 0.01）。最后，踝关节力量与 AT 长度归一化值和肌腹缩短值呈正相关（r = 0.60 和 r = 0.54，p < 0.01）。
本研究的结果更深入地了解了痉挛性肌肉肌腱单元的特定功能适应性。虽然在评估 6MWT 时与 GM 束长度归一化值相关的行走，但与 AT 刚度增加相关的冲刺表现。这些结果提供了对功能任务与痉挛性肌肉肌腱特性之间关系的更好理解，这为 CP 中更有针对性的干预提供了潜力。
