Department of Pediatrics, Hasbro Children's Hospital, Providence, RI 02905, USA.
Center for Applied Brain and Cognitive Sciences, Tufts University, Medford, MA 02155, USA.
Hum Mov Sci. 2021 Dec;80:102875. doi: 10.1016/j.humov.2021.102875. Epub 2021 Nov 1.
Muscle clinical metrics are crucial for spastic cocontraction management in children with Cerebral Palsy (CP). We investigated whether the ankle plantar flexors cocontraction index (CCI) normalized with respect to the bipedal heel rise (BHR) approach provides more robust spastic cocontraction estimates during gait than those obtained through the widely accepted standard maximal isometric plantar flexion (IPF).
Ten control and 10 CP children with equinus gait pattern performed the BHR and IPF testing and walked barefoot 10-m distance. We compared agonist medial gastrocnemius EMG during both testing and CCIs obtained as the ratios of antagonist EMG during swing phase of gait and either BHR or IPF agonist EMG.
Agonist EMG values from the BHR were: (i) internally reliable (Cronbach's α = 0.993), (ii) ~50 ± 0.4% larger than IPF, (iii) and positively correlated. Derived CCIs were significantly smaller (p < 0.05) in both populations.
The bipedal heel rise approach may be accurate enough to reveal greater agonist activity of plantar flexors than the maximal isometric plantar flexion and seems to be more appropriate to obtain cocontraction estimates during swing of gait.
This modified biomarker may represent a step forward towards improved accuracy of spastic gait management in pediatric.
肌肉临床指标对于脑瘫（CP）患儿痉挛性共收缩的管理至关重要。我们研究了相对于双足足跟抬起（BHR）方法，将踝跖屈肌共收缩指数（CCI）归一化为双足足跟抬起是否能在步态中提供更可靠的痉挛性共收缩估计，而不是通过广泛接受的标准最大等长跖屈（IPF）来获得。
10 名正常儿童和 10 名痉挛性马蹄内翻足的 CP 患儿进行了 BHR 和 IPF 测试，并赤脚行走 10 米。我们比较了在两种测试和 CCIs 中获得的拮抗剂肌电图在摆动相期间的比，CCIs 是通过将拮抗剂 EMG 与 BHR 或 IPF 激动剂 EMG 的比值来获得。
BHR 的激动剂 EMG 值为：（i）内部可靠（Cronbach's α=0.993），（ii）比 IPF 大~50±0.4%，（iii）呈正相关。在两个群体中，衍生的 CCIs 显著较小（p<0.05）。
双足足跟抬起的方法可能足够准确，以揭示比最大等长跖屈更大的跖屈肌激动剂活性，并且似乎更适合在摆动相期间获得共收缩估计。
这种改良的生物标志物可能代表了在儿科中提高痉挛性步态管理准确性的一个进步。
