Manikowska Faustyna, Brazevič Sabina, Jóźwiak Marek, Lebiedowska Maria K
Department of Pediatric Orthopedics and Traumatology, Poznań University of Medical Sciences, 61-701 Poznań, Poland.
Independent Researcher, Edmonton, AB T5R 2R2, Canada.
J Pers Med. 2022 Sep 23;12(10):1568. doi: 10.3390/jpm12101568.
The coexistence of overlapping impairments modulates the knee pattern in the swing phase of walking in children with cerebral palsy (CP). The impact and contribution of each impairment to the reduction of knee range-of-motion is unknown. The aim of the study was to establish the gradation of the impact of individual coexisting impairments on the knee flexion range-of-motion. Passive range-of-motion, selective motor control, strength, and spasticity from 132 patients (Male = 76, Female = 56, age:11 ± 4 years) with spastic CP were tested with clinical tools. Knee flexion range-of-motion at terminal stance, pre-swing, and initial swing phases were assessed by gait analysis. Hypertonia (β = −5.75) and weakness (β = 2.76) of knee extensors were associated with lower range of knee flexion (R2 = 0.0801, F = 11.0963, p < 0.0001). The predictive factors (R2 = 0.0744, F = 7.2135, p < 0.0001) were strength (β = 4.04) and spasticity (β = −2.74) of knee extensors and strength of hip flexors (β = −2.01); in swing those were knee extensors hypertonia (β = −2.55) and passive range of flexion (β = 0.16) (R2 = 0.0398, F = 3.4010, p = 0.01). Hypertonia of knee extensors has the strongest impact on knee flexion range-of-motion; secondary is the strength of knee extensors. The knee extensors strength with knee extensors hypertonia and strength of hip flexors contributes in stance. Knee extensors hypertonia with passive knee flexion range-of-motion contributes in swing.
重叠损伤的共存会调节脑瘫（CP）患儿步行摆动期的膝关节运动模式。每种损伤对膝关节活动度降低的影响和作用尚不清楚。本研究的目的是确定个体共存损伤对膝关节屈曲活动度影响的等级。使用临床工具对132例痉挛型CP患者（男性 = 76例，女性 = 56例，年龄：11±4岁）的被动活动度、选择性运动控制、力量和痉挛情况进行测试。通过步态分析评估终末站立、摆动前期和初始摆动期的膝关节屈曲活动度。膝关节伸肌的张力亢进（β = -5.75）和无力（β = 2.76）与较低的膝关节屈曲活动度相关（R2 = 0.0801，F = 11.0963，p < 0.0001）。预测因素（R2 = 0.0744，F = 7.2135，p < 0.0001）为膝关节伸肌的力量（β = 4.04）和痉挛（β = -2.74）以及髋部屈肌的力量（β = -2.01）；在摆动期，预测因素为膝关节伸肌的张力亢进（β = -2.55）和被动屈曲活动度（β = 0.16）（R2 = 0.0398，F = 3.4010，p = 0.01）。膝关节伸肌的张力亢进对膝关节屈曲活动度的影响最大；其次是膝关节伸肌力量。膝关节伸肌力量与膝关节伸肌张力亢进和髋部屈肌力量在站立期起作用。膝关节伸肌张力亢进与被动膝关节屈曲活动度在摆动期起作用。
