Yonsei Med J.  2016 Jan;57(1):217-224. 10.3349/ymj.2016.57.1.217.

Relationships between Isometric Muscle Strength, Gait Parameters, and Gross Motor Function Measure in Patients with Cerebral Palsy

• Shin HI
• Sung KH
• Chung CY
• Lee KM
• Lee SY
• Lee IH
• Park MS

• KMID: 2466373
• DOI: http://doi.org/10.3349/ymj.2016.57.1.217

Abstract

PURPOSE
This study investigated the correlation between isometric muscle strength, gross motor function, and gait parameters in patients with spastic cerebral palsy and to find which muscle groups play an important role for gait pattern in a flexed knee gait.
MATERIALS AND METHODS
Twenty-four ambulatory patients (mean age, 10.0 years) with spastic cerebral palsy who were scheduled for single event multilevel surgery, including distal hamstring lengthening, were included. Preoperatively, peak isometric muscle strength was measured for the hip flexor, hip extensor, knee flexor, and knee extensor muscle groups using a handheld dynamometer, and three-dimensional (3D) gait analysis and gross motor function measure (GMFM) scoring were also performed. Correlations between peak isometric strength and GMFM, gait kinematics, and gait kinetics were analyzed.
RESULTS
Peak isometric muscle strength of all muscle groups was not related to the GMFM score and the gross motor function classification system level. Peak isometric strength of the hip extensor and knee extensor was significantly correlated with the mean pelvic tilt (r=-0.588, p=0.003 and r=-0.436, p=0.033) and maximum pelvic obliquity (r=-0.450, p=0.031 and r=-0.419, p=0.041). There were significant correlations between peak isometric strength of the knee extensor and peak knee extensor moment in early stance (r=0.467, p=0.021) and in terminal stance (r=0.416, p=0.043).
CONCLUSION
There is no correlation between muscle strength and gross motor function. However, this study showed that muscle strength, especially of the extensor muscle group of the hip and knee joints, might play a critical role in gait by stabilizing pelvic motion and decreasing energy consumption in a flexed knee gait.

Keyword

Muscle strength; gross motor function; gait parameter; cerebral palsy

MeSH Terms

Biomechanical Phenomena
Cerebral Palsy/*physiopathology/surgery
Female
Gait/*physiology
Humans
Isometric Contraction/physiology
Knee/physiopathology
Knee Joint/surgery
Male
Muscle Spasticity/etiology/physiopathology
Muscle Strength/*physiology
Muscle Strength Dynamometer
Muscle, Skeletal/*physiopathology
Pelvis
Postural Balance/physiology
Tenotomy

Figure

• 

  Fig. 1 Measurement of peak isometric strength for the hip flexor (A), hip extensor (B), knee flexor (C), and knee extensor (D) muscle group. (A and B) The leg to be measured is flexed at 90° at the hip and knee joint. The patient may hold the examination table and presses toward the ground with the other leg as depicted. The dynamometer is fixed to a rigid frame. The patient presses the knee slowly forward (A) or backward (B) against the band and the pelvis stays rigid. (C and D) Knee joint to be measured is flexed at 90° and hands are relaxed or folded. The band is placed on the lower leg, with its distal border as close as possible to the ankle joint and the dynamometer is fixed to a rigid frame. The patient presses the lower legs slowly backward (C) or forward (D) against the band. The trunk remains upright and no weight shifting is allowed.

• 

  Fig. 2 Scatter plots of isometric muscle strength and gait kinematics.

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