Publications

Objectives: To compare muscle tone and stiffness in ambulatory children with unilateral spastic cerebral palsy (UCP) with typically developing peers and explore their relationship with postural balance and functional mobility.

Methods: Forty ambulatory children with UCP and age-matched typically developing peers were assessed for tone and stiffness of lumbar spinal extensors, gastrocnemius, and hamstring muscles using a myotonometer. Functional mobility was evaluated with the 2-Minute Walk Test, and the Timed Up and Go Test, while postural balance was evaluated using the Pediatric Balance Scale and the Trunk Control Measurement Scale (TCMS).

Results: The gastrocnemius muscle tone and stiffness were higher on the affected side in UCP compared with the less affected side and typically developing peers (P < .05). Lumbar spinal extensor tone correlated with improved Trunk Control Measurement Scale scores (P = .003). The gastrocnemius and hamstring muscles’ tone and stiffness did not significantly affect functional mobility measures in UCP (P > .05).

Conclusions: Our study highlights the importance of achieving muscle symmetry, particularly in the plantar flexors, for functional mobility in UCP children. While differences in ankle and knee muscle biomechanics were observed, they didn’t significantly impact functional mobility or postural balance. Symmetry in lumbar spinal extensor biomechanics correlated with better outcomes, emphasizing the crucial role of trunk control in rehabilitation strategies for ambulatory children with UCP.

Figure 2. Assessment of the biomechanical properties and physical performance. (a) Assessment of the tone and stiffness of lumbar spinal extensor and gastrocnemius muscles. (A) Gastrocnemius muscle assessment (B) Lumbar spinal extensor muscle assessment at the L3–L4 level.

Keywords: muscle properties, mobility, trunk control, gait, rehabilitation

Despite having lower levels of mobility and postural balance compared with their TD peers, our research indicates that observed changes in ankle plantar flexor and knee flexor muscle tone and stiffness may not significantly affect the mobility and postural balance of ambulatory children diagnosed with UCP. Our research indicates that in ambulatory children with UCP, the tone and stiffness of dorsally located muscles, including the plantar flexors and lumbar spinal extensors, are pivotal factors influencing functional outcomes. Achieving symmetry in muscle biomechanics, particularly in the plantar flexors, is crucial for attaining mobility levels akin to TD peers. Furthermore, while differences in ankle and knee flexor muscle tone and stiffness were observed between children with UCP and TD peers, these disparities did not significantly impact functional mobility or postural balance. Notably, symmetry in lumbar spinal extensor muscle biomechanics correlated with improved outcomes, highlighting the importance of trunk control in rehabilitation strategies. Therefore, our findings stress the significance of considering the relationship between trunk control and muscle biomechanical properties, especially in the lumbar spinal extensors, when designing rehabilitation approaches for children with UCP.