ABSTRACT
OBJECTIVE: The purpose of this study was to investigate if leg cycling could reduce lower extremity spasticity in patients with cerebral palsy (CP). In addition, we investigated whether the intervention could cause changes in the modulation of presynaptic inhibition. METHODS: This study was a quasi-experimental study, with pretest-posttest for 1 group. Participants in this experiment were eight adult patients with CP with lower extremity spasticity. Spasticity parameters assessed were the amplitude of soleus maximum Hoffmann's reflex (Hmax) and maximum angular velocity (MAV) of knee flexion measured using the pendulum test. D1 inhibition, which seems to be related to the presynaptic inhibition, was recorded by measuring soleus Hoffmann's reflex (H-reflex) with conditioned electric stimuli to the common peroneal nerve. RESULTS: D1 inhibition was significantly enhanced immediately by the cycling intervention. The amplitude of the soleus Hmax was significantly depressed, and there was significant difference in Hmax/maximum M-wave. The MAV was increased due to inhibition of the stretch reflex. CONCLUSION: Leg cycling suppressed stretch reflex and H-reflex, and caused plasticity of inhibitory circuits in patients with CP with lower extremity spasticity. These findings strongly suggest that lower extremity spasticity can be improved by cycling movements.
ABSTRACT
[Purpose] Adults with cerebral palsy often use a cane as a walking aid because of their decreased gait ability. However, it is unclear whether this affects lower limb muscle activity during walking. The purpose of this study was to clarify the influence of using a cane during walking on the spatio-temporal parameters of walking, lower limb muscle activity, and lower limb muscle coactivation in adults with spastic cerebral palsy. [Participants and Methods] Eleven participants with cerebral palsy were included. The spatio-temporal parameters of walking, lower limb muscle activity, and coactivation of lower limb muscle were measured during a 10â m trial with no cane, one cane, and two canes. [Results] Walking speed was lower and the stride time longer when using two canes than when using no cane. All muscle activities significantly reduced when using two canes. No significant difference was observed between using no cane and one cane, except for walking speed. In addition, there was no significant difference in coactivation between the conditions. [Conclusion] This study revealed that when two canes were used, the walking speed was reduced, and lower limb muscle activity was reduced, reducing the burden. In contrast, the movement pattern was not suggested to have changed.
ABSTRACT
[Purpose] We aimed to examine the relationship between gross motor function, selective motor control (SMC), range of motion (ROM), and spasticity in the lower extremities of adults with cerebral palsy (CP), as well as the proximal to distal distribution of SMC impairment in lower extremity joints. [Participants and Methods] We recruited 11 adults with bilateral spastic CP, ranging from levels I to III according to the Gross Motor Function Classification System (GMFCS). We evaluated participants according to the Selective Control Assessment of the Lower Extremity (SCALE), ROM, and the Modified Ashworth Scale (MAS). We conducted the Friedman test to assess differences among the SCALE scores of each joint. The relationship between GMFCS level, SCALE scores, ROM, and MAS scores was assessed. [Results] The mean SCALE scores were lower for distal than for proximal joints. The SCALE scores of each leg showed significant inverse correlations with the GMFCS level. [Conclusion] SMC in adults with CP strongly influences gross motor function. SMC did not have a significant relationship with spasticity or ROM. SMC, ROM, and spasticity independently influenced gross motor function in adults with CP. SMC impairment in adults with CP was higher in distal than in proximal joints.
