Managing spastic hypertonia in children with cerebral palsy via repetitive passive knee movements.

OBJECTIVE: Most children with cerebral palsy have increased muscle tension in the lower extremities, which inevitably leads to abnormal gait characteristics. Proper management of excessive muscle tension is therefore of great importance. The aim of this study was to explore the effects of continuous passive motion on children with cerebral palsy, regarding their lower extremity spastic hypertonia and ambulatory function. DESIGN: A repeated measures design. SUBJECTS: Sixteen children with cerebral palsy. METHODS: Intervention was applied to the subject's knees with a continuous passive motion device (at velocities of 15 and 0º/s) for 20 min. Effects were evaluated via variables measuring range-of-motion, muscle tone, and ambulatory function before, immediately after, and 30 min after intervention. RESULTS: For the 15º/s intervention, significant differences were found in time, intervention, and interaction among variables, including active range-of-motion of the knee (increased), relaxation index (increased), Modified Ashworth Scale (decreased), Timed Up-and-Go (decreased), and 6-Minute Walk test (increased). No difference was found in passive range of motion measurements. For the 0º/s control condition, none of the dependent variables demonstrated statistically significant differences. CONCLUSION: Repetitive passive movement can reduce lower extremity spastic hypertonia in children with cerebral palsy, and improve ambulatory function in terms of walking speed.

The role of the great toe in balance performance.

The objective of this study was to evaluate great toe function in maintaining static and dynamic balance. Correlation among great toe length, body height, and balance performance parameters were also investigated. Thirty females (aged 22.1 +/- 1.9 years) were tested in two great toe conditions: unconstrained and constrained. Balance testing was done in the following order: (1) static balance, single-leg stance with right or left foot, eyes open or closed; (2) static balance, stance with both feet, eyes open or closed; (3) dynamic balance, left/right or forward/backward, rhythmic weight shifting; and (4) dynamic balance, target reaching test, eight targets within 90% limit of stability. Significant differences were found in sway velocity between the two toe conditions with eyes open or closed in single-leg stance (p < 0.05). No difference was found between the two conditions while standing with both feet. For rhythmic weight shifting, significant differences in sway velocity were found in toe conditions and in weight-shifting directions (p < 0.05). As to target reaching, significance was only noted in directional control scores. Great toe length was correlated with subject's height (r = 0.553, p < 0.05). Our results indicate that constraining the great toe deteriorated the subjects' single-leg stance performance and worsened the directional control ability during forward/backward weight shifting. The importance of the great toe in balance may be taken into account in toe amputation or transfer in the future.