| Objective:Cerebral palsy is a syndrome with posture and movement dysfunction, as well asdisorders in sensation, perception, communication and behavior. Exercise therapy isan essential intervention for individuals with this condition. About70-75%of thesufferers belong to spastic cerebral palsy which shows extensor spasticity withdropfoot that interferes with patient’s standing and walking. There are conditions ofcoexisting muscle spasticity and weakness, incoordination between flexors andextensors, impaired balance control in both sides of body. Therefore,“balancetraining” was proposed by Mr. Ye on the basis of Bobath neurophysiology method soas to improve the abnormalities in movement. Three common movement actions usedin training for pelvis and lower limb control of the children are kneeling-walk,alternate single limb kneeling and squat-walking. However, the muscle activationpatterns in these movements have not been investigated and understood, thereforewhen and how to utilize these movements to achieve optimal outcomes are unknown.The aim of the study was to use the surface electromyogram (sEMG) technique toinvestigate the activation characteristics of the major muscle groups, namely tibialisanterior, gastrocnemius, quadriceps, hamstrings, gluteus maximus, duringkneeling-walk, alternate single limb kneeling and squat-walking, in children withspastic cerebral palsy and compared with that of normal control. In order to providethe evidence for better exercise training for children with spastic cerebral palsy.MethodsIn this study,10children with spastic cerebral palsy (3children with spasticdiplegia and7children with spastic hemiplegia）who have the ability to walk wereselected as the experimental group. Nine boys and one girl were recruited for thisgroup, and their mean age was6.7±0.82years. The inclusion criteria were: grade1+ and grade3as assessed by the modified Ashworth scale during passive dorsiflexion ofankle and having a good understanding of instructions and capability ofcommunication in cerebral palsy. Ten age-matched healthy boys with mean age was6.85±0.78years were recruited as control group. The sEMG signals from the muscletibialis anterior, gastrocnemius, quadriceps, hamstrings, gluteus maximus duringkneeling-walk, alternate single limb kneeling and squat-walking were collected andanalyzed. The integrated EMG during maximal muscle contraction was measured, andused to calculate the muscle activation ratio in the movements. IEMG and muscleactivation ratios were measured to determine the mobilization pattern of ankle andknee. Both sides of cerebral palsy children were compared with normal control groupto find whether they had the same movement patterns or characteristics, so as tounderstand the effectiveness of improving pointed and genu recurvatum.Within-group comparison used paired sample t test, and between-groups comparisonused independent sample t test, and the significance level was set as P <0.05.Results:1. The tibialis anterior muscle and hamstring muscle of swing side demonstratedhigher activation, and the hamstring muscle and gastrocnemius muscle of support sidedemonstrated significant activity during squat-walking in normal children andchildren with spastic hemiplegia. However, the anterior tibial muscle and quadricepsof swing side and support side were dominant during squat-walking in diplegiachildren.2. The proximal lower limb, especially the hamstrings, demonstrated higher activationduring the kneeling-walk in the control group(P<0.05). When the children withspastic cerebral palsy doing the same action, the activity of the quadriceps andhamstrings had no significant difference. The tibialis anterior, gastrocnemius andgluteus maximus in lower legs were not activated much in both groups. Thegastrocnemius did not show spasticity during the kneeling-walk in patients.3. In the control group, the tibialis anterior and quadriceps of the swing side and thehamstrings of the support side were greatly activated during swinging forward,thetibialis anterior was greatly activated during swinging back. Activation of quadriceps and hamstring have no significant difference. In the experimental group, the tibialisanterior of the swing side and the hamstrings of the support side were greatlyactivated during swinging forward and the tibialis anterior, the hamstrings weregreatly activated during swinging back with gluteus activation level was significantlygreater than the control group.Conclusions:1. The normal squat-walk involved predominantly flexion movement of lower limb,which mainly activated flexion muscles. It is good for using the exercise to improveclubfoot and knee hyperextension of the children with spastic hemiplegia, but shouldavoid excessive activity of the gastrocnemius muscle of support side,because it causefatigue of gastrocnemius and abnormal action.So quantity of training is little but manytimes.we also by helping to reduce the difficulty of movement to Reduce the activitiesof the quadriceps.2. The normal exercise of kneeling-walk underline the proximal flexion movementpatterns of the lower limb, mainly activated the hamstring muscle, so it is suitable forimprove knee hyperextension of the children with spastic hemiplegia,but we shouldPay attention to amount of exercise control,avoiding quadriceps compensatory lead tofatigue.3. The normal exercise of alternate single limb kneeling might be able to improve tipwalking, but significant differences between the two groups were observed.According to the characteristics of the cerebral palsy, flexion muscles of lower limband hamstring muscles in the swing back side were heavily activated during alternatesingle limb kneeling. So It is suitable for improving drop foot, knee hyperextensionand hip extension difficulty in children with cerebral palsy. |
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