Motor Control Assessment for Rhizotomy in Cerebral Palsy

Abstract

PEMG patterns may allow the physician to select the appropriate children with spastic cerebral palsy to receive SPR with good results.

Providing a Primary Care Medical Home for Children and Youth With Cerebral Palsy

“…32,33 The greatest benefit is seen in young children (3-7 years of age) with spastic diplegia but stable trunk control and good lower extremity strength.…”

Correlation of Polyelectromyographic Patterns and Clinical Motor Manifestations in Children with Cerebral Palsy

“…25 Children with CP who had better gait patterns had increased stretch reflex of the calf muscles only 4 with equinus gait, 4,22 whereas those who had worse gait patterns had lower EMG activities or diffuse coactivation of the leg muscles 4,14 with more proximal joint involvement. 14,22 In this study, we found that reciprocal EMG activities are present in normal gait, whereas the cocontraction present in CP gait suggests an impairment of supraspinal control that results in the persistence of immature locomotor patterns such as equinus gait. A reciprocal model of leg muscle activation 6,26,27 with the mutual modulation of monosynaptic and polysynaptic responses 6,27 depends on the maturation of supraspinal motor centers.…”

“…12 However, SPR should not be used for such cases because it has a permanent effect and may increase existing weakness. 8,12,14 In the previous study, SPR did not improve or may even aggravate the function for these children with pattern V. 14 Serial casting, tendon lengthening, or tenotomy may be needed for children with CP who have muscle shortening or contracture to increase the ROM by lengthening either muscle or tendon, or both. 35 Tendon lengthening or tenotomy may be more beneficial in cases in which reduced extensibility results from inappropriate muscle length, whereas serial casting is more appropriate if muscle hyperactivity is present.…”

“…14 A previous study found that although hypertonia did not necessarily impair voluntary movements, synchronous coactivation (pattern IV) disabled voluntary movement 5 and interfered with independent ambulatory capabilities because of the lack of reciprocal movement of the bilateral lower limbs. 14 Previous studies have also suggested that PEMG patterns in the supine position, 14,16,24 or during gait 4,22 may be well correlated with ambulatory capacities. CP children with more cocontraction in the agonist and antagonist tended to be more energy efficient.…”

“…This result was compatible with previous studies. 14,19 Differentiation of PEMG patterns was based on EMG activities of agonist muscles, cocontraction of agonists and antagonists in ipsilateral distal/proximal muscles, and coactivation of contralateral or bilateral muscles. Cocontraction means synchronous and increased antagonists contraction during the agonists contraction.…”