1st Joint ESMAC-GCMAS Meeting - Análise de Marcha

O-07
CORRELATIONS BETWEEN CLINICAL EXAMINATION AND GAIT DATA:
IMPLICATIONS FOR CONTRACTURE CORRECTION
Bromwich, Will, Mr 1 , Stewart, Caroline, Dr 1 , Williams, Haf, Miss 1
1 Orthotic Research & Locomotor Assessment Unit, Oswestry, UK
Summary/conclusions
Contractures are treated to improve passive range of joint motion in order to optimise function.
This study aims to investigate if there is a relationship between passive range and function. 14
subjects with cerebral palsy (CP) were recruited, all having passive range of knee extension
increased with Contracture Correction Devices (CCDs). Passive range-of-motion data and
other parameters from clinical examination were compared with gait kinematics and temperospatial
parameters. Dynamic knee extension (at initial contact and mid-stance) and step length
had a positive relationship with passive knee extension and a negative relationship with
popliteal angle, as hypothesised. However, the correlation coefficients for the group were
weak. The strength of the quadriceps had stronger correlations with gait parameters, suggesting
that, to gain functional benefit from treating joint contractures, muscle strength must be
maximised as well as passive range.
Introduction
Fixed joint contractures are a limitation of joint motion due to structural shortening. They can
be treated by manual physiotherapy stretches, surgery, serial casting, and orthotics [1]. The
latter can include the use of dynamic splints – orthoses with a spring mounted across the
orthotic joint that provides a turning moment to the splint and hence a stretch to the contracted
tissues [2]. The initial aim of all these treatments is to gain range of motion, and their success
is usually judged by how much range increases. However, the ultimate aim should be an
improvement in a patient’s function.
The development of contractures occurs in response to immobility, which may be secondary to
muscle imbalance, immobilisation, scaring, habitual postures and pain. The muscle imbalance,
immobilisation & habitual postures can be due to spasticity, which is a common component of
CP (cerebral palsy). When CP patients develop knee flexion contractures, these can have a
significant effect on their functional mobility.
A study using gait analysis to monitor the effect of treating knee contractures with dynamic
orthoses was undertaken which provided data on the relationship between clinical exam data
(including passive range of motion) and function. Treating a knee flexion contracture is aimed
primarily at increasing the range of motion of knee extension and extensibility of the
hamstrings, but in ambulant patients it should also improve function. Therefore, it is
hypothesised that, for children with spastic cerebral palsy who have knee flexion contractures,
there is a correlation between passive range and functional kinematics. Specifically for treating
knee flexion contractures, it is hypothesised that the knee flexion contracture angle has a
negative correlation with knee extension at initial contact & mid-stance; that popliteal angle
has a positive correlation with knee flexion at initial contact, but a negative correlation hip
flexion at initial contact, and step length; and that passive ankle dorsiflexion has a positive
correlation with dorsiflexion at initial contact and mid-stance.
Statement of clinical significance
The study tests if, for children with spastic cerebral palsy who have knee flexion contractures,
there is a correlation between passive range of motion and functional gait parameters. If a
strong relationship exists it would support the treatment of crouch gait by treating passive
range.
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