Samire Deliu and Arbnore Ibrahimaj

In children with Cerebral Palsy (CP), spasticity is one of the most frequent and disabling problems. Spasticity is described as a velocity-dependent increase in tonic stretch reflex. Although often measured by passively stretching a muscle during a single joint (SJ) movement, spasticity can also be assessed during gait. An accurate method to link SJ spasticity assessments to gait is to identify those common muscle lengthening velocity thresholds at which spasticity is elicited in both conditions. This method requires highly accurate muscle length estimations. The primary goal of this explorative study was therefore to compare different muscle length estimation methods during SJ movements.In eight children with CP, muscle lengths derived from musculoskeletal models (direct method) were compared to muscle lengths derived from regression models (indirect method). Estimated muscle lengths of the gastrocnemius (GAS) and medial hamstrings (MEH) were compared during gait analysis and during SJ movements, using Root Mean Square error (RMSE) calculations. For both muscles, RMSEs were significantly larger for the direct versus indirect comparison during SJ movements than during gait (MEH: 12% vs. 3.7% respectively, p=0.012; GAS: 4.7% vs. 2.1% respectively, p=0.012). This discrepancy was largely caused by a lack of proper fixation of the proximal joint during the SJ movements.Indirect method to estimate muscle lengths does not provide accurate results when applied during SJ movements. Furthermore to accurately determine spastic threshold velocities during such SJ movement, the joints not under examination must be properly fixated.

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