title: Significance of the confusion test in cerebral palsy.
abstract: The confusion test examines ankle dorsiflexion in patients with cerebral palsy. Orthopedists have related this test to swing-phase activity of the tibialis anterior, and have used it as a prerequisite for tendon transfer. To determine the validity of this assumption, ankle dorsiflexion was tested in 47 normal children. Forty-seven percent had a positive, unresisted confusion test, and 97% had a positive, resisted confusion test. Twenty-three patients with cerebral palsy who had a positive confusion test underwent gait analysis. Tibialis anterior electromyographs showed wide variability. Sagittal-plane ankle-movement curves revealed five patterns. Thirty-three percent of the patients showed abnormal swing-phase dorsiflexion, and 61% had abnormal swing-phase plantar-flexion. We conclude that the confusion test evaluates a normal, patterned response, and is positive in most children with cerebral palsy. Although a positive confusion test shows that active ankle dorsiflexion is possible, it is not predictive of swing-phase ankle kinematics.
authors.affiliation: Department of Orthopaedics, Children's Hospital and Health Center, San Diego.
authors.forename: J R
authors.initials: JR
authors.lastname: Davids
authors.forename: W C
authors.initials: WC
authors.lastname: Holland
authors.forename: D H
authors.initials: DH
authors.lastname: Sutherland
mesh_terms: D000842:Ankle / Q000503:physiopathology*; D002547:Cerebral Palsy / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D009068:Movement; D011187:Posture; D011446:Prospective Studies; D012016:Reference Values; D012189:Retrospective Studies