Reflex excitability and isometric force production in cerebral palsy: the effect of serial casting.
During passive dorsiflexion, the angle of stretch-reflex onset was earlier in the dorsiflexion range for children with spastic cerebral palsy (CP) (N=10) compared with controls (P<0.001) at comparable velocities of stretch. Isometric plantar-flexor force was lower in children with CP (P<0.0001) and a leftward shift in the length-tension curve reflected that peak forces were produced in greater plantar flexion in children with CP than in controls (P<0.0001). Seven children with CP underwent 3 weeks of serial casting resulting in increased dorsiflexion at postcasting and at 6 weeks follow-up (P<0.002). There was no associated loss in plantar-flexor strength (P>0.32), but increased reflex threshold (P<0.03) and a decline in restraint to imposed stretch (P<0.002) were evident. A rightward shift in the length-tension curve illustrated that peak tension was generated in dorsiflexion rather than plantar flexion following casting (P<0.001). The gains were still evident at follow-up although generally to a lesser extent.
Brouwer
B
B
School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada. Brouwerb@post.queensu.ca
Wheeldon
R K
RK
Stradiotto-Parker
N
N
Allum
J
J
D000293:Adolescent; D000704:Analysis of Variance; D002370:Casts, Surgical; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D004576:Electromyography; D015444:Exercise / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000294:innervation; D011595:Psychomotor Agitation / Q000209:etiology* / Q000534:rehabilitation*; D012026:Reflex, Stretch / Q000502:physiology*; D016896:Treatment Outcome