title: Roles of reflex activity and co-contraction during assessments of spasticity of the knee flexor and knee extensor muscles in children with cerebral palsy and different functional levels.
abstract: OBJECTIVE
  Spasticity is a common impairment in children with cerebral palsy (CP). The purpose of this study was to examine differences in passive resistive torque, reflex activity, coactivation, and reciprocal facilitation during assessments of the spasticity of knee flexor and knee extensor muscles in children with CP and different levels of functional ability.
  
  
  METHODS
  Study participants were 20 children with CP and 10 children with typical development (TD). The 20 children with CP were equally divided into 2 groups: 10 children classified in Gross Motor Function Classification Scale (GMFCS) level I and 10 children classified in GMFCS level III.
  
  
  METHODS
  One set of 10 passive movements between 25 and 90 degrees of knee flexion and one set of 10 passive movements between 90 and 25 degrees of knee flexion were completed with an isokinetic dynamometer at 15 degrees /s, 90 degrees /s, and 180 degrees /s and concurrent surface electromyography of the vastus lateralis and medial hamstring muscles.
  
  
  RESULTS
  Children in the GMFCS level III group demonstrated significantly more peak knee flexor torque with passive movements at 180 degrees /s than children with TD. Children in the GMFCS level I and level III groups demonstrated significantly more repetitions with medial hamstring muscle activity, vastus lateralis muscle activity, and co-contraction than children with TD during the assessment of knee flexor spasticity at a velocity of 180 degrees /s.
  
  
  CONCLUSIONS
  Children with CP and more impaired functional mobility may demonstrate more knee flexor spasticity and reflex activity, as measured by isokinetic dynamometry, than children with TD. However, the finding of increased reflex activity with no increase in torque in the GMFCS I group in a comparison with the TD group suggests that reflex activity may play a less prominent role in spasticity.
authors.affiliation: Shriners Hospitals for Children, Philadelphia, Pennsylvania, USA. srpierce@mail.widener.edu
authors.forename: Samuel R
authors.initials: SR
authors.lastname: Pierce
authors.forename: Mary F
authors.initials: MF
authors.lastname: Barbe
authors.forename: Ann E
authors.initials: AE
authors.lastname: Barr
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Shewokis
authors.forename: Richard T
authors.initials: RT
authors.lastname: Lauer
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002547:Cerebral Palsy / Q000150:complications / Q000503:physiopathology*; D002648:Child; D004576:Electromyography; D005260:Female; D006801:Humans; D007717:Knee / Q000503:physiopathology*; D008297:Male; D009119:Muscle Contraction / Q000502:physiology*; D009128:Muscle Spasticity / Q000209:etiology / Q000503:physiopathology*; D018482:Muscle, Skeletal / Q000503:physiopathology*; D016059:Range of Motion, Articular / Q000502:physiology; D012018:Reflex / Q000502:physiology*