title: Effects of novel tubing gait on neuromuscular imbalance in cerebral palsy.
abstract: BACKGROUND
  Gait impairments from a neuromuscular imbalance are crucial issues in cerebral palsy. The purpose of our study was to compare the effects of the assistive tubing gait (ATG) and assistive-resistive tubing gait (ARTG) on improving the vasti and hamstring muscle imbalance during the initial contact to mid-stance phases in individuals with spastic diplegic cerebral palsy (CP).
  
  
  METHODS
  Fourteen age-matched individuals including seven normal individuals (11.7 years) and seven individuals with CP (12.9 years) were recruited. All participants underwent electromyography (EMG) measurement of the unilateral vasti and hamstring muscle activity during the three gait training conditions of no-tubing gait (NTG), ATG, and ARTG. A statistical one-way repeated-measure analysis of variance (ANOVA) was used to determine differences in the vasti and hamstring activity, the vasti/hamstring ratio, and the knee joint angle across the three gait training conditions for each group.
  
  
  RESULTS
  The initial vasti and hamstring muscle imbalance in CP was significantly improved by applying the ARTG compared with the ATG. The vasti/hamstring ratio during the ARTG was compatible with the ratio value obtained from the NTG of normal individuals. The knee joint angle in CP was not improved in this short-term intervention.
  
  
  CONCLUSIONS
  The ARTG proportionately increased the vasti activation and reciprocally inhibited the hamstring activity, subsequently improving the neuromuscular imbalance associated with the flexed-knee gait in individuals with spastic diplegic CP.
authors.affiliation: Department of Rehabilitation Medicine, Severance Hospital, Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea Brain Korea 21 PLUS project for Medical Science, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea.
authors.forename: Yoon Kyum
authors.initials: YK
authors.lastname: Shin
authors.affiliation: Department of Physical Therapy, Honam University, Gwangju, Republic of Korea.
authors.forename: Dong Ryul
authors.initials: DR
authors.lastname: Lee
authors.affiliation: Movement Healing Laboratory, Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea.
authors.forename: Do Hyun
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Movement Healing Laboratory, Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea.
authors.forename: Jae Jin
authors.initials: JJ
authors.lastname: Lee
authors.affiliation: Movement Healing Laboratory, Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea.
authors.forename: Sung Joshua Hyun
authors.initials: SJ
authors.lastname: You
authors.affiliation: Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea.
authors.forename: Chung Hwi
authors.initials: CH
authors.lastname: Yi
authors.affiliation: Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea.
authors.forename: Hye Seon
authors.initials: HS
authors.lastname: Jeon
mesh_terms: D000293:Adolescent; D001696:Biomechanical Phenomena; D002547:Cerebral Palsy / Q000534:rehabilitation*; D002648:Child; D004576:Electromyography; D005260:Female; D020233:Gait Disorders, Neurologic / Q000534:rehabilitation*; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D007866:Leg / Q000503:physiopathology; D008297:Male; D018482:Muscle, Skeletal / Q000503:physiopathology; D016059:Range of Motion, Articular; D012656:Self-Help Devices; D055815:Young Adult
keywords: Neuromuscular imbalance; reciprocal inhibition; spastic diplegic CP; tubing gait