title: Gait training reduces ankle joint stiffness and facilitates heel strike in children with Cerebral Palsy.
abstract: BACKGROUND
  Foot drop and toe walking are frequent concerns in children with cerebral palsy (CP). Increased stiffness of the ankle joint muscles may contribute to these problems.
  
  
  OBJECTIVE
  Does four weeks of daily home based treadmill training with incline reduce ankle joint stiffness and facilitate heel strike in children with CP?
  
  
  METHODS
  Seventeen children with CP (4-14 years) were recruited. Muscle stiffness and gait ability were measured twice before and twice after training with an interval of one month. Passive and reflex-mediated stiffness were measured by a dynamometer which applied stretches below and above reflex threshold. Gait kinematics were recorded by 3-D video-analysis during treadmill walking. Foot pressure was measured by force-sensitive foot soles during treadmill and over-ground walking.
  
  
  RESULTS
  Children with increased passive stiffness showed a significant reduction in stiffness following training (P = 0.01). Toe lift in the swing phase (P = 0.014) and heel impact (P = 0.003) increased significantly following the training during both treadmill and over-ground walking.
  
  
  CONCLUSIONS
  Daily intensive gait training may influence the elastic properties of ankle joint muscles and facilitate toe lift and heel strike in children with CP. Intensive gait training may be beneficial in preventing contractures and maintain gait ability in children with CP.
authors.affiliation: Department of Nutrition, Exercise and Sport & Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark Helene Elsass Center, Charlottenlund, Denmark.
authors.forename: Maria
authors.initials: M
authors.lastname: Willerslev-Olsen
authors.affiliation: Department of Nutrition, Exercise and Sport & Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark Helene Elsass Center, Charlottenlund, Denmark.
authors.forename: Jakob
authors.initials: J
authors.lastname: Lorentzen
authors.affiliation: Department of Nutrition, Exercise and Sport & Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jens Bo
authors.initials: JB
authors.lastname: Nielsen
mesh_terms: D000293:Adolescent; D000842:Ankle / Q000503:physiopathology*; D000843:Ankle Joint / Q000503:physiopathology; D001696:Biomechanical Phenomena; D002547:Cerebral Palsy / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D004576:Electromyography; D005260:Female; D005684:Gait; D020233:Gait Disorders, Neurologic / Q000534:rehabilitation*; D006365:Heel / Q000503:physiopathology*; D006801:Humans; D008297:Male; D053581:Muscle Strength Dynamometer; D018482:Muscle, Skeletal / Q000503:physiopathology; D064797:Physical Conditioning, Human; D014034:Toes; D016896:Treatment Outcome
keywords: Cerebral palsy; gait training; passive muscle stiffness