title: Decrease in ankle-foot dorsiflexion range of motion is related to increased knee flexion during gait in children with spastic cerebral palsy.
abstract: OBJECTIVE
  To determine the effects of decreased ankle-foot dorsiflexion (A-Fdf) range of motion (ROM) on gait kinematics in children with spastic cerebral palsy (SCP).
  
  
  METHODS
  All participants were children with spastic cerebral palsy (n = 10) who walked with knee flexion in midstance. Data were collected over 2-5 sessions, at 3-monthly intervals. A-Fdf ROM was quantified using a custom-designed hand-held ankle dynamometer that exerted 4 Nm at the ankle. Ankle-foot and knee angles during gait were quantified on sagittal video recordings. Linear regression (cross-sectional analysis) and General Estimation Equation analysis (longitudinal analysis) were performed to assess relationships between (change in) A-Fdf ROM and (change in) ankle-foot and knee angle during gait.
  
  
  RESULTS
  Cross-sectional analysis showed a positive relationship between A-Fdf ROM and both ankle-foot angle in midstance and terminal swing. Longitudinal analysis showed a positive relationship between individual decreases in A-Fdf ROM and increases of knee flexion during gait (lowest knee angle in terminal stance and angle in terminal swing).
  
  
  CONCLUSIONS
  For this subgroup of SCP children, our results indicate that while changes in ankle angles during gait are unrelated to changes in A-Fdf ROM, changes in knee angles are related to changes in A-Fdf ROM.
authors.affiliation: Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, The EMGO+ Institute for Health and Care Research, VU University Medical Center, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands.
authors.forename: Josina C
authors.initials: JC
authors.lastname: Maas
authors.affiliation: MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University, Van der Boechorststraat 9, 1081BT Amsterdam, The Netherlands.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Huijing
authors.affiliation: Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, The EMGO+ Institute for Health and Care Research, VU University Medical Center, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands.
authors.forename: Annet J
authors.initials: AJ
authors.lastname: Dallmeijer
authors.affiliation: Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands.
authors.forename: Jaap
authors.initials: J
authors.lastname: Harlaar
authors.affiliation: MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University, Van der Boechorststraat 9, 1081BT Amsterdam, The Netherlands.
authors.forename: Richard T
authors.initials: RT
authors.lastname: Jaspers
authors.affiliation: Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, The EMGO+ Institute for Health and Care Research, VU University Medical Center, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands. Electronic address: jg.becher@vumc.nl.
authors.forename: Jules G
authors.initials: JG
authors.lastname: Becher
mesh_terms: D000842:Ankle / Q000502:physiology; D000843:Ankle Joint / Q000502:physiology*; D002547:Cerebral Palsy / Q000175:diagnosis / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005528:Foot / Q000502:physiology; D005684:Gait / Q000502:physiology*; D006801:Humans; D007717:Knee / Q000502:physiology; D007719:Knee Joint / Q000502:physiology*; D008297:Male; D018482:Muscle, Skeletal / Q000502:physiology; D016059:Range of Motion, Articular / Q000502:physiology*; D016138:Walking / Q000502:physiology
keywords: Ankle; Cerebral palsy; Equinus deformity; Gait; Knee; Range of motion