Assessment of net knee moment-angle characteristics by instrumented hand-held dynamometry in children with spastic cerebral palsy and typically developing children.
BACKGROUND
The limited range of motion during walking in children with spastic cerebral palsy (SCP) may be the result of altered mechanical characteristics of muscles and connective tissues around the knee joint. Measurement of static net knee moment-angle relation will provide insights into these alterations, for which instrumented hand-held dynamometry may be applied. The aims of this study were: (1) to test the measurement error of the estimated net knee moment-angle characteristics, (2) to determine the correlation between knee extension angle measurement at a standardized knee moment and popliteal angle from common physical examination and (3) to compare net knee moment-angle characteristics in SCP versus typically developing children.


METHODS
With the child lying in sideward position, the knee was extended by moving the lower leg by a hand-held force transducer on a low friction cart. Force data were collected for a range of knee angles. Data were excluded when activity (EMG) levels of knee extensor and flexor muscles exceeded the EMG level during rest by more than two standard deviations. The net knee flexion moments were calculated from recorded force data and measured moment arm. Reliability for knee angles corresponding with 0.5, 1, 2, 3, and 4 Nm knee net flexion moments was assessed by standard error of measurements (SEM) and smallest detectable difference (SDD).


RESULTS
For between day comparison, SEMs were about 5° and SDDs were below 14° for knee angles at 1-4 Nm net knee flexion moments. In SCP children, the knee angle measured at 4 Nm knee flexion moment was not related to the popliteal angle (r = 0.52). The slope at 4 Nm of the knee moment-angle curve in SCP children was significantly higher than that in typically developing children.


CONCLUSIONS
The presented knee hand-held dynamometry allows assessment of net knee flexion moment-knee angle characteristics in typically developing and SCP children and can be used to identify clinically relevant changes as a result of treatment. Overall stiffness of structures that contribute to the net knee flexion moment at the knee (i.e. muscles, tendons, ligaments) is elevated in SCP children.
Faculty of Human Movement Sciences, VU University Amsterdam, Van der Boechorststraat 9, 1081, BT, Amsterdam, The Netherlands. h.haberfehlner@vu.nl.|Department of Rehabilitation Medicine, VU University Medical Center, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands. h.haberfehlner@vu.nl.|MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, The Netherlands, Van der Boechorststraat 9, 1081, BT, Amsterdam, The Netherlands. h.haberfehlner@vu.nl.
Helga
H
Haberfehlner
Faculty of Human Movement Sciences, VU University Amsterdam, Van der Boechorststraat 9, 1081, BT, Amsterdam, The Netherlands. h.maas@vu.nl.|MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, The Netherlands, Van der Boechorststraat 9, 1081, BT, Amsterdam, The Netherlands. h.maas@vu.nl.
Huub
H
Maas
Department of Rehabilitation Medicine, VU University Medical Center, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands. j.harlaar@vumc.nl.|MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, The Netherlands, Van der Boechorststraat 9, 1081, BT, Amsterdam, The Netherlands. j.harlaar@vumc.nl.
Jaap
J
Harlaar
Department of Rehabilitation Medicine, VU University Medical Center, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands. i.newsum@vumc.nl.
Irene E
IE
Newsum
Department of Rehabilitation Medicine, VU University Medical Center, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands. jg.becher@vumc.nl.|MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, The Netherlands, Van der Boechorststraat 9, 1081, BT, Amsterdam, The Netherlands. jg.becher@vumc.nl.
Jules G
JG
Becher
Department of Rehabilitation Medicine, VU University Medical Center, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands. ai.buizer@vumc.nl.
Annemieke I
AI
Buizer
Faculty of Human Movement Sciences, VU University Amsterdam, Van der Boechorststraat 9, 1081, BT, Amsterdam, The Netherlands. r.t.jaspers@vu.nl.|MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, The Netherlands, Van der Boechorststraat 9, 1081, BT, Amsterdam, The Netherlands. r.t.jaspers@vu.nl.
Richard T
RT
Jaspers
D000328:Adult; D000465:Algorithms; D016477:Artifacts; D001696:Biomechanical Phenomena; D002547:Cerebral Palsy / Q000503:physiopathology* / Q000534:rehabilitation*; D002648:Child; D004576:Electromyography; D005260:Female; D006801:Humans; D007717:Knee / Q000033:anatomy & histology / Q000503:physiopathology*; D007719:Knee Joint / Q000503:physiopathology; D007866:Leg / Q000503:physiopathology; D008022:Ligaments / Q000503:physiopathology; D008297:Male; D053581:Muscle Strength Dynamometer; D018482:Muscle, Skeletal / Q000503:physiopathology; D016059:Range of Motion, Articular; D015203:Reproducibility of Results; D014159:Transducers