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Assessment of net knee moment-angle characteristics by instrumented hand-held dynamometry in children with spastic cerebral palsy and typically developing children.

Haberfehlner H, Maas H, Harlaar J, Newsum IE, Becher JG, Buizer AI, Jaspers RT - J Neuroeng Rehabil (2015)

Bottom Line: The slope at 4 Nm of the knee moment-angle curve in SCP children was significantly higher than that in typically developing children.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.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Human Movement Sciences, VU University Amsterdam, Van der Boechorststraat 9, 1081, BT, Amsterdam, The Netherlands. h.haberfehlner@vu.nl.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus

Example of five subsequently performed repetitions of knee moment-angle measurements. Typical examples of a child of the TD group (a) and the SCP group (b). Grey dots: measured data. Black lines: 3rd order polynomial fit. White symbols: calculated knee angles at 0.5, 1, 2, 3 and 4 Nm
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Fig2: Example of five subsequently performed repetitions of knee moment-angle measurements. Typical examples of a child of the TD group (a) and the SCP group (b). Grey dots: measured data. Black lines: 3rd order polynomial fit. White symbols: calculated knee angles at 0.5, 1, 2, 3 and 4 Nm

Mentions: Where y represents net knee moment and x knee angle, a, b, c and d are constants determined by the fitting procedure. For comparison of repetitions, data of each repetition was fitted. As the fits of the data of the repetitions were very similar (see Additional file 2 and Additional file 3, Fig. 1 and Fig. 2), we pooled the data for the between and within-day comparison. This increased the number as well as the range of data points that can be used for fitting the data. From the fitted curves, knee angles at 0.5, 1, 2, 3 and 4 Nm and the slope at 4 Nm were derived. Higher moments were not included because these were not measured in all subjects. Knee angles at different knee moments were used for statistical analysis.


Assessment of net knee moment-angle characteristics by instrumented hand-held dynamometry in children with spastic cerebral palsy and typically developing children.

Haberfehlner H, Maas H, Harlaar J, Newsum IE, Becher JG, Buizer AI, Jaspers RT - J Neuroeng Rehabil (2015)

Example of five subsequently performed repetitions of knee moment-angle measurements. Typical examples of a child of the TD group (a) and the SCP group (b). Grey dots: measured data. Black lines: 3rd order polynomial fit. White symbols: calculated knee angles at 0.5, 1, 2, 3 and 4 Nm
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4536590&req=5

Fig2: Example of five subsequently performed repetitions of knee moment-angle measurements. Typical examples of a child of the TD group (a) and the SCP group (b). Grey dots: measured data. Black lines: 3rd order polynomial fit. White symbols: calculated knee angles at 0.5, 1, 2, 3 and 4 Nm
Mentions: Where y represents net knee moment and x knee angle, a, b, c and d are constants determined by the fitting procedure. For comparison of repetitions, data of each repetition was fitted. As the fits of the data of the repetitions were very similar (see Additional file 2 and Additional file 3, Fig. 1 and Fig. 2), we pooled the data for the between and within-day comparison. This increased the number as well as the range of data points that can be used for fitting the data. From the fitted curves, knee angles at 0.5, 1, 2, 3 and 4 Nm and the slope at 4 Nm were derived. Higher moments were not included because these were not measured in all subjects. Knee angles at different knee moments were used for statistical analysis.

Bottom Line: The slope at 4 Nm of the knee moment-angle curve in SCP children was significantly higher than that in typically developing children.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.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Human Movement Sciences, VU University Amsterdam, Van der Boechorststraat 9, 1081, BT, Amsterdam, The Netherlands. h.haberfehlner@vu.nl.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus