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Published in: Journal of NeuroEngineering and Rehabilitation 1/2013

Open Access 01-12-2013 | Research

Hamstring and psoas length of crouch gait in cerebral palsy: a comparison with induced crouch gait in age- and sex-matched controls

Authors: Tae-Yon Rhie, Ki Hyuk Sung, Moon Seok Park, Kyoung Min Lee, Chin Youb Chung

Published in: Journal of NeuroEngineering and Rehabilitation | Issue 1/2013

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Abstract

Background

Previous studies have shown that hamstring lengths are often not short in patients with cerebral palsy, which raises concerns over the benefits of distal hamstring lengthening in patients with crouch gait. In this study, the authors measured lengths of hamstrings and psoas muscles in normal subjects mimicking crouch gait and compared these with lengths in cerebral palsy patients with crouch gait.

Methods

Thirty-six patients with cerebral palsy and crouch gait were included in this study, and in addition, 36 age- and sex-matched normal controls were recruited. Hamstring and psoas muscle lengths in patients were evaluated using gait analysis and interactive musculoskeletal modeling software. Muscle lengths were also measured in the normal control group during normal gait and while mimicking crouch gait, and these were compared with those of cerebral palsy patient with crouch gait.

Results

No significant differences were observed between maximum hamstring (p=0.810) and maximum psoas (p=0.456) lengths of patients and controls mimicking crouch gait. However, patients showed significantly shorter excursions of hamstring (p=0.022) and psoas (p=0.036) muscles than controls, whereas no significant excursion differences were observed between controls during normal gait and mimicking crouch gait.

Conclusions

Normal controls mimicking crouch gait and cerebral palsy patients with crouch gait demonstrate similar muscle length patterns. However, mimicked crouch gait did not reproduce the excursion pattern shown by patients with crouch gait, which suggests that reduced hamstring and psoas excursion is an innate characteristic of pathologic crouch gait.
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Literature
1.
go back to reference Gough M, Eve LC, Robinson RO, Shortland AP: Short-term outcome of multilevel surgical intervention in spastic diplegic cerebral palsy compared with the natural history. Dev Med Child Neurol 2004, 46: 91-97.CrossRefPubMed Gough M, Eve LC, Robinson RO, Shortland AP: Short-term outcome of multilevel surgical intervention in spastic diplegic cerebral palsy compared with the natural history. Dev Med Child Neurol 2004, 46: 91-97.CrossRefPubMed
2.
go back to reference Gordon AB, Baird GO, McMulkin ML, Caskey PM, Ferguson RL: Gait analysis outcomes of percutaneous medial hamstring tenotomies in children with cerebral palsy. J Pediatr Orthop 2008, 28: 324-329. 10.1097/BPO.0b013e318168d1c0CrossRefPubMed Gordon AB, Baird GO, McMulkin ML, Caskey PM, Ferguson RL: Gait analysis outcomes of percutaneous medial hamstring tenotomies in children with cerebral palsy. J Pediatr Orthop 2008, 28: 324-329. 10.1097/BPO.0b013e318168d1c0CrossRefPubMed
3.
go back to reference Thompson NS, Baker RJ, Cosgrove AP, Corry IS, Graham HK: Musculoskeletal modelling in determining the effect of Botulinum toxin on the hamstrings of patients with crouch gait. Dev Med Child Neurol 1998, 40: 622-625.CrossRefPubMed Thompson NS, Baker RJ, Cosgrove AP, Corry IS, Graham HK: Musculoskeletal modelling in determining the effect of Botulinum toxin on the hamstrings of patients with crouch gait. Dev Med Child Neurol 1998, 40: 622-625.CrossRefPubMed
4.
go back to reference Chung CY, Stout J, Gage JR: Rectus femoris transfer-gracilis versus Sartorius. Gait Posture 1997, 6: 137-146. 10.1016/S0966-6362(97)01116-8CrossRef Chung CY, Stout J, Gage JR: Rectus femoris transfer-gracilis versus Sartorius. Gait Posture 1997, 6: 137-146. 10.1016/S0966-6362(97)01116-8CrossRef
5.
go back to reference Rodda JM, Graham HK, Carson L, Galea MP, Wolfe R: Sagittal gait patterns in spastic diplegia. J Bone Joint Surg Br 2004, 86: 251-258. 10.1302/0301-620X.86B2.13878CrossRefPubMed Rodda JM, Graham HK, Carson L, Galea MP, Wolfe R: Sagittal gait patterns in spastic diplegia. J Bone Joint Surg Br 2004, 86: 251-258. 10.1302/0301-620X.86B2.13878CrossRefPubMed
6.
go back to reference Stout JL, Gage JR, Schwartz MH, Novacheck TF: Distal femoral extension osteotomy and patellar tendon advancement to treat persistent crouch gait in cerebral palsy. J Bone Joint Surg Am 2008, 90: 2470-2484. 10.2106/JBJS.G.00327CrossRefPubMed Stout JL, Gage JR, Schwartz MH, Novacheck TF: Distal femoral extension osteotomy and patellar tendon advancement to treat persistent crouch gait in cerebral palsy. J Bone Joint Surg Am 2008, 90: 2470-2484. 10.2106/JBJS.G.00327CrossRefPubMed
7.
go back to reference Schutte LM, Hayden SW, Gage JR: Lengths of hamstrings and psoas muscles during crouch gait: effects of femoral anteversion. J Orthop Res 1997, 15: 615-621. 10.1002/jor.1100150419CrossRefPubMed Schutte LM, Hayden SW, Gage JR: Lengths of hamstrings and psoas muscles during crouch gait: effects of femoral anteversion. J Orthop Res 1997, 15: 615-621. 10.1002/jor.1100150419CrossRefPubMed
8.
go back to reference Delp SL, Loan JP, Hoy MG, Zajac FE, Topp EL, Rosen JM: An interactive graphics-based model of the lower extremity to study orthopaedic surgical procedures. IEEE Trans Biomed Eng 1990, 37: 757-767. 10.1109/10.102791CrossRefPubMed Delp SL, Loan JP, Hoy MG, Zajac FE, Topp EL, Rosen JM: An interactive graphics-based model of the lower extremity to study orthopaedic surgical procedures. IEEE Trans Biomed Eng 1990, 37: 757-767. 10.1109/10.102791CrossRefPubMed
9.
go back to reference Hoffinger SA, Rab GT, Abou-Ghaida H: Hamstrings in cerebral palsy crouch gait. J Pediatr Orthop 1993, 13: 722-726. 10.1097/01241398-199311000-00006CrossRefPubMed Hoffinger SA, Rab GT, Abou-Ghaida H: Hamstrings in cerebral palsy crouch gait. J Pediatr Orthop 1993, 13: 722-726. 10.1097/01241398-199311000-00006CrossRefPubMed
10.
go back to reference Zwick EB, Saraph V, Zwick G, Steinwender C, Linhart WE, Steinwender G: Medial hamstring lengthening in the presence of hip flexor tightness in spastic diplegia. Gait Posture 2002, 16: 288-296. 10.1016/S0966-6362(02)00022-XCrossRefPubMed Zwick EB, Saraph V, Zwick G, Steinwender C, Linhart WE, Steinwender G: Medial hamstring lengthening in the presence of hip flexor tightness in spastic diplegia. Gait Posture 2002, 16: 288-296. 10.1016/S0966-6362(02)00022-XCrossRefPubMed
11.
go back to reference Park MS, Chung CY, Lee SH, Choi IH, Cho TJ, Yoo WJ, Park MY, Lee KM: Effects of distal hamstring lengthening on sagittal motion in patients with diplegia: hamstring length and its clinical use. Gait Posture 2009, 30: 487-491. 10.1016/j.gaitpost.2009.07.115CrossRefPubMed Park MS, Chung CY, Lee SH, Choi IH, Cho TJ, Yoo WJ, Park MY, Lee KM: Effects of distal hamstring lengthening on sagittal motion in patients with diplegia: hamstring length and its clinical use. Gait Posture 2009, 30: 487-491. 10.1016/j.gaitpost.2009.07.115CrossRefPubMed
12.
go back to reference Thometz J, Simon S, Rosenthal R: The effect on gait of lengthening of the medial hamstrings in cerebral palsy. J Bone Joint Surg Am 1989, 71: 345-353.PubMed Thometz J, Simon S, Rosenthal R: The effect on gait of lengthening of the medial hamstrings in cerebral palsy. J Bone Joint Surg Am 1989, 71: 345-353.PubMed
13.
go back to reference DeLuca PA, Ounpuu S, Davis RB, Walsh JH: Effect of hamstring and psoas lengthening on pelvic tilt in patients with spastic diplegic cerebral palsy. J Pediatr Orthop 1998, 18: 712-718.PubMed DeLuca PA, Ounpuu S, Davis RB, Walsh JH: Effect of hamstring and psoas lengthening on pelvic tilt in patients with spastic diplegic cerebral palsy. J Pediatr Orthop 1998, 18: 712-718.PubMed
14.
go back to reference Chang WN, Tsirikos AI, Miller F, Lennon N, Schuyler J, Kerstetter L: Distal hamstring lengthening in ambulatory children with cerebral palsy: primary versus revision procedures. Gait Posture 2004, 19: 298-304. 10.1016/S0966-6362(03)00070-5CrossRefPubMed Chang WN, Tsirikos AI, Miller F, Lennon N, Schuyler J, Kerstetter L: Distal hamstring lengthening in ambulatory children with cerebral palsy: primary versus revision procedures. Gait Posture 2004, 19: 298-304. 10.1016/S0966-6362(03)00070-5CrossRefPubMed
15.
go back to reference Adolfsen SE, Ounpuu S, Bell KJ, DeLuca PA: Kinematic and kinetic outcomes after identical multilevel soft tissue surgery in children with cerebral palsy. J Pediatr Orthop 2007, 27: 658-667. 10.1097/BPO.0b013e3180dca114CrossRefPubMed Adolfsen SE, Ounpuu S, Bell KJ, DeLuca PA: Kinematic and kinetic outcomes after identical multilevel soft tissue surgery in children with cerebral palsy. J Pediatr Orthop 2007, 27: 658-667. 10.1097/BPO.0b013e3180dca114CrossRefPubMed
16.
go back to reference Klatt J, Stevens PM: Guided growth for fixed knee flexion deformity. J Pediatr Orthop 2008, 28: 626-631. 10.1097/BPO.0b013e318183d573CrossRefPubMed Klatt J, Stevens PM: Guided growth for fixed knee flexion deformity. J Pediatr Orthop 2008, 28: 626-631. 10.1097/BPO.0b013e318183d573CrossRefPubMed
17.
go back to reference Thompson NS, Baker RJ, Cosgrove AP, Saunders JL, Taylor TC: Relevance of the popliteal angle to hamstring length in cerebral palsy crouch gait. J Pediatr Orthop 2001, 21: 383-387.PubMed Thompson NS, Baker RJ, Cosgrove AP, Saunders JL, Taylor TC: Relevance of the popliteal angle to hamstring length in cerebral palsy crouch gait. J Pediatr Orthop 2001, 21: 383-387.PubMed
18.
go back to reference Rethlefsen S, Tolo VT, Reynolds RA, Kay R: Outcome of hamstring lengthening and distal rectus femoris transfer surgery. J Pediatr Orthop 1999, 8: 75-79. Rethlefsen S, Tolo VT, Reynolds RA, Kay R: Outcome of hamstring lengthening and distal rectus femoris transfer surgery. J Pediatr Orthop 1999, 8: 75-79.
19.
go back to reference Gage JR: Surgical treatment of knee dysfunction in cerebral palsy. Clin Orthop Relat Res 1990, 253: 45-54.PubMed Gage JR: Surgical treatment of knee dysfunction in cerebral palsy. Clin Orthop Relat Res 1990, 253: 45-54.PubMed
20.
go back to reference Kadaba MP, Ramakrishnan HK, Wootten ME: Measurement of lower extremity kinematics during level walking. J Orthop Res 1990, 8: 383-392. 10.1002/jor.1100080310CrossRefPubMed Kadaba MP, Ramakrishnan HK, Wootten ME: Measurement of lower extremity kinematics during level walking. J Orthop Res 1990, 8: 383-392. 10.1002/jor.1100080310CrossRefPubMed
21.
go back to reference Delp SL, Arnold AS, Speers RA, Moore CA: Hamstrings and psoas lengths during normal and crouch gait: implications for muscle-tendon surgery. J Orthop Res 1996, 14: 144-151. 10.1002/jor.1100140123CrossRefPubMed Delp SL, Arnold AS, Speers RA, Moore CA: Hamstrings and psoas lengths during normal and crouch gait: implications for muscle-tendon surgery. J Orthop Res 1996, 14: 144-151. 10.1002/jor.1100140123CrossRefPubMed
22.
go back to reference Arnold AS, Liu MQ, Schwartz MH, Ounpuu S, Dias LS, Delp SL: Do the hamstrings operate at increased muscle-tendon lengths and velocities after surgical lengthening? J Biomech 2006, 39: 1498-1506. 10.1016/j.jbiomech.2005.03.026CrossRefPubMed Arnold AS, Liu MQ, Schwartz MH, Ounpuu S, Dias LS, Delp SL: Do the hamstrings operate at increased muscle-tendon lengths and velocities after surgical lengthening? J Biomech 2006, 39: 1498-1506. 10.1016/j.jbiomech.2005.03.026CrossRefPubMed
23.
go back to reference Arnold AS, Blemker SS, Delp SL: Evaluation of a deformable musculoskeletal model for estimating muscle-tendon lengths during crouch gait. Ann Biomed Eng 2001, 29: 263-274.CrossRefPubMed Arnold AS, Blemker SS, Delp SL: Evaluation of a deformable musculoskeletal model for estimating muscle-tendon lengths during crouch gait. Ann Biomed Eng 2001, 29: 263-274.CrossRefPubMed
24.
go back to reference Park MS, Kim SJ, Chung CY, Choi IH, Lee SH, Lee KM: Statistical consideration for bilateral cases in orthopaedic research. J Bone Joint Surg Am 2010, 92: 1732-1737. 10.2106/JBJS.I.00724CrossRefPubMed Park MS, Kim SJ, Chung CY, Choi IH, Lee SH, Lee KM: Statistical consideration for bilateral cases in orthopaedic research. J Bone Joint Surg Am 2010, 92: 1732-1737. 10.2106/JBJS.I.00724CrossRefPubMed
25.
go back to reference van der Krogt MM, Doorenbosch CA, Harlaar J: Muscle length and lengthening velocity in voluntary crouch gait. Gait Posture 2007, 26: 532-538. 10.1016/j.gaitpost.2006.11.208CrossRefPubMed van der Krogt MM, Doorenbosch CA, Harlaar J: Muscle length and lengthening velocity in voluntary crouch gait. Gait Posture 2007, 26: 532-538. 10.1016/j.gaitpost.2006.11.208CrossRefPubMed
26.
go back to reference Agarwal-Harding KJ, Schwartz MH, Delp SL: Variation of hamstrings lengths and velocities with walking speed. J Biomech 2010, 43: 1522-1526. 10.1016/j.jbiomech.2010.01.008PubMedCentralCrossRefPubMed Agarwal-Harding KJ, Schwartz MH, Delp SL: Variation of hamstrings lengths and velocities with walking speed. J Biomech 2010, 43: 1522-1526. 10.1016/j.jbiomech.2010.01.008PubMedCentralCrossRefPubMed
Metadata
Title
Hamstring and psoas length of crouch gait in cerebral palsy: a comparison with induced crouch gait in age- and sex-matched controls
Authors
Tae-Yon Rhie
Ki Hyuk Sung
Moon Seok Park
Kyoung Min Lee
Chin Youb Chung
Publication date
01-12-2013
Publisher
BioMed Central
Published in
Journal of NeuroEngineering and Rehabilitation / Issue 1/2013
Electronic ISSN: 1743-0003
DOI
https://doi.org/10.1186/1743-0003-10-10

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