The influence of preoperative knee flexion contracture severity on short-term outcome of orthopedic surgery in ambulatory children with bilateral cerebral palsy

Lower limb contracture definitions in children and adults with cerebral palsy: A systematic review

AIM

To examine the quantitative definitions and prevalence rates of fixed lower limb contractures in people with cerebral palsy (CP). Based on findings, to propose standardized values to define lower limb contractures to improve quality in future research.

METHOD

A systematic review was conducted according to PRISMA guidelines using 4 databases from inception to April 2024. Titles, abstracts, and full texts were independently screened. Data were extracted and quality assessed independently by 2 reviewers. Data were synthesized and presented descriptively.

RESULTS

Forty-four studies were included. Ankle plantarflexion contracture definitions ranged from < 10° dorsiflexion to ≥ 20° plantarflexion, and prevalence rates ranged from 32 % to 90 %. Knee flexion contracture definitions ranged from > 0° to ≥ 30° flexion, and prevalence rates ranged from 19 % to 44 %. Hip flexion contracture definitions ranged from > 0° to ≥ 30° flexion, and prevalence rates ranged from 7 % to 68 %. Hip extension and abduction contractures were seldom defined.

INTERPRETATION

There is considerable variability in reported contracture definitions and prevalence rates. Based on findings, we propose the following cut-offs for defining contractures; ankle plantarflexion contracture < 0° dorsiflexion, knee flexion contracture < 0° knee extension, hip flexion contracture < 0° hip extension, hip abduction contracture < 30° hip abduction, hip extension contracture ≤ 90° hip flexion range of motion.

Aberrant movement-related somatosensory cortical activity mediates the extent of the mobility impairments in persons with cerebral palsy

KEY POINTS

Persons with cerebral palsy (CP) have reduced somatosensory cortical responses at rest and during movement. The somatosensory cortical responses during movement mediate the relationship between the somatosensory cortical responses at rest and mobility. Persons with CP may have altered sensorimotor feedback that ultimately contributes to impaired mobility.

ABSTRACT

There are numerous clinical reports that persons with cerebral palsy (CP) have proprioceptive, stereognosis and tactile discrimination deficits. The current consensus is that these altered perceptions are attributable to aberrant somatosensory cortical activity. It has been inferred from these data that persons with CP do not adequately process ongoing sensory feedback during motor actions, which accentuates the extent of their mobility impairments. However, this hypothesis has yet to be directly tested. We used magnetoencephalographic (MEG) brain imaging to address this knowledge gap by quantifying the somatosensory dynamics evoked by applying electrical stimulation to the tibial nerve in 22 persons with CP and 25 neurotypical (NT) controls while at rest and during an ankle plantarflexion isometric force motor task. We also quantified the spatiotemporal gait biomechanics of participants outside the scanner. Consistent with the literature, our results confirmed that the strength of somatosensory cortical activity was weaker in the persons with CP compared to the NT controls. Our results also showed that the strength of the somatosensory cortical responses were significantly weaker during the isometric ankle force task than at rest. Most importantly, our results showed that the strength of somatosensory cortical activity during the ankle plantarflexion force production task mediated the relationship between somatosensory cortical activity at rest and both walking velocity and step length. These results suggest that youth with CP have aberrant somatosensory cortical activity during isometric force generation, which ultimately contributes to the extent of mobility impairments seen in this patient population. Abstract figure legend Magnetoencephalographic brain imaging was used to determine the effect of sensory feedback during movement on mobility in persons with cerebral palsy. Persons with cerebral palsy had reduced somatosensory cortical activity at rest and during movement compared with their neurotypical peers. Further, the somatosensory cortical activity during movement mediated the relationship between somatosensory cortical activity at rest and mobility. These results indicate that difficulties in sensorimotor integration may contribute to the mobility impairments seen in this patient population. This article is protected by copyright. All rights reserved.