Predictive Contribution of Clinical Measures of Ankle Neuromuscular Impairments to Ankle Kinematic Deviations During Gait in Children With Cerebral Palsy.

Introductions

Children with cerebral palsy (CP) commonly exhibit neuromuscular impairments that affect ankle motion during gait. These include hypertonia, muscle weakness, poor selective motor control, and restricted range-of-motion. However, their individual and combined impacts on sagittal ankle kinematics remain unclear. This study aimed to quantify the relative contribution of these impairments on ankle motion during gait in children with spastic CP.

Methods

A total of 132 children with spastic CP, 264 limbs, underwent clinical assessments, and three-dimensional gait analysis. Clinical tests evaluated muscle strength, hypertonia, selective motor control, and passive ankle range-of-motion. Ankle angles were measured at five key gait events: initial contact, loading response, terminal stance, preswing, and mid-swing. Multiple linear regression models examined the association between impairments and ankle kinematics.

Results

Soleus shortening explained 8% of the variance in ankle position at initial contact. Mid-swing dorsiflexion was influenced by soleus shortening, triceps surae hypertonia, and impaired plantarflexor selective motor control, accounting for 25% of the variance. The change from initial contact to mid-swing was similarly explained around 15%, with hypertonia emerging as the strongest predictor. No clinical variables significantly explained stance-phase kinematics.

Conclusion

Soleus length, plantarflexor hypertonia, and selective motor control impairments partially explain swing-phase ankle motion but not stance-phase kinematics. These findings suggest that standard clinical assessments have limited value in predicting weight-bearing gait function. Comprehensive evaluations incorporating objective biomechanical measures are needed to guide individualized treatment planning in children with CP.

Keywords

ankle, cerebral palsy, gait, hypertonia, kinematics, neuromuscular impairment