Selective motor control may be associated with the single support time of gait and single limb standing time in cerebral palsy

Abstract

The Selective Motor Control Assessment of the Lower Extremity (SCALE) is a tool used to assess the quality of motor control of the lower extremity in cerebral palsy (CP). Selective motor control (SMC) is known to be associated with balance and some walking alterations, as well as a significant sign for gross motor function (1-3). It is well known that the single limb stance has a strong relationship with the stability in stance which is the main aim of physiotherapy for improving the quality of walking for CP (4). Therefore the aim of this study is to determine the relationship between SMC, single-limb standing (SLS) time and single support time (SST) of gait in CP. Is there any relationship between SMC with SLS time and SST of gait in individuals with CP? In this study, 10 individuals with spastic type diplegics CP (mean age: 12,7±5,86) were included and bilateral limbs (n:20) were evaluated. Inclusion criteria were GMFCS level I or II, walk 10 meters without assistive device. Patients who had undergone surgery or had botulinum toxin injections in the last 6 months were excluded. The Selective Control Assessment of the Lower Extremity (SCALE) was performed on the hip (S1), knee (S2), subtalar (S3), ankle (S4) and toes (S5) joint for SMC. In addition, the total foot score (TFS) was calculated by summing the subtalar, ankle and toe joint scores; and the total score (TS) is calculated by summing all joints. Independent SLS score of the Gross Motor Function Measure was applied (three point scale). The interested gait parameters of each individual were analyzed with a pedobarography (Win-track, Balma, France). The SST was normalized by dividing stance time. For each parameter, 3 averaged trials were included. Pearson and Spearman’s correlation with Cohen's classification were used for statistical analysis (5). S3, TFS and TS had a strongly positive correlation with SLS score. There was a moderate positive correlation between S5 and SST (Table 1). Download : Download high-res image (207KB)Download : Download full-size image Strong positive correlation of total foot and total scores on SCALE test with single limb stance may show that improving total SMC, especially on subtalar joints, may increase the time of independent standing on one leg. Although only SMC at toes has the moderate level correlation with SST which is also the parameter related with stability in stance phase (4). Therefore improving motor control on toe flex-extension may have a great potential on increasing stance phase stability for CP. It is worthwhile to design randomized control studies with a large number of participants to analyze the relationship of improving SMC and stability in the stance phase by 3D gait analysis in the future.