Motor control investigation of dystonic cerebral palsy: A pilot study of passive knee trajectory.

The purpose of this study is to better understand dystonia in CP and be able to objectively distinguish between individuals who experience spasticity, dystonia, or a combination of these conditions while evaluating the effect of 2Hz vestibular stimulation. Selected outcome measures included knee ROM, angular velocity and acceleration and all measures increased post vestibular stimulation; these results are indications of a possible reduction in the level of disability. The current investigation also identified an unexpected and unique behavior of the knee in children with dystonic cerebral palsy (CP) that was noticed while administering the Pendulum Knee Drop test (PKD) at approximately 0.4 rad (a mid-angle between full extension and zero vertical). There was a catch-like phenomenon at the described mid-angle in dystonic individuals. These results may suggest that dystonia is not a velocity dependent hypersensitivity of reflexes, but may include position dependent muscle reflexes and co-contractions. This reinforces the need for a more precise objective measure or perhaps a modified measure such as a mid-angle PKD test. Furthermore, based on the results obtained through the modified technique, beneficial alterations can be made to the form of treatment such as: robotic therapy or physical therapy that specifically accommodates the unique motor control disorder in individuals with dystonic CP.

Estimation of intrinsic joint impedance using quasi-static passive and dynamic methods in individuals with and without Cerebral Palsy.

Modeling the passive behavior of the knee in subjects with spasticity involves the applied external torques (e.g. gravitational torque), the intrinsic moments due to tissue properties, as well as active, neurally defined moments resulting from the hypersensitivity of reflexes introduced by disability. In order to provide estimates of the necessary intrinsic terms in the equation of motion, the push-pull and Wartenberg Pendulum Knee Drop (PKD) tests were administered. Four subjects without disability and two subjects with Cerebral Palsy (CP) were evaluated for their active and intrinsic knee stiffness parameters. Separation of these two terms requires an additional stiffness term be added to the traditional equation of motion. This holds true for subjects with and without neurological disability. Very interestingly, the optimized non-disabled PKD produced lumped stiffness (K) that is similar to the push-pull passive stiffness (KI) for both populations. On the other hand the optimized K value in the PKD test for subjects with disability was approximately 19 times larger than the KI value found graphically from the push-pull test. This leads us to the conclusion that we can partition our lumped K as the sum of a neurally generated stiffness (Ka) and KI to complete the trajectory model. Therefore, this study shows that spasticity is a velocity dependent, that would not appear in disabled individuals unless the examined limb has a non-zero velocity.