Spontaneous decrease in gastrocnemius spasticity after correction of knee flexion gait in children with cerebral palsy.

Abstract

Synergistic neuro-excitability in the lower extremities may be related to gait disorders. This study aimed to report spontaneous changes after correcting knee flexion gait and discuss the underlying mechanisms. A prospective study of 23 children with cerebral palsy was conducted to assess postoperative changes in gross motor function, joint range of motion (ROM), and spasticity. Characteristics of children/limbs with spontaneous decrease in gastrocnemius spasticity were assessed. In 10 patients (19 limbs) without gastrocnemius release, the Modified Ashworth scores in the gastrocnemius decreased in 6 limbs after 3 months and in 10 limbs after 6 months. Those limbs with spontaneous changes had worse preoperative knee flexion contracture than the limbs without spasticity changes (knee ROM limitation score 5.4 vs. 3.7, <i>p</i> = 0.026). Patients with knee flexion contracture recruited greater plantar flexion-knee extension couple to balance knee flexion gait, and synergistic neuro-excitability of the gastrocnemius was enhanced. Our early results suggest preservation of the gastrocnemius in treating knee flexion gait, especially for patients with knee flexion contracture.