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, 44 (4), 509-17

Tibialis Anterior Architecture, Strength, and Gait in Individuals With Cerebral Palsy

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Tibialis Anterior Architecture, Strength, and Gait in Individuals With Cerebral Palsy

Daniel C Bland et al. Muscle Nerve.

Abstract

Introduction: The relationship of tibialis anterior (TA) muscle architecture, including muscle thickness (MT), cross-sectional area (CSA), pennation angle (PA), and fascicle length (FL), to strength and ankle function was examined in ambulatory individuals with CP and unilateral foot drop.

Methods: Twenty individuals with CP participated in muscle ultrasound imaging, unilateral strength testing, and three-dimensional gait analysis.

Results: Muscle size (MT and CSA) was positively related to strength, fast gait velocity, and ankle kinematics during walking. Higher PA was related to a more dorsiflexed ankle position at initial contact and inversely with fast gait velocity. FL was related to strength, fast velocity, and step length at a self-selected speed.

Conclusions: Muscle architecture partially explains the degree of impairment in strength and ankle function in CP. Treatments to increase TA size and strength may produce some gait improvement, but other factors that may contribute to ankle performance deficits must be considered.

Figures

Figure 1
Figure 1
Representative mean ankle angle data during gait from one participant who was GMFCS Level II (black line). The gray band represents one standard deviation around the mean for typical gait. Stance phase is the period when the limb is in contact with the ground; swing phase is the period when the limb is not in contact with the ground and is advancing forward. Gait variables of interest are noted: ICDf, dorsiflexion at initial contact; DfMxSt, maximum dorsiflexion in stance; DfTO, dorsiflexion at toe-off; DfMxSw, maximum dorsiflexion in swing.
Figure 2
Figure 2
Longitudinal (top) and transverse views (bottom) of the tibialis anterior muscle on the more (left) and less (right) affected side for one participant. Thickness and pennation angle were measured in the longitudinal views, and cross-sectional area in the transverse views. The top of each image is the skin and fascial layer. The muscle directly below the TA in the longitudinal image is the tibialis posterior.

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