Gait training reduces ankle joint stiffness and facilitates heel strike in children with Cerebral Palsy

NeuroRehabilitation. 2014;35(4):643-55. doi: 10.3233/NRE-141180.


Background: Foot drop and toe walking are frequent concerns in children with cerebral palsy (CP). Increased stiffness of the ankle joint muscles may contribute to these problems.

Objective: Does four weeks of daily home based treadmill training with incline reduce ankle joint stiffness and facilitate heel strike in children with CP?

Methods: Seventeen children with CP (4-14 years) were recruited. Muscle stiffness and gait ability were measured twice before and twice after training with an interval of one month. Passive and reflex-mediated stiffness were measured by a dynamometer which applied stretches below and above reflex threshold. Gait kinematics were recorded by 3-D video-analysis during treadmill walking. Foot pressure was measured by force-sensitive foot soles during treadmill and over-ground walking.

Results: Children with increased passive stiffness showed a significant reduction in stiffness following training (P = 0.01). Toe lift in the swing phase (P = 0.014) and heel impact (P = 0.003) increased significantly following the training during both treadmill and over-ground walking.

Conclusions: Daily intensive gait training may influence the elastic properties of ankle joint muscles and facilitate toe lift and heel strike in children with CP. Intensive gait training may be beneficial in preventing contractures and maintain gait ability in children with CP.

Keywords: Cerebral palsy; gait training; passive muscle stiffness.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Ankle / physiopathology*
  • Ankle Joint / physiopathology
  • Biomechanical Phenomena
  • Cerebral Palsy / rehabilitation*
  • Child
  • Child, Preschool
  • Electromyography
  • Female
  • Gait Disorders, Neurologic / rehabilitation*
  • Gait*
  • Heel / physiopathology*
  • Humans
  • Male
  • Muscle Strength Dynamometer
  • Muscle, Skeletal / physiopathology
  • Physical Conditioning, Human
  • Toes
  • Treatment Outcome