Predictive Contribution of Clinical Measures of Ankle Neuromuscular Impairments to Ankle Kinematic Deviations During Gait in Children With Cerebral Palsy.
- 1Department of Pediatric Orthopedics and Traumatology, Gait and Motion Analysis Laboratory, Poznań University of Medical Sciences, Poznań, Poland.
- 2Motion Analysis Laboratory, Bone and Joint Research Center, Chang Gung Memorial Hospital-Linkou, Taoyuan City, Taiwan.
- 3Independent Researcher, Edmonton, Alberta, Canada.
Abstract
Introductions
Children with cerebral palsy (CP) commonly exhibit neuromuscular impairments that affect ankle motion during gait. These include hypertonia, muscle weakness, poor selective motor control, and restricted range-of-motion. However, their individual and combined impacts on sagittal ankle kinematics remain unclear. This study aimed to quantify the relative contribution of these impairments on ankle motion during gait in children with spastic CP.Methods
A total of 132 children with spastic CP, 264 limbs, underwent clinical assessments, and three-dimensional gait analysis. Clinical tests evaluated muscle strength, hypertonia, selective motor control, and passive ankle range-of-motion. Ankle angles were measured at five key gait events: initial contact, loading response, terminal stance, preswing, and mid-swing. Multiple linear regression models examined the association between impairments and ankle kinematics.Results
Soleus shortening explained 8% of the variance in ankle position at initial contact. Mid-swing dorsiflexion was influenced by soleus shortening, triceps surae hypertonia, and impaired plantarflexor selective motor control, accounting for 25% of the variance. The change from initial contact to mid-swing was similarly explained around 15%, with hypertonia emerging as the strongest predictor. No clinical variables significantly explained stance-phase kinematics.Conclusion
Soleus length, plantarflexor hypertonia, and selective motor control impairments partially explain swing-phase ankle motion but not stance-phase kinematics. These findings suggest that standard clinical assessments have limited value in predicting weight-bearing gait function. Comprehensive evaluations incorporating objective biomechanical measures are needed to guide individualized treatment planning in children with CP.
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BibTeX
@article{manikowska2026predictive,
title = {{Predictive Contribution of Clinical Measures of Ankle Neuromuscular Impairments to Ankle Kinematic Deviations During Gait in Children With Cerebral Palsy.}},
author = {Faustyna Manikowska and Sabina Brazevic and Brian Po-Jung Chen and Marek Jóźwiak and Maria K Lebiedowska},
journal = {Journal of foot and ankle research},
year = {2026},
month = oct,
doi = {10.1002/jfa2.70195},
url = {https://europepmc.org/article/MED/42905945},
note = {CC BY},
}
RIS
TY - JOUR
TI - Predictive Contribution of Clinical Measures of Ankle Neuromuscular Impairments to Ankle Kinematic Deviations During Gait in Children With Cerebral Palsy.
AU - Faustyna Manikowska
AU - Sabina Brazevic
AU - Brian Po-Jung Chen
AU - Marek Jóźwiak
AU - Maria K Lebiedowska
PY - 2026
DA - 2026/10/30
JO - Journal of foot and ankle research
DO - 10.1002/jfa2.70195
UR - https://europepmc.org/article/MED/42905945
AB - Introductions Children with cerebral palsy (CP) commonly exhibit neuromuscular impairments that affect ankle motion during gait. These include hypertonia, muscle weakness, poor selective motor control, and restricted range-of-motion. However, their individual and combined impacts on sagittal ankle kinematics remain unclear. This study aimed to quantify the relative contribution of these impairments on ankle motion during gait in children with spastic CP.Methods A total of 132 children with spastic CP, 264 limbs, underwent clinical assessments, and three-dimensional gait analysis. Clinical tests evaluated muscle strength, hypertonia, selective motor control, and passive ankle range-of-motion. Ankle angles were measured at five key gait events: initial contact, loading response, terminal stance, preswing, and mid-swing. Multiple linear regression models examined the association between impairments and ankle kinematics.Results Soleus shortening explained 8% of the variance in ankle position at initial contact. Mid-swing dorsiflexion was influenced by soleus shortening, triceps surae hypertonia, and impaired plantarflexor selective motor control, accounting for 25% of the variance. The change from initial contact to mid-swing was similarly explained around 15%, with hypertonia emerging as the strongest predictor. No clinical variables significantly explained stance-phase kinematics.Conclusion Soleus length, plantarflexor hypertonia, and selective motor control impairments partially explain swing-phase ankle motion but not stance-phase kinematics. These findings suggest that standard clinical assessments have limited value in predicting weight-bearing gait function. Comprehensive evaluations incorporating objective biomechanical measures are needed to guide individualized treatment planning in children with CP.
SN - 1757-1146
ER -