Case reports: the influence of selective voluntary motor control on gait after hamstring lengthening surgery.

BACKGROUND: Preliminary evidence suggests selective voluntary motor control (SVMC), defined as performance of isolated voluntary joint movement on request, may be an important factor affecting functional movement tasks. Individuals with poor SVMC are unable to dissociate hip and knee synergistic movement during the swing phase of gait and have difficulty extending their knee while the hip is flexing during terminal swing regardless of hamstring length. This pattern may limit their ability to take advantage of hamstring-lengthening surgery (HLS) and may explain a lack of improved stride length postoperatively. QUESTIONS/PURPOSES: Provide a preliminary clinical and conceptual framework for using SVMC to predict swing phase parameters of gait after HLS. PATIENTS AND METHODS: We contrasted two patients with spastic diplegia of similar age, gross motor function, and spasticity but with different SVMC scores using the Selective Control Assessment of the Lower Extremity (SCALE). The patients underwent bilateral HLS. Popliteal angles, joint kinematics, step length, stride length, and walking velocity were assessed pre- and postoperatively. RESULT: Popliteal angles, terminal knee extension, and knee range of motion improved for both patients. However, only the patient with higher SCALE scores improved stride length postoperatively.
CONCLUSION: Although preliminary, the data suggest that SVMC, as measured by SCALE, may be a prognostic factor for improved stride length after HLS in patients with spastic diplegia. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.