Pathophysiology of gait in children with cerebral palsy.

The surface electromyogram (EMG) of leg muscles was recorded together with the changes of the angle at the ankle joint during slow gait in 10 normal children and 10 with cerebral palsy. The characteristic pattern of muscle activity recorded from the spastic legs mainly consisted of a co-activation of antagonistic leg muscles during the stance phase of a gait cycle and a general reduction in amplitude of EMG activity. The tension of the Achilles tendon, measured in 2 hemiparetic children during gait, increased much more steeply in the spastic leg than in the normal one at the beginning of the stance phase, when the electrically almost silent triceps surae was stretched. It is suggested that muscle hypertonia during gait in spastic children is mainly due to changed muscle fibre mechanical properties, as recently discussed also for spastic adults. While in the latter the reciprocal EMG activity of antagonistic leg muscles was preserved it is proposed that muscle co-activation recorded in spastic children is due to an impaired maturation of the locomotor pattern with an early neuronal adaptation to altered muscle fibre mechanical characteristics.