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and/or parent was informed about the project and gave informed
consent. In each child with an able body only one leg was -8"
tested. Attempts were made to test both legs of the children
with cerebral palsy, but if a child became tired, bored, or unco- Knee Flexed ] IKnee Extended
operative, only one leg was tested. Initial efforts at determining -lC
-7o -~o -~o 4o -5o -~o -10 1'o ~o 30
the reliability of the measure were accomplished by testing KinCem Angle (degrees)
two children at two different times after their selective dorsal
rhizotomy surgery. One child was tested at 34 and 41 weeks Fig 1. Quantification of the work done (torque × angular displacement)
after surgery and a second child was tested at 10 and 21 months by the KinCom machine on one subject at one speed (shaded area). The
after surgery. boundaries for the a r e a were the torque-angle curve, the zero torque line,
and the end range of motion (about 12°). A work value was calculated for
The KinCom dynamometer~can move the passive leg through each of the four speeds for each child. Inertial and gravitational effects
a range of motion at a specified speed, measuring the force have been accounted for in the torque values.
applied to a support arm during the motion. Each child sat on
the KinCom with stabilization straps across the distal aspect of
the thigh and pelvis. The child was supported at his or her back The force data from each child were downloaded to a personal
and was capable of maintaining an upright position. The axis computer in which the weight of the leg and foot due to gravity,
of the KinCom was aligned with the knee axis of the child. The estimated to be 5.8% of total body weight, was partialled out
leg of the child was attached to the support arm by securing in a custom computer program. 2° The acceleration of the leg
the leg against a tibia pad with Velcro straps. A fixed laboratory from a motionless position to a constant angular velocity pro-
coordinate system was established by moving the lever arm to duced a torque component in the data that was unwanted. As
a horizontal position (0°). Torques were calculated by inputting would be expected this component was increased as both the
the distance of the tibia pad from the rotation axis of the ma- speed of the test and the mass of the leg and foot increased.
chine. These inertial effects were removed by modeling the accelera-
Before conducting the spasticity tests, the anatomic range tion component as an underdamped second-order system and
of motion limits for knee extension or hamstring length were subtracting it from the torque values.2~
established for each child. The starting position for the test was The areas quantifying the work done (ie, fT*d0 where T =
approximately 60 ° below the horizontal, although this position Torque and dO is a small angular displacement measured in
was decreased to 50 ° if substantial quadriceps resistance existed. radians) by the machine on the child were calculated using the
A special feature of the KinCom was used to determine the trapezoid rule. The boundaries for the areas were the torque-
limits for knee extension. This feature caused the machine to angle curve, the zero torque line, and the end range of motion
stop if a preset force (ie, termination force) was reached. Ini- (fig 1). Four areas quantifying work were determined for each
tially, the machine was set to take the knee of the child beyond child for the given speeds (ie, 10°, 30°, 60 °, 90°/sec). Linear
its physiological limits. To prevent this from happening a low regression was used to determine the line of best fit for these
termination force value was programmed into the machine to four areas as a function of speed. The slope of the linear regres-
stop the test. The end range of extension motion was determined sion line was considered to be the measure of spasticity. It was
by assigning a speed of 10°/sec to the KinCom and engaging hypothesized that the children with able bodies would have
the passive mode. The child was instructed not to help the lever slopes close to zero because they have no velocity-dependent
arm move and remain as relaxed as possible as the leg rotated resistance to stretch and the children with cerebral palsy would
from a flexed to an extended position. The end range of motion have slopes greater than zero because they do have a velocity-
for knee extension was determined and recorded by gradually dependent resistance to stretch.
increasing the termination force until the child felt uncomfort- Because not all children wit~l cerebral palsy had both legs
able, the pelvis began to rotate posteriorly, or the knee began tested, the single leg tested was used in the analysis (n = 6).
to rise. The final termination force values were converted to In the cases where both legs were tested, a single leg from each
torques for each child and ranged between 6 and 20Nm. To child was randomly chosen for analysis (n = 11). A chi-squared
insure the safety of the child an adult closely observed the tests test was performed to determine if the distribution of the slopes
and held a button that, if pressed, would stop the test. for the children with cerebral palsy were significantly different
The spasticity tests were then conducted. These tests were from a normal distribution. Since no significant difference was
similar to the previous one except that the end range of exten- found (p < .01) an independent t test was used to determine if
sion motion was used to stop the tests instead of a termination a significant difference existed between the slopes for the two
force value. The starting angle remained at approximately 60 ° groups of children (p < .05).
below the horizontal. The termination force was increased from
its preset value to assure that the end range of motion was
achieved. Tests for knee extension were conducted at speeds of RESULTS
10°, 30°, 60 °, and 90°/sec, and the resistive torque was continu- Torque-angle data for a typical child with an able body indi-
ously monitored during the trials. cated very little change in resistive torque as a function of speed
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[ K ~ _T~Kn~eeExtended I ~ ,,g/-~
-10 2
-70 -60 -50 -40 -30 -20 -10 0 10 20 30 0 1'0 2'0 ~o 4o 10 ~0 #0 do $0 lO0
KinComAngle(degrees) Velocity of Knee Extension(degrees/s)
Fig 3. Results of the passive resistance tests for a typical child with Fig 4. Work done by the KinCom machine on the children with cerebral
spastic diplegic cerebral palsy (girl, age 12 years, mass 39kg}. In contrast palsy and on the children with able bodies presented in table 1 and
to the results presented in figure 2, this test showed an increase in plotted as a function of velocity. Linear regression lines are included
resistance corresponding to an increase in speed of knee extension, re- with their slopes. The slope for the children with cerebral palsy was
flecting the velocity-dependent resistance to stretch characteristic of approximately 10 times greater than the corresponding slope for the
children with cerebral palsy. Inertial and gravitational effects have been children with able bodies. The slopes were significantly different (Cere-
accounted for in the torque values. bral palsy slope [---] - .033; able body slope [ - - | = .0031),