Involuntary and voluntary muscle activation in children with unilateral cerebral palsy - Relationship to upper limb activity

Background: Spasticity and reduced strength are both primary neuromuscular impairments associated with cerebral palsy (CP). However, it is unclear whether spasticity or reduced strength is the strongest contributor to activity limitations. Aim: To study whether involuntary activation of the biceps brachii muscle, in addition to reduced strength, contributes to limitations in upper limb activity in children with CP. Method: Fifteen children with unilateral CP (9 males and 6 females, age range 8-17 years) participated in this study. Involuntary activation, reflecting spasticity, was studied as biceps brachii activity during passive elbow extension at four isokinetic velocities (10, 90, 180 and 300 degrees/s). Elbow flexion peak torque, reflecting strength, was measured during maximal voluntary isometric contraction, and concurrent biceps brachii activity was registered reflecting voluntary muscle activation. Bimanual upper limb activity was assessed in the performance domain using the Assisting Hand Assessment (ABA). Results: Both involuntary and voluntary muscle activation were related to activity, the former negatively, but voluntary activation showed the strongest relationship (Spearmans rho = .84). Involuntary muscle activation at 10, 90 and 180 degrees/s was negatively related to muscle strength (Spearmans rho = -.63, -.58 and -.62, respectively). Conclusions: Our results do not indicate that spasticity affects upper limb activity in addition to strength. Most likely, muscle weakness and spasticity jointly contribute to activity limitations, reflected by the strong relationship between the ability to voluntarily activate a muscle and activity performance. (C) 2012 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.