Date: Thu, 8 Aug 1996 10:51:27 +0800 (WST)
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From: "Sang-Hyun Cho MD." 
To: Multiple recipients of list <[n/a]>
Subject: Reply to case of 6/8/96.
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Hello, this is Dr. Sanghyun Cho at Seoul, S-Korea, again.
I hope I could get opinions from more clinicians here.

The case of 6/8/96 was rather simple I think.
He is CP diplegia with more involvement on right side.
Dr. Kirtley, could you give us basic physical findings of ease weekly
case from now on ?    The ROM(range of motion) and modified Ashworth's
spasticity scale of lower extremety joints will be great help for our
future discussion.

1. Is his gait symmetrical? If not, which is his 'better' leg? 
>> No.  His left leg is better.
First, although the ROM of both side's ankle joint is similar, power
generation at the push-of moment is bigger on the left side.
Second, soon after the "initial contact", reflexic power generation on
ankle plantarflexor which suggests "spastic ankle clonus" can be seen
only on right leg.

2. What happens at initial contact on the right-side? 
First, though his both legs seems to start "initial contact" with toe
touch, his right ankle responses more spastic.  Because his right ankle
joint became more rigid from spaticity, the dorsiflexing torque
generated at the joint by "toe touch" is immediately transmitted to his
right knee and hip pushing them backward(hyperextension).
Second, as the right knee and hip joints are hyperexteded during the
midstance phase, he is trying to counter the force by generating more
power on his hip flexor and knee flexor which is displayed as peaks on
moment and power plots of right leg during "loading response" period.

Cheers, colleagues !
What a wonderful brain exercise !

Sanghyun Cho MD.
Yonsei University,College of Medicine, Rehabilitation Hospital

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