Estimation of intrinsic joint impedance using quasi-static passive and dynamic methods in individuals with and without Cerebral Palsy

Modeling the passive behavior of the knee in subjects with spasticity involves the applied external torques (e.g. gravitational torque), the intrinsic moments due to tissue properties, as well as active, neurally defined moments resulting from the hypersensitivity of reflexes introduced by disability. In order to provide estimates of the necessary intrinsic terms in the equation of motion, the push-pull and Wartenberg Pendulum Knee Drop (PKD) tests were administered. Four subjects without disability and two subjects with Cerebral Palsy (CP) were evaluated for their active and intrinsic knee stiffness parameters. Separation of these two terms requires an additional stiffness term be added to the traditional equation of motion. This holds true for subjects with and without neurological disability. Very interestingly, the optimized non-disabled PKD produced lumped stiffness (K) that is similar to the push-pull passive stiffness (K_I) for both populations. On the other hand the optimized K value in the PKD test for subjects with disability was approximately 19 times larger than the K_I value found graphically from the push-pull test. This leads us to the conclusion that we can partition our lumped K as the sum of a neurally generated stiffness (K_a) and K_I to complete the trajectory model. Therefore, this study shows that spasticity is a velocity dependent, that would not appear in disabled individuals unless the examined limb has a non-zero velocity.