Commentary on “Number of Synergies Is Dependent on Spasticity and Gait Kinetics in Children With Cerebral Palsy”
Selective motor control is one component for the assessment of motor coordination but can be limited by behavior, cognition, and positioning and other variables such as joint contractures. The muscle synergies described in this study can be correlated with more complex multijoint movements that are seen in gait. Optimizing gait patterns and gait efficiency in all patients, particularly those diagnosed with cerebral palsy, is a common goal for physical therapists in the pediatric setting. In addition, variables such as weight, height, muscle tone, balance, and postural deviations caused by structural or compensatory mechanisms can impact recruitment of muscles for functional activities. This research suggests gait training and the practice of activities of daily living as treatment strategies. This can be streamlined by using the Canadian Occupational Performance Measure and the Goal Attainment Scale to identify goals that are meaningful to the patient and the family.
“What should I be mindful about when applying this information?”
While standardized measures could be associated with smaller or larger numbers of synergies, the small sample size and age of participants limit generalizability. Gait analysis and electromyography to assess muscle activity may be inconvenient or cost-prohibitive in the early intervention, outpatient, or school-based settings. Therefore, assessing for muscle synergies may not be helpful in advancing physical therapy treatment without more accessible testing or clinical assessments. Further research is needed to demonstrate techniques for assessing muscle synergies in the clinic, as well as the importance of these synergies for functional skills. Muscle synergies can be defined in a variety of ways and a more detailed definition would be helpful.