Contributors to excess antagonist activity during movement in children with secondary dystonia due to cerebral palsy.

Children with secondary dystonia due to cerebral palsy exhibit abnormal upper extremity postures and slow voluntary movement. However, the interaction between abnormal postures and abnormal movement in dystonia is still unclear. Some mechanisms by which postures are maintained in dystonia include stretch reflexes, overflow of muscle activation to other muscles, and direct coactivation of antagonist muscles. This study explored the independent contributions of each of these postural mechanisms to abnormal biceps brachii (antagonist) activity during elbow extension, which slows movement. A linear model of biceps activation as a function of velocity-dependent reflexes, triceps-dependent overflow, and direct drive to the biceps was fitted to experimental data from 11 children and young adults with secondary dystonia due to cerebral palsy and 11 age-matched control subjects. Subjects performed elbow extension movements against each of four levels of resistance without perturbations or in each of two perturbation conditions. Results show that biceps activity in children with dystonia consists of significant contributions of reflex activation, overflow from triceps, and direct muscular drive. Additionally, stretch reflexes during movement are shown to be elevated at three latencies after stretch. These findings suggest that there are postural mechanisms involved in stabilizing the elbow along its slow trajectory during movement and provide a quantitative basis for the selection of treatments targeting specific impairments in children with secondary dystonia due to cerebral palsy.