SIGNIFICANCE OF THE CONFUSION TEST IN CEREBRAL-PALSY

The confusion test examines ankle dorsiflexion in patients with cerebr al palsy. Orthopedists have related this test to swing-phase activity of the tibialis anterior, and have used it as a prerequisite for tendo n transfer. To determine the validity of this assumption, ankle dorsif lexion was tested in 47 normal children. Forty-seven percent had a pos itive, unresisted confusion test, and 97% had a positive, resisted con fusion test. Twenty-three patients with cerebral palsy who had a posit ive confusion test underwent gait analysis. Tibialis anterior electrom yographs showed wide variability. Sagittal-plane ankle-movement curves revealed five patterns. Thirty-three percent of the patients showed a bnormal swing-phase dorsiflexion, and 61% had abnormal swing-phase pla ntar-flexion. We conclude that the confusion test evaluates a normal, patterned response, and is positive in most children with cerebral pal sy. Although a positive confusion test shows that active ankle dorsifl exion is possible, it is not predictive of swing-phase ankle kinematic s.