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States RA, Salem Y, Krzak JJ, Godwin EM, McMulkin ML, Kaplan SL. Three-Dimensional Instrumented Gait Analysis for Children With Cerebral Palsy: An Evidence-Based Clinical Practice Guideline. Pediatr Phys Ther 2024; 36:182-206. [PMID: 38568266 DOI: 10.1097/pep.0000000000001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
BACKGROUND Children with cerebral palsy (CP) who walk have complex gait patterns and deviations often requiring physical therapy (PT)/medical/surgical interventions. Walking in children with CP can be assessed with 3-dimensional instrumented gait analysis (3D-IGA) providing kinematics (joint angles), kinetics (joint moments/powers), and muscle activity. PURPOSE This clinical practice guideline provides PTs, physicians, and associated clinicians involved in the care of children with CP, with 7 action statements on when and how 3D-IGA can inform clinical assessments and potential interventions. It links the action statement grades with specific levels of evidence based on a critical appraisal of the literature. CONCLUSIONS This clinical practice guideline addresses 3D-IGA's utility to inform surgical and non-surgical interventions, to identify gait deviations among segments/joints and planes and to evaluate the effectiveness of interventions. Best practice statements provide guidance for clinicians about the preferred characteristics of 3D-IGA laboratories including instrumentation, staffing, and reporting practices.Video Abstract: Supplemental digital content available at http://links.lww.com/PPT/A524.
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Affiliation(s)
- Rebecca A States
- Physical Therapy Program, School of Health Professions and Human Services, Hofstra University, Hempstead, New York (Drs States and Salem); Faculty of Physiotherapy, Cairo University, Cairo, Egypt (Dr Salem); Midwestern University - Physical Therapy Program, Downers Grove, Illinois (Dr Krzak); Shriners Children's Chicago, Gerald F. Harris Motion Analysis Center, Chicago, Illinois (Dr Krzak); Department of Physical Therapy, Long Island University - Brooklyn, Brooklyn, New York (Dr Godwin); Shriners Children's Spokane, Walter E. & Agnes M. Griffin Motion Analysis Center, Spokane, Washington (Dr McMulkin); Department of Rehabilitation & Movement Sciences, Rutgers, The State University of New Jersey, Newark, New Jersey (Dr Kaplan)
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Galán-Olleros M, Lerma-Lara S, Torres-Izquierdo B, Ramírez-Barragán A, Egea-Gámez RM, Hosseinzadeh P, Martínez-Caballero I. Does patella lowering as part of multilevel surgery improve knee kinematics in children with cerebral palsy and crouch gait? A meta-analysis of comparative studies. J Child Orthop 2024; 18:13-25. [PMID: 38348440 PMCID: PMC10859119 DOI: 10.1177/18632521231217542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/14/2023] [Indexed: 02/15/2024] Open
Abstract
Purpose To evaluate differences in knee kinematic outcomes of patellar-lowering surgery, specifically patellar tendon advancement or patellar tendon shortening, compared with no-patellar-lowering surgery in multilevel surgery for children with cerebral palsy and crouch gait. Methods Four databases were searched to retrieve studies published from inception until 2023. Three reviewers independently screened for studies with observational or randomized control designs, comparing two groups of patients with cerebral palsy and crouch gait who underwent multilevel surgery (with patellar-lowering surgery versus no-patellar-lowering surgery), where various gait analysis outcomes were reported (CRD42023450692). The risk of bias was assessed with the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool. Results Seven studies (249 patients and 368 limbs) met the eligibility criteria. Patients undergoing patellar-lowering surgery demonstrated statistically significant improvements in knee flexion at initial contact (mean difference = -6.39; 95% confidence interval = [-10.4, -2.75]; p = 0.0006; I2 = 84%), minimum knee flexion in stance (mean difference = -14.27; 95% confidence interval = [-18.31, -10.23]; p < 0.00001; I2 = 89%), and clinical knee flexion contracture (mean difference = -5.6; 95% confidence interval = [-9.59, -1.6]; p = 0.006; I2 = 95%), with a significant increase in anterior pelvic tilt (mean difference = 2.97; 95% confidence interval = [0.58, 5.36]; p = 0.01; I2 = 15%). However, improvements in gait deviation index and decrease in peak knee flexion in swing did not reach statistical significance. Subgroup analysis reduced heterogeneity and revealed (1) greater improvement using patellar tendon shortening versus patellar tendon advancement techniques; (2) lack of knee flexion contracture improvement in high-quality or longer-term studies; (3) longer-term improvement only in minimum knee flexion in stance, with a decrease in peak knee flexion in swing; and (4) an inability to assess the potential benefit of rectus femoris procedure and hamstring preservation. Conclusions Overall, the combination of patellar-lowering surgery with multilevel surgery demonstrated superior improvements in stance-phase knee kinematics compared with multilevel surgery alone, despite an increase in anterior pelvic tilt and a longer-term knee flexion reduction during the swing phase. Level of evidence Level III, Systematic review of level III studies.
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Affiliation(s)
- María Galán-Olleros
- Neuro-Orthopaedic Unit, Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Sergio Lerma-Lara
- Departament of Physiotherapy, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Beltran Torres-Izquierdo
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Ana Ramírez-Barragán
- Neuro-Orthopaedic Unit, Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Rosa M Egea-Gámez
- Neuro-Orthopaedic Unit, Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Pooya Hosseinzadeh
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Ignacio Martínez-Caballero
- Neuro-Orthopaedic Unit, Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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O'Sullivan R, French H, Horgan F. A prospective assessment of gait kinematics and related clinical examination measures in cerebral palsy crouch gait. HRB Open Res 2023; 5:81. [PMID: 37601116 PMCID: PMC10435924 DOI: 10.12688/hrbopenres.13647.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 08/22/2023] Open
Abstract
Background While prospectively assessed crouch gait in cerebral palsy (CP) does not necessarily progress, prospective changes in clinical examination measures have not been reported. This study prospectively examined the association between selected clinical examination variables and change in crouch gait in a cohort with bilateral CP. Methods Inclusion criteria were a diagnosis of ambulant bilateral CP, knee flexion at mid-stance >19 0 and a minimum of two-years between gait analyses. The change in kinematic variables was assessed using Statistical Parameter Mapping (SPM) and changes in clinical measures using appropriate paired tests. Linear regression examined the association between progression of crouch and clinical examination variables. Results There was no mean change in crouch in 27 participants over 3.29 years. However, there was significant variability within this group. Clinical hamstring tightness (60.00 0 to 70.48 0, p<0.01) and external knee rotation during stance (SPM analysis, p<0.001) increased but there was no association between changes in clinical examination variables and changes in crouch (p-values 0.06 - 0.89). Conclusions This prospective study found no association between the changes in clinical examination variables and changes in crouch highlighting the likely multi-factorial aetiology of this gait pattern and the need for larger prospective studies. The variability crouch gait progression among the 27 participants highlights the pitfall of group mean values in such a heterogeneous population.
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Affiliation(s)
- Rory O'Sullivan
- Specialist Services, Central Remedial Clinic, Dublin, Ireland
| | - Helen French
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
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O'Sullivan R, French H, Horgan F. A prospective assessment of gait kinematics and related clinical examination measures in cerebral palsy crouch gait. HRB Open Res 2022. [DOI: 10.12688/hrbopenres.13647.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background While prospectively assessed crouch gait in cerebral palsy (CP) does not necessarily progress, prospective changes in clinical examination measures have not been reported. This study prospectively examined the association between selected clinical examination variables and change in crouch gait in a cohort with bilateral CP. Methods Inclusion criteria were a diagnosis of ambulant bilateral CP, knee flexion at mid-stance >190 and a minimum of two-years between gait analyses. The change in kinematic variables was assessed using Statistical Parameter Mapping (SPM) and changes in clinical measures using appropriate paired tests. Linear regression examined the association between progression of crouch and clinical examination variables. Results There was no mean change in crouch in 27 participants over 3.29 years. However, there was significant variability within this group. Clinical hamstring tightness (60.000 to 70.480, p<0.01) and external knee rotation during stance (SPM analysis, p<0.001) increased but there was no association between changes in clinical examination variables and changes in crouch (p-values 0.06 - 0.89). Conclusions The variability crouch gait progression highlights the pitfall of group mean values in such a heterogeneous population. The lack of association between changes in clinical examination variables and changes in crouch highlights the multi-factorial aetiology of this gait pattern and the need for larger prospective studies.
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Ibrahim NM, Galal Abdallah Ibrahim H, Alsayad T, Seddeek MI, Dawa TA, Ibrahim Azzam A, Gaber AEH, Abdelkader A. Gait Rehabilitation in Ambulant Diplegic Children Using Botulinum A Injection and Ankle Weights. Int J Clin Pract 2022; 2022:6544813. [PMID: 36683599 PMCID: PMC9822735 DOI: 10.1155/2022/6544813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Standing and walking serve an individual's basic needs to move from place to place, and both are the most common activities that people do daily. So, this study aims to investigate the combined effect of botulinum A injection and ankle weight on excessive knee flexion in diplegic children with crouch gait. METHODS Sixty children with spastic diplegia walking with a crouch gait were included in this study. They were divided equally into three groups (twenty in each): group A received classical gait rehabilitation, group B received the same gait training while adding ankle weights, and group C received the same as group A and B plus botulinum A injection. The modified Ashworth scale (MAS) and Hoffman reflex/Myogenic response (H/M ratio) were used to evaluate the spasticity of the hamstring and gastrocnemius muscles, while two-dimension gait analysis was used to record knee flexion angles during gait. The assessment was held one day before starting the treatment and after completing three months of the treatment program. RESULTS There was no significant difference between groups before treatment regarding all measured variables. group A revealed a statistically nonsignificant improvement after treatment. Patients in group B showed significant improvement after treatment for both knees regarding the H/M ratio and MAS, which was reflected in the right and left knee range of motion at initial contact (P values 0.030 and 0.001, respectively) and midstance (P values 0.030 and 0.006, respectively). However, more significant improvement was detected regarding all studied variables in both knees after treatment in group C patients with a P value <0.001. CONCLUSION The combination of botulinum A injection and ankle weights was more effective in controlling excessive knee flexion in diplegic children with a crouch gait.
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Affiliation(s)
- Nahla M. Ibrahim
- Department of Physical Therapy for Paediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | | | - Tarek Alsayad
- Department of Pediatrics, Faculty of Medicine (Boys), Al-Azhar University, Cairo, Egypt
| | - Mahrous I. Seddeek
- Department of Neurology, Al-Azhar University, Faculty of Medicine (Boys), Cairo, Egypt
| | - Talal A. Dawa
- Department of Neurology, Al-Azhar University, Faculty of Medicine (Boys), Cairo, Egypt
| | - Adel Ibrahim Azzam
- Department of Rheumatology and Rehabilitation, Faculty of Medicine (Boys), Al-Azhar University, Cairo, Egypt
| | - Abd El-Hamid Gaber
- Department of Clinical Pharmacology, Faculty of Medicine, Menoufia University, Menoufia, Shebin Al Kawm, Egypt
| | - Ashraf Abdelkader
- Department of Pediatrics, Faculty of Medicine (Boys), Al-Azhar University, Cairo, Egypt
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Bensa M, Xavier F, Facca S, Liverneaux P. Iatrogenic hand trauma in institutionalized brain-injured patients: About 2 cases. ANN CHIR PLAST ESTH 2021; 66:406-409. [PMID: 34229910 DOI: 10.1016/j.anplas.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/11/2021] [Accepted: 06/16/2021] [Indexed: 11/17/2022]
Abstract
The objective of this work was to draw the attention of caretakers for institutionalized brain-injured patients to the risk of iatrogenic trauma associated with improper manipulation of the fingers during hand opening for grooming. Two clinical cases of chronic open dislocation of the thumb and the fifth finger in institutionalized brain-injured patients were reviewed. Interrogation of the patients and their relatives did not reveal either the date or the mechanism of the injury. In the light of these two cases, it appears that better training of caretakers should make it possible to avoid iatrogenic trauma during hygiene care of institutionalized brain-injured patients.
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Affiliation(s)
- M Bensa
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1, avenue Molière, 67200 Strasbourg, France.
| | - F Xavier
- Department of Orthopedic Pediatric Surgery, Morvan Hospital, Brest, France.
| | - S Facca
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1, avenue Molière, 67200 Strasbourg, France; ICube CNRS UMR7357, Strasbourg University, 2-4, rue Boussingault, 67000 Strasbourg, France.
| | - P Liverneaux
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1, avenue Molière, 67200 Strasbourg, France; ICube CNRS UMR7357, Strasbourg University, 2-4, rue Boussingault, 67000 Strasbourg, France.
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Kiernan D. Lower limb biomechanics during gait in children with Achondroplasia. J Biomech 2021; 119:110313. [PMID: 33631664 DOI: 10.1016/j.jbiomech.2021.110313] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/27/2021] [Accepted: 02/03/2021] [Indexed: 11/28/2022]
Abstract
Achondroplasia is an autosomal dominant disorder that has been reported to be the most common condition associated with severe disproportionate short stature. A limited number of studies exist in the literature reporting kinematic abnormalities in children with Achondroplasia. Reported deviations include increased pelvic tilt, flexed knees during stance and excessive hip abduction. However, studies lack full 3-dimensional data and results are variable. The aim of this study was to examine differences in 3-dimensional kinematics during gait between children with Achondroplasia and age-matched controls A retrospective analysis was conducted of our gait laboratory database over a 20-year period. Eight children with Achondroplasia and 32 children with typical development were included. A full 3-dimensional kinematic analysis was performed using a CODA mpx30/cx1 active marker system. Increased flexion at all joints in the sagittal plane, increased hip abduction and foot supination in the coronal plane and increased external hip rotation were present for children with Achondroplasia. In contrast to other studies, increased knee varus was not an issue for the children in this study. This study provides a full description of the kinematic patterns associated with children with Achondroplasia and, as such, a comprehensive baseline for planning rehabilitation strategies in these children.
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Affiliation(s)
- Damien Kiernan
- Movement Analysis Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland.
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O'Sullivan R, French HP, Van Rossom S, Jonkers I, Horgan F. The association between gait analysis measures associated with crouch gait, functional health status and daily activity levels in cerebral palsy. J Pediatr Rehabil Med 2021; 14:227-235. [PMID: 33896854 DOI: 10.3233/prm-200676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The aim of this study was to examine the relationship between gait analysis measures associated with crouch gait, functional health status and daily activity in ambulant cerebral palsy (CP). METHODS Three-dimensional gait analysis was carried out on 35 ambulant participants with bilateral CP crouch gait (knee flexion at mid-stance (KFMS) ⩾ 190). KFMS, knee-flexion at initial contact, gait speed and step-lengths were extracted for analysis. Steps/day and sedentary time/day were assessed using an ActivPAL accelerometer. Functional health status was assessed using the five relevant domains of the Pediatric Outcomes Data Collection Instrument (PODCI) questionnaire. Associations between variables were assessed with correlation coefficients and multivariable linear regression. RESULTS There were no significant correlations between KFMS and PODCI domains (ρ=-0.008-0.110) or daily activity (ρ=-0.297-0.237) variables. In contrast, multivariable analysis found that step-length was independently associated with the Sports and Physical Function (p= 0.030), Transfers and Basic Mobility (p= 0.041) and Global Function (< 0.001) domains of the PODCI assessment. Gait speed was independently associated with mean steps/day (p< 0.001). CONCLUSIONS Step length and gait speed are more strongly associated with functional health status and daily activity than knee flexion during stance in children and adolescents with CP crouch gait.
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Affiliation(s)
- Rory O'Sullivan
- Gait Analysis Laboratory, Central Remedial Clinic, Dublin, Ireland.,School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Helen P French
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sam Van Rossom
- Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium
| | - Ilse Jonkers
- Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
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O'Sullivan R, French HP, Horgan F. A prospective assessment of the progression of flexed-knee gait over repeated gait analyses in the absence of surgical intervention in bilateral cerebral palsy. Gait Posture 2020; 79:133-138. [PMID: 32408036 DOI: 10.1016/j.gaitpost.2020.04.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Flexed-knee gait is a common pattern associated with cerebral palsy (CP). It leads to excessive forces on the knee and is thought to contribute to pain and deformity. While studies have shown improvements in mid-stance knee flexion following surgery there remains a lack of prospective data on the progression of flexed-knee gait in the absence of surgery. RESEARCH QUESTION Does knee flexion progress over repeated assessments in the absence of surgery in a prospectively assessed cohort with CP? METHODS Inclusion criteria were a diagnosis of bilateral CP, knee flexion at mid-stance >19° and no surgery within one year of the first gait analysis. Gait analysis was carried out at six-month intervals (minimum of three and maximum of six assessments). The progression of knee flexion over repeated analyses was assessed. The association between changes in knee flexion between assessments and gender, age, GMFCS level, change in ankle dorsiflexion, change in height and change in weight was examined. RESULTS Forty-eight participants met the initial inclusion criteria and 32 (GMFCS I = 11, II = 17, III = 4) completed the minimum three assessments. Of the 32 included participants, 21 participants (66%) demonstrated decreased knee flexion at mid-stance (mean decrease 6.6° ± 3.4°; range 2.0°-13.0°) and 11 participants (34%) demonstrated increased knee flexion at mid-stance (mean increase 10.4° ± 7.1°; range 2.0°-20.0°) at one-year follow-up. Eighteen (56%) then demonstrated an overall decrease (mean 7.4° ± 5.1°) in knee flexion between the first and last assessment with last follow-up at 1-2 years (n = 3), 2-3 years (n = 3) and 3-4 years (n = 12). The majority of participants (78%) demonstrated episodes of both increasing and decreasing Knee flexion between individual assessments and further analysis found that age was associated with this inter-assessment variability in knee flexion. SIGNIFICANCE Flexed-knee gait is not always progressive in bilateral CP and demonstrated variability associated with age.
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Affiliation(s)
- Rory O'Sullivan
- Gait Analysis Laboratory, Central Remedial Clinic, Vernon Avenue, Clontarf, Dublin 3, Ireland; School of Physiotherapy, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland.
| | - Helen P French
- School of Physiotherapy, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland
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Kiernan D, O'Sullivan R. The influence of crouch gait on sagittal trunk position and lower lumbar spinal loading in children with cerebral palsy. Gait Posture 2019; 67:65-70. [PMID: 30290367 DOI: 10.1016/j.gaitpost.2018.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/08/2018] [Accepted: 09/05/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Crouch gait is a common pattern in children with CP. Little investigation has been performed as to the role of the trunk during crouch gait. A compensatory movement of the trunk may alter the position of the ground reaction force with the effect of reducing the moment arm about the knee or hip. While this may benefit these joints in the context of reduced loading, there may be implications further up the kinematic chain at the level of the lumbar spine. RESEARCH QUESTION Are compensatory movements of the trunk present during crouch gait in children with CP and are levels of loading at the lower lumbar spine affected? METHODS A full barefoot lower limb and trunk 3-dimensional kinematic and kinetic analysis, with kinetics estimated at the spinal position of L5/S1, was performed on 3 groups of children, namely CP Crouch, CP No-Crouch and TD. Differences in trunk position and L5/S1 loading were compared between groups. RESULTS Mean trunk position in relation to the pelvis and laboratory was not statistically significant between groups. At the level of the spine, no differences were present in mean position between groups for L5/S1 sagittal moment or anterior/posterior force. SIGNIFICANCE Crouch gait does not elicit a compensatory response of the trunk in children with CP and, consequently, reactive forces and moments at the lower lumbar spine remain within normal limits. With this in mind, it is unlikely that a crouch gait pattern will affect the health of the spine over time in these children.
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Affiliation(s)
- D Kiernan
- Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland.
| | - R O'Sullivan
- Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland
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Cherni Y, Pouliot Laforte A, Parent A, Marois P, Begon M, Ballaz L. Lower limb extension is improved in fast walking condition in children who walk in crouch gait. Disabil Rehabil 2018; 41:3210-3215. [PMID: 30266072 DOI: 10.1080/09638288.2018.1493158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background and purpose: The strategies for walking fast have never been reported in children with cerebral palsy who walk in crouch gait. This study aimed to assess to what extent children who walk in crouch gait are able to increase their gait speed and to report the corresponding three-dimensional kinematic adaptations.Methods: Eleven children and adolescents (aged between 7 and 17 years) with bilateral cerebral palsy, who walk in crouch gait, were asked to walk at their self-selected comfortable speed and then as fast as possible without running. The spatio-temporal and kinematic parameters, as well as the center of mass displacements were compared between walking conditions.Results: Children were able to walk 30% faster than their comfortable speed (+0.30 m/s, p = 0.000) by increasing both cadence (+21 step/min, p = 0.000) and step length (+0.05 m, p = 0.001). During the stance phase, pelvis anteversion (+3 Deg, p = 0.010), hip flexion-extension range of motion (+4 Deg, p = 0.002), and knee extension (+5 Deg, p = 0.000) were increased in fast walking. During fast walking, the center of mass showed larger range of vertical displacements (p < 0.05).Conclusions: Children with cerebral palsy who walk in crouch gait increased their walking speed by adopting a less crouched posture. Compared to comfortable walking speed condition, fast walking could be beneficial in rehabilitation to solicit higher lower limbs range of motion.Implications for rehabilitation:Children who walk in crouch gait can walk 30% fasterFast walking required higher hip and knee extensions during stance phaseFast walking could be an interesting training modality to improve the lower limb range of motion of children who walk in crouch gait.
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Affiliation(s)
- Yosra Cherni
- School of Kinesiology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada.,CHU Sainte-Justine Research Center, Montréal, Québec, Canada
| | - Annie Pouliot Laforte
- CHU Sainte-Justine Research Center, Montréal, Québec, Canada.,Department of Physical Activity Sciences, Université de Québec à Montréal, Montréal, Québec, Canada
| | - Audrey Parent
- CHU Sainte-Justine Research Center, Montréal, Québec, Canada.,Department of Physical Activity Sciences, Université de Québec à Montréal, Montréal, Québec, Canada
| | - Pierre Marois
- CHU Sainte-Justine Research Center, Montréal, Québec, Canada
| | - Mickael Begon
- School of Kinesiology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada.,CHU Sainte-Justine Research Center, Montréal, Québec, Canada
| | - Laurent Ballaz
- CHU Sainte-Justine Research Center, Montréal, Québec, Canada.,Department of Physical Activity Sciences, Université de Québec à Montréal, Montréal, Québec, Canada
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O'Sullivan R, Horgan F, O'Brien T, French H. The natural history of crouch gait in bilateral cerebral palsy: A systematic review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 80:84-92. [PMID: 29960128 DOI: 10.1016/j.ridd.2018.06.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 04/05/2018] [Accepted: 06/19/2018] [Indexed: 06/08/2023]
Abstract
AIM To systematically review the natural history of crouch gait in bilateral cerebral palsy (CP) in the absence of surgical intervention and to review any relationship between clinical variables and progression of knee crouch. METHODS Relevant literature was identified by searching article databases (PubMed, CINAHL, EMBASE, and Web of Science). Included studies reported on participants with bilateral CP who had 3-dimensional gait analysis on at least two occasions with no surgical interventions between analyses. RESULTS Five papers (4 retrospective cohort studies; 1 case report) comprised the final selection. Studies varied in follow-up times and participant numbers. Increased knee flexion over time was reported in the four retrospective studies with two distinct patterns of increasing knee flexion evident. Only the case-study reported improved knee extension between assessments. Four studies demonstrated increased hamstring tightness over time with the biggest increases related to longer follow-up time rather than increase in crouch. CONCLUSION AND IMPLICATIONS The existing literature suggests that the natural history of crouch gait is towards increasing knee flexion over time. Future prospective studies of bigger groups are needed to examine the relationship between increasing crouch and clinical variables.
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Affiliation(s)
- Rory O'Sullivan
- Gait Laboratory, Central Remedial Clinic, Dublin, Ireland; School of Physiotherapy, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland.
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland
| | - Tim O'Brien
- Gait Laboratory, Central Remedial Clinic, Dublin, Ireland
| | - Helen French
- School of Physiotherapy, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland
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13
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Law S. Risk factors contributing to crouch gait in children with spastic cerebral palsy. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x13y.0000000119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Malone A, Kiernan D, O Brien T. Bilateral sleeve fractures of the patella in a 12-year-old boy with hereditary spastic paraparesis and crouch gait. BMJ Case Rep 2013; 2013:bcr-2013-202217. [PMID: 24306432 DOI: 10.1136/bcr-2013-202217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
This is the first reported case of bilateral sleeve fractures of the patellae in a child with crouch gait. A 12-year-old boy with hereditary spastic paraparesis (HSP), who was found to have mid-stance crouch of 20° on previous gait analysis, presented with pain of gradual onset and limited mobility. There was no history of trauma. Three-dimensional gait analysis showed that extensor mechanism function during loading response was intact, but knee flexion in swing was significantly reduced, indicating protective guarding by rectus femoris. X-rays showed bilateral minimally displaced sleeve fractures of the patellae. These were treated with immobilisation in cylinder casts in extension for 4 weeks. Follow-up X-rays showed that the fractures had successfully united and the patient progressed to full weight bearing and mobility as tolerated.
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Elhassan Y, Kiernan D, Lynch T, O'Brien T. Bilateral knee extensor disruption in severe crouch gait. BMJ Case Rep 2013; 2013:bcr-2013-010337. [PMID: 23814213 DOI: 10.1136/bcr-2013-010337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Crouch gait is one of the most troublesome abnormal gait patterns in ambulant patients with spastic diplegic cerebral palsy (CP). Although CP is a non-progressive condition, crouch gait can result in knee extensor disruption (KED) causing deterioration or cessation of ambulation. Diagnosis of KED in crouch gait is often overlooked. We report a seminal case of a 28-year-old active woman with diplegic CP with severe crouch gait who was referred for gait analysis due to subjective decreased walking speed and endurance. Gait analysis showed kinematic features typical of KED and radiology confirmed the diagnosis.
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Affiliation(s)
- Yahya Elhassan
- Gait Laboratory, Central Remedial Clinic, Dublin, Ireland
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Elhassan Y, O'Sullivan R, Walsh M, O Brien T. Knee extensor disruption in mild diplegic cerebral palsy: a risk for adolescent athletes. BMJ Case Rep 2013; 2013:bcr2012008120. [PMID: 23429018 PMCID: PMC3603957 DOI: 10.1136/bcr-2012-008120] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report three cases of adolescent boys with mild diplegic cerebral palsy (CP) who suffered disruption of the knee extensor mechanism. Two had fractures of the patella and the third a fracture avulsion of the tibial tubercle combined with an undisplaced fracture of the patella. All three had gait analysis prior to sustaining the fractures and were known to have mild knee crouch. Each participated in sport including football. Each suffered an acute deterioration in gait resulting in a referral for repeat gait analysis, and x-ray of the affected knee. With the increased involvement of children with CP in sporting activities, especially children with mild knee crouch, we caution that knee extensor rupture might be an increasing problem.
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Affiliation(s)
- Yahya Elhassan
- Department of Gait Laboratory, Central Remedial Clinic, Dublin, Ireland
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Steele KM, Damiano DL, Eek MN, Unger M, Delp SL. Characteristics associated with improved knee extension after strength training for individuals with cerebral palsy and crouch gait. J Pediatr Rehabil Med 2012; 5:99-106. [PMID: 22699100 PMCID: PMC3579590 DOI: 10.3233/prm-2012-0201] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Muscle weakness may contribute to crouch gait in individuals with cerebral palsy, and some individuals participate in strength training programs to improve crouch gait. Unfortunately, improvements in muscle strength and gait are inconsistent after completing strength training programs. The purpose of this study was to examine changes in knee extensor strength and knee extension angle during walking after strength training in individuals with cerebral palsy who walk in crouch gait and to determine subject characteristics associated with these changes. A literature review was performed of studies published since January 2000 that included strength training, three-dimensional motion analysis, and knee extensor strength measurements for individuals with cerebral palsy. Three studies met these criteria and individual subject data was obtained from the authors for thirty crouch gait subjects. Univariate regression analyses were performed to determine which of ten physical examination and motor performance variables were associated with changes in strength and knee extension during gait. Change in knee extensor strength ranged from a 25% decrease to a 215% increase, and change in minimum knee flexion angle during gait ranged from an improvement of 9° more knee extension to 15° more knee flexion. Individuals without hamstring spasticity had greater improvement in knee extension after strength training. Hamstring spasticity was associated with an undesired increase in knee flexion during walking. Subject-specific factors such as hamstring spasticity may be useful for predicting which subjects will benefit from strength training to improve crouch gait.
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Affiliation(s)
- K M Steele
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305, USA
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