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Abd Elmonem YM, Salem EE, Elshafey MA, Mostafa AH. Efficacy of neuromuscular electrical stimulation and interrupted serial casting in children with spastic diplegia. J Taibah Univ Med Sci 2024; 19:628-636. [PMID: 38812723 PMCID: PMC11133911 DOI: 10.1016/j.jtumed.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/23/2024] [Accepted: 05/04/2024] [Indexed: 05/31/2024] Open
Abstract
Objectives This research was aimed at comparing the effects of neuromuscular electrical stimulation (NMES) combined with interrupted serial casting (SC) versus SC alone on various aspects of lower limb function in children with diplegic cerebral palsy. SC is a clinical technique used to increase passive range of motion (ROM), decrease hypertonicity, and improve walking in children with cerebral palsy (CP). Methods This randomized comparative trial involved 33 children with diplegic CP, who were randomly assigned to group A or group B at recruitment. Group A received SC along with a customized physical therapy program, whereas group B received the same interventions as group A along with NMES applied through cast windows during casting. Evaluations were based on ROM, the Modified Tardieu Scale, handheld dynamometer measurements, and the Observational Gait Scale. Assessments were conducted before and after 8 weeks of intervention. Results Both groups exhibited significant improvements in dorsiflexion ROM, popliteal angle, gastrocnemius dynamic spasticity, and hamstring dynamic spasticity after the intervention (P = 0.0001 for all). However, significant differences (P < 0.05) in dorsiflexor strength, knee extensor strength, and observational gait scale score were observed between groups after the intervention, favoring group B. Conclusions The use of NMES during SC may help overcome the substantial decrease in strength resulting from casting, thus achieving less reduction of tone, improving ROM without significantly decreasing strength, and attaining greater improvements in gait function.
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Affiliation(s)
- Yasser M. Abd Elmonem
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Egypt
| | - Elham E. Salem
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Egypt
| | - Mohamed A. Elshafey
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Egypt
| | - Amr H. Mostafa
- Department of Pediatric, Faculty of Medicine, Al Azhar University, Egypt
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Rapson R, Latour JM, Marsden J, Hughes H, Carter B. Defining usual physiotherapy care in ambulant children with cerebral palsy in the United Kingdom: A mixed methods consensus study. Child Care Health Dev 2022; 48:708-723. [PMID: 35080029 PMCID: PMC9541552 DOI: 10.1111/cch.12977] [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: 03/22/2021] [Revised: 01/17/2022] [Accepted: 01/17/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Ambulant children with cerebral palsy (CP) undertake physiotherapy to improve balance and walking. However, there are no relevant clinical guidelines to standardize usual physiotherapy care in the United Kingdom. A consensus process can be used to define usual physiotherapy care for children with CP. The resulting usual care checklist can support the development of clinical guidelines and be used to measure fidelity to usual care in the control groups of trials for children with CP. METHODS Twelve expert physiotherapists were recruited. In Phase 1, statements on usual care were developed using a survey and two nominal groups. Phase 2 included a literature review to support usual physiotherapy interventions. Phase 3 used a confirmatory survey, which also captured changes to provision during the COVID-19 pandemic. Consensus was calculated by deriving the mean of the deviations from the median score (MDM). High consensus was deemed to be where MDM < 0.42. RESULTS Physiotherapists reached high consensus on five outcome measures (MDM range 0-0.375) and nine areas of assessment (MDM range 0-0.25). Physiotherapists reached moderate consensus on task-specific training (MDM = 0.75), delivered at weekly intensity for 4-6 weeks (MDM = 0.43). There was high consensus (MDM = 0) that children should participate in modified sport and fitness activities and that children with Gross Motor Function Classification System Level III should be monitored on long-term pathways (MDM = 0.29). CONCLUSIONS Physiotherapists reached consensus on two usual care interventions, and a checklist was developed to inform the control groups of future randomized controlled trials. Further consensus work is required to establish clinical guidelines to standardize usual physiotherapy care in the United Kingdom.
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Affiliation(s)
- Rachel Rapson
- PhysiotherapyTorbay and South Devon NHS Foundation TrustTorquayUK
| | - Jos M. Latour
- School of Nursing & Midwifery, Faculty of Health and Human SciencesUniversity of PlymouthPlymouthUK,Plymouth Hospitals NHS TrustsPlymouthUK,Musgrove Park HospitalTauntonUK
| | | | | | - Bernie Carter
- Faculty of Health and Social CareEdge Hill UniversityOrmskirkUK
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Woof AL, Selby K, Harris SR. Ankle contractures and functional motor decline in Duchenne muscular dystrophy. Brain Dev 2022; 44:105-113. [PMID: 34629214 DOI: 10.1016/j.braindev.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION This prospective, correlational pilot study investigated the relationship between ankle plantar flexion contractures and motor function in boys with Duchenne muscular dystrophy in British Columbia (BC), Canada. PARTICIPANTS Ambulatory boys with Duchenne muscular dystrophy were recruited from BC Children's Hospital, which follows everyone with Duchenne muscular dystrophy in BC ≤ 18 years of age (n = 14). METHODS Spearman and Pearson correlation coefficients were estimated to examine the association between the degree of ankle dorsiflexion range of motion and North Star Ambulatory Assessment scores and the degree of ankle dorsiflexion range and six-minute walk test distances. RESULTS Our analysis showed a moderate correlation between the degree of ankle dorsiflexion range and North Star Ambulatory Assessment scores [rho (14) = 0.50; p = 0.070] and a weak correlation between ankle dorsiflexion range of motion and six-minute walk test distances [rho (13) = 0.08; p = 0.747], however neither result was statistically significant. DISCUSSION Although a significant relationship between ankle dorsiflexion range of motion and motor function was not found, the variability of ankle dorsiflexion range suggests challenges with preventing ankle contracture. This reinforces the importance of assessing ankle range of motion in boys with Duchenne muscular dystrophy with sufficient frequency to identify a need for additional interventions.
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Affiliation(s)
- Angelina L Woof
- Rehabilitation Science Online Programs, Faculty of Medicine, University of British Columbia, T325-2211 Wesbrook Mall, Vancouver, British Columbia V6T 2B5, Canada; BC Centre for Ability, 2805 Kingsway, Vancouver, British Columbia V5R 5H9, Canada
| | - Kathryn Selby
- British Columbia Children's Hospital, University of British Columbia, 4500 Oak St., Vancouver, British Columbia V6H 3N1, Canada
| | - Susan R Harris
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3, Canada.
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Restoration of Heel-Toe Gait Patterns for the Prevention of Asymmetrical Hip Internal Rotation in Patients with Unilateral Spastic Cerebral Palsy. CHILDREN-BASEL 2021; 8:children8090773. [PMID: 34572205 PMCID: PMC8467232 DOI: 10.3390/children8090773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/24/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022]
Abstract
Forward modelling has indicated hip internal rotation as a secondary physical effect to plantar flexion under load. It could therefore be of interest to focus the treatment for patients with unilateral spastic cerebral palsy on achieving a heel-toe gait pattern, to prevent development of asymmetrical hip internal rotation. The aim of this preliminary retrospective cohort investigation was to evaluate the effect of restoring heel-toe gait, through use of functional orthoses, on passive hip internal rotation. In this study, the affected foot was kept in an anatomically correct position, aligned to the leg and the gait direction. In case of gastrosoleus shortness, a heel raise was attached to compensate for the equinus and yet to provide heel-floor contact (mean equinus = -2.6 degrees of dorsiflexion). Differences in passive hip internal rotation between the two sides were clinically assessed while the hip was extended. Two groups were formed according to the achieved correction of their gait patterns through orthotic care: patients with a heel-toe gait (with anterograde rocking) who wore the orthosis typically for at least eight hours per day for at least a year, or patients with toe-walking (with retrograde rocking) in spite of wearing the orthosis who used the orthosis less in most cases. A Student's t-test was used to compare the values of clinically assessed passive hip rotation (p < 0.05) between the groups and the effect size (Hedges' g) was estimated. Of the 70 study participants, 56 (mean age 11.5 y, majority GMFCS 1, similar severity of pathology) achieved a heel-toe gait, while 14 remained as toe-walkers. While patients with heel-toe gait patterns showed an almost symmetrical passive hip internal rotation (difference +1.5 degrees, standard deviation 9.6 degrees), patients who kept toe-walking had an increased asymmetrical passive hip internal rotation (difference +10.4 degrees, standard deviation 7.5 degrees; p = 0.001, Hedges's g = 0.931). Our clinical findings are in line with the indications from forward modelling that treating the biomechanical problem might prevent development of a secondary deformity. Further prospective studies are needed to verify the presented hypothesis.
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Hornáček K, Kujawa J, Varela Donoso E, Dincer F, Ilieva E, Takáč P, Petronic Markovic I, Votava J, Vetra A, Nikolic D, Christodoulou N, Zampolini M, Kiekens C. Evidence Based Position Paper on Physical and Rehabilitation Medicine professional practice for persons with cerebral palsy. Eur J Phys Rehabil Med 2021; 57:1020-1035. [PMID: 33861040 DOI: 10.23736/s1973-9087.21.06983-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Cerebral palsy (CP) is a group of the most common developmental disorders affecting movement and posture of the body, causing activity limitations and participation restrictions. The motor disorders of persons with CP are often accompanied by disturbances of sensation, cognition, communication and perception. The symptoms of CP are very diverse and persons with CP are usually presented with a mixed type of symptoms. The non-progressive disturbances can be attributed to disorders that were developed during pregnancy, birth and/or infant stage. AIM The aim of this study was to improve Physical and Rehabilitation Medicine physician´s professional practice for persons with cerebral palsy in order to improve their functionality, social and community integration, and to reduce activity limitations and/or participation restrictions. MATERIAL AND METHODS A systematic review of the literature including an eighteen-year period and consensus procedure by means of a Delphi process was performed and involved the delegates of all European countries represented in the Union of European Medical Specialists Physical and Rehabilitation Medicine (UEMS PRM) Section. RESULTS As the result of a Consensus Delphi procedure process 74 recommendations are presented together with the systematic literature review. CONCLUSIONS The PRM physician´s role for persons with cerebral palsy is to lead and coordinate the multiprofessional team, working in an interdisciplinary way. They should propose and manage the complex but individual PRM programme developed in conjunction with other health professionals, medical specialists and importantly in agreement with the patient, their family and care giver. This should be, according to the specific medical diagnosis to improve patients´ health, functioning, social and education status, considering all impairments, comorbidities and complications, activity limitations and participation restrictions.
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Affiliation(s)
- Karol Hornáček
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Slovak Medical University, Bratislava, Slovakia
| | - Jolanta Kujawa
- Department of Physical and Rehabilitation Medicine, Medical University of Lodz, Lodz, Poland
| | - Enrique Varela Donoso
- Physical and Rehabilitation Medicine Department, Complutense University of School of Medicine, Madrid, Spain
| | - Fitnat Dincer
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Elena Ilieva
- Department of Physical and Rehabilitation Medicine, Medical Faculty, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Peter Takáč
- Department of Physical and Rehabilitation Medicine, L. Pasteur University Hospital, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic -
| | - Ivana Petronic Markovic
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jiří Votava
- Faculty of Health Studies, University of J. E. Purkyně, Ústí nad Labem, Czech Republic
| | - Anita Vetra
- Rehabilitation Department, Riga Stradins University, Riga, Latvia
| | - Dejan Nikolic
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Mauro Zampolini
- Department of Rehabilitation, Foligno Hospital, USL Umbria 2, Perugia, Italy
| | - Carlotte Kiekens
- Spinal Unit, Montecatone Rehabilitation Institute, Imola Bologna, Italy
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Walhain F, Desloovere K, Declerck M, Van Campenhout A, Bar-On L. Interventions and lower-limb macroscopic muscle morphology in children with spastic cerebral palsy: a scoping review. Dev Med Child Neurol 2021; 63:274-286. [PMID: 32876960 DOI: 10.1111/dmcn.14652] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 12/24/2022]
Abstract
AIM To identify and map studies that have assessed the effect of interventions on lower-limb macroscopic muscle-tendon morphology in children with spastic cerebral palsy (CP). METHOD We conducted a literature search of studies that included pre- and post-treatment measurements of lower-limb macroscopic muscle-tendon morphology in children with spastic CP. Study quality was evaluated and significant intervention effects and effect sizes were extracted. RESULTS Twenty-eight articles were identified. They covered seven different interventions including stretching, botulinum neurotoxin A (BoNT-A), strengthening, electrical stimulation, whole-body vibration, balance training, and orthopaedic surgery. Study quality ranged from poor (14 out of 28 studies) to good (2 out of 28). Study samples were small (n=4-32) and studies were variable regarding which muscles and macroscopic morphological parameters were assessed. Inconsistent effects after intervention (thickness and cross-sectional area for strengthening, volume for BoNT-A), no effect (belly length for stretching), and small effect sizes were reported. INTERPRETATION Intervention studies reporting macroscopic muscle-tendon remodelling after interventions are limited and heterogeneous, making it difficult to generalize results. Studies that include control groups and standardized assessment protocols are needed to improve study quality and data synthesis. Lack or inconclusive effects at the macroscopic level could indicate that the effects of interventions should also be evaluated at the microscopic level. WHAT THIS PAPER ADDS Muscle-targeted interventions to remodel muscle morphology are not well understood. Studies reporting macroscopic muscle remodelling following interventions are limited and heterogeneous. Passive stretching may preserve but does not increase muscle length. The effects of isolated botulinum neurotoxin A injections on muscle volume are inconsistent. Isolated strengthening shows no consistent increase in muscle volume or thickness.
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Affiliation(s)
- Fenna Walhain
- Department of Anatomy, Anton de Kom University of Suriname, Paramaribo, Suriname.,Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospital Leuven, Leuven, Belgium
| | - Marlies Declerck
- Department of Physical Therapy, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Anja Van Campenhout
- Department of Development and Regeneration, University Hospital Leuven, Leuven, Belgium
| | - Lynn Bar-On
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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Novak I, Morgan C, Fahey M, Finch-Edmondson M, Galea C, Hines A, Langdon K, Namara MM, Paton MC, Popat H, Shore B, Khamis A, Stanton E, Finemore OP, Tricks A, Te Velde A, Dark L, Morton N, Badawi N. State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy. Curr Neurol Neurosci Rep 2020; 20:3. [PMID: 32086598 PMCID: PMC7035308 DOI: 10.1007/s11910-020-1022-z] [Citation(s) in RCA: 409] [Impact Index Per Article: 102.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Cerebral palsy is the most common physical disability of childhood, but the rate is falling, and severity is lessening. We conducted a systematic overview of best available evidence (2012-2019), appraising evidence using GRADE and the Evidence Alert Traffic Light System and then aggregated the new findings with our previous 2013 findings. This article summarizes the best available evidence interventions for preventing and managing cerebral palsy in 2019. RECENT FINDINGS Effective prevention strategies include antenatal corticosteroids, magnesium sulfate, caffeine, and neonatal hypothermia. Effective allied health interventions include acceptance and commitment therapy, action observations, bimanual training, casting, constraint-induced movement therapy, environmental enrichment, fitness training, goal-directed training, hippotherapy, home programs, literacy interventions, mobility training, oral sensorimotor, oral sensorimotor plus electrical stimulation, pressure care, stepping stones triple P, strength training, task-specific training, treadmill training, partial body weight support treadmill training, and weight-bearing. Effective medical and surgical interventions include anti-convulsants, bisphosphonates, botulinum toxin, botulinum toxin plus occupational therapy, botulinum toxin plus casting, diazepam, dentistry, hip surveillance, intrathecal baclofen, scoliosis correction, selective dorsal rhizotomy, and umbilical cord blood cell therapy. We have provided guidance about what works and what does not to inform decision-making, and highlighted areas for more research.
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Affiliation(s)
- Iona Novak
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia.
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Michael Fahey
- Department of Paediatric Neurology, Monash Health, Clayton, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Megan Finch-Edmondson
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Claire Galea
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
- Grace Centre for Newborn Care, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Ashleigh Hines
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Katherine Langdon
- Department of Paediatric Rehabilitation, Kids Rehab WA, Perth Children's Hospital, Perth, Australia
| | - Maria Mc Namara
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Madison Cb Paton
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Himanshu Popat
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
- Grace Centre for Newborn Care, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Benjamin Shore
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Amanda Khamis
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Emma Stanton
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Olivia P Finemore
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Alice Tricks
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Anna Te Velde
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Leigha Dark
- Allied and Public Helath, Faculty of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - Natalie Morton
- Allied and Public Helath, Faculty of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
- School of Allied Health, Australian Catholic University, North Sydney, New South Wales, Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
- Grace Centre for Newborn Care, Children's Hospital at Westmead, Westmead, New South Wales, Australia
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Abstract
The article discusses the nuances required to effectively perform the biomechanical examination in children and assess the findings. The author covers several factors in children that make the examination different in certain respects than in that of adults, including growth, osseous maturation, gait development, and interpretation of symptoms as conveyed by the child. Further delineation is made for prewalkers, foot-flat to foot-flat walkers, and heel-to-toe walkers. Segmental review of the lower extremity is covered by age bracket, with clinical pearls inserted where relevant to assist the clinician. A brief discussion of shoe wear and orthoses is made as well.
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Affiliation(s)
- Marc A Benard
- Baja Project for Crippled Children/Operation Footprint, Westlake Village, CA, USA; American Board of Podiatric Medicine, Hermosa Beach, CA, USA; Western University of Podiatric Medicine, Pomona, CA, USA.
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Weide G, Sloot L, Oudenhoven L, Jaspers RT, Harlaar J, Buizer AI, Bar‐On L. Comprehensive evaluation of gait, spasticity, and muscle morphology: A case report of a child with spastic paresis treated with Botulinum NeuroToxin‐A, serial casting, and physiotherapy. Clin Case Rep 2019; 7:1637-1646. [PMID: 31534717 PMCID: PMC6745351 DOI: 10.1002/ccr3.2227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 04/14/2019] [Accepted: 05/03/2019] [Indexed: 12/03/2022] Open
Abstract
Comprehensive instrumented muscle and joint assessments should be considered when prescribing Botulinum NeuroToxin‐A (BoNT‐A) treatment in spastic paresis. In a child with spastic paresis, comprehensive evaluation following treatment with BoNT‐A, serial casting, and physiotherapy showed that short‐term improvements in gait occurred without changes in muscle morphology. Rather, foot flexibility increased.
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Affiliation(s)
- Guido Weide
- Laboratory for Myology, Department of Human Movement Sciences, Amsterdam Movement Sciences Vrije Universiteit Amsterdam Amsterdam The Netherlands
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences Amsterdam UMC, location VUmc Amsterdam The Netherlands
| | - Lizeth Sloot
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences Amsterdam UMC, location VUmc Amsterdam The Netherlands
| | - Laura Oudenhoven
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences Amsterdam UMC, location VUmc Amsterdam The Netherlands
| | - Richard T. Jaspers
- Laboratory for Myology, Department of Human Movement Sciences, Amsterdam Movement Sciences Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences Amsterdam UMC, location VUmc Amsterdam The Netherlands
- Department of Biomechanical Engineering Delft University of Technology Delft The Netherlands
| | - Annemieke I. Buizer
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences Amsterdam UMC, location VUmc Amsterdam The Netherlands
| | - Lynn Bar‐On
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences Amsterdam UMC, location VUmc Amsterdam The Netherlands
- Department of Rehabilitation Sciences KU Leuven Leuven Belgium
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Gendy S, ElGebeily M, El-Sobky TA, Khoshhal KI, Jawadi AH. Current practice and preferences to management of equinus in children with ambulatory cerebral palsy: A survey of orthopedic surgeons. SICOT J 2019; 5:3. [PMID: 30816087 PMCID: PMC6394235 DOI: 10.1051/sicotj/2019003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 01/19/2019] [Indexed: 12/28/2022] Open
Abstract
Introduction: The consensus among orthopedic surgeons on the management of equinus deformity in cerebral palsy (CP) children has not been reported previously despite being a prevalent deformity. The goals of this study were to examine the orthopedic surgeons’ current practice regarding the management of equinus deformity in children with ambulatory CP, and analyze variations in current practice between general orthopedic and pediatric orthopedic surgeons. Methods: We implemented a brief cross-sectional self-reported questionnaire that addressed the areas of clinical examination and decision-making skills of management of equinus deformity in CP children. We targeted a convenience sample of 400 participants. Surgeons that provided complete responses to the questionnaire were 223 with a response rate of 56%, of which 123 (55%) were general orthopedic surgeons, whereas 100 (45%) were pediatric orthopedic surgeons. The target population consisted of orthopedic surgeons who were further sub-classified in accordance with practice age, general versus pediatric, and exposure to children’s orthopedics during the last three years of their practice. For analytical statistics, the Chi-Square test and Fisher’s exact test were used to examine the relationship between two qualitative variables. Results: The overall clinical practice preferences of all survey participants were unimpressive with discordant survey responses. Pediatric orthopedic surgeons generally demonstrated a statistically significant difference regarding clinical assessment skill items of the survey, in contrast to general orthopedic surgeons. However, we found no differences between pediatric orthopedic and general orthopedic surgeons regarding most of the decision-making/knowledge items. Discussion: Generally, there are insufficient clinical practice trends of both general and pediatric orthopedic surgeons regarding equinus treatment in CP children. This may indicate a knowledge–practice gap with potential risks to CP children undergoing surgery for equinus. There is a need for a more competent exposure to CP in orthopedic surgeons’ educational curricula and an updated health referral system.
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Affiliation(s)
- Samuel Gendy
- Department of Orthopedic Surgery, Hurghada General Hospital, Hurghada, Egypt
| | - Mohamed ElGebeily
- Division of Pediatric Orthopaedics and Limb Reconstruction Surgery, Department of Orthopaedic Surgery, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Tamer A El-Sobky
- Division of Pediatric Orthopaedics and Limb Reconstruction Surgery, Department of Orthopaedic Surgery, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Khalid I Khoshhal
- Department of Orthopedics, College of Medicine, Taibah University, Almadinah Almunawwarah, Saudi Arabia
| | - Ayman H Jawadi
- Department of Pediatric Orthopedic Surgery, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Martín Lorenzo T, Rocon E, Martínez Caballero I, Lerma Lara S. Medial gastrocnemius structure and gait kinetics in spastic cerebral palsy and typically developing children: A cross-sectional study. Medicine (Baltimore) 2018; 97:e10776. [PMID: 29794756 PMCID: PMC6392514 DOI: 10.1097/md.0000000000010776] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To compare medial gastrocnemius muscle-tendon structure, gait propulsive forces, and ankle joint gait kinetics between typically developing children and those with spastic cerebral palsy, and to describe significant associations between structure and function in children with spastic cerebral palsy.A sample of typically developing children (n = 9 /16 limbs) and a sample of children with spastic cerebral palsy (n = 29 /43 limbs) were recruited. Ultrasound and 3-dimensional motion capture were used to assess muscle-tendon structure, and propulsive forces and ankle joint kinetics during gait, respectively.Children with spastic cerebral palsy had shorter fascicles and muscles, and longer Achilles tendons than typically developing children. Furthermore, total negative power and peak negative power at the ankle were greater, while total positive power, peak positive power, net power, total vertical ground reaction force, and peak vertical and anterior ground reaction forces were smaller compared to typically developing children. Correlation analyses revealed that smaller resting ankle joint angles and greater maximum dorsiflexion in children with spastic cerebral palsy accounted for a significant decrease in peak negative power. Furthermore, short fascicles, small fascicle to belly ratios, and large tendon to fascicle ratios accounted for a decrease in propulsive force generation.Alterations observed in the medial gastrocnemius muscle-tendon structure of children with spastic cerebral palsy may impair propulsive mechanisms during gait. Therefore, conventional treatments should be revised on the basis of muscle-tendon adaptations.
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Affiliation(s)
- Teresa Martín Lorenzo
- Laboratorio de Análisis del Movimiento, Hospital Infantil Universitario Niño Jesús
- Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos
| | - Eduardo Rocon
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas, Arganda del Rey
| | | | - Sergio Lerma Lara
- Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
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Martín Lorenzo T, Rocon E, Martínez Caballero I, Ramírez Barragán A, Lerma Lara S. Prolonged stretching of the ankle plantarflexors elicits muscle-tendon adaptations relevant to ankle gait kinetics in children with spastic cerebral palsy. Med Hypotheses 2017; 109:65-69. [DOI: 10.1016/j.mehy.2017.09.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 09/18/2017] [Accepted: 09/25/2017] [Indexed: 12/21/2022]
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