1
|
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.
Collapse
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)
| | | | | | | | | | | |
Collapse
|
2
|
Grosse L, Schnabel JF, Börner-Schröder C, Späh MA, Meuche AC, Sollmann N, Breuer U, Warken B, Hösl M, Heinen F, Berweck S, Schröder SA, Bonfert MV. Safety and Feasibility of Functional Repetitive Neuromuscular Magnetic Stimulation of the Gluteal Muscles in Children and Adolescents with Bilateral Spastic Cerebral Palsy. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1768. [PMID: 38002859 PMCID: PMC10670153 DOI: 10.3390/children10111768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023]
Abstract
Background: For children and adolescents affected by bilateral spastic cerebral palsy (BSCP), non-invasive neurostimulation with repetitive neuromuscular magnetic stimulation (rNMS) combined with physical exercises, conceptualized as functional rNMS (frNMS), represents a novel treatment approach. Methods: In this open-label study, six children and two adolescents (10.4 ± 2.5 years) with BSCP received a frNMS intervention targeting the gluteal muscles (12 sessions within 3 weeks). Results: In 77.1% of the sessions, no side effects were reported. In 16.7%, 6.3% and 5.2% of the sessions, a tingling sensation, feelings of pressure/warmth/cold or very shortly lasting pain appeared, respectively. frNMS was highly accepted by families (100% adherence) and highly feasible (97.9% of treatment per training protocol). A total of 100% of participants would repeat frNMS, and 87.5% would recommend it. The Canadian Occupational Performance Measure demonstrated clinically important benefits for performance in 28% and satisfaction in 42% of mobility-related tasks evaluated by caregivers for at least one follow-up time point (6 days and 6 weeks post intervention). Two patients accomplished goal attainment for one mobility-related goal each. One patient experienced improvement for both predefined goals, and another participant experienced improvement in one and outreach of the other goal as assessed with the goal attainment scale. Conclusions: frNMS is a safe and well-accepted neuromodulatory approach that could improve the quality of life, especially in regard to activity and participation, of children and adolescents with BSCP. Larger-scaled studies are needed to further explore the effects of frNMS in this setting.
Collapse
Affiliation(s)
- Leonie Grosse
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany (S.B.)
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Julian F. Schnabel
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany (S.B.)
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Corinna Börner-Schröder
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany (S.B.)
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany;
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Malina A. Späh
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany (S.B.)
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Anne C. Meuche
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany (S.B.)
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany;
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, 89081 Ulm, Germany
| | - Ute Breuer
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Birgit Warken
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Matthias Hösl
- Gait and Motion Analysis Laboratory, Schoen Clinic Vogtareuth, 83569 Vogtareuth, Germany
| | - Florian Heinen
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany (S.B.)
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Steffen Berweck
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany (S.B.)
- Specialist Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schoen Clinic Vogtareuth, 83569 Vogtareuth, Germany
| | - Sebastian A. Schröder
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany (S.B.)
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Michaela V. Bonfert
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany (S.B.)
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| |
Collapse
|
3
|
Grosse L, Späh MA, Börner C, Schnabel JF, Meuche AC, Parzefall B, Breuer U, Warken B, Sitzberger A, Hösl M, Heinen F, Berweck S, Schröder SA, Bonfert MV. Addressing gross motor function by functional repetitive neuromuscular magnetic stimulation targeting to the gluteal muscles in children with bilateral spastic cerebral palsy: benefits of functional repetitive neuromuscular magnetic stimulation targeting the gluteal muscles. Front Neurol 2023; 14:1161532. [PMID: 37564737 PMCID: PMC10410564 DOI: 10.3389/fneur.2023.1161532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/20/2023] [Indexed: 08/12/2023] Open
Abstract
Background Impaired selective motor control, weakness and spasticity represent the key characteristics of motor disability in the context of bilateral spastic cerebral palsy. Independent walking ability is an important goal and training of the gluteal muscles can improve endurance and gait stability. Combining conventional physical excercises with a neuromodulatory, non-invasive technique like repetitive neuromuscular magnetic stimulation probably enhances effects of the treatment. This prospective study aimed to assess the clinical effects of repetitive neuromuscular magnetic stimulation in combination with a personalized functional physical training offered to children and adolescents with bilateral spastic cerebral palsy. Methods Eight participants Gross Motor Function Classification System level II and III (10.4 ± 2y5m; 50% Gross Motor Function Classification System level II) received a personalized intervention applying functional repetitive neuromuscular magnetic stimulation (12 sessions within 3 weeks; 12,600 total stimuli during each session). At baseline and follow up the following assessments were performed: 10-m-walking-test, 6-min-walking-test, GMFM-66. Six weeks after the end of treatment the patient-reported outcome measure Gait Outcome Assessment List was completed. Results GMFM-66 total score improved by 1.4% (p = 0.002), as did scoring in domain D for standing (1.9%, p = 0.109) and domain E for walking, jumping and running (2.6%, p = 0.021). Gait speed or distance walked during 6 min did not improve from baseline to follow up. Patient-reported outcome showed improvement in 4 patients in altogether 14 ratings. Caregiver-reported outcome reported benefits in 3 participants in altogether 10 ratings. Conclusion Repetitive neuromuscular magnetic stimulation promises to be a meaningful, non-invasive treatment approach for children and adolescents with bilateral spastic cerebral palsy that could be offered in a resource-efficient manner to a broad number of patients. To further investigate the promising effects of repetitive neuromuscular magnetic stimulation and its mechanisms of action, larger-scaled, controlled trials are needed as well as comprehensive neurophysiological investigations.
Collapse
Affiliation(s)
- Leonie Grosse
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Malina A. Späh
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Corinna Börner
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Julian F. Schnabel
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Anne C. Meuche
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Barbara Parzefall
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Ute Breuer
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Birgit Warken
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Alexandra Sitzberger
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Matthias Hösl
- Gait and Motion Analysis Laboratory, Schoen Clinic Vogtareuth, Vogtareuth, Germany
| | - Florian Heinen
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Steffen Berweck
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- Specialist Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schoen Clinic Vogtareuth, Vogtareuth, Germany
| | - Sebastian A. Schröder
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Michaela V. Bonfert
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| |
Collapse
|
4
|
Relationship between kinematic gait quality and caregiver-reported everyday mobility in children and youth with spastic Cerebral Palsy. Eur J Paediatr Neurol 2023; 42:88-96. [PMID: 36587415 DOI: 10.1016/j.ejpn.2022.11.009] [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: 01/18/2022] [Revised: 08/09/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND 3D gait analysis (3DGA) is a common assessment in Cerebral Palsy (CP) to quantify the extent of movement abnormalities. Yet, 3DGA is performed in laboratories and may thus be of debatable significance to everyday life. AIM The aim was to assess the relationship between kinematic gait abnormality and everyday mobility in ambulatory children and youth with spastic CP. METHODS 73 paediatric and juvenile patients with uni- or bilateral spastic CP (N = 21 USCP, N = 52, BSCP, age: 4-20 y, GMFCS I-III) underwent a 3DGA, while the MobQues47 Questionnaire quantified caregiver-reported mobility. We calculated the Gait Profile Score (GPS), a metric that summarizes how far the lower limb joint angles during walking deviate from those of matched controls. RESULTS The GPS correlated well with indoor and outdoor mobility (rho = -0.69 and -0.70, both p < 0.001) and the relationships were not significantly different for USCP and BSCP. Still, mobility was lower in BSCP (p < 0.001) and more compromised outdoors (p = 0.002). Indoor mobility could be predicted by walking speed, GPS and age (adj. R2 = 0.62). Outdoor mobility was best predicted by walking speed and GPS (adj. R2 = 0.60). The additive explained variance by the GPS was even higher outdoors than indoors (17.1% vs. 11.4%). CONCLUSIONS Measuring movement deviations with 3DGA seems equally meaningful in uni- and bilaterally affected children and has considerable relevance for real-life ambulation, particurlarly outdoors, where children with spastic CP typically face greater difficulties. Therapeutic strategies that achieve faster walking and reduction of kinematic deviations may increase outdoor mobility.
Collapse
|
5
|
Iwasa M, Hamada H, Uemura K, Ando W, Takao M, Sugano N. Errors in the radiographic measurement of pelvic incidence. J Orthop Res 2022; 41:1266-1272. [PMID: 36317843 DOI: 10.1002/jor.25477] [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: 06/30/2022] [Revised: 09/27/2022] [Accepted: 10/28/2022] [Indexed: 11/15/2022]
Abstract
Pelvic incidence (PI) is often quantified in patients undergoing total hip arthroplasty. Errors in radiographic PI measurements can affect clinical outcomes. The purposes of this study were (1) to evaluate the error in radiographic PI measurement in patients with hip osteoarthritis (OA) and (2) to analyze the factors related to the error. Radiographs and computer tomography (CT) images of 100 patients (24 men and 76 women; mean age 63.7 years) with unilateral OA were reviewed. The error in radiographic PI measurement was defined as the difference between the radiographic measurement of the PI (rPI) and the accurate value of PI measured using CT images (cPI). Factors related to the error in the rPI were analyzed, including the coronal and axial rotation of the pelvis on lateral radiographs. The degree of coronal and axial rotation was expressed as the angle of rotation around the anteroposterior and craniocaudal axes. The mean rPI was significantly larger than the cPI (57.8° and 54.1°, p < 0.01). The error in the rPI was 3.6° on average and 15.8° at maximum. The mean coronal and axial rotation of the pelvis was 9.6° and 4.4°, respectively. The error in the rPI positively correlated with coronal pelvic rotation and rPI, and negatively correlated with axial pelvic rotation (p < 0.01, r = 0.35, 0.43, and -0.45, respectively). The rPI was 3.6° larger on average than the cPI in patients with hip OA. Coronal and axial rotation of the pelvis and a large PI were related to the error in the rPI.
Collapse
Affiliation(s)
- Makoto Iwasa
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Keisuke Uemura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Wataru Ando
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masaki Takao
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
6
|
Tsitlakidis S, Campos S, Beckmann NA, Wolf SI, Hagmann S, Renkawitz T, Götze M. Transversal Malalignment and Proximal Involvement Play a Relevant Role in Unilateral Cerebral Palsy Regardless the Subtype. J Clin Med 2022; 11:jcm11164816. [PMID: 36013051 PMCID: PMC9409971 DOI: 10.3390/jcm11164816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/09/2022] [Accepted: 08/13/2022] [Indexed: 11/16/2022] Open
Abstract
Classification of gait disorders in cerebral palsy (CP) remains challenging. The Winters, Gage, and Hicks (WGH) is a commonly used classification system for unilateral CP regarding the gait patterns (lower limb kinematics) solely in the sagittal plane. Due to the high number of unclassified patients, this classification system might fail to depict all gait disorders accurately. As the information on trunk/pelvic movements, frontal and transverse planes, and kinetics are disregarded in WGH, 3D instrumented gait analysis (IGA) for further characterization is necessary. The objective of this study was a detailed analysis of patients with unilateral CP using IGA taking all planes/degrees of freedom into account including pelvic and trunk movements. A total of 89 individuals with unilateral CP matched the inclusion criteria and were classified by WGH. Subtype-specific differences were analyzed. The most remarkable findings, in addition to the established WGH subtype-specific deviations, were pelvic obliquity and pelvic retraction in all WGH types. Furthermore, the unclassified individuals showed altered hip rotation moments and pelvic retraction almost throughout the whole gait cycle. Transversal malalignment and proximal involvement are relevant in all individuals with unilateral CP. Further studies should focus on WGH type-specific rotational malalignment assessment (static vs. dynamic, femoral vs. tibial) including therapeutic effects and potential subtype-specific compensation mechanisms and/or tertiary deviations of the sound limb.
Collapse
|
7
|
Darbandi H, Baniasad M, Baghdadi S, Khandan A, Vafaee A, Farahmand F. Automatic classification of gait patterns in children with cerebral palsy using fuzzy clustering method. Clin Biomech (Bristol, Avon) 2020; 73:189-194. [PMID: 32007827 DOI: 10.1016/j.clinbiomech.2019.12.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 12/23/2019] [Accepted: 12/31/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Subjective classification of gait pattern in children with cerebral palsy depends on the assessor's experience, while mathematical methods produce virtual groups with no clinical interpretation. METHODS In a retrospective study, gait data from 66 children (132 limbs) with a mean age of 9.6 (SD 3.7) years with cerebral palsy and no history of surgery or botulinum toxin injection were reviewed. The gait pattern of each limb was classified in four groups according to Rodda using three methods: 1) a team of experts subjectively assigning a gait pattern, 2) using the plantarflexor-knee extension couple index introduced by Sangeux et al., and 3) employing a fuzzy algorithm to translate the experiences of experts into objective rules and execute a clustering tool. To define fuzzy repeated-measures, 75% of the members in each group were used, and the remaining were used for validation. Eight parameters were objectively extracted from kinematic data for each group and compared using repeated measure ANOVA and post-hoc analysis was performed. Finally, the results of the clustering of the latter two methods were compared to the subjective method. FINDINGS The plantarflexor-knee extension couple index achieved 86% accuracy while the fuzzy system yielded a 98% accuracy. The most substantial errors occurred between jump and apparent in both methods. INTERPRETATION The presented method is a fast, reliable, and objective fuzzy clustering system to classify gait patterns in cerebral palsy, which produces clinically-relevant results. It can provide a universal common language for researchers.
Collapse
Affiliation(s)
- Hamed Darbandi
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
| | - Mina Baniasad
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran.
| | - Soroush Baghdadi
- Department of Orthopaedic Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Aminreza Khandan
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
| | - Amirreza Vafaee
- Department of Orthopaedic Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzam Farahmand
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
| |
Collapse
|
8
|
Contini BG, Bergamini E, Alvini M, Di Stanislao E, Di Rosa G, Castelli E, Vannozzi G, Camomilla V. A wearable gait analysis protocol to support the choice of the appropriate ankle-foot orthosis: A comparative assessment in children with Cerebral Palsy. Clin Biomech (Bristol, Avon) 2019; 70:177-185. [PMID: 31525659 DOI: 10.1016/j.clinbiomech.2019.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 07/17/2019] [Accepted: 08/21/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cerebral Palsy is, nowadays, the most common cause of pediatric disabilities, particularly debilitating for daily living activities. While the adoption of ankle-foot orthoses is very well established as gait treatment, the choice of the most appropriate orthotic configuration is not strongly supported by scientific evidence. The aim of this study was to develop an instrumented assessment protocol based on wearable gait analysis to support clinicians in ankle-foot orthoses configuration selection. METHODS Ten children with spastic diplegic Cerebral Palsy were assessed (7 males, aged 4 to 11 years; all functionally classified as Gross Motor Function Classification System I or II, with clinical indication of conservative treatment through use of ankle-foot orthoses). They performed a 10Meter Walk Test in three conditions: barefoot and wearing alternatively a polypropylene hinged and solid ankle-foot orthosis accommodated in the same off-the-shelf shoe model, after 20 days of daily use of each configuration. An instrumented assessment protocol based on body-mounted magneto-inertial sensors was devised to derive spatio-temporal, gait stability and symmetry biomechanical parameters within an observational pre and post cross over design. FINDINGS The analysis at the individual level quantitatively revealed how different patients benefited differently from the two orthoses. No general indications were obtained in favour of or against a specific configuration for the sample as a whole. INTERPRETATION The proposed instrumented protocol represents a quantitative and useful tool to support the clinical selection of an appropriate orthotic treatment and, potentially, in evaluating its effectiveness.
Collapse
Affiliation(s)
- Bruno Giuseppe Contini
- Division of Pediatric Neurorehabilitation, "Ospedale Pediatrico Bambino Gesù", Rome, Italy
| | - Elena Bergamini
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome "Foro Italico", Rome, Italy; Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza de Bosis 15, 00135 Rome, Italy.
| | | | - Eugenio Di Stanislao
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome "Foro Italico", Rome, Italy; ITOP SpA Officine Ortopediche, Palestrina (Rome), Italy.
| | - Giuseppe Di Rosa
- Division of Pediatric Neurorehabilitation, "Ospedale Pediatrico Bambino Gesù", Rome, Italy.
| | - Enrico Castelli
- Division of Pediatric Neurorehabilitation, "Ospedale Pediatrico Bambino Gesù", Rome, Italy.
| | - Giuseppe Vannozzi
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome "Foro Italico", Rome, Italy; Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza de Bosis 15, 00135 Rome, Italy.
| | - Valentina Camomilla
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome "Foro Italico", Rome, Italy; Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza de Bosis 15, 00135 Rome, Italy.
| |
Collapse
|
9
|
Park KB, Park H, Park BK, Abdel-Baki SW, Kim HW. Clinical and Gait Parameters Related to Pelvic Retraction in Patients with Spastic Hemiplegia. J Clin Med 2019; 8:jcm8050679. [PMID: 31091787 PMCID: PMC6571873 DOI: 10.3390/jcm8050679] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/01/2019] [Accepted: 05/13/2019] [Indexed: 11/20/2022] Open
Abstract
Pelvic retraction during walking is a common finding seen in patients with spastic hemiplegia. However, potential factors related to this condition have not been comprehensively examined in a systemic manner in previous studies. The purpose of this study was to elucidate any clinical and gait parameters related to pelvic retraction in patients with hemiplegic cerebral palsy. A total of 212 independent ambulatory patients were enrolled in the study. Group I consisted of 113 patients who had persistent pelvic retraction, and Group II of 99 with a normal range of pelvic rotation throughout the gait cycle as evidenced by kinematic analysis. A multivariate logistic regression analysis using a clustering technique was performed, with use of eight gait factors and five clinical factors. Decreased ankle dorsiflexion, increased hip internal rotation, increased anterior pelvic tilt, the Winters classification type II, and asymmetrical posturing of the upper extremity during gait were found to be related to pelvic retraction. This is the only study including a broader array of assessment domains of both clinical and gait parameters with a considerably large and homogenous population with hemiplegia. Further studies will be needed to see whether the rectification of those parameters may improve abnormal gait and pelvic retraction in hemiplegia.
Collapse
Affiliation(s)
- Kun-Bo Park
- Division of Pediatric Orthopaedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.
| | - Hoon Park
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Seoul 06273, Korea.
| | - Byoung Kyu Park
- Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Busan 48108, Korea.
| | - Sharkawy Wagih Abdel-Baki
- Division of Pediatric Orthopaedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.
| | - Hyun Woo Kim
- Division of Pediatric Orthopaedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.
| |
Collapse
|
10
|
Kiernan D, O'Sullivan R, Malone A, O'Brien T, Simms CK. Pathological Movements of the Pelvis and Trunk During Gait in Children With Cerebral Palsy: A Cross-Sectional Study With 3-Dimensional Kinematics and Lower Lumbar Spinal Loading. Phys Ther 2018; 98:86-94. [PMID: 29106655 DOI: 10.1093/ptj/pzx113] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 10/29/2017] [Indexed: 02/09/2023]
Abstract
BACKGROUND Increased loading at the lumbar spine, particularly in the coronal plane, has been reported in children with cerebral palsy (CP). As pelvic and trunk movements associated with Trendelenburg and Duchenne type gait are most significant in the coronal plane, the potential exists for lower lumbar spinal loading to be negatively affected in children with CP and these types of movement patterns. OBJECTIVE The objective of this study was to assess trunk and pelvic kinematics and lower lumbar spinal loading patterns in children with CP and Trendelenburg and Duchenne type gait. DESIGN This was a cross-sectional study. METHODS Three-dimensional kinematic (lower limb and thorax) and L5-S1 kinetic data were recorded. Children were divided according to clinical presentation of Trendelenburg or Duchenne type gait. Several discrete kinematic and kinetic parameters were assessed between groups. RESULTS Three distinct pelvic and trunk movement patterns were identified for children with CP: Trendelenburg, Duchenne, and complex Trendelenburg-Duchenne. Peak L5-S1 lateral bending moments were increased by 62% in children with CP and Duchenne type gait. Children with CP and complex Trendelenburg-Duchenne gait demonstrated the largest deviations from normal, with increased peak ipsilateral and contralateral directed moments of 69% and 54%, respectively, compared with children with typical development. LIMITATIONS A test-retest reliability analysis or measure of minimal detectable change was not conducted as part of this study. Results suggest that measures of minimal detectable change may be high for some of the reported variables. In addition, the inverse dynamic approach determines only the net intersegmental reactive forces that reflect the effect of external loads. Previous studies have shown that spinal loads may be larger than the net intersegmental force. CONCLUSIONS Trendelenburg and Duchenne type movements were not always distinct, and a third type of movement, a combination of the two, was the most common in this study. Clinicians should be aware that children with CP and the Duchenne type or the complex Trendelenburg-Duchenne type of gait pattern experience abnormal loading that may have significant implications for the lower spine in the long term.
Collapse
Affiliation(s)
- Damien Kiernan
- Gait Laboratory, Central Remedial Clinic, Vernon Ave, Clontarf, Dublin 3, Ireland, and Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland
| | | | | | | | - Ciaran K Simms
- Trinity Centre for Bioengineering, Trinity College Dublin
| |
Collapse
|
11
|
Nieuwenhuys A, Papageorgiou E, Schless SH, De Laet T, Molenaers G, Desloovere K. Prevalence of Joint Gait Patterns Defined by a Delphi Consensus Study Is Related to Gross Motor Function, Topographical Classification, Weakness, and Spasticity, in Children with Cerebral Palsy. Front Hum Neurosci 2017; 11:185. [PMID: 28446871 PMCID: PMC5388743 DOI: 10.3389/fnhum.2017.00185] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 03/28/2017] [Indexed: 11/18/2022] Open
Abstract
During a Delphi consensus study, a new joint gait classification system was developed for children with cerebral palsy (CP). This system, whose reliability and content validity have previously been established, identified 49 distinct joint patterns. The present study aims to provide a first insight toward the construct validity and clinical relevance of this classification system. The retrospective sample of convenience consisted of 286 patients with spastic CP (3-18 years old, GMFCS levels I-III, 166 with bilateral CP). Kinematic and kinetic trials from three-dimensional gait analysis were classified according to the definitions of the Delphi study, and one classified trial was randomly selected for each included limb (n = 446). Muscle weakness and spasticity were assessed for different muscle groups acting around the hip, knee, and ankle. Subsequently, Pearson Chi square tests, Cramer's V, and adjusted standardized residuals were calculated to explore the strength and direction of the associations between the joint patterns, and the different patient-specific characteristics (i.e., age, GMFCS level, and topographical classification) or clinical symptoms (muscle weakness and spasticity). Patient-specific characteristics showed several significant associations with the patterns of different joints, but the strength of most identified associations was weak. Apart from the knee during stance phase and the pelvis in the sagittal plane, the results systematically showed that the patterns with "minor gait deviations" were the most frequently observed. These minor deviations were found significantly more often in limbs with a lower level of spasticity and good muscle strength. Several other pathological joint patterns were moderately associated with weakness or spasticity, including but not limited to "outtoeing" for weakness and "intoeing" for spasticity. For the joints in the sagittal plane, significantly stronger associations were found with muscle weakness and spasticity, possibly because most of the evaluated muscles in this study mainly perform sagittal plane motions. Remarkably, the hip patterns in the coronal plane did not associate significantly with any of the investigated variables. Although further validation is warranted, this study contributes to the construct validity of the joint patterns of the Delphi consensus study, by demonstrating their ability to distinguish between clinically relevant subgroups in CP.
Collapse
Affiliation(s)
- Angela Nieuwenhuys
- Neuromotor Research Group, Department of Rehabilitation Sciences, KU LeuvenLeuven, Belgium
| | - Eirini Papageorgiou
- Neuromotor Research Group, Department of Rehabilitation Sciences, KU LeuvenLeuven, Belgium
| | - Simon-Henri Schless
- Neuromotor Research Group, Department of Rehabilitation Sciences, KU LeuvenLeuven, Belgium
| | - Tinne De Laet
- Faculty of Engineering Science, KU LeuvenLeuven, Belgium
| | - Guy Molenaers
- Department of Development and Regeneration, KU LeuvenLeuven, Belgium
- Department of Orthopedics, University Hospitals LeuvenLeuven, Belgium
| | - Kaat Desloovere
- Neuromotor Research Group, Department of Rehabilitation Sciences, KU LeuvenLeuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospitals LeuvenLeuven, Belgium
| |
Collapse
|
12
|
Three-dimensional lumbar segment movement characteristics during paediatric cerebral palsy gait. Gait Posture 2017; 53:41-47. [PMID: 28088678 DOI: 10.1016/j.gaitpost.2017.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 12/23/2016] [Accepted: 01/01/2017] [Indexed: 02/02/2023]
Abstract
Kinematic analysis of the trunk during cerebral palsy (CP) gait has been well described. In contrast, movement of the lumbar spine is generally ignored. This is most likely due to the complex nature of the spine. As an alternative to using complex sensor protocols, this study modelled the lumbar region as a single segment and investigated characteristic patterns of movement during CP gait. In addition, the impact of functional level of impairment and the relationship with lower lumbar spinal loading were examined. Fifty-two children with CP (26 GMFCS I and 26 GMFCS II) and 26 controls were recruited. A full barefoot 3-dimensional kinematic and kinetic analysis were conducted. Lumbar segment movement demonstrated increased forward flexion for CP children. This movement became more pronounced according to GMFCS level with GMFCS II children demonstrating increases of up to 8°. In addition, a moderate correlation was present between lumbar flexion/extension and L5/S1 sagittal moments (r=0.427 in the global frame and r=0.448 with respect to the pelvis, p<0.01). Children with CP demonstrated increased movement of the lumbar region compared to TD, with movement becoming more excessive as GMFCS level increased. Excessive forward flexion and loading at the lumbar spine were linked. However, the moderate correlation suggests other contributors to increased loading were present. In conclusion, this study is a first step at identifying how lumbar segment movement is altered during CP gait.
Collapse
|
13
|
Restriction of pelvic lateral and rotational motions alters lower limb kinematics and muscle activation pattern during over-ground walking. Med Biol Eng Comput 2016; 54:1621-1629. [PMID: 26830107 DOI: 10.1007/s11517-016-1450-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 01/13/2016] [Indexed: 10/22/2022]
Abstract
Restriction of pelvic lateral and rotational motions caused by robotic gait assistive devices can hinder satisfactory functional outcomes as it alters normal gait patterns. However, the effect of pelvic motion restriction caused by assistive devices on human locomotion is still unclear; thus, we empirically evaluated the influences of pelvic lateral and rotational motions on gait during over-ground walking by inhibiting the respective pelvic motions. The pelvic motions were restricted through a newly developed over-ground walking device. Variations in gait descriptive parameters as well as joint kinematics and muscle activation patterns were measured to indicate gait difference caused by pelvic restrictions. The results showed that pelvic lateral and rotational restriction significantly reduced the stride and step length as well as gait velocity and increased ratio of stance phase. It was also observed that the restriction caused a significant reduction in the range of motion of the ankle, knee, and hip joints. In addition, significantly higher muscle activations and prolonged patterns were observed in the tibialis anterior, gastrocnemius, and biceps femoris muscles, as compared to the normal patterns when the pelvis was restricted. We concluded that the pelvic restriction significantly altered normal gait dynamics, thus inhibiting the efficacy of gait rehabilitation.
Collapse
|
14
|
|
15
|
Kim HS, Chung SC, Choi MH, Gim SY, Kim WR, Tack GR, Lim DW, Chun SK, Kim JW, Mun KR. Primary and secondary gait deviations of stroke survivors and their association with gait performance. J Phys Ther Sci 2016; 28:2634-2640. [PMID: 27799710 PMCID: PMC5080192 DOI: 10.1589/jpts.28.2634] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 05/31/2016] [Indexed: 11/29/2022] Open
Abstract
[Purpose] Stroke survivors exhibit abnormal pelvic motion and significantly deteriorated
gait performance. Although the gait of stroke survivors has been evaluated at the primary
level pertaining to ankle, knee, and hip motions, secondary deviations involving the
pelvic motions are strongly related to the primary level. Therefore, the aim of this study
was to identify the kinematic differences of the primary and secondary joints and to
identify mechanism differences that alter the gait performance of stroke survivors.
[Subjects and Methods] Five healthy subjects and five stroke survivors were recruited. All
the subjects were instructed to walk at a self-selected speed. The joint kinematics and
gait parameters were calculated. [Results] For the stroke survivors, the range of motion
of the primary-joint motions were significantly reduced, and the secondary-joint motions
were significantly increased. Additionally, for the healthy subjects, the primary joint
kinematics were the main factors ensuring gait performance, whereas for the stoke
survivors, the secondary-joint motions were the main factors. [Conclusion] The results
indicate that while increasing the range of motion of primary-joint movements is the main
target to achieve, there is a strong need to constrain and support pelvic motions in order
to improve the outcome of gait rehabilitation.
Collapse
Affiliation(s)
- Hyung-Sik Kim
- Department of Biomedical Engineering, BK21+ Research Institute of Biomedical Engineering, College of Biomedical and Health Science, Konkuk University, Republic of Korea
| | - Soon-Cheol Chung
- Department of Biomedical Engineering, BK21+ Research Institute of Biomedical Engineering, College of Biomedical and Health Science, Konkuk University, Republic of Korea
| | - Mi-Hyun Choi
- Department of Biomedical Engineering, BK21+ Research Institute of Biomedical Engineering, College of Biomedical and Health Science, Konkuk University, Republic of Korea
| | - Seon-Young Gim
- Department of Biomedical Engineering, BK21+ Research Institute of Biomedical Engineering, College of Biomedical and Health Science, Konkuk University, Republic of Korea
| | - Woo-Ram Kim
- Department of Biomedical Engineering, BK21+ Research Institute of Biomedical Engineering, College of Biomedical and Health Science, Konkuk University, Republic of Korea
| | - Gye-Rae Tack
- Department of Biomedical Engineering, BK21+ Research Institute of Biomedical Engineering, College of Biomedical and Health Science, Konkuk University, Republic of Korea
| | - Dae-Woon Lim
- Department of Information and Communication Engineering, Dongguk University, Republic of Korea
| | - Sung-Kuk Chun
- Imaging Media Research Center, Korea Institute of Science and Technology, Republic of Korea
| | - Jin-Wook Kim
- Imaging Media Research Center, Korea Institute of Science and Technology, Republic of Korea
| | - Kyung-Ryoul Mun
- Imaging Media Research Center, Korea Institute of Science and Technology, Republic of Korea
| |
Collapse
|
16
|
"Children with cerebral palsy experience greater levels of loading at the low back during gait compared to healthy controls". Gait Posture 2016; 48:249-255. [PMID: 27343832 DOI: 10.1016/j.gaitpost.2016.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/03/2016] [Accepted: 06/05/2016] [Indexed: 02/02/2023]
Abstract
Excessive trunk motion has been shown to be characteristic of cerebral palsy (CP) gait. However, the associated demands on the lower spine are unknown. This study investigated 3-dimensional reactive forces and moments at the low back in CP children compared to healthy controls. In addition, the impact of functional level of impairment was investigated (GMFCS levels). Fifty-two children with CP (26 GMFCS I and 26 GMFCS II) and 26 controls were recruited to the study. Three-dimensional thorax kinematics and reactive forces and moments at the low back (L5/S1 spine) were examined. Discrete kinematic and kinetic parameters were assessed between groups. Thorax movement demonstrated increased range for CP children in all 3 planes while L5/S1 reactive forces and moments increased with increasing level of functional impairment. Peak reactive force data were increased by up to 57% for GMFCS I and 63% for GMFCS II children compared to controls. Peak moment data were increased by up to 21% for GMFCS II children compared to GMFCS I and up to 90% for GMFCS II compared to control. In addition, a strong correlation was demonstrated between thorax side flexion and L5/S1 lateral bend moment (r=0.519, p<0.01) and medial/lateral force (r=0.352, p<0.01). Children with CP demonstrated increased lower spinal loading compared to TD. Furthermore, GMFCS II children demonstrated significantly more involvement. Intervention should be aimed at reducing excessive thorax movement, especially in the coronal plane, in order to reduce abnormal loading on the spine in this population.
Collapse
|
17
|
Swinnen E, Goten LV, De Koster B, Degelaen M. Thorax and pelvis kinematics during walking, a comparison between children with and without cerebral palsy: A systematic review. NeuroRehabilitation 2016; 38:129-46. [DOI: 10.3233/nre-161303] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Eva Swinnen
- Vrije Universiteit Brussel, Rehabilitation Research (RERE), Brussel, Belgium
- Erasmus University College, Knowledge Centre Brussels Integrated Care (BIC), Brussel, Belgium
| | - Laura Vander Goten
- Vrije Universiteit Brussel, Rehabilitation Research (RERE), Brussel, Belgium
| | - Berdien De Koster
- Vrije Universiteit Brussel, Rehabilitation Research (RERE), Brussel, Belgium
| | - Marc Degelaen
- Vrije Universiteit Brussel, Rehabilitation Research (RERE), Brussel, Belgium
- Rehabilitation Hospital Inkendaal, Vlezenbeek (St.-Pieters-Leeuw), Belgium
| |
Collapse
|
18
|
Shin YK, Chong HJ, Kim SJ, Cho SR. Effect of Rhythmic Auditory Stimulation on Hemiplegic Gait Patterns. Yonsei Med J 2015; 56:1703-13. [PMID: 26446657 PMCID: PMC4630063 DOI: 10.3349/ymj.2015.56.6.1703] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 12/28/2014] [Accepted: 02/12/2015] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The purpose of our study was to investigate the effect of gait training with rhythmic auditory stimulation (RAS) on both kinematic and temporospatial gait patterns in patients with hemiplegia. MATERIALS AND METHODS Eighteen hemiplegic patients diagnosed with either cerebral palsy or stroke participated in this study. All participants underwent the 4-week gait training with RAS. The treatment was performed for 30 minutes per each session, three sessions per week. RAS was provided with rhythmic beats using a chord progression on a keyboard. Kinematic and temporospatial data were collected and analyzed using a three-dimensional motion analysis system. RESULTS Gait training with RAS significantly improved both proximal and distal joint kinematic patterns in hip adduction, knee flexion, and ankle plantar flexion, enhancing the gait deviation index (GDI) as well as ameliorating temporal asymmetry of the stance and swing phases in patients with hemiplegia. Stroke patients with previous walking experience demonstrated significant kinematic improvement in knee flexion in mid-swing and ankle dorsiflexion in terminal stance. Among stroke patients, subacute patients showed a significantly increased GDI score compared with chronic patients. In addition, household ambulators showed a significant effect on reducing anterior tilt of the pelvis with an enhanced GDI score, while community ambulators significantly increased knee flexion in mid-swing phase and ankle dorsiflexion in terminal stance phase. CONCLUSION Gait training with RAS has beneficial effects on both kinematic and temporospatial patterns in patients with hemiplegia, providing not only clinical implications of locomotor rehabilitation with goal-oriented external feedback using RAS but also differential effects according to ambulatory function.
Collapse
Affiliation(s)
- Yoon-Kyum Shin
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Ju Chong
- Department of Music Therapy, Graduate School and Ewha Music Rehabilitation Center, Ewha Womans University, Seoul, Korea
| | - Soo Ji Kim
- Music Therapy Education, Graduate School of Education and Ewha Music Rehabilitation Center, Ewha Womans University, Seoul, Korea.
| | - Sung-Rae Cho
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
- Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea.
| |
Collapse
|
19
|
Wang X, Wang Y. Gait analysis of children with spastic hemiplegic cerebral palsy. Neural Regen Res 2015; 7:1578-84. [PMID: 25657696 PMCID: PMC4308754 DOI: 10.3969/j.issn.1673-5374.2012.20.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 04/23/2012] [Indexed: 11/18/2022] Open
Abstract
An experiment was carried out in the key laboratory for Technique Diagnosis and Function Assessment of Winter Sports of China to investigate the differences in gait characteristics between healthy children and children with spastic hemiplegic cerebral palsy. With permission of their parents, 200 healthy children aged 3 to 6 years in the kindergarten of Northeastern University were enrolled in this experiment. Twenty children aged 3 to 6 years with spastic hemiplegic cerebral palsy from Shengjing Hospital, China were also enrolled in this experiment. Standard data were collected by simultaneously recording gait information from two digital cameras. DVracker was used to analyze the standard data. The children with hemiplegic cerebral palsy had a longer gait cycle, slower walking speed, and longer support phase than did the healthy children. The support phase was longer than the swing phase in the children with hemiplegic cerebral palsy. There were significant differences in the angles of the hip, knee, and ankle joint between children with cerebral palsy and healthy children at the moment of touching the ground and buffering, and during pedal extension. Children with hemiplegic cerebral palsy had poor motor coordination during walking, which basically resulted in a short stride, high stride frequency to maintain speed, more obvious swing, and poor stability.
Collapse
Affiliation(s)
- Xin Wang
- Department of Human Sports Science, Shenyang Sport University, Shenyang 110102, Liaoning Province, China
| | - Yuexi Wang
- Recuperate Center, Shengjing Hospital of China Medical University, Shenyang 110021, Liaoning Province, China
| |
Collapse
|
20
|
Trunk movements during gait in cerebral palsy. Clin Biomech (Bristol, Avon) 2015; 30:28-32. [PMID: 25480360 DOI: 10.1016/j.clinbiomech.2014.11.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 11/18/2014] [Accepted: 11/18/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lower limb deficits have been widely studied during gait in cerebral palsy, deficits in upper body have received little attention. The purpose of this research was to describe the characteristics of trunk movement of cerebral palsy children in terms of type of deficits (diplegia/hemiplegia) and gross motor function classification system (1, 2 or 3). METHODS Data from 92 cerebral palsy children, which corresponds to 141 clinical gait analysis, were retrospectively selected. Kinematic parameters of trunk were extracted from thorax and spine angles in the sagittal, transverse and coronal planes. The range of motion and the mean positions over the gait cycle were analysed. Intra-group differences between the children with diplegia or hemiplegia, gross motor function classification systems 1 to 3 and typically developing participants were analysed with Kruskal-Wallis tests and post hoc tests. Pearson correlation coefficients between the gait profile score normalised walking speed and kinematic parameters of the thorax were assessed. FINDINGS The results revealed: 1) the range of motion of the thorax and spine exhibited more significant differences between groups than the mean positions; 2) greater levels of impairment were associated with higher thorax range of motion, and 3) the children with diplegia and gross motor function classification system 3 exhibited a greater range of motion for all planes with the exception of spine rotation. INTERPRETATION This study confirmed that greater levels of impairment in cerebral palsy are associated with greater thorax range of motion during gait. The thorax plays an important role during gait in cerebral palsy.
Collapse
|
21
|
Houx L, Lempereur M, Rémy-Néris O, Brochard S. Threshold of equinus which alters biomechanical gait parameters in children. Gait Posture 2013; 38:582-9. [PMID: 23465759 DOI: 10.1016/j.gaitpost.2013.01.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 01/23/2013] [Accepted: 01/31/2013] [Indexed: 02/02/2023]
Abstract
The main aim of this study was to define the threshold angle of equinus beyond which significant changes in 3D lower limb kinematics and kinetics occur in typically developing children and to describe these changes.A customized orthosis was fitted on the right ankle of 10 typically developing children and was adjusted to +10° ankle dorsiflexion, 0°, -10°, -20° plantarflexion and maximum plantarflexion. Gait was analyzed using an optoelectronic system. A gait velocity of 1m/s was imposed.Most of the kinematic and kinetic changes were significantly altered from the -10° condition. In the sagittal plane, the results showed increased knee flexion at initial contact, increased knee flexion or hyperextension in stance, increased hip flexion at initial contact and increased anterior pelvic tilt. Other changes included increased knee varus, reduced hip adduction and more internal foot progression. The ankle plantarflexion moment was bi-phasic during stance, peak ankle power generation was reduced, peak knee extension moment was decreased and hip extension moments increased. On the contralateral side, there was a significant increase in ankle plantarflexion at initial contact and a significant decrease in knee flexion during swing phaseat maximum plantarflexion.Although slight modifications occurred for smaller degrees of equinus, the results suggest that significant kinematic and kinetic changes occurred during gait in both limbs from 10° of plantarflexion. The results of this study also provide some indications regarding the primary causes of gait deviations and secondary compensatory strategiesin children with a clinical dorsiflexion limitation.
Collapse
Affiliation(s)
- Laetitia Houx
- CHRU de Brest, Hôpital Morvan, Service de Médecine Physique et de Réadaptation, Brest, France; Université de Bretagne Occidentale, Brest, France.
| | | | | | | |
Collapse
|
22
|
Böhm H, Döderlein L. Gait asymmetries in children with cerebral palsy: do they deteriorate with running? Gait Posture 2012; 35:322-7. [PMID: 22055251 DOI: 10.1016/j.gaitpost.2011.10.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 09/30/2011] [Accepted: 10/09/2011] [Indexed: 02/02/2023]
Abstract
In children with cerebral palsy (CP) analysis of gait asymmetry can provide insight into the control of walking and may help in guiding the clinician's treatment decisions. Running is more difficult that walking for the musculoskeletal system, however, in the literature it has been shown that gait deviations associated with CP maybe better tolerated during running. This leads us to the hypothesis that running might increase gait symmetry in patients with CP. Therefore the purpose of this study was to investigate the effect of running on asymmetries in spatio-temporal, kinematic and kinetic gait parameters for children with CP. Twenty-four children with diplegia and 25 with hemiplegia were examined using 3D gait analysis during running and walking. MANOVA on two factors: diagnosis (hemiplegic, diplegic) and movement (walking, running) was conducted on a total of 22 gait parameters. The MANOVA revealed a significant difference in symmetry between walking and running (p<0.001) and between patients groups (p=0.004). The detailed analysis of gait parameters demonstrated a significant decrease of symmetry in 13 of the 22 gait parameters investigated, only symmetry of step time was significantly increased. Therefore the hypothesis that gait symmetry improved with running in children with CP can be rejected. Based on the results of this study, asymmetries masked during walking might appear during running. Therefore, analysis of asymmetry of walking and running gives a more comprehensive assessment of the gait pathology for clinical decision making.
Collapse
Affiliation(s)
- Harald Böhm
- Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bernauerstr. 18, 83229 Aschau i. Chiemgau, Germany.
| | | |
Collapse
|