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Barik S, Chaudhary S, Kumar V, Raj V, Singh V. A systematic review and meta-analysis of long-term outcomes of femoral derotation surgery for intoeing gait in cerebral palsy. Gait Posture 2024; 112:1-7. [PMID: 38718437 DOI: 10.1016/j.gaitpost.2024.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Femoral derotation osteotomy is treatment of choice in intoeing gait secondary to cerebral palsy (CP). RESEARCH QUESTION The aim of this study was to critically appraise the literature regarding the long-term outcomes of femoral derotation surgery in CP. METHODS Electronic databases of PubMed and Scopus was used for the literature review by two researchers independently (SB, SC). The study population included patients of cerebral palsy undergoing femoral derotation surgery. The keywords used were "cerebral palsy", "intoeing gait", "femur anteversion", "hip anteversion", "femur derotation" and "femur osteotomy". RESULTS Nine studies which included 657 limbs in 407 patients were selected for this study of which eight were retrospective in nature. The improvement in hip rotation at stance at last follow up (more than five years) maintained a statistical significance (SMD 1.67 95 %CI 1.12-2.22). Similar statistically significant outcomes were noted for foot progression angle (SMD 1.19 95 %CI 0.92-1.47), anteversion (SMD 2.75 95 %CI 1.49-4.01) and total passive internal rotation (SMD 1.71 95 %CI 1.19-2.22). SIGNIFICANCE Femoral derotation surgery is the procedure of choice for correction of intoeing gait in CP. Even though, there is deterioration of results on long-term as compared to short term, majority of the patients shall maintain overall correction without recurrence of an intoeing gait. Future studies with uniform criteria for defining recurrence on the basis of functional limitations shall provide better idea about the natural course of this procedure.
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Affiliation(s)
- Sitanshu Barik
- Department of Orthopedics, All India Institute of Medical Sciences, Nagpur, India.
| | - Sunny Chaudhary
- Department of Spine Surgery, Alberta Children's Hospital, Calgary, Canada
| | - Vishal Kumar
- Department of Orthopedics, PGIMER, Chandigarh, India
| | - Vikash Raj
- Department of Orthopedics, All India Institute of Medical Sciences, Deoghar, India
| | - Vivek Singh
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, India
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States RA, Salem Y, Krzak JJ, Godwin EM, McMulkin ML, Kaplan SL. Three-Dimensional Instrumented Gait Analysis for Children With Cerebral Palsy: An Evidence-Based Clinical Practice Guideline. Pediatr Phys Ther 2024; 36:182-206. [PMID: 38568266 DOI: 10.1097/pep.0000000000001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
BACKGROUND Children with cerebral palsy (CP) who walk have complex gait patterns and deviations often requiring physical therapy (PT)/medical/surgical interventions. Walking in children with CP can be assessed with 3-dimensional instrumented gait analysis (3D-IGA) providing kinematics (joint angles), kinetics (joint moments/powers), and muscle activity. PURPOSE This clinical practice guideline provides PTs, physicians, and associated clinicians involved in the care of children with CP, with 7 action statements on when and how 3D-IGA can inform clinical assessments and potential interventions. It links the action statement grades with specific levels of evidence based on a critical appraisal of the literature. CONCLUSIONS This clinical practice guideline addresses 3D-IGA's utility to inform surgical and non-surgical interventions, to identify gait deviations among segments/joints and planes and to evaluate the effectiveness of interventions. Best practice statements provide guidance for clinicians about the preferred characteristics of 3D-IGA laboratories including instrumentation, staffing, and reporting practices.Video Abstract: Supplemental digital content available at http://links.lww.com/PPT/A524.
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Affiliation(s)
- Rebecca A States
- Physical Therapy Program, School of Health Professions and Human Services, Hofstra University, Hempstead, New York (Drs States and Salem); Faculty of Physiotherapy, Cairo University, Cairo, Egypt (Dr Salem); Midwestern University - Physical Therapy Program, Downers Grove, Illinois (Dr Krzak); Shriners Children's Chicago, Gerald F. Harris Motion Analysis Center, Chicago, Illinois (Dr Krzak); Department of Physical Therapy, Long Island University - Brooklyn, Brooklyn, New York (Dr Godwin); Shriners Children's Spokane, Walter E. & Agnes M. Griffin Motion Analysis Center, Spokane, Washington (Dr McMulkin); Department of Rehabilitation & Movement Sciences, Rutgers, The State University of New Jersey, Newark, New Jersey (Dr Kaplan)
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Alexander N, Brunner R, Cip J, Viehweger E, De Pieri E. Increased Femoral Anteversion Does Not Lead to Increased Joint Forces During Gait in a Cohort of Adolescent Patients. Front Bioeng Biotechnol 2022; 10:914990. [PMID: 35733525 PMCID: PMC9207384 DOI: 10.3389/fbioe.2022.914990] [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: 04/07/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
Orthopedic complications were previously reported for patients with increased femoral anteversion. A more comprehensive analysis of the influence of increased femoral anteversion on joint loading in these patients is required to better understand the pathology and its clinical management. Therefore, the aim was to investigate lower-limb kinematics, joint moments and forces during gait in adolescent patients with increased, isolated femoral anteversion compared to typically developing controls. Secondly, relationships between the joint loads experienced by the patients and different morphological and kinematic features were investigated. Patients with increased femoral anteversion (n = 42, 12.8 ± 1.9 years, femoral anteversion: 39.6 ± 6.9°) were compared to typically developing controls (n = 9, 12.0 ± 3.0 years, femoral anteversion: 18.7 ± 4.1°). Hip and knee joint kinematics and kinetics were calculated using subject-specific musculoskeletal models. Differences between patients and controls in the investigated outcome variables (joint kinematics, moments, and forces) were evaluated through statistical parametric mapping with Hotelling T2 and t-tests (α = 0.05). Canonical correlation analyses (CCAs) and regression analyses were used to evaluate within the patients’ cohort the effect of different morphological and kinematic predictors on the outcome variables. Predicted compressive proximo-distal loads in both hip and knee joints were significantly reduced in patients compared to controls. A gait pattern characterized by increased knee flexion during terminal stance (KneeFlextSt) was significantly correlated with hip and knee forces, as well as with the resultant force exerted by the quadriceps on the patella. On the other hand, hip internal rotation and in-toeing, did not affect the loads in the joints. Based on the finding of the CCAs and linear regression analyses, patients were further divided into two subgroups based KneeFlextSt. Patients with excessive KneeFlextSt presented a significantly higher femoral anteversion than those with normal KneeFlextSt. Patients with excessive KneeFlextSt presented significantly larger quadriceps forces on the patella and a larger posteriorly-oriented shear force at the knee, compared to patients with normal KneeFlextSt, but both patients’ subgroups presented only limited differences in terms of joint loading compared to controls. This study showed that an altered femoral morphology does not necessarily lead to an increased risk of joint overloading, but instead patient-specific kinematics should be considered.
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Affiliation(s)
- Nathalie Alexander
- Laboratory for Motion Analysis, Department of Paediatric Orthopaedics, Children’s Hospital of Eastern Switzerland, St. Gallen, Switzerland
- Department of Orthopaedics and Traumatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Reinald Brunner
- Laboratory for Movement Analysis, University of Basel Children’s Hospital, Basel, Switzerland
- Department of Paediatric Orthopaedics, University of Basel Children’s Hospital, Basel, Switzerland
- Dpartment of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Johannes Cip
- Department of Paediatric Orthopaedics, Children’s Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Elke Viehweger
- Laboratory for Movement Analysis, University of Basel Children’s Hospital, Basel, Switzerland
- Department of Paediatric Orthopaedics, University of Basel Children’s Hospital, Basel, Switzerland
- Dpartment of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Enrico De Pieri
- Laboratory for Movement Analysis, University of Basel Children’s Hospital, Basel, Switzerland
- Dpartment of Biomedical Engineering, University of Basel, Basel, Switzerland
- *Correspondence: Enrico De Pieri,
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Elnaggar RK. Relationship Between Transverse-plane Kinematic Deviations of Lower Limbs and Gait Performance in Children with Unilateral Cerebral Palsy: A Descriptive Analysis. Gait Posture 2020; 79:224-228. [PMID: 32442898 DOI: 10.1016/j.gaitpost.2020.05.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/23/2020] [Accepted: 05/06/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Transverse-plane kinematic deviations of lower limbs are common in children with unilateral cerebral palsy (UCP), often with detrimental consequences for gait. RESEARCH QUESTION To identify the most important factor among rotational anomalies of lower limbs for gait in children with UCP. METHODS In a descriptive observational study, 42 children with UCP (age; 5-8 years) who had the ability of independent walking were included. Comprehensive gait analysis was performed and included assessment of the transverse-plane kinematic deviations of the lower limbs [pelvis, hip, and ankle rotation angles, and foot progression (FP) angle], and spatial-temporal gait features [velocity, step length (SL), single-limb support time (SLSt), temporal gait-symmetry index (T-GSI), and spatial gait-symmetry index (S-GSI)]. RESULTS AND SIGNIFICANCE The regression analysis indicated that hip rotation was the key determinant of gait velocity (R2 = 0.75, P < .001) and S-GSI (R2 = 0.24, P = .001). The FP angle was the most important factor for T-GSI (R2 = 0.22, P = .002). The ankle rotation explained in part the variance in T-GSI (R2 = 0.10, P = .001). CONCLUSION Gait velocity and spatial gait-symmetry are primarily affected by hip rotation anomalies. The temporal gait-symmetry is generally associated with the FP angle deviation and partly with ankle rotation deviation.
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Affiliation(s)
- Ragab K Elnaggar
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt; Department of Physical Therapy and Health Rehabilitation, Collage of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia.
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Bitenc-Jasiejko A, Konior K, Lietz-Kijak D. Meta-Analysis of Integrated Therapeutic Methods in Noninvasive Lower Back Pain Therapy (LBP): The Role of Interdisciplinary Functional Diagnostics. Pain Res Manag 2020; 2020:3967414. [PMID: 32256908 PMCID: PMC7109562 DOI: 10.1155/2020/3967414] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/07/2020] [Indexed: 12/12/2022]
Abstract
Introduction. Lower back pain (LBP) is almost a problem of civilizations. Quite often, it is a consequence of many years of disturbed distribution of tension within the human body caused by local conditions (injuries, hernias, stenoses, spondylolisthesis, cancer, etc.), global factors (postural defects, structural integration disorders, lifestyle, type of activity, etc.), or systemic diseases (connective tissue, inflammation, tumours, abdominal aneurysm, and kidney diseases, including urolithiasis, endometriosis, and prostatitis). Therefore, LBP rehabilitation requires the use of integrated therapeutic methods, combining the competences of interdisciplinary teams, both in the process of diagnosis and treatment. Aim of the Study. Given the above, the authors of the article conducted meta-analysis of the literature in terms of integrated therapeutic methods, indicating the techniques focused on a holistic approach to the patient. The aim of the article is to provide the reader with comprehensive knowledge about treating LBP using noninterventional methods. Material and Methods. An extensive search for the materials was conducted online using PubMed, the Cochrane database, and Embase. The most common noninterventional methods have been described, as well as the most relevantly updated and previously referenced treatment of LBP. The authors also proposed noninvasive (measurable) diagnostic procedures for the functional assessment of the musculoskeletal system, including initial, systematic, and cross-sectional control. All figures and images have been prepared by the authors and are their property. Results This review article goes beyond combining a detailed description of each procedure with full references, as well as a comprehensive discussion of this very complex and troublesome problem. Conclusions Lower back pain is a serious health problem, and this review article will help educate physicians and physiotherapists dealing with LBP in the options of evidence-based treatment. Ultimately, the article introduces and postulates the need to systematize therapeutic procedures in LBP therapy, with a long-term perspective.
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Affiliation(s)
- Aleksandra Bitenc-Jasiejko
- Department of Propedeutics, Physical Diagnostics and Dental Physiotherapy, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | | | - Danuta Lietz-Kijak
- Department of Propedeutics, Physical Diagnostics and Dental Physiotherapy, Pomeranian Medical University in Szczecin, Szczecin, Poland
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Rethwilm R, Böhm H, Dussa CU, Federolf P. Excessive Lateral Trunk Lean in Patients With Cerebral Palsy: Is It Based on a Kinematic Compensatory Mechanism? Front Bioeng Biotechnol 2019; 7:345. [PMID: 31803737 PMCID: PMC6877595 DOI: 10.3389/fbioe.2019.00345] [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: 07/03/2019] [Accepted: 11/06/2019] [Indexed: 12/24/2022] Open
Abstract
Introduction: Excessive lateral trunk lean is a commonly observed gait deviation in children with cerebral palsy (CP), with implications for energy expenditure and the development of back pain. While the trunk lean toward the stance leg is widely interpreted as a compensatory strategy to unload the hip, in CP the relation to hip abductor muscle strength is only weak. Therefore, other mechanisms may play a role in the prevalence of excessive trunk lean in CP, or it could be a primary motor function deficit. Research Question: Is the excessive lateral trunk lean in patients with CP part of an underlying biomechanical mechanism? Materials and Methods: Patients with bilateral CP (N = 255; age 13.6 ± 6.6 years) were retrospectively included and divided into a group with (n = 174) and without (n = 81) excessive lateral trunk lean. Ten lower-extremity joint angle waveforms were analyzed using a principal component analysis (PCA) to identify patterns of correlated deviations from average angle waveforms. Binary logistic regressions were performed to determine the discriminative capacity of the identified patterns. Results: The PCA identified correlated kinematic patterns, with lower-order patterns showing more common gait pathologies, such as torsional malalignments and crouch gait pattern. Within five patterns, significant (p < 0.0025) group differences were identified. Interestingly, the trunk lean was not always distinctive in these patterns and despite the significant differences their effect sizes were small. The logistic regression was unable to reliably classify patients based on their trunk lean patterns. Discussion: The current study identified multiple trunk lean-related patterns, however, excessive trunk lean was not attributable to a distinctive CP related gait pathology or to a specific compensatory strategy. Overall, the results do not support the hypothesis that excessive trunk lean is part of a biomechanical mechanism. Therefore, it seems more likely that excessive lateral trunk lean is based on other disease specific dysfunctions, influenced by the severity of the disease.
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Affiliation(s)
- Roman Rethwilm
- Orthopedic Children's Hospital Aschau, Aschau im Chiemgau, Germany.,Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Harald Böhm
- Orthopedic Children's Hospital Aschau, Aschau im Chiemgau, Germany
| | | | - Peter Federolf
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
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Measurement and Analysis of Gait Pattern during Stair Walk for Improvement of Robotic Locomotion Rehabilitation System. Appl Bionics Biomech 2019; 2019:1495289. [PMID: 31737093 PMCID: PMC6817922 DOI: 10.1155/2019/1495289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/26/2019] [Accepted: 08/13/2019] [Indexed: 11/30/2022] Open
Abstract
Background Robotic locomotion rehabilitation systems have been used for gait training in patients who have had a stroke. Most commercialized systems allow patients to perform simple exercises such as balancing or level walking, but an additional function such as stair-walk training is required to provide a wide range of recovery cycle rehabilitation. In this study, we analyzed stair-gait patterns and applied the result to a robotic rehabilitation system that can provide a vertical motion of footplates. Methods To obtain applicable data for the robotic system with vertically movable footplates, stair-walk action was measured using an optical marker-based motion capture system. The spatial position data of joints during stair walking was obtained from six healthy adults who participated in the experiment. The measured marker data were converted into joint kinematic data by using an algorithm that included resampling and normalization. The spatial position data are represented as angular trajectories and the relative displacement of each joint on the anatomical sagittal plane and movements of hip joints on the anatomical transverse plane. Results The average range of motion (ROM) of each joint was estimated as (−6.75°, 48.69°) at the hip, (8.20°, 93.78°) at the knee, and (−17.78°, 11.75°) at the ankle during ascent and as (6.41°, 31.67°) at the hip, (7.38°, 91.93°) at the knee, and (−24.89°, 24.18°) at the ankle during descent. Additionally, we attempted to create a more natural stair-gait pattern by analyzing the movement of the hip on the anatomical transverse plane. The hip movements were estimated to within ±1.57 cm and ±2.00 cm for hip translation and to within ±2.52° and ±2.70° for hip rotation during stair ascent and stair descent, respectively. Conclusions Based on the results, standard patterns of stair ascent and stair descent were derived and applied to a lower-limb rehabilitation robot with vertically movable footplates. The relative trajectory from the experiment ascertained that the function of stair walking in the robotic system properly worked within a normal ROM.
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Simonsen MB, Yurtsever A, Næsborg-Andersen K, Leutscher PDC, Hørslev-Petersen K, Andersen MS, Hirata RP. Tibialis posterior muscle pain effects on hip, knee and ankle gait mechanics. Hum Mov Sci 2019; 66:98-108. [PMID: 30981150 DOI: 10.1016/j.humov.2019.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/14/2019] [Accepted: 04/05/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Tibialis posterior (TP) dysfunction is a common painful complication in patients with rheumatoid arthritis (RA), which can lead to the collapse of the medial longitudinal arch. Different theories have been developed to explain the causality of tibialis posterior dysfunction. In all these theories, pain is a central factor, and yet, it is uncertain to what extent pain causes the observed biomechanical alterations in the patients. The aim of this study was to investigate the effect of experimental tibialis posterior muscle pain on gait mechanics in healthy subjects. METHODS Twelve healthy subjects were recruited for this randomized crossover study. Experimental pain was induced by ultrasound-guided injection of 1 mL hypertonic saline into the upper part of the right tibialis posterior muscle with the use of isotonic saline as non-pain-inducing control. Subsequently, kinematic data during three self-paced over ground walking for each condition were collected. Ground reaction forces and external moments were measured from force plates installed in the floor. Painful areas were evaluated using body charts and pain intensity scoring via a verbal numerical rating scale. FINDINGS Decreased hip internal rotation was observed during the pain condition at the end of the stance phase. There were no changes in gait velocity and duration of stand phase between the pain and no pain conditions. Reduced external joint moment was found for external knee rotation and for external hip rotation. INTERPRETATION The study has demonstrated that induced pain in the TP muscle evokes kinematic alteration in the hip and the knee joints, but not in the ankle, which suggest an underlying early stage joint compensatory mechanism. These findings suggest the need to include those joints in current physical evaluations of tibialis posterior dysfunction.
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Affiliation(s)
- Morten Bilde Simonsen
- Center for Sensory-Motoric Interaction (SMI®), Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7, DK-9220 Aalborg East, Denmark; Centre for Clinical Research, North Denmark Regional Hospital, Bispensgade 37, DK-9800 Hjoerring, Denmark
| | - Aysun Yurtsever
- Centre for Clinical Research, North Denmark Regional Hospital, Bispensgade 37, DK-9800 Hjoerring, Denmark; Department of Rheumatology, Hjørring Hospital, Bispensgade 37, DK-9800 Hjørrring, Denmark
| | - Ketill Næsborg-Andersen
- Centre for Clinical Research, North Denmark Regional Hospital, Bispensgade 37, DK-9800 Hjoerring, Denmark
| | - Peter Derek Christian Leutscher
- Centre for Clinical Research, North Denmark Regional Hospital, Bispensgade 37, DK-9800 Hjoerring, Denmark; Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, DK-9000, Denmark
| | - Kim Hørslev-Petersen
- King Christian 10th Hospital for Rheumatic Diseases, University of Southern Denmark, Toldbodgade 3, DK-6300 Gråsten, Denmark
| | - Michael Skipper Andersen
- Department of Materials and Production, Aalborg University, Fibigerstraede 16, DK-9220 Aalborg East, Denmark
| | - Rogerio Pessoto Hirata
- Center for Sensory-Motoric Interaction (SMI®), Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7, DK-9220 Aalborg East, Denmark.
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Analysis of gait pattern during stair walk for improvement of gait training robot. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:1905-1908. [PMID: 29060264 DOI: 10.1109/embc.2017.8037220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This paper seeks stair gait patterns which can improve effectiveness of gait training by applying to robotic locomotion therapy system. To get applicable data for stair walking function of the system, the stair walk of five subjects were measured by a motion capture system. From the acquired data, trajectories of each joint angle and relative change of the joints were calculated in the anatomical sagittal plane. Also, we were attempt to create more natural stair gait pattern by analyzing the movement of hip on the transverse plane.
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Correlation between transverse plan kinematics and foot progression angle in children with spastic diplegia. J Pediatr Orthop B 2017; 26:211-216. [PMID: 27902635 DOI: 10.1097/bpb.0000000000000416] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
In diplegic patients, the orientation of foot progression depends on multiple factors. We investigated the relationship between foot progression alignment, hip and pelvic rotations during gait, femoral anteversion, and tibial torsion. Kinematic and clinical parameters were evaluated for 114 children who walked independently and had not undergone previous surgery. Causes of intoeing presented combined in 72% of cases. Internal foot progression correlated with internal hip rotation and showed an inverse correlation with tibial torsion. Our results indicate that data from clinical examination and gait analysis should be evaluated carefully before making treatment recommendations, especially in terms of the correction of torsional problems, in patients with cerebral palsy.
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Ehlert R, Manfio EF, Heidrich RDO, Goldani R. Cerebral palsy: Influence of TheraTogs ® on gait, posture and in functional performance. FISIOTERAPIA EM MOVIMENTO 2017. [DOI: 10.1590/1980-5918.030.002.ao11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: For children with cerebral palsy, orthoses take an important role in improving posture, gait, functional performance and preventing secondary musculoskeletal disorders. Objective: To evaluate the influence of TheraTogs® on the posture, distribution of plantar pressure during gait and functional performance of a child with spastic diplegia cerebral palsy. Methods: A quantitative evaluation was carried out on a case study in which an 11-year-old child diagnosed with diplegic cerebral palsy underwent postural assessment through the Postural Assessment Software (PAS), plantar pressure distribution assessment during barefoot gait through the Emed-X system, before and after the intervention period of 8 weeks and functional assessment (Pediatric Evaluation of Disability Inventory - PEDI), with and without TheraTogs®. Results: In posture, TheraTogs® had greater influence on hip extension and this change was greater during its use. In the plantar pressure distribution assessment, an increase in posteriorization of plantar pressure occurred in the initial contact, the performance of the push-off phase and initial swing phase improved. In functionality, the child showed improvements in mobility, however, their self-care ability with TheraTogs® was reduced. Conclusion: Although improvements in posture, gait and functionality were verified with the use of TheraTogs®, the excessive heat, difficulties in toileting and self-care were disadvantages in wearing TheraTogs®.
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Klugarova J, Janura M, Svoboda Z, Sos Z, Stergiou N, Klugar M. Hallux valgus surgery affects kinematic parameters during gait. Clin Biomech (Bristol, Avon) 2016; 40:20-26. [PMID: 27792950 PMCID: PMC5325701 DOI: 10.1016/j.clinbiomech.2016.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 10/03/2016] [Accepted: 10/05/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of our study was to compare spatiotemporal parameters and lower limb and pelvis kinematics during the walking in patients with hallux valgus before and after surgery and in relation to a control group. METHODS Seventeen females with hallux valgus, who underwent first metatarsal osteotomy, constituted our experimental group. The control group consisted of thirteen females. Kinematic data during walking were obtained using the Vicon MX system. FINDINGS Our results showed that hallux valgus before surgery affects spatiotemporal parameters and lower limb and pelvis kinematics during walking. Hallux valgus surgery further increased the differences that were present before surgery. Specifically after hallux valgus surgery, the walking speed decreased even more (p=0.09, η2=0.19) while step time increased (p=0.002, η2=0.44) on both legs. The maximum ankle plantar flexion of the operated leg during toe-off decreased to a greater extend (p=0.03, η2=0.26). The asymmetry in the hip and the pelvis movements in the frontal plane (present preoperatively) persisted after surgery. INTERPRETATION Hallux valgus is not an isolated problem of the first ray, which could be just surgically addressed by correcting the foot's alignment. It is a long-term progressive malfunction of the foot affecting the entire kinematic chain of the lower extremity.
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Affiliation(s)
- J. Klugarova
- The Czech Republic (Middle European) Centre for Evidence-Based Healthcare: A Joanna Briggs Institute Centre of Excellence, Department of Social Medicine and Public Health, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic
| | - M. Janura
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacky University Olomouc, Tr. Miru 115, 771 11 Olomouc, Czech Republic
| | - Z. Svoboda
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacky University Olomouc, Tr. Miru 115, 771 11 Olomouc, Czech Republic
| | - Z. Sos
- Military Hospital, Pasteurova 13, 779 00 Olomouc, Czech Republic
| | - N. Stergiou
- Biomechanics Research Building, Center for Research in Human Movement Variability, University of Nebraska at Omaha, 6160 University Drive South, 68182 Omaha, NE, USA
| | - M. Klugar
- The Czech Republic (Middle European) Centre for Evidence-Based Healthcare: A Joanna Briggs Institute Centre of Excellence, Department of Social Medicine and Public Health, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic
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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.
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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.
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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
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Svoboda Z, Janura M, Kutilek P, Janurova E. Relationships between movements of the lower limb joints and the pelvis in open and closed kinematic chains during a gait cycle. J Hum Kinet 2016; 51:37-43. [PMID: 28149366 PMCID: PMC5260548 DOI: 10.1515/hukin-2015-0168] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Lots of athletic skills performed during practice or competition are initiated by the legs, where athletes either walk or run prior to executing specific skills. Kinematic chains are used to describe the relationships between body segments and joints during movement. The aim of this study was to determine the relationships between movements of lower limb segments and the pelvis in open and closed kinematic chains while walking. The experimental group consisted of 32 males (age 23.3 ± 2.5 years, body mass 78.1 ± 8.7 kg, body height 182 ± 6 cm). For 3D analysis, an optoelectronic system Vicon MX (7 cameras, frequency 200 Hz) was used. Positioning of the segments was determined by the PlugInGait Model. Each participant executed five trials at speeds ranging from 1.38 to 1.52 m·s-1. The relationships between angle variables of the lower limbs and the pelvis in selected gait cycle phases were evaluated using STATISTICA software (version 10.0) and the Spearman correlation. The highest numbers of moderate and large correlations were found at opposite toe off, heel rise and initial contact for the sagittal and transversal planes in comparison to the frontal plane. The closed kinematic chain had a stronger impact on determining the movement pattern. The instructions or interventions focusing on closed kinematic chain alternation are more effective for changes in a movement pattern. The preferred limb initiates kinematics in the direction of propulsion, while the non-preferred limb in internal and external rotation.
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Affiliation(s)
- Zdenek Svoboda
- Faculty of Physical Culture, Palacky University Olomouc, Olomouc, Czech Republic
| | - Miroslav Janura
- Faculty of Physical Culture, Palacky University Olomouc, Olomouc, Czech Republic
| | - Patrik Kutilek
- Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
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Degelaen M, De Borre L, Buyl R, Kerckhofs E, De Meirleir L, Dan B. Effect of supporting 3D-garment on gait postural stability in children with bilateral spastic cerebral palsy. NeuroRehabilitation 2016; 39:175-81. [PMID: 27341370 DOI: 10.3233/nre-161349] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Children with cerebral palsy show dysfunctional postural control which interferes with their functional performance and daily-life activities. OBJECTIVE The aim of the study was to identify the effect of a 3D supporting garment on trunk postural control and interjoint coordination during gait in children with bilateral cerebral palsy. METHODS We analyzed tridimensional trunk motion, trunk-thigh and interjoint coordination in 15 4-10 year-old children with bilateral spastic cerebral palsy (GMFCS I or II) and 16 4-10 year-old typically developing children while walking with or without a supporting garment. RESULTS We found significantly changes in the coordination between trunk and lower limbs in children with cerebral palsy. Step velocity and cadence both increased significantly in children with cerebral palsy but in controls, the cadence remained unaltered. Interjoint coordination between hip-knee and knee-ankle was altered during the stance phase only in the subgroup of children with cerebral palsy without any limitations in ankle joint passive range of motion. CONCLUSION 3D supporting garments improve trunk-thigh and lower limb interjoint coordination in walking in children with bilateral cerebral palsy.
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Affiliation(s)
- Marc Degelaen
- Centre d'Analyse du Mouvement, Hôpital Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium.,Rehabilitation Hospital Inkendaal, Vlezenbeek, Belgium.,Vrije Universiteit Brussel, Rehabilitation Research (RERE), Brussels, Belgium
| | - Ludo De Borre
- Centre d'Analyse du Mouvement, Hôpital Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium.,Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Ronald Buyl
- Dienst Biostatistiek en Informatica, Faculteit Geneeskunde en Farmacie, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Eric Kerckhofs
- Vrije Universiteit Brussel, Rehabilitation Research (RERE), Brussels, Belgium
| | - Linda De Meirleir
- Universitair Ziekenhuis Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Bernard Dan
- Rehabilitation Hospital Inkendaal, Vlezenbeek, Belgium.,Laboratory of Neurophysiology and Movement Biomechanics Faculty of Movement Science, Université Libre de Bruxelles (ULB), Brussels, Belgium.,Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Abstract
BACKGROUND Lower limb rotational anomalies in spastic diplegic children with cerebral palsy (CP) are common and difficult to identify through physical examination alone. The identification and treatment of the overall rotational disorders must be considered to restore physiological lever-arms lengths and lever-arms orientation.The aims of the study were to assess the prevalence of lower limb rotational malalignment and to describe the distribution of the different kinematic torsional profiles in children with spastic diplegia. METHODS Instrumented gait analysis data from 188 children with spastic diplegia were retrospectively reviewed. None of the patients had undergone surgery previously or received botulinum toxin treatment within 6 months before the review. Kinematic data, collected at the midstance phase, included: pelvic, hip, and ankle rotation and foot progression angle. RESULTS The prevalence of kinematic rotational deviations was 98.4%. Sixty-one percent of the children walked with an internal foot progression angle and 21% exhibited external alignment. The pelvis was internally rotated in 41% of the cases and externally in another 27%. Hip rotation was internal in 29% and external in 27% of the cases. Ankle rotation was internal in 55% and external in 16% of the cases. Lower limb rotational anomalies involved more than one level in 77% of the limbs. A kinematic compensatory deviation was identified in at least one level in 48% of the limbs. CONCLUSIONS Kinematic rotational anomalies were identified in nearly all the 188 children in the study. The multilevel involvement of lower limb malalignment was not systematically associated with compensatory mechanisms between the levels. Ankle rotational anomalies were the most frequent cause of lower limb torsional deviations followed by pelvic malalignment. LEVEL OF EVIDENCE Level IV.
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Brunner R. Therapie spastischer Gangstörungen im Wachstum. Monatsschr Kinderheilkd 2014. [DOI: 10.1007/s00112-013-3050-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Buganè F, Benedetti MG, D'Angeli V, Leardini A. Estimation of pelvis kinematics in level walking based on a single inertial sensor positioned close to the sacrum: validation on healthy subjects with stereophotogrammetric system. Biomed Eng Online 2014; 13:146. [PMID: 25336170 PMCID: PMC4216872 DOI: 10.1186/1475-925x-13-146] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/12/2014] [Indexed: 11/10/2022] Open
Abstract
Background Kinematics measures from inertial sensors have a value in the clinical assessment of pathological gait, to track quantitatively the outcome of interventions and rehabilitation programs. To become a standard tool for clinicians, it is necessary to evaluate their capability to provide reliable and comprehensible information, possibly by comparing this with that provided by the traditional gait analysis. The aim of this study was to assess by state-of-the-art gait analysis the reliability of a single inertial device attached to the sacrum to measure pelvis kinematics during level walking. Methods The output signals of the three-axis gyroscope were processed to estimate the spatial orientation of the pelvis in the sagittal (tilt angle), frontal (obliquity) and transverse (rotation) anatomical planes These estimated angles were compared with those provided by a 8 TV-cameras stereophotogrammetric system utilizing a standard experimental protocol, with four markers on the pelvis. This was observed in a group of sixteen healthy subjects while performing three repetitions of level walking along a 10 meter walkway at slow, normal and fast speeds. The determination coefficient, the scale factor and the bias of a linear regression model were calculated to represent the differences between the angular patterns from the two measurement systems. For the intra-subject variability, one volunteer was asked to repeat walking at normal speed 10 times. Results A good match was observed for obliquity and rotation angles. For the tilt angle, the pattern and range of motion was similar, but a bias was observed, due to the different initial inclination angle in the sagittal plane of the inertial sensor with respect to the pelvis anatomical frame. A good intra-subject consistency has also been shown by the small variability of the pelvic angles as estimated by the new system, confirmed by very small values of standard deviation for all three angles. Conclusions These results suggest that this inertial device is a reliable alternative to stereophotogrammetric systems for pelvis kinematics measurements, in addition to being easier to use and cheaper. The device can provide to the patient and to the examiner reliable feedback in real-time during routine clinical tests.
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Affiliation(s)
- Francesca Buganè
- LetSense Srl, via Bruno Buozzi 25, Castel Maggiore 40013, Italy.
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Brunner R. [Principles of treatment of spastic palsy in children: a critical review]. DER ORTHOPADE 2014; 43:643-8. [PMID: 24939715 DOI: 10.1007/s00132-013-2218-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND In patients with cerebral palsy who are able to walk the source of the problem of spasticity must first be correctly determined. The weakness appears to be the main problem and the first line treatment must concentrate on improvement of strength and bodily control. THERAPY Spasticity can also compensate for weaknesses. The indications for weakening measures for correction of muscle tonus must therefore be carefully appraised but are part of the repertoire. Orthoses result in stability and correction of deformities. Night braces are in our experience of doubtful value. Biomechanical objectives are a right-angle between the sole of the shoe and lower leg axis (leading edge of the tibia) and full passive and active extension in the knees and hips. CONCLUSION Severely handicapped patients often suffer from hip luxation and scoliosis. Regular control of the hips and spine under loading are necessary. Early interventions, conservative and operative, have a better prognosis than a late correction. In general patients who have a risk for deformities and dysfunction of the musculoskeletal system due to the underlying disease should undergo early orthopedic control.
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Affiliation(s)
- R Brunner
- Abt. Neuroorthopädie, Univ.-Kinderspital beider Basel, Spitalstraße 33, 4005, Basel, Schweiz,
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Brunner R, Rutz E. Biomechanics and muscle function during gait. J Child Orthop 2013; 7:367-71. [PMID: 24432096 PMCID: PMC3838524 DOI: 10.1007/s11832-013-0508-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 06/17/2013] [Indexed: 02/03/2023] Open
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Do changes in torsional magnetic resonance imaging reflect improvement in gait after femoral derotation osteotomy in patients with cerebral palsy? INTERNATIONAL ORTHOPAEDICS 2013; 37:2193-8. [PMID: 23955818 DOI: 10.1007/s00264-013-2054-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 07/22/2013] [Indexed: 01/17/2023]
Abstract
PURPOSE Femoral derotation osteotomy (FDO) is commonly used to correct internal rotation gait (IRG) in spastic diplegia. The purpose of this study was to investigate whether the extent of intraoperative derotation is reflected in changes in static (clinical ROM and anteversion angle measured on torsional MRI) and dynamic parameters (transverse plane kinematics in three-dimensional gait analysis) after FDO in children with spastic diplegia. METHODS In a prospective study, 30 children with spastic diplegia and IRG were treated with FDO as part of a multilevel surgery and were examined pre- and postoperatively clinically, by three-dimensional gait analysis and by torsional MRI according to a standardised protocol. RESULTS A correlation (r = 0.317, p = 0.015) between the extent of intraoperative derotation and mean hip rotation in stance as well as the anteversion angle measured on torsional MRI (r = 0.454, p < 0.001) was found. However, no significant correlation was observed between anteversion angle (tMRI) and mean hip rotation in stance, either before or after FDO. CONCLUSIONS Significant improvements were found in IRG after FDO, confirming the results of previous studies. There was no correlation between the anteversion measured on MRI and the mean hip rotation in stance in 3D gait analysis before or after FDO. Thus, the data suggest that if the intraoperative extent of derotation is determined only by the anteversion angle, the result will not be better after FDO. It might only help to avoid retroversion and indicate the maximum amount of femoral derotation. In this study the extent of the intraoperative derotation was orientated at the preoperative midpoint of rotation. Based on the small, but significant correlation between the clinical midpoint and the mean hip rotation in stance in the gait analysis, determination of the intraoperative extent of derotation according to the mean hip rotation in stance seems to give the best results.
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Secondary gait deviations in patients with and without neurological involvement: a systematic review. Gait Posture 2013; 37:480-93. [PMID: 23022156 DOI: 10.1016/j.gaitpost.2012.09.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 08/30/2012] [Accepted: 09/04/2012] [Indexed: 02/02/2023]
Abstract
Pathologies that lead to biomechanical restrictions in human gait interfere with the tightly regulated muscle activation patterns that control the external moments. In order to maintain proper function, secondary mechanisms are required. The aims of this systematic review were (1) to identify secondary mechanisms in pathologic gait that have been described throughout the scientific literature by means of instrumented gait analysis, (2) to distinguish between active compensatory mechanisms and passive physical effects and (3) to identify common compensatory mechanisms that appear to be independent from the underlying disease. A comprehensive literature search revealed 4080 citations for review, whereof 148 studies entered the full-text review. Thirty-six studies were included and the quality of these studies was assessed by two independent reviewers (kappa=0.83). The quality of the included studies showed large variation and several methodological issues were identified. Five studies were further identified describing only passive physical effects, leaving a total of 31 studies reporting on compensations. The qualitative analysis revealed common compensations that appeared to be independent from the underlying pathology. In clinical practice, distinguishing primary from secondary gait deviations can be considered highly important since unnecessary treatment may be avoided. However, given the introduction of general principles of compensatory mechanisms and the fact that certain presumed "compensations" were identified as simple passive physical effects, secondary gait deviations have to be further investigated. Computer simulation studies are valuable, especially in respect of the distinction between compensations and physical effects. Furthermore, the need for a uniform terminology was highlighted.
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Bibliography Current World Literature. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e31826b35c1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Dreher T, Wolf SI, Heitzmann D, Swartman B, Schuster W, Gantz S, Hagmann S, Döderlein L, Braatz F. Long-term outcome of femoral derotation osteotomy in children with spastic diplegia. Gait Posture 2012; 36:467-70. [PMID: 22766044 DOI: 10.1016/j.gaitpost.2012.04.017] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 04/19/2012] [Indexed: 02/02/2023]
Abstract
Satisfactory short-term results after femoral derotation osteotomy (FDO) for the treatment of internal rotation gait in cerebral palsy have been reported by various authors. However, there are only a few longer-term studies reporting results 5 years after FDO and these are not in agreement. There are no reports on the clinical course beyond the pubertal growth spurt. 33 children with diplegia (n=59 legs, age: 10.5±3.6 years) and internally rotated gait were examined pre- (E0), 1 year (E1), 3±1 (E2) and 9±2 (E3) years after distal (27 legs) or proximal (32 legs) FDO as part of multilevel surgery, using standardized clinical exam and 3D gait-analysis at all examinations. The amount of intra-operative derotation averaged 25°. ANOVA was used for statistics (p<0.05). Mean hip internal rotation in stance at E0 of 17.3° was significantly changed to 1.0° of external rotation at E1 and was maintained at 4.2° at E3. The same clinical course was found for foot progression angle. The mid-point of passive hip rotation at E0 was 21°. This was significantly decreased to 6° at E1 and showed a small but significant increase reaching 12° at E3. The results of this study showed a good overall correction of internally rotated gait following FDO. These improvements were maintained at long-term follow-up after the pubertal growth spurt. Recurrence was observed in some cases with overall severe deterioration. In those patients persistent dynamic factors leading to recurrence should be further investigated.
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Affiliation(s)
- Thomas Dreher
- Paediatric Orthopaedics and Foot Surgery, Department of Orthopaedic and Trauma Surgery, Heidelberg University Clinics, Germany.
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