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Skoutelis VC, Kanellopoulos AD, Vrettos S, Dimitriadis Z, Dinopoulos A, Papagelopoulos PJ, Kontogeorgakos VA. Effect of selective percutaneous myofascial lengthening and functional physiotherapy on walking in children with cerebral palsy: Three-dimensional gait analysis assessment. J Orthop Sci 2024; 29:885-890. [PMID: 37031098 DOI: 10.1016/j.jos.2023.03.010] [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: 08/08/2022] [Revised: 09/20/2022] [Accepted: 03/13/2023] [Indexed: 04/10/2023]
Abstract
BACKGROUND Walking is the most affected motor function in children with cerebral palsy (CP). Orthopaedic surgery is regularly used to improve ambulation in children with CP. Selective Percutaneous Myofascial Lengthening (SPML) is considered the state-of-the art technique for surgical lengthening of spastic/contracted muscles in CP. The purpose of this study was to investigate the effect of combined SPML surgery and postoperative functional physiotherapy on gait function and characteristics of children with spastic cerebral palsy (CP). METHODS Twenty-six children with spastic CP, aged 5-7 years, Gross Motor Function Classification System (GMFCS) levels II (n = 6), III (n = 12) and IV (n = 8) participated in a quasi-experimental one-group pretest-posttest study with a 9-month follow-up. The Global Motion Graph Deviation Index (MGDI) (including MGDI sub-indices of each joint in each plane of motion) and spatiotemporal parameters of a three-dimensional kinematic gait analysis were used to assess the gait function and characteristics, respectively. RESULTS Nine months following SPML and functional physiotherapy, statistically significant improvements (p < 0.05) were noted in the Global MGDI, the MGDIs of sagittal plane knee and ankle motion analysis graphs, and the four most common spatiotemporal measures of gait: walking velocity, stride length, step length, and cadence. CONCLUSION Children with spastic CP seem to gain better overall gait function following SPML procedure and functional physiotherapy, by achieving higher walking velocity, longer stride length and step length, and faster cadence. Further studies with control group and longer follow-up three-dimensional gait analyses are warranted to validate these positive results.
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Affiliation(s)
- Vasileios C Skoutelis
- Medical School, National and Kapodistrian University of Athens, Athens, Attica, Greece; Department of Physiotherapy, Laboratory of Neuromuscular and Cardiovascular Study of Motion, School of Health and Caring Sciences, University of West Attica, Egaleo, Attica, Greece; Department of Physiotherapy, 'Attikon' University General Hospital, Chaidari, Attica, Greece.
| | | | - Stamatis Vrettos
- 'ENA' Pediatric Physiotherapy Practice, Chalandri, Attica, Greece
| | - Zacharias Dimitriadis
- Department of Physiotherapy, Health and Quality of Life Research Laboratory, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Argirios Dinopoulos
- Medical School, National and Kapodistrian University of Athens, Athens, Attica, Greece; Third Department of Paediatrics, 'Attikon' University General Hospital, Chaidari, Attica, Greece
| | - Panayiotis J Papagelopoulos
- Medical School, National and Kapodistrian University of Athens, Athens, Attica, Greece; First Department of Orthopaedic Surgery, 'Attikon' University General Hospital, Chaidari, Attica, Greece
| | - Vasileios A Kontogeorgakos
- Medical School, National and Kapodistrian University of Athens, Athens, Attica, Greece; First Department of Orthopaedic Surgery, 'Attikon' University General Hospital, Chaidari, Attica, Greece
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Kanashvili B, Niiler TA, Church C, Lennon N, Shrader MW, Howard JJ, Miller F. The impact of hamstring lengthening on stance knee flexion at skeletal maturity in ambulatory cerebral palsy. J Pediatr Orthop B 2024:01202412-990000000-00189. [PMID: 38451810 DOI: 10.1097/bpb.0000000000001174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
This study reports the long-term outcomes of hamstring lengthening to treat flexed knee gait in children with ambulatory cerebral palsy (CP) after skeletal maturity. This retrospective longitudinal observational study used instrumented gait analysis (GA) <8 and >15 years old in children with bilateral CP. The primary variable was knee flexion in stance phase. Eighty children (160 limbs) were included; 49% were male, 51% female. Mean age at first GA was 6.0 (SD: 1.2) years and 19.6 (SD: 4.5) years at final GA. Mean follow-up was 13.7 (SD: 4.7) years. Children were classified as Gross Motor Function Classification System I-8, II-46 and III-26. Average Gross Motor Function Measure Dimension D was 72% (SD: 20%). Hamstring lengthenings occurred once in 82, twice in 54 and three times in 10 limbs. From initial to final GA, average knee flexion in stance was unchanged, 27.8° (SD: 14.8°) to final 27.0° (SD: 11.2°; P = 0.54). Knee flexion at foot contact was 39.6° (SD: 13.0°), improving to final GA of 30.7° (SD: 10.6°; P < 0.001). Initial gait deviation index was 65.8 (SD: 31.9), improving to final 78.9 (SD: 28.2; P < 0.001). Older age, males and concomitant plantar flexor lengthening predicted change toward more flexed knee gait. Hamstring lengthening did not lead to back-kneeing gait at maturity while maintaining childhood stance phase knee flexion. A subgroup still developed significant flexed knee gait posture and may have benefited from more aggressive treatment options. This outcome may also be impacted by diverse functional levels, etiologies and treatments of flexed knee gait.
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Hajibozorgi M, Leijen I, Hijmans JM, Greve C. Functional popliteal angle tests improve identification of short hamstring muscle-tendon length in patients with a central neurological lesion. Sci Rep 2023; 13:20510. [PMID: 37993595 PMCID: PMC10665385 DOI: 10.1038/s41598-023-47667-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/16/2023] [Indexed: 11/24/2023] Open
Abstract
This study introduces a functional exercise protocol to improve the identification for short hamstring muscle-tendon length (HMTL), a common contributor to crouch gait in patients with central neurological lesions (CNL). The functional exercise protocol incorporates a knee extension movement with hip in a flexed position, while standing on one leg (functional popliteal angle test) and walking with large steps to the current standard protocol (walking at comfortable speed and as fast as possible). The main aim was to establish whether the new protocol allows better determination of maximum HMTLs and diagnostics of short HMTL in patients with a CNL. Lower limb 3D marker position data from 39 patient limbs and 10 healthy limbs performing the exercises were processed in OpenSim to extract HMTLs. The new protocol provoked significantly larger HMTLs compared to the current standard protocol. The total number of limbs classified as having too short HMTLs reduced from 16 to 4 out of a total of 30 limbs walking in crouch. The new protocol improves determination of maximum HMTL, thereby improving short HMTL diagnostics and identification of patients in need of lengthening treatment. Inter-individual variability observed among patients, indicating the need to include all exercises for comprehensive diagnosis.
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Affiliation(s)
- Mahdieh Hajibozorgi
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Ilse Leijen
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Juha M Hijmans
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Christian Greve
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Saraswat P, MacWilliams BA, McMulkin ML, Carpenter AM, Shull ER, Carroll KL, Stotts AK, Sousa T, Hyer LC, Westberry DE. Is peak hamstrings muscle-tendon length criterion a sufficient indicator to recommend against surgical lengthening of hamstrings? Gait Posture 2023; 105:149-157. [PMID: 37573759 DOI: 10.1016/j.gaitpost.2023.08.004] [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: 03/01/2023] [Revised: 07/26/2023] [Accepted: 08/09/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Excessive knee flexion during stance in children with cerebral palsy is often treated by surgical hamstrings lengthening. Pre-operative hamstrings muscle-tendon length can be estimated from kinematics and often used for decision making to rule out surgical lengthening if peak hamstrings muscle-tendon length is 'Not Short'. RESEARCH QUESTION If peak hamstrings muscle-tendon length is within two standard deviations of typical, is that a sufficient indicator to rule out surgical hamstrings lengthening? METHODS Three motion analysis centers retrospectively identified children with cerebral palsy, age 6-17 years, who had consecutive gait analyses with knee flexion at initial contact > 20° and popliteal angle > 35° at initial study. Three groups were considered: Medial Hamstrings Lengthening (MHL), Medial and Lateral Hamstrings Lengthening (MLHL), no surgical intervention (Control). Peak hamstrings muscle-tendon length at initial gait study was computed and categorized as 'Short' or 'Not Short'. Two outcomes variables were considered: change in peak knee extension (PKE) and change in pelvic tilt. Univariate comparisons of all variables were assessed along with a multivariate stepwise regression analysis to identify pre-operative characteristics that may predict post-operative improvement. RESULTS 440 individuals met inclusion criteria. Percentage of individuals with improved PKE by grouping were- MHL-'Short': 60%, MHL-'Not Short': 65%, MLHL-'Short': 74%, MLHL-'Not Short': 74%, Control 'Short': 20%, Control 'Not Short': 19%. Percentage of individuals with worsened pelvic tilt were- MHL-'Short': 25%, MHL-'Not Short': 11%, MLHL-'Short': 42%, MLHL-'Not Short': 21% with significantly more individuals in MHL-'Short' subgroup compared to MHL-'Not Short'. Multivariate analysis suggested that pre-operative pelvic tilt and weak hip extensor strength have the largest effect on predicting post-operative increase in APT. Peak muscle-tendon length was not a significant predictor of post-operative knee kinematics or increase in APT. SIGNIFICANCE This study suggests that hamstrings muscle-tendon length criteria by itself is not a sufficient indicator to recommend against hamstrings lengthening.
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Affiliation(s)
- Prabhav Saraswat
- Shriners Children's, Motion Analysis Center, Greenville, SC, USA.
| | - Bruce A MacWilliams
- Shriners Children's, Motion Analysis Center, Salt Lake City, UT, USA; University of Utah, Department of Orthopedic Surgery, Salt Lake City, UT, USA
| | - Mark L McMulkin
- Shriners Children's, Motion Analysis Center, Spokane, WA, USA
| | | | - Emily R Shull
- Shriners Children's, Motion Analysis Center, Greenville, SC, USA
| | - Kristen L Carroll
- Shriners Children's, Motion Analysis Center, Salt Lake City, UT, USA
| | - Alan K Stotts
- Shriners Children's, Motion Analysis Center, Salt Lake City, UT, USA; University of Utah, Department of Orthopedic Surgery, Salt Lake City, UT, USA
| | - Ted Sousa
- Shriners Children's, Motion Analysis Center, Spokane, WA, USA
| | - Lauren C Hyer
- Shriners Children's, Motion Analysis Center, Greenville, SC, USA
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Brunner R, De Pieri E, Wyss C, Weidensteiner C, Bracht-Schweizer K, Romkes J, Garcia M, Ma N, Rutz E. The Non-Affected Muscle Volume Compensates for the Partial Loss of Strength after Injection of Botulinum Toxin A. Toxins (Basel) 2023; 15:toxins15040267. [PMID: 37104205 PMCID: PMC10141169 DOI: 10.3390/toxins15040267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/18/2023] [Accepted: 03/25/2023] [Indexed: 04/07/2023] Open
Abstract
Local botulinum toxin (BTX-A, Botox®) injection in overactive muscles is a standard treatment in patients with cerebral palsy. The effect is markedly reduced in children above the age of 6 to 7. One possible reason for this is the muscle volume affected by the drug. Nine patients (aged 11.5; 8.7–14.5 years) with cerebral palsy GMFCS I were treated with BTX-A for equinus gait at the gastrocnemii and soleus muscles. BTX-A was administered at one or two injection sites per muscle belly and with a maximum of 50 U per injection site. Physical examination, instrumented gait analysis, and musculoskeletal modelling were used to assess standard muscle parameters, kinematics, and kinetics during gait. Magnetic resonance imaging (MRI) was used to detect the affected muscle volume. All the measurements were carried out pre-, 6 weeks post-, and 12 weeks post-BTX-A. Between 9 and 15% of the muscle volume was affected by BTX-A. There was no effect on gait kinematics and kinetics after BTX-A injection, indicating that the overall kinetic demand placed on the plantar flexor muscles remained unchanged. BTX-A is an effective drug for inducing muscle weakness. However, in our patient cohort, the volume of the affected muscle section was limited, and the remaining non-affected parts were able to compensate for the weakened part of the muscle by taking over the kinetic demands associated with gait, thus not enabling a net functional effect in older children. We recommend distributing the drug over the whole muscle belly through multiple injection sites.
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Affiliation(s)
- Reinald Brunner
- Department of Paediatric Orthopaedics, University Children’s Hospital Basel (UKBB), 4056 Basel, Switzerland
- Laboratory of Movement Analysis, University Children’s Hospital Basel (UKBB), 4056 Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
| | - Enrico De Pieri
- Laboratory of Movement Analysis, University Children’s Hospital Basel (UKBB), 4056 Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
| | - Christian Wyss
- Laboratory of Movement Analysis, University Children’s Hospital Basel (UKBB), 4056 Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
| | - Claudia Weidensteiner
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, 4031 Basel, Switzerland
| | - Katrin Bracht-Schweizer
- Laboratory of Movement Analysis, University Children’s Hospital Basel (UKBB), 4056 Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
| | - Jacqueline Romkes
- Laboratory of Movement Analysis, University Children’s Hospital Basel (UKBB), 4056 Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
| | - Meritxell Garcia
- Department of Neuroradiology, University Hospital Zürich, 8091 Zürich, Switzerland
- Division of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, 4031 Basel, Switzerland
| | - Norine Ma
- Orthopaedic Department, The Royal Children’s Hospital, Melbourne 3052, Australia
| | - Erich Rutz
- Orthopaedic Department, The Royal Children’s Hospital, Melbourne 3052, Australia
- Murdoch Children’s Research Institute—MCRI, Melbourne 3052, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne 3052, Australia
- Medical Faculty, University of Basel, 4000 Basel, Switzerland
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Philp F, Freeman R, Stewart C. An international survey mapping practice and barriers for upper-limb assessments in movement analysis. Gait Posture 2022; 96:93-101. [PMID: 35623317 DOI: 10.1016/j.gaitpost.2022.05.018] [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: 12/17/2021] [Revised: 04/26/2022] [Accepted: 05/17/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Upper-limb movement analysis could improve our understanding of function, pathological mechanisms and inform rehabilitation and surgical decision-making. Despite the potential benefits, the use of clinical upper-limb motion analysis is not well established and it is not clear what the barriers to clinical motion analysis are. RESEARCH QUESTION What is current practice for assessment of the upper-limb and what are the barriers currently limiting upper-limb motion analysis being routinely used in clinical practice? METHODS A web-based questionnaire was used to collect responses through international professional movement analysis society coordinators over an 18 month-period. RESULTS A total of 55 responses were received and 75% of laboratories performed some form of upper-limb assessment. In total 44% of laboratories performed upper-limb assessments for clinical purposes and only 33% did 3D-movement analysis. The most commonly seen patient groups were those with neurological injury e.g. cerebral palsy (adults and children) and normal controls for comparative purposes. Barriers to upper-limb motion analysis were the availability of standard reference tasks, protocols, software, funding and clinical need. Practice was variable with no universally identified approaches to upper-limb movement analysis. Differences in practice were also identified between laboratories accredited by the Clinical Movement Analysis Society of the UK and Ireland and other international professional societies and affiliate laboratories. SIGNIFICANCE These findings may be used to inform the development of practice standards and progress the use of clinical motion analysis in the upper-limb. This study provides a summary and describes current practice, potentially providing access to peer support and experience for laboratories with an identified clinical need looking to conduct upper-limb assessment. A national picture (UK and Ireland) for practice regarding upper-limb assessment in this sub-population is presented. We have laid out further work which is needed to establish standards of practice or consensus initiatives for enhancing clinical upper-limb motion analysis.
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Affiliation(s)
- Fraser Philp
- School of Health Sciences, University of Liverpool, L69 3GB, UK.
| | - Robert Freeman
- ORLAU, RJAH Orthopaedic Hospital, Oswestry, Shropshire SY10 7AG, UK.
| | - Caroline Stewart
- ORLAU, RJAH Orthopaedic Hospital, Oswestry, Shropshire SY10 7AG, UK; School of Pharmacy and Bioengineering, Keele University, ST5 5BG, UK.
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Scott B, Seyres M, Philp F, Chadwick EK, Blana D. Healthcare applications of single camera markerless motion capture: a scoping review. PeerJ 2022; 10:e13517. [PMID: 35642200 PMCID: PMC9148557 DOI: 10.7717/peerj.13517] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/09/2022] [Indexed: 01/17/2023] Open
Abstract
Background Single camera markerless motion capture has the potential to facilitate at home movement assessment due to the ease of setup, portability, and affordable cost of the technology. However, it is not clear what the current healthcare applications of single camera markerless motion capture are and what information is being collected that may be used to inform clinical decision making. This review aims to map the available literature to highlight potential use cases and identify the limitations of the technology for clinicians and researchers interested in the collection of movement data. Survey Methodology Studies were collected up to 14 January 2022 using Pubmed, CINAHL and SPORTDiscus using a systematic search. Data recorded included the description of the markerless system, clinical outcome measures, and biomechanical data mapped to the International Classification of Functioning, Disability and Health Framework (ICF). Studies were grouped by patient population. Results A total of 50 studies were included for data collection. Use cases for single camera markerless motion capture technology were identified for Neurological Injury in Children and Adults; Hereditary/Genetic Neuromuscular Disorders; Frailty; and Orthopaedic or Musculoskeletal groups. Single camera markerless systems were found to perform well in studies involving single plane measurements, such as in the analysis of infant general movements or spatiotemporal parameters of gait, when evaluated against 3D marker-based systems and a variety of clinical outcome measures. However, they were less capable than marker-based systems in studies requiring the tracking of detailed 3D kinematics or fine movements such as finger tracking. Conclusions Single camera markerless motion capture offers great potential for extending the scope of movement analysis outside of laboratory settings in a practical way, but currently suffers from a lack of accuracy where detailed 3D kinematics are required for clinical decision making. Future work should therefore focus on improving tracking accuracy of movements that are out of plane relative to the camera orientation or affected by occlusion, such as supination and pronation of the forearm.
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Affiliation(s)
- Bradley Scott
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Martin Seyres
- School of Engineering, University of Aberdeen, Aberdeen, United Kingdom
| | - Fraser Philp
- School of Health Sciences, University of Liverpool, Liverpool, United Kingdom
| | | | - Dimitra Blana
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
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Kainz H, Schwartz MH. The importance of a consistent workflow to estimate muscle-tendon lengths based on joint angles from the conventional gait model. Gait Posture 2021; 88:1-9. [PMID: 33933913 DOI: 10.1016/j.gaitpost.2021.04.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Musculoskeletal models enable us to estimate muscle-tendon length, which has been shown to improve clinical decision-making and outcomes in children with cerebral palsy. Most clinical gait analysis services, however, do not include muscle-tendon length estimation in their clinical routine. This is due, in part, to a lack of knowledge and trust in the musculoskeletal models, and to the complexity involved in the workflow to obtain the muscle-tendon length. RESEARCH QUESTION Can the joint angles obtained with the conventional gait model (CGM) be used to generate accurate muscle-tendon length estimates? METHODS Three-dimensional motion capture data of 15 children with cerebral palsy and 15 typically developing children were retrospectively analyzed and used to estimate muscle-tendon length with the following four modelling frameworks: (1) 2392-OSM-IK-angles: standard OpenSim workflow including scaling, inverse kinematics and muscle analysis; (2) 2392-OSM-CGM-angle: generic 2392-OpenSim model driven with joint angles from the CGM; (3) modif-OSM-IK-angles: standard OpenSim workflow including inverse kinematics and a modified model with segment coordinate systems and joint degrees-of-freedom similar to the CGM; (4) modif-OSM-CGM-angles: modified model driven with joint angles from the CGM. Joint kinematics and muscle-tendon length were compared between the different modelling frameworks. RESULTS Large differences in hip joint kinematics were observed between the CGM and the 2392-OpenSim model. The modif-OSM showed similar kinematics as the CGM. Muscle-tendon length obtained with modif-OSM-IK-angles and modif-OSM-CGM-angles were similar, whereas large differences in some muscle-tendon length were observed between 2392-OSM-IK-angles and 2392-OSM-CGM-angles. SIGNIFICANCE The modif-OSM-CGM-angles framework enabled us to estimate muscle-tendon lengths without the need for scaling a musculoskeletal model and running inverse kinematics. Hence, muscle-tendon length estimates can be obtained simply, without the need for the complexity, knowledge and time required for musculoskeletal modeling and associated software. An instruction showing how the framework can be used in a clinical setting is provided on https://github.com/HansUniVie/MuscleLength.
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Affiliation(s)
- Hans Kainz
- Centre for Sport Science and University Sports, Department of Biomechanics, Kinesiology and Computer Science in Sport, Neuromechanics Research Group, University of Vienna, Vienna, Austria.
| | - Michael H Schwartz
- Center for Gait and Motion Analysis, Gillette Children's Specialty Healthcare, St Paul, MN, USA; Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
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Cloodt E, Krasny J, Jozwiak M, Rodby-Bousquet E. Interrater reliability for unilateral and bilateral tests to measure the popliteal angle in children and youth with cerebral palsy. BMC Musculoskelet Disord 2021; 22:275. [PMID: 33714264 PMCID: PMC7956112 DOI: 10.1186/s12891-021-04135-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/02/2021] [Indexed: 11/18/2022] Open
Abstract
Background Short hamstring muscles can cause several problems for children with cerebral palsy. The results of the clinical measurement of hamstring length are often used in decision-making about treatment of children with cerebral palsy. There are different ways of performing this measurement. The aim of this study was to evaluate the interrater reliability of the unilateral and bilateral measurement of the popliteal angle in children and youth with cerebral palsy. Methods Two methods for estimating hamstring length using unilateral and bilateral measurements of the popliteal angle were applied in children with cerebral palsy. Both tests were applied bilaterally by two independent examiners on the same day for each child. The intraclass correlation coefficient (ICC) was calculated to evaluate the interrater reliability of both measurements. Seventy young people with cerebral palsy (32 females, 38 males, mean age 10 years 8 months, range 5–22 years) at Gross Motor Function Classification System levels I (n = 17), II (n = 31), III (n = 12) and IV (n = 10) were included. Results The interrater reliability was good for both measurements. The ICC values were 0.80 on the right and 0.86 on the left for the unilateral popliteal angle, and 0.82 on the right and 0.83 on the left for the bilateral popliteal angle. Conclusions Both unilateral and bilateral measurement of the popliteal angle is a reliable method for estimating hamstring length in children and youth with cerebral palsy.
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Affiliation(s)
- Erika Cloodt
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden. .,Department of Research and Development, Region Kronoberg, Växjö, Sweden.
| | - Joanna Krasny
- Department of Pediatric Orthopedics and Traumatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Jozwiak
- Department of Pediatric Orthopedics and Traumatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Elisabet Rodby-Bousquet
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden.,Centre for Clinical Research, Uppsala University-Region Västmanland, Västerås, Sweden
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Review of musculoskeletal modelling in a clinical setting: Current use in rehabilitation design, surgical decision making and healthcare interventions. Clin Biomech (Bristol, Avon) 2021; 83:105292. [PMID: 33588135 DOI: 10.1016/j.clinbiomech.2021.105292] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Musculoskeletal modelling is a common means by which to non-invasively analyse movement. Such models have largely been used to observe function in both healthy and patient populations. However, utility in a clinical environment is largely unknown. The aim of this review was to explore existing uses of musculoskeletal models as a clinical intervention, or decision-making, tool. METHODS A literature search was performed using PubMed and Scopus to find articles published since 2010 and relating to musculoskeletal modelling and joint and muscle forces. FINDINGS 4662 abstracts were found, of which 39 relevant articles were reviewed. Journal articles were categorised into 5 distinct groups: non-surgical treatment, orthoses assessment, surgical decision making, surgical intervention assessment and rehabilitation regime assessment. All reviewed articles were authored by collaborations between clinicians and engineers/modellers. Current uses included insight into the development of osteoarthritis, identifying candidates for hamstring lengthening surgery, and the assessment of exercise programmes to reduce joint damage. INTERPRETATION There is little evidence showing the use of musculoskeletal modelling as a tool for patient care, despite the ability to assess long-term joint loading and muscle overuse during functional activities, as well as clinical decision making to avoid unfavourable treatment outcomes. Continued collaboration between model developers should aim to create clinically-friendly models which can be used with minimal input and experience by healthcare professionals to determine surgical necessity and suitability for rehabilitation regimes, and in the assessment of orthotic devices.
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Implications for the design of a Diagnostic Decision Support System (DDSS) to reduce time and cost to diagnosis in paediatric shoulder instability. BMC Med Inform Decis Mak 2021; 21:78. [PMID: 33639920 PMCID: PMC7912970 DOI: 10.1186/s12911-021-01446-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/16/2021] [Indexed: 12/02/2022] Open
Abstract
Background Currently the diagnosis of shoulder instability, particularly in children, is difficult and can take time. These diagnostic delays can lead to poorer outcome and long-term complications. A Diagnostic Decision Support System (DDSS) has the potential to reduce time to diagnosis and improve outcomes for patients. The aim of this study was to develop a concept map for a future DDSS in shoulder instability. Methods A modified nominal focus group technique, involving three clinical vignettes, was used to elicit physiotherapists decision-making processes. Results Twenty-five physiotherapists, (18F:7 M) from four separate clinical sites participated. The themes identified related to ‘Variability in diagnostic processes and lack of standardised practice’ and ‘Knowledge and attitudes towards novel technologies for facilitating assessment and clinical decision making’. Conclusion No common structured approach towards assessment and diagnosis was identified. Lack of knowledge, perceived usefulness, access and cost were identified as barriers to adoption of new technology. Based on the information elicited a conceptual design of a future DDSS has been proposed. Work to develop a systematic approach to assessment, classification and diagnosis is now proposed. Trial Registraty This was not a clinical trial and so no clinical trial registry is needed.
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O'Sullivan R, French HP, Van Rossom S, Jonkers I, Horgan F. The association between gait analysis measures associated with crouch gait, functional health status and daily activity levels in cerebral palsy. J Pediatr Rehabil Med 2021; 14:227-235. [PMID: 33896854 DOI: 10.3233/prm-200676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The aim of this study was to examine the relationship between gait analysis measures associated with crouch gait, functional health status and daily activity in ambulant cerebral palsy (CP). METHODS Three-dimensional gait analysis was carried out on 35 ambulant participants with bilateral CP crouch gait (knee flexion at mid-stance (KFMS) ⩾ 190). KFMS, knee-flexion at initial contact, gait speed and step-lengths were extracted for analysis. Steps/day and sedentary time/day were assessed using an ActivPAL accelerometer. Functional health status was assessed using the five relevant domains of the Pediatric Outcomes Data Collection Instrument (PODCI) questionnaire. Associations between variables were assessed with correlation coefficients and multivariable linear regression. RESULTS There were no significant correlations between KFMS and PODCI domains (ρ=-0.008-0.110) or daily activity (ρ=-0.297-0.237) variables. In contrast, multivariable analysis found that step-length was independently associated with the Sports and Physical Function (p= 0.030), Transfers and Basic Mobility (p= 0.041) and Global Function (< 0.001) domains of the PODCI assessment. Gait speed was independently associated with mean steps/day (p< 0.001). CONCLUSIONS Step length and gait speed are more strongly associated with functional health status and daily activity than knee flexion during stance in children and adolescents with CP crouch gait.
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Affiliation(s)
- Rory O'Sullivan
- Gait Analysis Laboratory, Central Remedial Clinic, Dublin, Ireland.,School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Helen P French
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sam Van Rossom
- Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium
| | - Ilse Jonkers
- Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
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Campbell R, Tipping N, Carty C, Walsh J, Johnson L. Orthopaedic management of knee joint impairment in cerebral palsy: A systematic review and meta-analysis. Gait Posture 2020; 80:347-360. [PMID: 32615408 DOI: 10.1016/j.gaitpost.2020.06.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/01/2020] [Accepted: 06/14/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The optimal management of impaired knee joint function in patients with cerebral palsy (CP) remains a significant and ongoing challenge in paediatric orthopaedic surgery. RESEARCH QUESTION What are the clinical and functional outcomes after operative and non-operative orthopaedic interventions for knee joint impairment in patients with CP? METHODS This systematic review and meta-analysis of orthopaedic interventions for the management of knee joint impairment in paediatric CP patients evaluated study-level data in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. We performed searches of the following electronic databases from their dates of inception to November 2019: Medline (Ovid), Embase (Ovid) and Pubmed. We extracted mean differences in pre-operative and post-operative measurements for the following outcomes: minimum knee flexion in stance; knee flexion at initial contact; maximum knee flexion in swing; range of motion; popliteal angle; fixed flexion deformity angle; and mean pelvic tilt. RESULTS Sixty-nine retrospective cohort studies, prospective cohort studies and RCTs comprising 2991 patients were included with 4578 knees analysed. Included studies were of sufficient quality as assessed by the MOOSE checklist. Operative interventions showed significant improvement in knee flexion at initial contact, knee flexion in stance, range of motion, popliteal angle and fixed flexion deformity which were comparable when subgrouped according to operative technique. In contrast, non-operative techniques and botulinum toxin injection did not confer significant improvements. Operative interventions for knee joint impairment led to increased mean pelvic tilt and reduced maximum knee flexion in swing. SIGNIFICANCE This review provides strong evidence that operative interventions for the management of knee joint impairment in cerebral palsy patients improve knee kinematics and clinical examination findings.
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Affiliation(s)
- Ryan Campbell
- Department of Medicine, University of New South Wales, Australia.
| | - Nicholas Tipping
- Department of Medicine, University of New South Wales, Australia
| | - Christopher Carty
- School of Allied Health Sciences and GCORE, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia; Department of Orthopaedics, Queensland Children's Hospital, QLD 4101, Australia
| | - John Walsh
- Department of Orthopaedics, Queensland Children's Hospital, QLD 4101, Australia
| | - Liam Johnson
- Department of Orthopaedics, Queensland Children's Hospital, QLD 4101, Australia
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Chung CY, Kwon SS, Park MS, Lee KM, Sung KH. Surgical outcomes after single event multilevel surgery in cerebral palsy patients with mid-stance knee hyperextension. Gait Posture 2020; 77:1-5. [PMID: 31945635 DOI: 10.1016/j.gaitpost.2020.01.005] [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: 05/26/2019] [Revised: 11/26/2019] [Accepted: 01/05/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Some patients with cerebral palsy (CP) exhibit excessive knee flexion at initial contact followed by knee hyperextension (KE) in mid-stance. RESEARCH QUESTION This study investigated the change in sagittal kinematics after distal hamstring lengthening (DHL) and triceps surae lengthening procedures in CP patients with KE, and compared it to those without KE. In addition, the risk factors for the worsening of postoperative KE were analyzed. METHODS Consecutive 312 patients (596 limbs) with CP who underwent DHL and triceps surae lengthening were included. All patients underwent preoperative and 1-year postoperative three-dimensional gait analysis. Patients' limbs were divided into the KE and knee flexion (KF) groups, according to preoperative minimum knee flexion in stance. KE was defined as minimum knee flexion in stance less than 0°. RESULTS The KE and KF groups included 130 and 466 limbs, respectively. Knee and ankle sagittal kinematics significantly improved after surgery in both groups. Minimum knee flexion in stance significantly increased from -6.6˚ to 0.5˚ in the KE group, but decreased from 14.6˚ to 7.8˚ in the KF group. Among the KE group, minimum knee flexion in stance improved in 103 limbs (79.2 %), but worsened in 27 limbs (20.8 %). Degree of preoperative KE was the only factor significantly associated with postoperative worsening of KE (p=0.002). The cutoff value for the worsening of KE was -5.8˚ of preoperative minimum knee flexion in stance. SIGNIFICANCE This study demonstrated that the sagittal kinematics of the knee and ankle joints improved after DHL and triceps surae lengthening procedures in CP patients with and without KE. Preoperative degree of KE was a risk factor for the worsening of KE after surgery. Therefore, careful selection for indication of DHL is required to prevent postoperative KE due to overlengthening of the hamstrings, particularly in patients with severe preoperative KE.
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Affiliation(s)
- Chin Youb Chung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, South Korea
| | - Soon-Sun Kwon
- Department of Mathematics, College of Natural Sciences, Ajou University, Gyeonggi, South Korea
| | - Moon Seok Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, South Korea
| | - Kyoung Min Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, South Korea
| | - Ki Hyuk Sung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, South Korea.
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Chagas PS, Peixoto JG, Ortis MDDC, Ribeiro LC, Alves JWF, Defilipo EC. Comprimento de isquiotibiais, função motora grossa e marcha em crianças e adolescentes com paralisia cerebral. FISIOTERAPIA E PESQUISA 2019. [DOI: 10.1590/1809-2950/18018026042019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O objetivo desse estudo é verificar se há relação entre o comprimento dos isquiotibiais, função motora grossa e marcha em crianças e adolescentes com paralisia cerebral (PC). Os participantes, entre 6 e 18 anos, foram classificados pelo Sistema de Classificação da Função Motora Grossa (GMFCS) nos níveis I, II e III através da escala Tardieu modificada, para avaliar o comprimento dos músculos isquiotibiais, sendo identificados em: R1 (primeira resistência da extensão da perna), R2 (segunda resistência da extensão da perna) e R2-R1 (diferença entre R1 e R2) do membro inferior esquerdo e direito. Para avaliar a função motora grossa, foi utilizado o teste gross motor function measure (GMFM-88), e a escala physicians rating scale modificada (PRS) foi utilizada para avaliar a marcha. Vinte e três participantes foram incluídos e os resultados evidenciaram correlações moderadas entre R1, R2 e PRS do membro inferior esquerdo e GMFM. As demais variáveis apresentaram uma correlação fraca.
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16
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Stewart C. Hamstring lengthening in cerebral palsy and the use of musculoskeletal modelling. Dev Med Child Neurol 2019; 61:739. [PMID: 30474208 DOI: 10.1111/dmcn.14116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Caroline Stewart
- ORLAU - RJAH Orthopaedic Hospital, Oswestry, Shropshire, UK.,ISTM, Keele University, Staffordshire, UK
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Lee DY. Differences of the ankle plantar flexor length in typically developing children and children with spastic hemiplegic cerebral palsy. J Exerc Rehabil 2019; 15:445-448. [PMID: 31316939 PMCID: PMC6614768 DOI: 10.12965/jer.1938216.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 05/29/2019] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study is to analyze the lengths of the medial and lateral gastrocnemius and soleus muscles in children with spastic hemiplegic cerebral palsy to quantitatively assess the structural differences in skeletal muscles. This study included 10 children with spastic cerebral palsy and 10 children with typically development. To assess the changes in the length of the ankle plantar flexor due to cerebral palsy, we utilized both gait analysis and software for interactive musculoskeletal modeling to model skeletal muscle length. With this model, the differences in the lengths of the medial and lateral gastrocnemius and soleus muscles were assessed at different knee (0°, 45°, and 90°) and ankle (-10°, 0°, 15°, and 30°) angles. Muscle length on the paretic group was shorter than the typically developing and nonparetic group for all three muscles (medial and lateral gastrocnemius and soleus muscles) for knee and ankle angles. These results were not statistically significant. Normalized muscle lengths in the dynamic/static status revealed a significant difference in the length of the lateral gastrocnemius muscle between the cerebral palsy and typically developing group. I observed muscle shortening on the paretic side of the children with cerebral palsy. This finding suggests that the recovery of plantar flexor length is the most important issue that must be resolved for normal gait and motor function.
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Affiliation(s)
- Dae-Yeon Lee
- Faculty of Liberal Arts, Kangnam University, Yongin, Korea
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18
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Desailly E, Khouri N. Benefits of a musculoskeletal modelling decision making procedure on hamstring lengthening outcomes: a retrospective study. Comput Methods Biomech Biomed Engin 2019. [DOI: 10.1080/10255842.2020.1714252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- E. Desailly
- Fondation Ellen Poidatz, St Fargeau-Ponthierry, France
| | - N. Khouri
- Fondation Ellen Poidatz, St Fargeau-Ponthierry, France
- Hôpital Necker, Paris, France
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19
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Amirmudin NA, Lavelle G, Theologis T, Thompson N, Ryan JM. Multilevel Surgery for Children With Cerebral Palsy: A Meta-analysis. Pediatrics 2019; 143:peds.2018-3390. [PMID: 30918016 DOI: 10.1542/peds.2018-3390] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2019] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Multilevel surgery (MLS) is standard care for reducing musculoskeletal disorders among children with spastic cerebral palsy (CP). OBJECTIVE To summarize the literature examining effects of MLS and satisfaction with MLS for children with CP. DATA SOURCES Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials were searched. STUDY SELECTION Studies in which authors reported effects of or satisfaction with MLS in children with CP were selected. DATA EXTRACTION Two authors screened and extracted data on gross motor function, gait speed, gait (eg, Gait Profile Score), range of motion, strength, spasticity, participation, quality of life, satisfaction, and adverse events. RESULTS Seventy-four studies (3551 participants) were identified. One was a randomized controlled trial (RCT) (n = 19); the remainder were cohort studies. Pooled analysis of cohort studies revealed that MLS did not have a long-term effect on gross motor function (standardized mean difference [SMD]: 0.38; 95% confidence interval [CI]: -0.25 to 1.01) or gait speed (SMD: 0.12; 95% CI: -0.01 to 0.25) but did improve gait (SMD: -0.80; 95% CI: -0.95 to -0.65). The RCT also revealed no effect of MLS on gross motor function but improvements in the Gait Profile Score at 1 year. Participation and quality of life were reported in only 5 studies, and adverse events were adequately reported in 17 studies. LIMITATIONS Data were largely from cohort studies. CONCLUSIONS Findings reveal that gait, but not gross motor function, improves after MLS. RCTs and improved reporting of studies of MLS are required.
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Affiliation(s)
- Noor Amirah Amirmudin
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Grace Lavelle
- Department of Clinical Sciences, Brunel University London, London, United Kingdom; and
| | - Tim Theologis
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Nicky Thompson
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Jennifer M Ryan
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; .,Department of Clinical Sciences, Brunel University London, London, United Kingdom; and
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Skoutelis VC, Kanellopoulos A, Vrettos S, Gkrimas G, Kontogeorgakos V. Improving gait and lower-limb muscle strength in children with cerebral palsy following Selective Percutaneous Myofascial Lengthening and functional physiotherapy. NeuroRehabilitation 2019; 43:361-368. [PMID: 30400115 DOI: 10.3233/nre-182468] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Selective Percutaneous Myofascial Lengthening (SPML) is an innovative minimally invasive surgical procedure, using micro incisions often combined with alcohol nerve block, for managing muscle contractures and stiffness in children with cerebral palsy (CP). There is lack of evidence of effects of a combined intervention of SPML and physiotherapy on gait function and muscle strength in CP. OBJECTIVE This study investigated the change in gait function and muscle strength in children with CP who underwent gait laboratory assessment before and after SPML, combined with obturator nerve blocks, and 9-month post-surgical functional physiotherapy. METHODS Ten children with bilateral spastic CP, Gross Motor Function Classification System (GMFCS) level II-IV, age 5-7 years, participated in this study. The Global Gait Graph Deviation Index (Global GGDI) and isometric muscle strength (hand-held dynamometry) were the primary outcome measures. Changes in spatiotemporal gait parameters, gross motor function and GMFCS level were secondarily examined. RESULTS A significant improvement of Global GGDI was found (p < 0.05). The mean strength in hip flexors, extensors and adductors, knee extensors, and ankle dorsiflexors increased significantly (p < 0.05). Children improved significantly their GMFCS level and gross motor capacity (p < 0.05). CONCLUSIONS SPML procedure combined with functional physiotherapy can improve gait function and lower-limb muscle strength.
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Affiliation(s)
| | | | | | - Georgios Gkrimas
- Gait & Motion Analysis Laboratory, Hellenic Society for Disabled Children (ELEPAP), Athens, Greece
| | - Vasileios Kontogeorgakos
- Medical School, National and Kapodistrian University of Athens, Athens, Greece.,First Department of Orthopaedics, 'Attikon' University Hospital, Chaidari, Greece
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21
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Lee SY, Kwon SS, Chung CY, Lee KM, Sung KH, Kim S, Park MS. Influence of surgery involving tendons around the knee joint on ankle motion during gait in patients with cerebral palsy. BMC Musculoskelet Disord 2018; 19:82. [PMID: 29544488 PMCID: PMC5856371 DOI: 10.1186/s12891-018-2003-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/08/2018] [Indexed: 12/02/2022] Open
Abstract
Background Simultaneous motion of the knee and ankle joints is required for many activities including gait. We aimed to evaluate the influence of surgery involving tendons around the knee on ankle motion during gait in the sagittal plane in cerebral palsy patients. Methods We included data from 55 limbs in 34 patients with spastic cerebral palsy. Patients were followed up after undergoing only distal hamstring lengthening with or without additional rectus femoris transfer. The patients’ mean age at the time of knee surgery was 11.2 ± 4.7 years, and the mean follow-up duration was 2.2 ± 1.5 years (range, 0.9–6.0 years). Pre- and postoperative kinematic variables that were extracted from three-dimensional gait analyses were then compared to assess changes in ankle motion after knee surgery. Outcome measures included ankle dorsiflexion at initial contact, peak ankle dorsiflexion during stance, peak ankle dorsiflexion during swing, and dynamic range of motion of the ankle. Various sagittal plane knee kinematics were also measured and used to predict ankle kinematics. A linear mixed model was constructed to estimate changes in ankle motion after adjusting for multiple factors. Results Improvement in total range of motion of the knee resulted in improved motion of the ankle joint. We estimated that after knee surgery, ankle dorsiflexion at initial contact, peak ankle dorsiflexion during stance, peak ankle dorsiflexion during swing, and dynamic range of motion of the ankle decreased, respectively, by 0.4° (p = 0.016), 0.6° (p < 0.001), 0.2° (p = 0.038), and 0.5° (p = 0.006) per degree increase in total range of motion of the knee after either knee surgery. Furthermore, dynamic range of motion of the ankle increased by 0.4° per degree increase in postoperative peak knee flexion during swing. Conclusions Improvement in total knee range of motion was found to be correlated with improvement in ankle kinematics after surgery involving tendons around the knee. As motion of the knee and ankle joints is cross-linked, surgeons should be aware of potential changes in the ankle joint after knee surgery. Electronic supplementary material The online version of this article (10.1186/s12891-018-2003-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Seung Yeol Lee
- Department of Orthopaedic Surgery, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Soon-Sun Kwon
- Department of Mathematics, College of Natural Science, Ajou University, Suwon, Gyeonggi, South Korea
| | - Chin Youb Chung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seoungnam, Gyeonggi, 463-707, South Korea.,Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyoung Min Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seoungnam, Gyeonggi, 463-707, South Korea
| | - Ki Hyuk Sung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seoungnam, Gyeonggi, 463-707, South Korea
| | - Sangwoo Kim
- Department of Orthopaedic Surgery, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Moon Seok Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seoungnam, Gyeonggi, 463-707, South Korea.
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Sung KH, Lee J, Chung CY, Lee KM, Cho BC, Moon SJ, Kim J, Park MS. Factors influencing outcomes after medial hamstring lengthening with semitendinosus transfer in patients with cerebral palsy. J Neuroeng Rehabil 2017; 14:83. [PMID: 28806980 PMCID: PMC5556982 DOI: 10.1186/s12984-017-0296-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 08/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although several studies have investigated the outcomes after distal hamstring lengthening (DHL), no study has undertaken an approach that included all or most of the important factors that could influence the results. This study was performed to evaluate the outcomes after DHL and analyze the factors that influence the improvement and serial change in knee motion after surgery in patients with cerebral palsy (CP), using a linear mixed model (LMM). METHODS The study included 314 ambulatory CP patients (594 limbs) with spsastic diplegia who were followed up after undergoing DHL as part of a single-event multilevel surgery and who underwent preoperative and postoperative 3-dimensional (3D) gait analyses. Relevant kinematic values, including knee flexion at initial contact, minimum knee flexion in the stance phase, knee range of motion (ROM), mean pelvic tilt and gait deviation index (GDI) score, were the outcome measures. Changes in knee motion and the GDI score were adjusted for multiple factors, such as sex, the Gross Motor Function Classification System (GMFCS) level, and concomitant surgeries as fixed effects, and follow-up duration, laterality, and each subject as random effects, using a LMM. RESULTS We found significant improvements in knee flexion at initial contact, minimum knee flexion in the stance phase, knee ROM, and GDI score 2 years after DHL. In patients with GMFCS level I and II, improvement in all sagittal knee kinematics was maintained during follow-up. In addition, GDI score, which represents overall gait pathology, consistently improved throughout the follow-up duration (1.2 per year, p = 0.008). CONCLUSION Medial hamstring lengthening with semitendinosus transfer, as a part of a SEMLS, was effective procedure in treating flexed knee gait with regard to sagittal knee kinematics and GDI score in spastic CP with flexed knee gait.
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Affiliation(s)
- Ki Hyuk Sung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Seongnam, Gyeonggi, South Korea
| | - Jaebong Lee
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Seongnam, Gyeonggi, South Korea
| | - Chin Youb Chung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Seongnam, Gyeonggi, South Korea
| | - Kyoung Min Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Seongnam, Gyeonggi, South Korea
| | - Byung Chae Cho
- Department of Orthopaedic Surgery, Seoul Jaeil Hospital, 70 Jisan-ro, Pyeongtack, Gyeonggi, South Korea
| | - Seung Jun Moon
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Seongnam, Gyeonggi, South Korea
| | - Jaeyoung Kim
- Department of Orthopaedic Surgery, H Plus Yangji Hospital, 1636 Nambusunhwan-ro, Gwanak-Gu, Seoul, South Korea
| | - Moon Seok Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Seongnam, Gyeonggi, South Korea.
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Galey SA, Lerner ZF, Bulea TC, Zimbler S, Damianoa DL. Effectiveness of surgical and non-surgical management of crouch gait in cerebral palsy: A systematic review. Gait Posture 2017; 54:93-105. [PMID: 28279852 PMCID: PMC9619302 DOI: 10.1016/j.gaitpost.2017.02.024] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 02/13/2017] [Accepted: 02/22/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cerebral palsy (CP) is a prevalent group of neuromotor disorders caused by early injury to brain regions or pathways that control movement. Patients with CP exhibit a range of functional motor disabilities and pathologic gait patterns. Crouch gait, characterized by increased knee flexion throughout stance, is a common gait pattern in CP that increases energy costs of walking and contributes to ambulatory decline. Our aim was to perform the first systematic literature review on the effectiveness of interventions utilized to ameliorate crouch gait in CP. METHODS Comprehensive searches of five medical databases yielded 38 papers with 30 focused on orthopaedic management. RESULTS Evidence supports the use of initial hamstring lengthenings and rectus femoris transfers, where indicated, for improving objective gait measures with limited data on improving gait speed or gross motor function. In contrast, evidence argues against hamstring transfers and revision hamstring lengthening, with recent interest in more technically demanding corrective procedures. Only eight studies evaluated alternatives to surgery, specifically strength training, botulinum toxin or orthoses, with inconsistent and/or short-lived results. CONCLUSIONS Although crouch in CP is recognized clinically as a complex multi-joint, multi-planar gait disorder, this review largely failed to identify interventions beyond those which directly address sagittal plane knee motion, indicating a major knowledge gap. Quality of existing data was notably weak, with few studies properly controlled or adequately sized. Outcomes from specific procedures are confounded by multilevel surgeries. Successful longer term strategies to prevent worsening of crouch and subsequent functional decline are needed. LEVEL OF EVIDENCE Systematic review.
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Affiliation(s)
- Scott A. Galey
- Functional & Applied Biomechanics Section, Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bldg. 10CRC Rm 1-1469, 10 Center Dr. MSC 1604, Bethesda, MD 20892-1604, USA,The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Zachary F. Lerner
- Functional & Applied Biomechanics Section, Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bldg. 10CRC Rm 1-1469, 10 Center Dr. MSC 1604, Bethesda, MD 20892-1604, USA
| | - Thomas C. Bulea
- Functional & Applied Biomechanics Section, Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bldg. 10CRC Rm 1-1469, 10 Center Dr. MSC 1604, Bethesda, MD 20892-1604, USA
| | | | - Diane L. Damianoa
- Functional & Applied Biomechanics Section, Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bldg. 10CRC Rm 1-1469, 10 Center Dr. MSC 1604, Bethesda, MD 20892-1604, USA,Corresponding author, (D.L. Damiano)
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Sartori M, Fernandez JW, Modenese L, Carty CP, Barber LA, Oberhofer K, Zhang J, Handsfield GG, Stott NS, Besier TF, Farina D, Lloyd DG. Toward modeling locomotion using electromyography-informed 3D models: application to cerebral palsy. WILEY INTERDISCIPLINARY REVIEWS-SYSTEMS BIOLOGY AND MEDICINE 2016; 9. [DOI: 10.1002/wsbm.1368] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 10/11/2016] [Accepted: 10/18/2016] [Indexed: 01/17/2023]
Affiliation(s)
- M. Sartori
- Department of Trauma Surgery; Orthopedics and Plastic Surgery, Neurorehabilitation Systems Research Group, University Medical Center Göttingen; Göttingen Germany
| | - J. W. Fernandez
- Auckland Bioengineering Institute; University of Auckland; Auckland New Zealand
- Department of Engineering Science; University of Auckland; Auckland New Zealand
| | - L. Modenese
- Department of Mechanical Engineering; The University of Sheffield; Sheffield UK
- Queensland Children's Motion Analysis Service, Queensland Paediatric Rehabilitation Service; Children's Health Queensland; Brisbane Australia
- Menzies Health Institute Queensland; Griffith University; Queensland Australia
| | - C. P. Carty
- Queensland Children's Motion Analysis Service, Queensland Paediatric Rehabilitation Service; Children's Health Queensland; Brisbane Australia
- Menzies Health Institute Queensland; Griffith University; Queensland Australia
- School of Allied Health Sciences; Griffith University; Queensland Australia
| | - L. A. Barber
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine; The University of Queensland; Brisbane Australia
| | - K. Oberhofer
- Auckland Bioengineering Institute; University of Auckland; Auckland New Zealand
| | - J. Zhang
- Auckland Bioengineering Institute; University of Auckland; Auckland New Zealand
| | - G. G. Handsfield
- Auckland Bioengineering Institute; University of Auckland; Auckland New Zealand
| | - N. S. Stott
- School of Medicine; University of Auckland; Auckland New Zealand
| | - T. F. Besier
- Auckland Bioengineering Institute; University of Auckland; Auckland New Zealand
- Department of Engineering Science; University of Auckland; Auckland New Zealand
| | - D. Farina
- Department of Bioengineering; Imperial College London; London UK
| | - D. G. Lloyd
- Menzies Health Institute Queensland; Griffith University; Queensland Australia
- School of Allied Health Sciences; Griffith University; Queensland Australia
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Haberfehlner H, Jaspers RT, Rutz E, Becher JG, Harlaar J, van der Sluijs JA, Witbreuk MM, Romkes J, Freslier M, Brunner R, Maas H, Buizer AI. Knee Moment-Angle Characteristics and Semitendinosus Muscle Morphology in Children with Spastic Paresis Selected for Medial Hamstring Lengthening. PLoS One 2016; 11:e0166401. [PMID: 27861523 PMCID: PMC5115739 DOI: 10.1371/journal.pone.0166401] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 10/30/2016] [Indexed: 11/18/2022] Open
Abstract
To increase knee range of motion and improve gait in children with spastic paresis (SP), the semitendinosus muscle (ST) amongst other hamstring muscles is frequently lengthened by surgery, but with variable success. Little is known about how the pre-surgical mechanical and morphological characteristics of ST muscle differ between children with SP and typically developing children (TD). The aims of this study were to assess (1) how knee moment-angle characteristics and ST morphology in children with SP selected for medial hamstring lengthening differ from TD children, as well as (2) how knee moment-angle characteristics and ST morphology are related. In nine SP and nine TD children, passive knee moment-angle characteristics and morphology of ST (i.e. fascicle length, muscle belly length, tendon length, physiological cross-sectional area, and volume) were assessed by hand-held dynamometry and freehand 3D ultrasound, respectively. At net knee flexion moments above 0.5 Nm, more flexed knee angles were found for SP compared to TD children. The measured knee angle range between 0 and 4 Nm was 30% smaller in children with SP. Muscle volume, physiological cross-sectional area, and fascicle length normalized to femur length were smaller in SP compared to TD children (62%, 48%, and 18%, respectively). Sixty percent of the variation in knee angles at 4 Nm net knee moment was explained by ST fascicle length. Altered knee moment-angle characteristics indicate an increased ST stiffness in SP children. Morphological observations indicate that in SP children planned for medial hamstring lengthening, the longitudinal and cross-sectional growth of ST muscle fibers is reduced. The reduced fascicle length can partly explain the increased ST stiffness and, hence, a more flexed knee joint in these SP children.
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Affiliation(s)
- Helga Haberfehlner
- Laboratory for Myology, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
- MOVE Research Institute Amsterdam, The Netherlands
| | - Richard T. Jaspers
- Laboratory for Myology, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
- MOVE Research Institute Amsterdam, The Netherlands
- * E-mail:
| | - Erich Rutz
- Pediatric Orthopaedic Department, University Children’s Hospital Basle (UKBB), Basle, Switzerland
- Laboratory for Movement Analysis, University Children's Hospital Basle (UKBB), Basle, Switzerland
| | - Jules G. Becher
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
- MOVE Research Institute Amsterdam, The Netherlands
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
- MOVE Research Institute Amsterdam, The Netherlands
| | - Johannes A. van der Sluijs
- MOVE Research Institute Amsterdam, The Netherlands
- Department of Orthopaedic Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Melinda M. Witbreuk
- MOVE Research Institute Amsterdam, The Netherlands
- Department of Orthopaedic Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Jacqueline Romkes
- Laboratory for Movement Analysis, University Children's Hospital Basle (UKBB), Basle, Switzerland
| | - Marie Freslier
- Laboratory for Movement Analysis, University Children's Hospital Basle (UKBB), Basle, Switzerland
| | - Reinald Brunner
- Pediatric Orthopaedic Department, University Children’s Hospital Basle (UKBB), Basle, Switzerland
- Laboratory for Movement Analysis, University Children's Hospital Basle (UKBB), Basle, Switzerland
| | - Huub Maas
- Laboratory for Myology, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
- MOVE Research Institute Amsterdam, The Netherlands
| | - Annemieke I. Buizer
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
- MOVE Research Institute Amsterdam, The Netherlands
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Kainz H, Modenese L, Lloyd D, Maine S, Walsh H, Carty C. Joint kinematic calculation based on clinical direct kinematic versus inverse kinematic gait models. J Biomech 2016; 49:1658-1669. [DOI: 10.1016/j.jbiomech.2016.03.052] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 12/31/2015] [Accepted: 03/28/2016] [Indexed: 11/28/2022]
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