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Povedano E, Gallardo-Calero I, Navarrete M, Adillon C, Knorr J, Soldado F. Analysis of dynamic elbow flexion deformity in children with hemiplegic cerebral palsy. Clin Biomech (Bristol, Avon) 2021; 81:105245. [PMID: 33302117 DOI: 10.1016/j.clinbiomech.2020.105245] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/28/2020] [Accepted: 12/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cerebral palsy affects 1 per 1.000 children, and in 83% of the cases upper extremity is involved. Dynamic elbow flexion deformity is a movement disorder observed in individuals with hemiparesis secondary to cerebral palsy. We sought to determine whether children with hemiplegic cerebral palsy exhibit dynamic elbow flexion deformity during daily activities and its influence to reaching function. METHODS Sixteen children with upper limb hemiparesis and cerebral palsy (age 11y 7mo (SD 3y 2mo); 11 boys, 5 girls; Gross Motor Function Classification System level I or II) were included in this observational descriptive study. Manual Ability Classification System, Children's Hand-use Experience Questionnaire and Shriners Hospital for Children Upper Extremity Evaluation were used to evaluate affected upper extremity function. Spasticity was assessed with Modified Ashworth scale. Involuntary elbow flexion was recorded in eight daily activities. Elbow motion during reach function was measured. FINDINGS Fifteen out of 16 individuals showed dynamic elbow flexion deformity. There was a significative increase of involved median elbow flexion in all the activities studied, except for "high speed stairs climbing" evaluation. Children's Hand-use Experience Questionnaire showed that children were independent in most of the daily activities (21 out of 29). Correlation between dynamic elbow flexion deformity and Shriners Hospital for Children Upper Extremity Evaluation was observed only in sitting-standing activity (Spearman's ρ 0.549, P = 0.028). INTERPRETATION Dynamic elbow flexion deformity is very common in hemiplegic cerebral palsy and occurs proportionally to the degree of the effort demanded by the activities. Despite of presenting this movement disorder, it does not affect in children participation in daily activities.
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Affiliation(s)
- Elsa Povedano
- Occupational Therapy Department, Rehabilitation and Physical Medicine, Sant Joan de Dèu Barcelona Children's Hospital, Passeig de Sant Joan de Déu, 2, 08950 Barcelona, Spain.
| | - Irene Gallardo-Calero
- Hand Surgery Unit, Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Passeig Vall Hebron 119-129, 08035, Barcelona 08035, Spain.
| | - Manel Navarrete
- Mechanical engineering department, Volpak. Can Vinyalets 4, 08130, Santa Perpètua de Mogoda, Barcelona, Spain
| | - Cristina Adillon
- Unit of Physiotherapy, Department of Medicina i Cirurgia, Faculty of Medicina i Ciències de la Salut, Rovira i Virgili University, 21 Sant Llorenç St., 43201 Reus, Spain.
| | - Jorge Knorr
- Pediatric upper limb and microsurgery. Barcelona University Children Hospital HM Nens, 437 Consell de Cent St., 08009, Barcelona, Spain. Unidad UCA Mikel Sanchez, Vithas San José, 10 Beato Tomás Zumárraga Av., 01008, Vitoria, Spain
| | - Francisco Soldado
- Pediatric upper limb and microsurgery, Barcelona University Children Hospital HM Nens, Unidad UCA Mikel Sanchez, 437 Consell de Cent St., 08009, Vithas San José, 10 Beato Tomás Zumárraga Av., 01008, Vitoria, Spain
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Müßig JA, Brauner T, Kröger I, Varady PA, Brand A, Klöpfer-Krämer I, Simmel S, Horstmann T, Augat P. Variability in trunk and pelvic movement of transfemoral amputees using a C-leg system compared to healthy controls. Hum Mov Sci 2019; 68:102539. [PMID: 31683085 DOI: 10.1016/j.humov.2019.102539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 10/14/2019] [Accepted: 10/16/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Gait variability is a measure of gait disturbance, and therefore constitutes a useful parameter for gait assessment as well as planning of therapeutic and medical interventions. To date, variability during walking has not been adequately analyzed in amputees. The aim of this examination was to evaluate trunk and pelvic movement variability in transfemoral amputees. The effect of different types of walking surfaces on variability in trunk and pelvic movement was also studied. METHOD This prospective clinical examination compares 20 transfemoral amputees (17 ♂, 42 ± 16 years; 3 ♀, 48 ± 3 years) with a group of 20 age and mass matched healthy controls regarding the extent of variability in trunk and pelvic movement. Kinematic data of trunk and pelvic movement during walking on level, uneven ground and slope was captured by eight infrared cameras (Vicon Nexus ™, Oxford, UK). Variability in trunk and pelvic movement was analyzed. Univariate ANCOVA and ANOVA with repeated measures and post hoc tests were used for statistical comparison. Fall history was retrospectively collected from medical history to assess the association between falls and variability in trunk and pelvic movement. RESULTS Trunk and pelvic movement variability in amputees was significantly higher during walking on uneven ground and slope compared to healthy controls (p ≤ 0.05). Variability in trunk and pelvic movement was increased during walking on uneven ground and slope compared to even ground for both groups (p ≤ 0.05). CONCLUSION Amputees showed increased trunk and pelvic movement variability during walking on uneven ground and slope, indicating an affected gait pattern in comparison to healthy controls. Therefore, trunk and pelvic movement variability could be a potential marker for gait quality with diagnostic implications.
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Affiliation(s)
- Janina A Müßig
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Prof.-Küntscher-Str. 8 Murnau, Germany; Institute for Biomechanics Paracelsus Medical University, Strubergasse 22, Salzburg, Austria; Institute for Conservative and Rehabilitative Orthopedics, Technical University of Munich, Georg-Brauchle-Ring 60/62, Munich, Germany.
| | - Torsten Brauner
- Institute for Conservative and Rehabilitative Orthopedics, Technical University of Munich, Georg-Brauchle-Ring 60/62, Munich, Germany
| | - Inga Kröger
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Prof.-Küntscher-Str. 8 Murnau, Germany; Institute for Biomechanics Paracelsus Medical University, Strubergasse 22, Salzburg, Austria
| | - Patrick A Varady
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Prof.-Küntscher-Str. 8 Murnau, Germany; Institute for Biomechanics Paracelsus Medical University, Strubergasse 22, Salzburg, Austria
| | - Andreas Brand
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Prof.-Küntscher-Str. 8 Murnau, Germany; Institute for Biomechanics Paracelsus Medical University, Strubergasse 22, Salzburg, Austria
| | - Isabella Klöpfer-Krämer
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Prof.-Küntscher-Str. 8 Murnau, Germany; Institute for Biomechanics Paracelsus Medical University, Strubergasse 22, Salzburg, Austria
| | - Stefan Simmel
- Abteilung für BG-Rehabilitation Berufsgenossenschaftliche Unfallklinik Murnau, Prof.-Küntscher-Str. 8 Murnau, Germany
| | - Thomas Horstmann
- Institute for Conservative and Rehabilitative Orthopedics, Technical University of Munich, Georg-Brauchle-Ring 60/62, Munich, Germany; Medical Park St. Hubertus Klinik, Sonnenfeldweg 29 Bad Wiessee, Germany
| | - Peter Augat
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Prof.-Küntscher-Str. 8 Murnau, Germany; Institute for Biomechanics Paracelsus Medical University, Strubergasse 22, Salzburg, Austria
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Gilfriche P, Arsac LM, Blons E, Deschodt-Arsac V. Fractal properties and short-term correlations in motor control in cycling: influence of a cognitive challenge. Hum Mov Sci 2019; 67:102518. [PMID: 31542675 DOI: 10.1016/j.humov.2019.102518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 09/05/2019] [Accepted: 09/05/2019] [Indexed: 10/26/2022]
Abstract
Fluctuations in cyclic tasks periods is a known characteristic of human motor control. Specifically, long-range fractal fluctuations have been evidenced in the temporal structure of these variations in human locomotion and thought to be the outcome of a multicomponent physiologic system in which control is distributed across intricate cortical, spinal and neuromuscular regulation loops. Combined with long-range correlation analyses, short-range autocorrelations have proven their use to describe control distribution across central and motor components. We used relevant tools to characterize long- and short-range correlations in revolution time series during cycling on an ergometer in 19 healthy young adults. We evaluated the impact of introducing a cognitive task (PASAT) to assess the role of central structures in control organization. Autocorrelation function and detrending fluctuation analysis (DFA) demonstrated the presence of fractal scaling. PSD in the short range revealed a singular behavior which cannot be explained by the usual models of even-based and emergent timing. The main outcomes are that (1) timing in cycling is a fractal process, (2) this long-range fractal behavior increases in persistence with dual-task condition, which has not been previously observed, (3) short-range behavior is highly persistent and unaffected by dual-task. Relying on the inertia of the oscillator may be a way to distribute more control to the periphery, thereby allocating less resources to central process and better managing additional cognitive demands. This original behavior in cycling may explain the high short-range persistence unaffected by dual-task, and the increase in long-range persistence with dual-task.
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Affiliation(s)
- Pierre Gilfriche
- CATIE - Centre Aquitain des Technologies de l'Information et Electroniques, Talence, France; Univ. Bordeaux, CNRS, Laboratoire IMS, UMR 5218, Talence, France.
| | - Laurent M Arsac
- Univ. Bordeaux, CNRS, Laboratoire IMS, UMR 5218, Talence, France
| | - Estelle Blons
- Univ. Bordeaux, CNRS, Laboratoire IMS, UMR 5218, Talence, France
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Tanimoto K, Takahashi M, Tokuda K, Sawada T, Anan M, Shinkoda K. Lower limb kinematics during the swing phase in patients with knee osteoarthritis measured using an inertial sensor. Gait Posture 2017; 57:236-240. [PMID: 28668737 DOI: 10.1016/j.gaitpost.2017.06.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 06/11/2017] [Accepted: 06/20/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND During gait, the swing limb requires flexible control to adapt to ever changing environmental circumstances. However, few studies have focused on the mechanics of swing limb control in patients with knee osteoarthritis (OA). Investigating the variability of swing limb kinematics, which can be represented by variables such as the peak shank angular velocity during the swing phase obtained from an inertial sensor, provides insights into the adaptability of swing limb control. The purpose of this study was to investigate how patients with knee OA control the swing limb and whether the degree of impairment and disability due to knee OA affects swing limb control. METHODS Twelve subjects diagnosed with knee OA and 11 healthy control subjects participated in this study. Subjects walked on a treadmill for 10min. The mean, coefficient of variation, and fractal scaling exponent α of the peak shank angular velocity during the swing phase were calculated. FINDINGS There were no significant differences between the groups for any of the kinematic parameters. The Knee Injury and Osteoarthritis Outcome Score (KOOS) activities of daily living (ADL) subsection correlated with the coefficient of variation (r=-0.677, p=0.016) and the scaling exponent α (r=0.604, p=0.037) of the peak shank angular velocity. INTERPRETATION Control of the swing limb was associated with the degree of impairment and disability. Larger and more random variability of peak shank angular velocity may indicate decreased ADL ability in patients with knee OA.
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Affiliation(s)
- Kenji Tanimoto
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 2-3, Kasumi 1-chome, Minami-ku, Hiroshima, 734-8553 Japan
| | - Makoto Takahashi
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, 2-3, Kasumi 1-chome, Minami-ku, Hiroshima, 734-8553 Japan; Center for Advanced Practice and Research of Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 2-3, Kasumi 1-chome, Minami-ku, Hiroshima, 734-8553 Japan
| | - Kazuki Tokuda
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 2-3, Kasumi 1-chome, Minami-ku, Hiroshima, 734-8553 Japan
| | - Tomonori Sawada
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 2-3, Kasumi 1-chome, Minami-ku, Hiroshima, 734-8553 Japan
| | - Masaya Anan
- Physical Therapy Course, Faculty of Welfare and Health Science, Oita University, 700, Dannoharu, Oita, 870-1192 Japan
| | - Koichi Shinkoda
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, 2-3, Kasumi 1-chome, Minami-ku, Hiroshima, 734-8553 Japan; Center for Advanced Practice and Research of Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 2-3, Kasumi 1-chome, Minami-ku, Hiroshima, 734-8553 Japan.
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