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Fowler EG, Vuong A, Staudt LA, Greenberg MB, Mesler SA, Chen K, Stearns-Reider KM. Selective voluntary motor control influences knee joint torque, work and power in children with spastic cerebral palsy. Gait Posture 2024; 113:151-157. [PMID: 38901387 DOI: 10.1016/j.gaitpost.2024.06.005] [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: 01/25/2024] [Revised: 05/12/2024] [Accepted: 06/06/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Children with spastic cerebral palsy (CP) have damage to the corticospinal tracts that are responsible for selective motor control (SMC). Force, velocity and timing of joint movement are related biomechanical features controlled by the corticospinal tracts (CSTs) that are important for skilled movement. RESEARCH QUESTION Does SMC influence knee joint biomechanics in spastic CP? METHODS In this prospective study, relationships between SMC and knee biomechanics (peak torque, total work, average power) across a range of velocities (0-300 deg/s) were assessed using an isokinetic dynamometer in 23 children with spastic CP. SMC was assessed using Selective Control Assessment of the Lower Extremity (SCALE). Logistic and linear regression models were used to evaluate relationships between SCALE and biomechanical measures. RESULTS The ability to produce knee torque diminished with increasing velocity for both Low (0-4 points) and High (5-10 points) SCALE limb score groups (p < 0.01). More knees in the High group produced extension torque at 300 deg/s (p < 0.05) and flexion torque at 30, 90,180, 240 and 300 deg/s (p < 0.05). The ability to produce torque markedly decreased above 180 deg/s for Low group flexion. For knees that produced torque, significant positive correlations between SCALE limb scores and joint torque (0 and 120 deg/s), work (120 deg/s) and power (120 deg/s) were found (p < 0.05). Greater knee torque, work and power for the High group was found for the extensors at most velocities and the flexors for up to 120 deg/s (p < 0.05). Few Low group participants generated knee flexor torque above 120 deg/s limiting comparisons. SIGNIFICANCE Biomechanical impairments found for children with low SMC are concerning as skilled movements during gait, play and sport activities occur at high velocities. Differences in SMC should be considered when designing individualized assessments and interventions.
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Affiliation(s)
- Eileen G Fowler
- Center for Cerebral Palsy at UCLA/Orthopaedic Institute for Children, Department of Orthopaedic Surgery, 22-70 Rehab Center, David Geffen School of Medicine, University of California at Los Angeles, 1000 Veteran Ave, Los Angeles, CA 90095-1795, USA; Tarjan Center at UCLA, USA.
| | - Andy Vuong
- Center for Cerebral Palsy at UCLA/Orthopaedic Institute for Children, Department of Orthopaedic Surgery, 22-70 Rehab Center, David Geffen School of Medicine, University of California at Los Angeles, 1000 Veteran Ave, Los Angeles, CA 90095-1795, USA.
| | - Loretta A Staudt
- Center for Cerebral Palsy at UCLA/Orthopaedic Institute for Children, Department of Orthopaedic Surgery, 22-70 Rehab Center, David Geffen School of Medicine, University of California at Los Angeles, 1000 Veteran Ave, Los Angeles, CA 90095-1795, USA.
| | - Marcia B Greenberg
- Center for Cerebral Palsy at UCLA/Orthopaedic Institute for Children, Department of Orthopaedic Surgery, 22-70 Rehab Center, David Geffen School of Medicine, University of California at Los Angeles, 1000 Veteran Ave, Los Angeles, CA 90095-1795, USA.
| | - Sophia A Mesler
- Center for Cerebral Palsy at UCLA/Orthopaedic Institute for Children, Department of Orthopaedic Surgery, 22-70 Rehab Center, David Geffen School of Medicine, University of California at Los Angeles, 1000 Veteran Ave, Los Angeles, CA 90095-1795, USA.
| | - Keren Chen
- Department of Medicine Statistics Core, David Geffen School of Medicine, UCLA, USA.
| | - Kristen M Stearns-Reider
- Center for Cerebral Palsy at UCLA/Orthopaedic Institute for Children, Department of Orthopaedic Surgery, 22-70 Rehab Center, David Geffen School of Medicine, University of California at Los Angeles, 1000 Veteran Ave, Los Angeles, CA 90095-1795, USA.
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Sorek G, Goudriaan M, Schurr I, Schless SH. Is dynamic motor control clinically important for identifying gait deviations in individuals with cerebral palsy? Gait Posture 2024; 111:44-47. [PMID: 38626568 DOI: 10.1016/j.gaitpost.2024.04.005] [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: 08/03/2023] [Revised: 04/01/2024] [Accepted: 04/05/2024] [Indexed: 04/18/2024]
Abstract
INTRODUCTION Individuals with cerebral palsy (CP) often present with altered motor control. This can be assessed selectively during sitting/lying with the Selective Control Assessment of the Lower Extremity (SCALE), or dynamically with the dynamic motor control index during walking (walk-DMC). Both approaches suggest that altered selective motor control relate to larger gait deviations. RESEARCH QUESTION Does the walk-DMC provide valuable information in addition to the SCALE for estimating gait deviations in individuals with CP. METHODS Retrospective, treadmill-based gait analysis data of 157 children with spastic CP (mean 11.4±3.5 years) and Gross Motor Function Classification System levels I (n=45), II (n=88) or III (n=24) were extracted. Gait kinematic deviations were evaluated using the Gait Profile Score (GPS). The SCALE, walk-DMC and GPS were extracted for the more clinically involved leg (unilateral-analysis), and for both legs together (bilateral-analysis). RESULTS GPS moderately correlated with both SCALE and walk-DMC scores, unilaterally and bilaterally (r≥0.4; p<0.001). Multivariate linear regression analyses were conducted, taking into account potential confounding factors. In the unilateral analysis, 54% of the GPS variance was explained (p<0.001), with both walk-DMC and SCALE significantly contributing to the GPS variance (p=0.006 and p=0.008, respectively). In the bilateral analysis, 61% of the GPS variance was explained (p<0.001), with both walk-DMC and SCALE significantly contributing to the GPS variance (p=0.006 and p<0.001, respectively). Dimensionless walking speed and use of assistive devices were the only confounding factors included in each analysis. SIGNIFICANCE Both SCALE and walk-DMC significantly contribute to GPS variance, suggesting that they likely measure different components of motor control, and both may be useful in understanding the underlying relationship between motor control and deviations in gait kinematics.
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Affiliation(s)
- Gilad Sorek
- Laboratory for Paediatric Motion Analysis and Biofeedback Rehabilitation, ALYN Paediatric and Adolescent Rehabilitation Research Centre (Helmsley PARC), Jerusalem, Israel
| | - Marije Goudriaan
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam, Netherlands; University corporate offices, student & academic affairs office, Utrecht university, Utrecht, the Netherlands
| | - Itai Schurr
- Clinical Motion Analysis Laboratory, ALYN Paediatric and Adolescent Rehabilitation Centre, Jerusalem, Israel
| | - Simon-Henri Schless
- Laboratory for Paediatric Motion Analysis and Biofeedback Rehabilitation, ALYN Paediatric and Adolescent Rehabilitation Research Centre (Helmsley PARC), Jerusalem, Israel; Clinical Motion Analysis Laboratory, ALYN Paediatric and Adolescent Rehabilitation Centre, Jerusalem, Israel.
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Goyal V, Gordon KE, Sukal-Moulton T. Children with bilateral cerebral palsy use their hip joint to complete a step-up task. Front Hum Neurosci 2024; 18:1343457. [PMID: 38445098 PMCID: PMC10912305 DOI: 10.3389/fnhum.2024.1343457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/31/2024] [Indexed: 03/07/2024] Open
Abstract
Performance in stair-climbing is largely associated with disruptions to mobility and community participation in children with cerebral palsy (CP). It is important to understand the nature of motor impairments responsible for making stairs a challenge in children with bilateral CP to clarify underlying causes of impaired mobility. In pediatric clinical populations, sensitive measurements of movement quality can be captured during the initial step of stair ascent. Thus, the purpose of this study was to quantify the lower limb joint moments of children with bilateral CP during the stance phases of a step-up task. Participants performed multiple stepping trials in a university gait laboratory. Outcome measures included extensor support moments (the sum of hip, knee, and ankle sagittal plane moments), hip abduction moments, and their timing. We recruited seven participants per group. We found that peak support and hip abduction moments were similar in the bilateral CP group compared to the typical development (TD) group. We also found that children with bilateral CP timed their peak moments closer together and increasingly depended on the hip joint to complete the task, especially in their more affected (MA) lower limb. Our investigation highlights some underlying causes that may make stair climbing a challenge for the CP population, including a loss of selective voluntary motor control (SVMC), and provides a possible treatment approach to strengthen lower limb muscles.
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Affiliation(s)
- Vatsala Goyal
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, United States
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Keith E. Gordon
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Edward Hines Jr. Veterans Administration Hospital, Hines, IL, United States
| | - Theresa Sukal-Moulton
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Hjalmarsson E, Lidbeck C, Barrero Santiago L, Pingel J, Norrbom J, Sanz G, Palmcrantz A, Pontén E, von Walden F, Fernandez-Gonzalo R. Determinants of Frame Running Capacity in Athletes With Cerebral Palsy to Improve Training Routines and Classification Strategies: A Cross-sectional Observational Study. Am J Phys Med Rehabil 2024; 103:79-86. [PMID: 36897812 DOI: 10.1097/phm.0000000000002233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
OBJECTIVES The aim of the study were to (1) investigate what physical and physiological parameters are most important for Frame Running capacity, a parasport for individuals with ambulatory difficulties, and (2) determine whether Frame Running capacity can be predicted in athletes with cerebral palsy. DESIGN Athletes with cerebral palsy ( N = 62, Gross Motor Classification System I-V; 2/26/11/21/2) completed a 6-min Frame Running test. Before the 6-min Frame Running test, muscle thickness, passive range of motion (hip, knee, ankle), selective motor control, and spasticity (hip, knee, ankle) were measured in both legs. In total, 54 variables per individual were included. Data were analyzed using correlations, principal component analysis, orthogonal partial least square regression, and variable importance in projection analysis. RESULTS The mean 6-min Frame Running test distance was 789 ± 335 m and decreased with motor function severity. The orthogonal partial least square analysis revealed a modest degree of covariance in the variables analyzed and that the variance in the 6-min Frame Running test distance could be predicted with 75% accuracy based on all the variables measured. Variable importance in projection analysis indicated hip and knee extensor spasticity (negative effect), and muscle thickness (positive effect) arose as the most important factors contributing to Frame Running capacity. CONCLUSIONS These results are an important resource to enable optimization of training regimes to improve Frame Running capacity and contribute to evidence-based and fair classification for this parasport.
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Affiliation(s)
- Emma Hjalmarsson
- From the Division of Paediatric Neurology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden (EH, AP, EP, FvW); Functional Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden (EH, AP); Department of Pediatric Orthopedic Surgery, Karolinska University Hospital, Stockholm, Sweden (CL); Department of Molecular Biology, Histology, and Pharmacology, Faculty of Medicine, University of Valladolid, Valladolid, Spain (LBS); Department of Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (JP); Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden (JN); Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden (GS); Department of Pediatric Orthopedic Surgery, Karolinska University Hospital, Stockholm, Sweden (EP); Division of Clinical Physiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden (RF-G); and Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden (RF-G)
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Gill PK, Steele KM, Donelan JM, Schwartz MH. Causal modelling demonstrates metabolic power is largely affected by gait kinematics and motor control in children with cerebral palsy. PLoS One 2023; 18:e0285667. [PMID: 37224117 DOI: 10.1371/journal.pone.0285667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 04/27/2023] [Indexed: 05/26/2023] Open
Abstract
Metabolic power (net energy consumed while walking per unit time) is, on average, two-to-three times greater in children with cerebral palsy (CP) than their typically developing peers, contributing to greater physical fatigue, lower levels of physical activity and greater risk of cardiovascular disease. The goal of this study was to identify the causal effects of clinical factors that may contribute to high metabolic power demand in children with CP. We included children who 1) visited Gillette Children's Specialty Healthcare for a quantitative gait assessment after the year 2000, 2) were formally diagnosed with CP, 3) were classified as level I-III under the Gross Motor Function Classification System and 4) were 18 years old or younger. We created a structural causal model that specified the assumed relationships of a child's gait pattern (i.e., gait deviation index, GDI) and common impairments (i.e., dynamic and selective motor control, strength, and spasticity) with metabolic power. We estimated causal effects using Bayesian additive regression trees, adjusting for factors identified by the causal model. There were 2157 children who met our criteria. We found that a child's gait pattern, as summarized by the GDI, affected metabolic power approximately twice as much as the next largest contributor. Selective motor control, dynamic motor control, and spasticity had the next largest effects. Among the factors we considered, strength had the smallest effect on metabolic power. Our results suggest that children with CP may benefit more from treatments that improve their gait pattern and motor control than treatments that improve spasticity or strength.
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Affiliation(s)
- Pavreet K Gill
- Department of Biomedical Physiology & Kinesiology, Locomotion Lab, Simon Fraser University, Burnaby, BC, Canada
| | - Katherine M Steele
- Department of Mechanical Engineering, Ability and Innovation Lab, University of Washington, Seattle, WA, United States of America
| | - J Maxwell Donelan
- Department of Biomedical Physiology & Kinesiology, Locomotion Lab, Simon Fraser University, Burnaby, BC, Canada
| | - Michael H Schwartz
- Gillette Children's Specialty Healthcare, St. Paul, MN, United States of America
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, United States of America
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Relationship between kinematic gait quality and caregiver-reported everyday mobility in children and youth with spastic Cerebral Palsy. Eur J Paediatr Neurol 2023; 42:88-96. [PMID: 36587415 DOI: 10.1016/j.ejpn.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 08/09/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND 3D gait analysis (3DGA) is a common assessment in Cerebral Palsy (CP) to quantify the extent of movement abnormalities. Yet, 3DGA is performed in laboratories and may thus be of debatable significance to everyday life. AIM The aim was to assess the relationship between kinematic gait abnormality and everyday mobility in ambulatory children and youth with spastic CP. METHODS 73 paediatric and juvenile patients with uni- or bilateral spastic CP (N = 21 USCP, N = 52, BSCP, age: 4-20 y, GMFCS I-III) underwent a 3DGA, while the MobQues47 Questionnaire quantified caregiver-reported mobility. We calculated the Gait Profile Score (GPS), a metric that summarizes how far the lower limb joint angles during walking deviate from those of matched controls. RESULTS The GPS correlated well with indoor and outdoor mobility (rho = -0.69 and -0.70, both p < 0.001) and the relationships were not significantly different for USCP and BSCP. Still, mobility was lower in BSCP (p < 0.001) and more compromised outdoors (p = 0.002). Indoor mobility could be predicted by walking speed, GPS and age (adj. R2 = 0.62). Outdoor mobility was best predicted by walking speed and GPS (adj. R2 = 0.60). The additive explained variance by the GPS was even higher outdoors than indoors (17.1% vs. 11.4%). CONCLUSIONS Measuring movement deviations with 3DGA seems equally meaningful in uni- and bilaterally affected children and has considerable relevance for real-life ambulation, particurlarly outdoors, where children with spastic CP typically face greater difficulties. Therapeutic strategies that achieve faster walking and reduction of kinematic deviations may increase outdoor mobility.
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Selective motor control correlates with gross motor ability, functional balance and gait performance in ambulant children with bilateral spastic cerebral palsy. Gait Posture 2023; 99:9-13. [PMID: 36283302 DOI: 10.1016/j.gaitpost.2022.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 09/21/2022] [Accepted: 10/16/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Selective motor control (SMC) is a fundamental component of typical human motion. As a result of brain damage, impaired SMC often leads to difficulties with coordination, balance, gait efficiency and symmetry. RESEARCH QUESTION What is the association between impaired SMC and lower limb motor ability, functional balance and gait performance in children with bilateral spastic cerebral palsy (CP)? METHODS Thirty-six children (aged 5-16 years) with spastic bilateral CP in Gross Motor Function Classification System (GMFCS) level I to II were included in this study. SMC was assessed using Selective Control Assessment of the Lower Extremity (SCALE). Gross motor function was assessed using Gross Motor Function Measure-88 items D and E dimension (GMFM-88 D&E). Functional balance was assessed using Pediatric Balance Scale (PBS) and Timed Up and Go Test (TUG). Gait quality was assessed using Edinburg Visual Gait Score (EVGS) and 10-Meter Walk Test (10MWT). Spearman's rank correlation analyses were used to determine the association between SMC and other factors. RESULTS Correlation analyses showed that SCALE was strongly positively correlated with GMFM-88 (D&E) (rs=0.756, p < 0.001), PBS (rs=0.769, p < 0.001), and height-normalized fast walking speed (rs=0.632, p < 0.001), and strongly negatively correlated with TUG (rs=-0.766, p < 0.001) and EVGS (rs=-0.893, p < 0.001). SIGNIFICANCE Lower extremity SMC deficits are associated with poor gross motor function and balance control, more severe overall gait deviations and decreased fast walking speed in children with bilateral spastic CP. Physical therapy should include interventions that promote selective motor control in order to improve overall functional ability.
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Leung T, Balzer J, Keller JW, van Hedel HJA. Playfully Assessing Lower Extremity Selective Voluntary Motor Control in Children With Cerebral Palsy: Psychometric Study. JMIR Rehabil Assist Technol 2022; 9:e39687. [PMID: 36525299 PMCID: PMC9804089 DOI: 10.2196/39687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Objective measures specifically assessing selective voluntary motor control are scarce. Therefore, we have developed an interval-scaled assessment based on accelerometers. OBJECTIVE This study provided a preliminary evaluation of the validity and reliability of this novel gamelike assessment measuring lower limb selective voluntary motor control in children with cerebral palsy (CP). METHODS Children with CP and their neurologically intact peers were recruited for this psychometric evaluation of the assessgame. The participants played the assessgame and steered an avatar by selective hip, knee, or ankle joint movements captured with accelerometers. The assessgame's scores provide information about the accuracy of the selective movement of the target joint and the amplitude and frequency of involuntary movements occurring in uninvolved joints. We established discriminative validity by comparing the assessgame scores of the children with CP with those of the neurologically intact children, concurrent validity by correlations with clinical scores and therapists' opinions, and relative and absolute test-retest reliability. RESULTS We included 20 children with CP (mean age 12 years and 5 months, SD 3 years and 4 months; Gross Motor Function Classification System levels I to IV) and 31 neurologically intact children (mean age 11 years and 1 month, SD 3 years and 6 months). The assessgame could distinguish between the children with CP and neurologically intact children. The correlations between the assessgame's involuntary movement score and the therapist's rating of the occurrence of involuntary movements during the game were moderate (Spearman ρ=0.56; P=.01), whereas the correlations of the assessgame outcomes with the Selective Control Assessment of the Lower Extremity and Gross Motor Function Classification System were low and not significant (|ρ|≤0.39). The intraclass correlation coefficients were >0.85 and indicated good relative test-retest reliability. Minimal detectable changes amounted to 25% (accuracy) and 44% (involuntary movement score) of the mean total scores. The percentage of children able to improve by the minimal detectable change without reaching the maximum score was 100% (17/17) for the accuracy score and 94% (16/17) for the involuntary movement score. CONCLUSIONS The assessgame proved reliable and showed discriminative validity in this preliminary evaluation. Concurrent validity was moderate with the therapist's opinion but relatively poor with the Selective Control Assessment of the Lower Extremity. We assume that the assessment's gamelike character demanded various other motor control aspects that are less considered in current clinical assessments.
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Affiliation(s)
| | - Julia Balzer
- Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern a.A., Switzerland.,Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jeffrey W Keller
- Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern a.A., Switzerland.,Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland.,Doctoral Program Clinical Science, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Hubertus J A van Hedel
- Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern a.A., Switzerland.,Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
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Kaya Ciddi P, Yilmaz Ö. Exercise intensity of active video gaming in cerebral palsy: hip- versus wrist-worn accelerometer data. Dev Neurorehabil 2022; 25:479-484. [PMID: 35815544 DOI: 10.1080/17518423.2022.2099028] [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] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The aim of this study was to compare exercise intensity of active video games (AVGs) between hip- and wrist-worn accelerometer data in cerebral palsy (CP). METHODS Twenty children and adolescents (9.35 ± 3.71 years) with CP performed two exercise sessions, completing a standardized series of AVGs. Exercise intensity was collected, while one accelerometer was fitted to wrist and hip in separate, counterbalanced sessions. RESULTS Accelerometer counts per minute and cut-points determined were significantly different between the wrist- and hip-worn outputs (p < .001). Metabolic equivalents (METs) of performing AVGs exceeded the three METs moderate intensity threshold in wrist-worn (3.12 ± 0.86) accelerometer and hip-worn data tend to underestimate intensity (1.16 ± 0.08). CONCLUSIONS Previous studies showed METs required to perform AVGs were related to moderate intensity (3-6 METs) in CP with mild deficits. Wrist-worn accelerometer, exceeding 3 METs, seem to have higher accuracy in measuring exercise intensity of AVGs than hip-worn.
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Affiliation(s)
- Pınar Kaya Ciddi
- Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Istanbul Medipol University, Istanbul, Turkey
| | - Öznur Yilmaz
- Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Hacettepe University, Ankara, Turkey
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Sorek G, Goudriaan M, Schurr I, Schless SH. Influence of the number of muscles and strides on selective motor control during gait in individuals with cerebral palsy. J Electromyogr Kinesiol 2022; 66:102697. [PMID: 36027660 DOI: 10.1016/j.jelekin.2022.102697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/26/2022] [Accepted: 08/10/2022] [Indexed: 10/15/2022] Open
Abstract
OBJECTIVE To evaluate the influence of the number of muscles and strides on estimating motor control accuracy during treadmill-gait, in individuals with cerebral palsy (CP). METHODS Bilateral lower limb electromyography data were extracted for 44 children/adolescents with CP. The number of synergy solutions required to explain 90 % of the variance (tVAF-threshold) and the total variance accounted for by one synergy (tVAF1) were calculated for a different number of strides (between 5 and 50) and muscles both unilaterally (four to seven) and bilaterally (eight to 14). The kappa and intraclass correlation coefficients were used to assess similarities in tVAF-threshold and tVAF1 between the different number of strides and muscle sets. RESULTS In both analyses, the number of muscles influenced the tVAF-threshold. Additionally, using <30 strides led to only substantial-moderate agreement with 50 strides (k < 0.80). In both analyses, the mean tVAF1 values demonstrated high-agreement between the different number of muscles (intraclass-correlations = 0.88-0.93) and strides (intraclass-correlations = 0.96-0.99); In the group level, it may result in an error of ≤2.3 %. However, in the individual level, using different number of muscles or <40 strides may result in an error of ≥6 %. CONCLUSION Differing numbers of muscles and strides did not influence the group mean tVAF1 value, but it influenced the tVAF-threshold value. In addition, using different number of muscles or strides can lead to a large measurement error in the individual tVAF1 value.
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Affiliation(s)
- Gilad Sorek
- Laboratory for Paediatric Motion Analysis and Biofeedback Rehabilitation, ALYN Paediatric and Adolescent Rehabilitation Research Centre (ALYN PARC), Jerusalem, Israel
| | - Marije Goudriaan
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Itai Schurr
- Clinical Motion Analysis Laboratory, ALYN Paediatric and Adolescent Rehabilitation Centre, Jerusalem, Israel
| | - Simon-Henri Schless
- Laboratory for Paediatric Motion Analysis and Biofeedback Rehabilitation, ALYN Paediatric and Adolescent Rehabilitation Research Centre (ALYN PARC), Jerusalem, Israel; Clinical Motion Analysis Laboratory, ALYN Paediatric and Adolescent Rehabilitation Centre, Jerusalem, Israel.
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Assessment of gait quality and efficiency after undergoing a single-event multilevel surgery in children with cerebral palsy presenting an intoeing gait pattern. Childs Nerv Syst 2022; 38:1523-1530. [PMID: 35552497 DOI: 10.1007/s00381-022-05548-x] [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: 11/15/2021] [Accepted: 04/27/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The biomechanical impact of undergoing a single-event multilevel surgery (SEMLS) for children with cerebral palsy (CP) presenting an intoeing gait pattern has been widely documented. However, past studies mostly focused on gait quality rather than efficiency. Thus, there is a need to determine the impact of undergoing a SEMLS on gait quality and efficiency in children with CP presenting an intoeing gait pattern. METHODS Data from 16 children with CP presenting an intoeing gait pattern who underwent a SEMLS were retrospectively selected. Gait kinematics was quantified before (baseline) and at least 1 year after the surgery (follow-up). Gait quality was investigated with the Gait Profile Score (GPS), hip internal rotation angle and foot progression angle (FPA). Gait efficiency was analysed using clinically accessible variables, namely the normalised gait speed and medio-lateral and vertical centre of mass excursions (COMp). Dependent variables were compared between sessions with paired t-tests. RESULTS At the follow-up, children with CP exhibited a more outward FPA and GPS as well as a decreased hip internal rotation angle. No changes in normalised gait speed and vertical COMp excursion were observed, and medio-lateral COMp excursion was slightly decreased. CONCLUSION Children with CP presenting an intoeing gait pattern who underwent a SEMLS exhibited an increased gait quality, but gait efficiency was only minimally improved at the follow-up compared to baseline. Further studies are needed to identify contributors of gait efficiency in children with CP, and the best treatment modalities to optimise both their gait quality and efficiency.
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Characteristics of sit-to-stand movement are associated with trunk and lower extremity selective control in children with cerebral palsy: a cross-sectional study. Int J Rehabil Res 2022; 45:279-286. [PMID: 35777970 DOI: 10.1097/mrr.0000000000000541] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Even though the effect of several factors on sit-to-stand (STS) performance of children with CP has been previously explored, the potential role of lower extremity selective control, trunk control and sitting function on the performance of STS has not been examined. This study aimed to investigate the association of trunk control and lower extremity selective motor control with STS performance in children with CP. We recruited 28 children with CP aged between 4 and 10 years whose Gross Motor Function Classification System levels were I and II and 32 age-matched typically developing (TP) children. Trunk control, sitting function, selective control of the lower extremities and STS were evaluated with Trunk Control Measurement Scale (TCMS), sitting section of Gross Motor Function Measure-88 (GMFM-88), Selective Control Assessment of the Lower Extremity (SCALE) and the STS outcomes of a force platform [weight transfer time, rising index, and center of gravity (COG) sway velocity], respectively. In all evaluations, children with CP demonstrated lower scores than TD children. A moderate correlation was found between total scores of TCMS, GMFM-88 sitting section scores and COG sway velocity during STS and a fair correlation between SCALE total scores and COG sway velocity in the CP group (r = -0.51, r = -0.52, r = -0.39, respectively). A fair correlation was found between SCALE total scores and the weight transfer time during STS in children with CP (r = -0.39). Based on these results, improving trunk and lower extremity selective control may enhance STS performance in children with CP.
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Minosse S, Favetta M, Romano A, Pisano A, Summa S, Schirinzi T, Vasco G, Castelli E, Petrarca M. Comparison of the Gait Biomechanical Constraints in Three Different Type of Neuromotor Damages. Front Hum Neurosci 2022; 16:822205. [PMID: 35422690 PMCID: PMC9001917 DOI: 10.3389/fnhum.2022.822205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/28/2022] [Indexed: 11/14/2022] Open
Abstract
Background and Objective Absolute angle represents the inclination of a body segment relative to a fixed reference in space. This work compares the absolute and relative angles for exploring biomechanical gait constraints. Methods Gait patterns of different neuromotor conditions were analyzed using 3D gait analysis: normal gait (healthy, H), Cerebral Palsy (CP), Charcot Marie Tooth (CMT) and Duchenne Muscular Dystrophy (DMD), representing central and peripheral nervous system and muscular disorders, respectively. Forty-two children underwent gait analysis: 10 children affected by CP, 10 children by CMT, 10 children by DMD and 12 healthy children. The kinematic and kinetic parameters were collected to describe the biomechanical pattern of participants’ lower limbs. The absolute angles of thigh, leg and foot were calculated using the trigonometric relationship of the tangent. For each absolute series, the mean, range, maximum, minimum and initial contact were calculated. Kinematic and kinetic gait data were studied, and the results were compared with the literature. Results Statistical analysis of the absolute angles showed how, at the local level, the single segments (thigh, leg and foot) behave differently depending on the pathology. However, if the lower limb is studied globally (sum of the kinematics of the three segments: thigh, leg and foot), a biomechanical constraint emerges. Conclusion Each segment compensates separately for the disease deficit so as to maintain a global biomechanical invariance. Using a model of inter-joint co-variation could improve the interpretation of the clinical gait pattern.
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Affiliation(s)
- Silvia Minosse
- Department of Neurorehabilitation and Robotics, Movement Analysis and Robotics Laboratory (MARLab), “Bambino Gesù” Children’s Hospital, IRCCS, Rome, Italy
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
| | - Martina Favetta
- Department of Neurorehabilitation and Robotics, Movement Analysis and Robotics Laboratory (MARLab), “Bambino Gesù” Children’s Hospital, IRCCS, Rome, Italy
| | - Alberto Romano
- Department of Neurorehabilitation and Robotics, Movement Analysis and Robotics Laboratory (MARLab), “Bambino Gesù” Children’s Hospital, IRCCS, Rome, Italy
| | - Alessandra Pisano
- Department of Neurorehabilitation and Robotics, Movement Analysis and Robotics Laboratory (MARLab), “Bambino Gesù” Children’s Hospital, IRCCS, Rome, Italy
| | - Susanna Summa
- Department of Neurorehabilitation and Robotics, Movement Analysis and Robotics Laboratory (MARLab), “Bambino Gesù” Children’s Hospital, IRCCS, Rome, Italy
- *Correspondence: Susanna Summa,
| | - Tommaso Schirinzi
- Department of Neurorehabilitation and Robotics, Movement Analysis and Robotics Laboratory (MARLab), “Bambino Gesù” Children’s Hospital, IRCCS, Rome, Italy
- Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Gessica Vasco
- Department of Neurorehabilitation and Robotics, Movement Analysis and Robotics Laboratory (MARLab), “Bambino Gesù” Children’s Hospital, IRCCS, Rome, Italy
| | - Enrico Castelli
- Department of Neurorehabilitation and Robotics, Movement Analysis and Robotics Laboratory (MARLab), “Bambino Gesù” Children’s Hospital, IRCCS, Rome, Italy
| | - Maurizio Petrarca
- Department of Neurorehabilitation and Robotics, Movement Analysis and Robotics Laboratory (MARLab), “Bambino Gesù” Children’s Hospital, IRCCS, Rome, Italy
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Tabard-Fougère A, Rutz D, Pouliot-Laforte A, De Coulon G, Newman CJ, Armand S, Wegrzyk J. Are Clinical Impairments Related to Kinematic Gait Variability in Children and Young Adults With Cerebral Palsy? Front Hum Neurosci 2022; 16:816088. [PMID: 35308609 PMCID: PMC8926298 DOI: 10.3389/fnhum.2022.816088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/02/2022] [Indexed: 11/20/2022] Open
Abstract
Intrinsic gait variability (GV), i.e., fluctuations in the regularity of gait patterns between repetitive cycles, is inherent to the sensorimotor system and influenced by factors such as age and pathology. Increased GV is associated with gait impairments in individuals with cerebral palsy (CP) and has been mainly studied based on spatiotemporal parameters. The present study aimed to describe kinematic GV in young people with CP and its associations with clinical impairments [i.e., passive range of motion (pROM), muscle weakness, reduced selective motor control (selectivity), and spasticity]. This retrospective study included 177 participants with CP (age range 5-25 years; Gross Motor Function Classification System I-III) representing 289 clinical gait analyses [n = 172 for unilateral CP (uCP) vs. 117 for bilateral CP (bCP)]. As variability metrics, Root Mean Square Deviation (RMSD) for nine lower-limb kinematic parameters and Gait Standard Deviation (GaitSD) - as composite score of the kinematic parameters - were computed for the affected (unilateral = uCP) and most affected side (bilateral = bCP), respectively, as defined by clinical scores. GaitSD was then computed for the non/less-affected side for between leg comparisons. Uni- and multivariate linear regressions were subsequently performed on GaitSD of the affected/most affected side with all clinical impairments (composite scores) as independent variables. Highest RMSD were found in the transverse plane (hip, pelvis), for distal joints in the sagittal plane (knee, ankle) and for foot progression. GaitSD was not different between uCP and bCP (affected/most affected side) but higher in the non-affected vs. affected side in uCP. GaitSD was associated with age (p < 0.001), gait deviation index (GDI) (p < 0.05), muscle weakness (p < 0.001), selectivity (p < 0.05), and pROM (p < 0.001). After adjustment for age and GDI, GaitSD remained associated with muscle weakness (uCP: p = 0.003, bCP: p < 0.001) and selectivity (bCP: p = 0.024). Kinematic GV can be expressed as global indicator of variability (GaitSD) in young people with CP given the strong correlation of RMSD for lower-limb kinematic parameters. In terms of asymmetry, increased variability of the non-affected vs. affected side may indicate contralateral compensation mechanisms in uCP. Notably muscle weakness (uCP, bCP) and selectivity (bCP) - but not spasticity - were associated with GaitSD. Further studies need to explore the clinical relevance of kinematic GV in CP to support the interpretation of clinical gait analyses and therapeutic decision-making.
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Affiliation(s)
- Anne Tabard-Fougère
- Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and Geneva University, Geneva, Switzerland
| | - Dionys Rutz
- Physical Therapy Unit, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Annie Pouliot-Laforte
- Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and Geneva University, Geneva, Switzerland
| | - Geraldo De Coulon
- Pediatric Orthopaedic Surgery Unit, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Christopher J. Newman
- Pediatric Neurology and Neurorehabilitation Unit, Department of Pediatrics, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Stéphane Armand
- Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and Geneva University, Geneva, Switzerland
| | - Jennifer Wegrzyk
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
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15
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Green MM, Kim H, Gauden R, Scheinberg A, Schroeder AS, Heinen F, Berweck S, Hong BY, Gormley M. Needlepoints: Clinical approach to child living with cerebral palsy. J Pediatr Rehabil Med 2022; 15:91-106. [PMID: 35275576 DOI: 10.3233/prm-220006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Heakyung Kim
- NewYork-Presbyterian Hospital, New York, NY, USA
| | - Ruth Gauden
- The Royal Children's Hospital Melbourne, Parkville, Australia
| | - Adam Scheinberg
- The Royal Children's Hospital Melbourne, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia
| | | | | | | | - Bo Young Hong
- St. Vincent's Hospital, Catholic University of Korea, College of Medicine, Seoul, Republic of Korea
| | - Mark Gormley
- Gillette Children's Specialty Healthcare, St.Paul, MN, USA
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16
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Thomas KF, Boyer ER, Krach LE. Variability in lower extremity motor function in spina bifida only partially associated with spinal motor level. J Pediatr Rehabil Med 2022; 15:559-569. [PMID: 36502349 DOI: 10.3233/prm-220047] [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] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Previous studies have found motor function to correlate with spinal motor level and, accordingly, individuals with spina bifida are frequently categorized clinically in this manner. The aim of the current study was to describe how lower extremity functions including strength, selective motor control, and mirror movements vary by motor level in children and young adults with spina bifida. METHODS A single center, retrospective, cross-sectional, descriptive study using data collected in the National Spina Bifida Patient Registry and by a gait laboratory was performed. RESULTS Seventy-seven individuals with spina bifida were included with the majority having myelomeningocele (59 lumbar, 18 sacral motor level). Lower extremity strength and selective motor control varied to a certain extent with motor level. However, 90% of individuals showed strength or weakness in at least one muscle group that was unexpected based on their motor level. Mirror movements did not clearly vary with motor level. CONCLUSION Lower extremity strength, selective motor control, and mirror movements in individuals with spina bifida were not entirely predicted by motor level. This highlights the possible need for an improved spina bifida classification system that describes not only spinal motor level but more clearly defines a particular individual's functional motor abilities.
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Affiliation(s)
- Katherine Fisher Thomas
- Department of Pediatric Rehabilitation Medicine, Gillette Children's, Saint Paul, MN, USA.,Department of Physical Medicine and Rehabilitation, University of Minnesota, Minneapolis, MN, USA
| | - Elizabeth Rose Boyer
- Center for Gait and Motion Analysis, Gillette Children's, Saint Paul, MN, USA.,Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Linda Elsie Krach
- Department of Pediatric Rehabilitation Medicine, Gillette Children's, Saint Paul, MN, USA.,Department of Physical Medicine and Rehabilitation, University of Minnesota, Minneapolis, MN, USA
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Sardoğan C, Muammer R, Akalan NE, Sert R, Bilgili F. Determining the relationship between the impairment of selective voluntary motor control and gait deviations in children with cerebral palsy using simple video-based analyses. Gait Posture 2021; 90:295-300. [PMID: 34564001 DOI: 10.1016/j.gaitpost.2021.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/20/2021] [Accepted: 08/24/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The impairment of selective voluntary motor control (SVMC) in children with cerebral palsy (CP) has been shown to correlate with their gait characteristics using complex 3D gait analysis systems (3DGA); however, this relationship has not been investigated using simple video-based observational gait analysis (VBOGA). The aim of this study was to determine the relationship between VBOGA and SVMC of the lower extremities in children with CP. METHODS Forty-two CP children 10.9 ± 5.7 years old with Gross Motor Function Classification System (GMFCS) levels I-III participated in the study. Their gait characteristics were assessed using the Edinburgh Visual Gait Score (EVGS), and selective voluntary motor control was tested using the Selective Control Assessment of the Lower Extremity (SCALE). Spearman's rho correlation test with Cohen's classification were used in the statistical analyses. RESULTS The GMFCS levels (r = 0.604, p < 0.001), foot clearance (r = -0.584. p < 0.001), and maximum ankle dorsiflexion (r =-0.567, p < 0.001) during the swing phase had strong correlations with total SCALE scores. There was also a moderate correlation between total SCALE scores and total EVGS (r =-0.494, p < 0.001), knee extension in the terminal swing phase (r = -0.353, p < 0.001), peak sagittal trunk position (r = -0.316, p < 0.005), and maximum lateral shift (r = -0.37, p < 0.001). CONCLUSION Impaired lower extremity SVMC was noticeably related to the foot and ankle movements in the swing phase and initial stance during walking as well as the total EVGS scores and sagittal and frontal trunk movements. The SCALE correlations with VBOGA were similar those observed in the complex 3DGA in the literature; therefore, we suggest that SVMC impairment of gait could be evaluated using simple VBOGA. These findings may help to tailor physical therapy programs for CP children to increase their motor control and walking quality.
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Affiliation(s)
- Cansu Sardoğan
- Yeditepe University, Institute of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey.
| | - Rasmi Muammer
- Yeditepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey
| | - Nazif Ekin Akalan
- Istanbul Kültür University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey.
| | - Rukiye Sert
- Istanbul University, Institute of Health Sciences, Department of Developmental Neurology, Istanbul, Turkey
| | - Fuat Bilgili
- Istanbul University, Istanbul Faculty of Medicine, Department of Orthopaedics and Traumatology, Istanbul, Turkey
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18
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Energetics of walking in individuals with cerebral palsy and typical development, across severity and age: A systematic review and meta-analysis. Gait Posture 2021; 90:388-407. [PMID: 34564011 DOI: 10.1016/j.gaitpost.2021.09.190] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/25/2021] [Accepted: 09/19/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Individuals with cerebral palsy (CP) report physical fatigue as a main cause of limitation, deterioration and eventually cessation of their walking ability. A consequence of higher level of fatigue in individuals with CP leads to a less efficient and long-distance walking ability. RESEARCH QUESTION This systematic review investigates the difference in 1) walking energy expenditure between individuals with CP and age-matched typically developing (TD) individuals; and 2) energetics of walking across Gross Motor Function Classification System (GMFCS) levels and age. METHODS Five electronic databases (PubMed, Web of Science, CINAHL, ScienceDirect and Scopus) were searched using search terms related to CP and energetics of walking. RESULTS Forty-one studies met inclusion criteria. Thirty-one studies compared energy expenditure between CP and age-matched controls. Twelve studies correlated energy expenditure and oxygen cost across GMFCS levels. Three studies investigated the walking efficiency across different ages or over a time period. A significant increase of energy expenditure and oxygen cost was found in individuals with CP compared to TD age-matched individuals, with a strong relationship across GMFCS levels. SIGNIFICANCE Despite significant differences between individuals with CP compared to TD peers, variability in methods and testing protocols may play a confounding role. Analysis suggests oxygen cost being the preferred/unbiased physiological parameter to assess walking efficacy in CP. To date, there is a knowledge gap on age-related changes of walking efficiency across GMFCS levels and wider span of age ranges. Further systematic research looking at longitudinal age-related changes of energetics of walking in this population is warranted.
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Hanssen B, Peeters N, Vandekerckhove I, De Beukelaer N, Bar-On L, Molenaers G, Van Campenhout A, Degelaen M, Van den Broeck C, Calders P, Desloovere K. The Contribution of Decreased Muscle Size to Muscle Weakness in Children With Spastic Cerebral Palsy. Front Neurol 2021; 12:692582. [PMID: 34381414 PMCID: PMC8350776 DOI: 10.3389/fneur.2021.692582] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/15/2021] [Indexed: 12/13/2022] Open
Abstract
Muscle weakness is a common clinical symptom in children with spastic cerebral palsy (SCP). It is caused by impaired neural ability and altered intrinsic capacity of the muscles. To define the contribution of decreased muscle size to muscle weakness, two cohorts were recruited in this cross-sectional investigation: 53 children with SCP [median age, 8.2 (IQR, 4.1) years, 19/34 uni/bilateral] and 31 children with a typical development (TD) [median age, 9.7 (IQR, 2.9) years]. Muscle volume (MV) and muscle belly length for m. rectus femoris, semitendinosus, gastrocnemius medialis, and tibialis anterior were defined from three-dimensional freehand ultrasound acquisitions. A fixed dynamometer was used to assess maximal voluntary isometric contractions for knee extension, knee flexion, plantar flexion, and dorsiflexion from which maximal joint torque (MJT) was calculated. Selective motor control (SMC) was assessed on a 5-point scale for the children with SCP. First, the anthropometrics, strength, and muscle size parameters were compared between the cohorts. Significant differences for all muscle size and strength parameters were found (p ≤ 0.003), except for joint torque per MV for the plantar flexors. Secondly, the associations of anthropometrics, muscle size, gross motor function classification system (GMFCS) level, and SMC with MJT were investigated using univariate and stepwise multiple linear regressions. The associations of MJT with growth-related parameters like age, weight, and height appeared strongest in the TD cohort, whereas for the SCP cohort, these associations were accompanied by associations with SMC and GMFCS. The stepwise regression models resulted in ranges of explained variance in MJT from 29.3 to 66.3% in the TD cohort and from 16.8 to 60.1% in the SCP cohort. Finally, the MJT deficit observed in the SCP cohort was further investigated using the TD regression equations to estimate norm MJT based on height and potential MJT based on MV. From the total MJT deficit, 22.6–57.3% could be explained by deficits in MV. This investigation confirmed the disproportional decrease in muscle size and muscle strength around the knee and ankle joint in children with SCP, but also highlighted the large variability in the contribution of muscle size to muscle weakness.
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Affiliation(s)
- Britta Hanssen
- Department of Rehabilitation Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Nicky Peeters
- Department of Rehabilitation Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Ines Vandekerckhove
- Department of Rehabilitation Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Nathalie De Beukelaer
- Department of Rehabilitation Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Lynn Bar-On
- Department of Rehabilitation Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.,Department of Rehabilitation Medicine, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
| | - Guy Molenaers
- Department of Development and Regeneration, Katholieke Universiteit (KU) Leuven, Leuven, Belgium.,Orthopaedic Section, University Hospitals Leuven, Leuven, Belgium
| | - Anja Van Campenhout
- Department of Development and Regeneration, Katholieke Universiteit (KU) Leuven, Leuven, Belgium.,Orthopaedic Section, University Hospitals Leuven, Leuven, Belgium
| | - Marc Degelaen
- Department of Rehabilitation Research, Vrije Universiteit Brussel, Brussels, Belgium.,Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium.,University Hospital, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Patrick Calders
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
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Fujimoto J, Umemoto Y, Koike Y, Isida K, Sakamoto K, Tajima F. Immediate effects of short period lower limb ergometer exercise in adolescent and young adult patients with cerebral palsy and spastic diplegia. J Phys Ther Sci 2021; 33:52-56. [PMID: 33519075 PMCID: PMC7829563 DOI: 10.1589/jpts.33.52] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/25/2020] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To determine the effects of lower limb ergometer exercise on the spasticity and joint range of motion of the lower extremity and gait function in patients with cerebral palsy and spastic paralysis. [Participants and Methods] This study included 8 participants with cerebral palsy and spastic paralysis (GMFCS levels I to IV) who received care at the outpatient clinic. After a 5-min rest, the lower limb ergometer exercises were performed for 10 min. We measured the participants' arterial blood pressure, pulse rate, passive range of knee joint extension, muscle tone using the Modified Ashworth scale (MAS) and Modified Tardieu scale (MTS), and 10-m walk test (10MWT). Measurements were collected three times (at baseline before exercise, immediately at the end of exercise, and 5 min after exercise during recovery). [Results] The 10-min lower limb ergometer exercise significantly improved the knee joint extension, MAS and MTS scores, and reduced lower extremity spasticity. Furthermore, it significantly increased the range of knee joint extension and decreased the 10MWT score. [Conclusion] The results showed that the 10-minute lower limb ergometer exercise is beneficial in reducing the spasticity of the lower limb muscles and in increasing the range of motion of knee extension in paraplegic patients with cerebral palsy, suggesting that its implementation in young children could prevent spasticity and enhance motor function.
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Affiliation(s)
- Junpei Fujimoto
- Department of Rehabilitation Medicine, Wakayama Medical University: 811-1 Kimiidera, Wakayama city, Wakayama 641-8509, Japan.,Aitoku Medical Welfare Center, Japan
| | - Yasunori Umemoto
- Department of Rehabilitation Medicine, Wakayama Medical University: 811-1 Kimiidera, Wakayama city, Wakayama 641-8509, Japan
| | - Yumi Koike
- Department of Rehabilitation Medicine, Wakayama Medical University: 811-1 Kimiidera, Wakayama city, Wakayama 641-8509, Japan
| | - Kazuya Isida
- Department of Rehabilitation Medicine, Wakayama Medical University: 811-1 Kimiidera, Wakayama city, Wakayama 641-8509, Japan
| | - Keiko Sakamoto
- Department of Rehabilitation Medicine, Wakayama Medical University: 811-1 Kimiidera, Wakayama city, Wakayama 641-8509, Japan
| | - Fumihiro Tajima
- Department of Rehabilitation Medicine, Wakayama Medical University: 811-1 Kimiidera, Wakayama city, Wakayama 641-8509, Japan
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Fahr A, Keller JW, van Hedel HJA. A Systematic Review of Training Methods That May Improve Selective Voluntary Motor Control in Children With Spastic Cerebral Palsy. Front Neurol 2020; 11:572038. [PMID: 33343485 PMCID: PMC7746811 DOI: 10.3389/fneur.2020.572038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/09/2020] [Indexed: 01/02/2023] Open
Abstract
Background: Impaired selective voluntary motor control is defined as “the reduced ability to isolate the activation of muscles in response to demands of a voluntary posture or movement.” It is a negative motor sign of an upper motor neuron lesion. Objective: This paper reviews interventions that may improve selective motor control in children and youths with spastic cerebral palsy. The aim was to systematically evaluate the methodological quality and formulate the level of evidence from controlled studies. Methods: Six databases (Scopus, Web of Science, PubMed, Embase, MEDLINE, and CINAHL) were searched with predefined search terms for population, interventions, and outcomes. Two reviewers independently completed study selection and ratings of methodological quality and risk of bias. Evidence was summarized in a best evidence synthesis. Results: Twenty-three studies from initially 2,634 papers were included. The interventions showed a wide variety of approaches, such as constraint-induced movement therapy (CIMT), electrical stimulation, robot-assisted therapy, and functional training. The evidence synthesis revealed conflicting evidence for CIMT, robot-assisted rehabilitation and mirror therapy for the upper extremities in children with cerebral palsy. Conclusions: Final recommendations are difficult due to heterogeneity of the reviewed studies. Studies that include both an intervention and an outcome that specifically focus on selective voluntary motor control are needed to determine the most effective therapy.
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Affiliation(s)
- Annina Fahr
- Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Jeffrey W Keller
- Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Doctoral Program Clinical Science, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Hubertus J A van Hedel
- Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
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22
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Fowler EG, Oppenheim WL, Greenberg MB, Staudt LA, Joshi SH, Silverman DHS. Brain Metabolism During A Lower Extremity Voluntary Movement Task in Children With Spastic Cerebral Palsy. Front Hum Neurosci 2020; 14:159. [PMID: 32528261 PMCID: PMC7263017 DOI: 10.3389/fnhum.2020.00159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/14/2020] [Indexed: 11/13/2022] Open
Abstract
Reduced selective voluntary motor control (SVMC) is a primary impairment due to corticospinal tract (CST) injury in spastic cerebral palsy (CP). There are few studies of brain metabolism in CP and none have examined brain metabolism during a motor task. Nine children with bilateral spastic CP [Age: 6-11 years, Gross Motor Function Classification System (GMFCS) Levels II-V] completed this study. SVMC was evaluated using Selective Control Assessment of the Lower Extremity (SCALE) ranging from 0 (absent) to 10 (normal). Brain metabolism was measured using positron emission tomography (PET) scanning in association with a selective ankle motor task. Whole brain activation maps as well as ROI averaged metabolic activity were correlated with SCALE scores. The contralateral sensorimotor and superior parietal cortex were positively correlated with SCALE scores (p < 0.0005). In contrast, a negative correlation of metabolic activity with SCALE was found in the cerebellum (p < 0.0005). Subsequent ROI analysis showed that both ipsilateral and contralateral cerebellar metabolism correlated with SCALE but the relationship for the ipsilateral cerebellum was stronger (R 2 = 0.80, p < 0.001 vs. R 2 = 0.46, p = 0.045). Decreased cortical and increased cerebellar activation in children with less SVMC may be related to task difficulty, activation of new motor learning paradigms in the cerebellum and potential engagement of alternative motor systems when CSTs are focally damaged. These results support SCALE as a clinical correlate of neurological impairment.
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Affiliation(s)
- Eileen G Fowler
- Center for Cerebral Palsy, Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, CA, United States.,Tarjan Center at UCLA, Los Angeles, CA, United States
| | - William L Oppenheim
- Center for Cerebral Palsy, Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Marcia B Greenberg
- Center for Cerebral Palsy, Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Loretta A Staudt
- Center for Cerebral Palsy, Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Shantanu H Joshi
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, United States
| | - Daniel H S Silverman
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, CA, United States.,Ahmanson Translational Imaging Division, UCLA Health System, Los Angeles, CA, United States
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23
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Inter-Rater Reliability, Concurrent Validity and Sensitivity of Current Methods to Assess Trunk Function in Boccia Player with Cerebral Palsy. Brain Sci 2020; 10:brainsci10030130. [PMID: 32110853 PMCID: PMC7139471 DOI: 10.3390/brainsci10030130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/23/2020] [Accepted: 02/25/2020] [Indexed: 11/16/2022] Open
Abstract
Trunk function is a core factor to allocate Boccia players with cerebral palsy in BC1 and BC2 sport classes, according to the Boccia International Sports Federation (BISFed). However, the appropriateness of the current test to assess trunk function has never been studied to determine its reliability, validity and sensitivity to discriminate between different levels of impairment. Thirty-six players (BC1 = 13 and BC2 = 23) took part in this study. Trunk control was assessed through the BISFed trunk function scale (TFS) and a posturographic test battery consisting of two static and three dynamic tasks. The inter-rater reliability for the BISFed TFS was set at 94.44% of agreement. Moderate-to-high correlations were obtained between posturographic tasks (0.39 < r < 0.96; p < 0.05–0.01), while the BISFed TFS only correlated with two of the dynamic tasks and the overall dynamic score (−0.38 < r < −0.51; p < 0.05). The BISFed TFS was not able to discriminate between sport classes, whereas the static posturographic task did so (p = 0.004). Even though the current BISFed TFS presented good inter-rater reliability, it does not seem to have enough sensitivity to discriminate between BC1 and BC2. Although the static posturographic tasks were able to discriminate between sports classes, it seems necessary to develop new field tests assessing participants’ trunk stabilization abilities.
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Papageorgiou E, Simon-Martinez C, Molenaers G, Ortibus E, Van Campenhout A, Desloovere K. Are spasticity, weakness, selectivity, and passive range of motion related to gait deviations in children with spastic cerebral palsy? A statistical parametric mapping study. PLoS One 2019; 14:e0223363. [PMID: 31603897 PMCID: PMC6788679 DOI: 10.1371/journal.pone.0223363] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 09/19/2019] [Indexed: 01/17/2023] Open
Abstract
This study aimed to identify the relationships between clinical impairments and gait deviations in children with cerebral palsy (CP). A retrospective convenience sample of 367 children with CP was selected (3-18 years old) and divided in two groups based on clinical symptomatology [unilateral (uCP) / bilateral CP (bCP), (n = 167/200)]. All children underwent a three-dimensional gait analysis and a standardized clinical examination. Gait was inspected on a vector level (all sagittal motions combined), and an individual joint level (pelvis, hip, knee and ankle joint motions). Statistical non-parametric mapping was applied to identify specific parts of the gait cycle displaying relationships between the gait deviations of both groups and the impairment scores of spasticity, weakness, selectivity, and passive range of motion. Impairment scores were summarized in two ways: a) composite impairment scores (e.g. combined spasticity of all assessed muscles acting around the hip, knee and ankle joints) and b) joint specific impairment scores (e.g. spasticity of the muscles acting around the knee joint). Results showed that the vector and most of the individual motions were related to the composite scores. Direct and carry-over relationships were found between certain individual motions and joint impairment scores (around the same or neighboring joints, respectively). All correlations were more prominent for children with bCP compared to uCP, especially regarding the relationships of gait deviations with weakness and reduced selectivity. In conclusion, this study enabled the mapping of relationships between clinical impairments and gait deviations in children with CP, by identifying specific parts of the gait cycle that are related to each of these impairments. These results provide a comprehensive description of these relationships, while simultaneously highlighting the differences between the two CP groups. Integration of these findings could lead to a better understanding of the pathophysiology of gait deviations and, eventually, support individualized treatment planning.
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Affiliation(s)
- Eirini Papageorgiou
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
| | | | - Guy Molenaers
- KU Leuven Department of Development and Regeneration, Leuven, Belgium
- Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium
| | - Els Ortibus
- KU Leuven Department of Development and Regeneration, Leuven, Belgium
| | - Anja Van Campenhout
- KU Leuven Department of Development and Regeneration, Leuven, Belgium
- Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium
| | - Kaat Desloovere
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
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25
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Booth ATC, van der Krogt MM, Harlaar J, Dominici N, Buizer AI. Muscle Synergies in Response to Biofeedback-Driven Gait Adaptations in Children With Cerebral Palsy. Front Physiol 2019; 10:1208. [PMID: 31611807 PMCID: PMC6776587 DOI: 10.3389/fphys.2019.01208] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 09/04/2019] [Indexed: 12/26/2022] Open
Abstract
Background Children with cerebral palsy (CP) often show impaired selective motor control (SMC) that induces limitations in motor function. Children with CP can improve aspects of pathological gait in an immediate response to visual biofeedback. It is not known, however, how these gait adaptations are achieved at the neural level, nor do we know the extent of SMC plasticity in CP. Aim Investigate the underlying SMC and changes that may occur when gait is adapted with biofeedback. Methods Twenty-three ambulatory children with CP and related (hereditary) forms of spastic paresis (Aged: 10.4 ± 3.1, 6–16 years, M: 16/F: 9) were challenged with real-time biofeedback to improve step length, knee extension, and ankle power while walking on an instrumented treadmill in a virtual reality environment. The electromyograms of eight superficial muscles of the leg were analyzed and synergies were further decomposed using non-negative matrix factorization (NNMF) using 1 to 5 synergies, to quantify SMC. Total variance accounted for (tVAF) was used as a measure of synergy complexity. An imposed four synergy solution was investigated further to compare similarity in weightings and timing patterns of matched paired synergies between baseline and biofeedback trials. Results Despite changes in walking pattern, changes in synergies were limited. The number of synergies required to explain at least 90% of muscle activation increased significantly, however, the change in measures of tVAF1 from baseline (0.75 ± 0.08) were less than ±2% between trials. In addition, within-subject similarity of synergies to baseline walking was high (>0.8) across all biofeedback trials. Conclusion These results suggest that while gait may be adapted in an immediate response, SMC as quantified by synergy analysis is perhaps more rigidly impaired in CP. Subtle changes in synergies were identified; however, it is questionable if these are clinically meaningful at the level of an individual. Adaptations may be limited in the short term, and further investigation is essential to establish if long term training using biofeedback leads to adapted SMC.
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Affiliation(s)
- Adam T C Booth
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Clinical Applications and Research, Motek Medical BV, Amsterdam, Netherlands
| | - Marjolein M van der Krogt
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - Nadia Dominici
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Institute for Brain and Behavior Amsterdam & Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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26
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Yu Y, Chen X, Cao S, Wu D, Zhang X, Chen X. Gait synergetic neuromuscular control in children with cerebral palsy at different gross motor function classification system levels. J Neurophysiol 2019; 121:1680-1691. [DOI: 10.1152/jn.00580.2018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Cerebral palsy (CP) is a neural developmental disease featured with gait abnormalities. CP gait assessment is usually performed with the Gross Motor Function Classification System (GMFCS) in clinics, which does not involve a thorough assessment of neuromuscular control. To understand how the neuromuscular control disorders lead to gait abnormalities, we explored the relationship between GMFCS levels and the gait synergetic control characteristics in this study. In total, 18 children with CP at different GMFCS levels (mean age: 4.41±1.30 yr) and 8 age-matched typically developing (TD) children (mean age: 4.43±1.36 yr) were recruited to perform a straight walking task, and the surface electromyographic (sEMG) signals from eight lower limb muscles on each side and accelerometer data were collected. A nonnegative matrix factorization method was applied to obtain the muscle synergies from the sEMG signals. Next, synergy structures were projected onto the basic gait synergies to test the completeness of those structures. Subsequently, synergy activation parameters, including total activation duration and coactivation index, were compared across the participants. This study showed that children with CP at GMFCS levels I and II and the TD children had similar synergy structures, but the synergy activations of these children with CP were different from those of TD children. In addition, similar to previous research, we also found that children with CP at GMFCS level III could not access all four basic synergies on both sides. Based on the synergy analysis results, a gait assessment paradigm was proposed to facilitate the clinical CP gait evaluation. NEW & NOTEWORTHY Understanding the mechanism of gait abnormality has important clinical significance for the diagnosis, prognosis, and possible treatment of motor dysfunction in children with cerebral palsy (CP). In this study, the comparisons of the lower limb muscle synergies among different groups of children with CP at different Gross Motor Function Classification System levels might provide some new insight into the mechanism underlying the gait disorder. In particular, the discrepancies of gait synergy structure and activation patterns across the study groups may indicate different neurophysiological and pathological attributes in different groups of patients.
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Affiliation(s)
- Yi Yu
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei, Anhui, China
| | - Xiang Chen
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei, Anhui, China
| | - Shuai Cao
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei, Anhui, China
| | - De Wu
- Department of Pediatrics, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xu Zhang
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei, Anhui, China
| | - Xun Chen
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei, Anhui, China
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27
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Vova JA, Eggebrecht EM. Utilizing Functional Electrical Stimulation and Exoskeletons in Pediatrics: a Closer Look at Their Roles in Gait and Functional Changes in Cerebral Palsy. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2019. [DOI: 10.1007/s40141-019-00215-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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28
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Combining muscle morphology and neuromotor symptoms to explain abnormal gait at the ankle joint level in cerebral palsy. Gait Posture 2019; 68:531-537. [PMID: 30623848 DOI: 10.1016/j.gaitpost.2018.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 10/24/2018] [Accepted: 12/03/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Individuals with spastic cerebral palsy (CP) have neuromotor symptoms contributing towards their gait patterns. However, the role of altered muscle morphology alongside these symptoms is yet to be fully investigated. RESEARCH QUESTION To what extent can medial gastrocnemius and tibialis anterior volume and echo-intensity, plantar/dorsiflexion strength and selective motor control, plantarflexion spasticity and passive ankle dorsiflexion explain abnormal ankle gait. METHOD In thirty children and adolescents with spastic CP (8.6 ± 3.4 y/mo) and ten typically developing peers (9.9 ± 2.4 y/mo), normalised muscle volume and echo-intensity were estimated. Both cohorts also underwent three-dimensional gait analysis, whilst for participants with spastic CP, plantar/dorsi-flexion strength and selective motor control, plantarflexion spasticity and maximum ankle dorsiflexion were also measured. The combined contribution of these parameters towards five clinically meaningful features of gait were evaluated, using backwards multiple regression analyses. RESULTS With respect to the typically developing cohort, the participants with spastic CP had deficits in normalised medial gastrocnemius and tibialis anterior volume of 40% and 33%, and increased echo-intensity values of 19% and 16%, respectively. The backwards multiple regression analyses revealed that the combination of reduced ankle dorsiflexion, muscle volume, plantarflexion strength and dorsiflexion selective motor control could account for 12-62% of the variance in the chosen features of gait. SIGNIFICANCE The combination of altered muscle morphology and neuromotor symptoms partly explained abnormal gait at the ankle in children with spastic CP. Both should be considered as important measures for informed treatment decision-making, but further work is required to better unravel the complex pathophysiology.
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29
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Zhou JY, Lowe E, Cahill-Rowley K, Mahtani GB, Young JL, Rose J. Influence of impaired selective motor control on gait in children with cerebral palsy. J Child Orthop 2019; 13:73-81. [PMID: 30838079 PMCID: PMC6376443 DOI: 10.1302/1863-2548.13.180013] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Spastic cerebral palsy (CP) is characterized by four neuromuscular deficits: weakness, short muscle-tendon unit, muscle spasticity and impaired selective motor control (SMC). We examined the influence of impaired SMC on gait in children with bilateral spastic CP. Delineating the influence of neuromuscular deficits on gait abnormalities can guide surgical and therapeutic interventions to reduce long-term debilitating effects of CP. METHODS The relationship between impaired SMC and gait was assessed using multivariate linear regression analysis of Selective Control Assessment of the Lower Extremity (SCALE) in relation to stance phase knee flexion and temporal-spatial gait parameters calculated using 3D kinematics for 57 children with bilateral spastic CP, ages seven to 11 years. RESULTS Mean SCALE values were 5.8 (0 to 10, sd 3.0) and 5.7 (0 to 10, sd 2.9) for right and left legs, respectively. Multivariate linear regression models, including right and left SCALE and height, significantly predicted right and left knee flexion at initial contact (R = 0.479, p = 0.003; R = 0.452, p = 0.007, respectively) and right and left knee flexion in midstance (R = 0.428, p = 0.013; R = 0.407, p = 0.022, respectively). The model significantly predicted right and left step length (R = 0.645, p = 0.000; R = 0.523, p = 0.001, respectively) and predicted gait velocity (R = 0.444, p = 0.008). The model including SCALE did not predict step width. CONCLUSION Results indicate impaired SMC predicts increased knee flexion at initial contact, and reduces step length and velocity. Understanding the influence of impaired SMC on gait can inform decisions regarding therapy and surgery, such as hamstring lengthening. LEVEL OF EVIDENCE Level II Retrospective Study.
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Affiliation(s)
- J. Y. Zhou
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA and Motion & Gait Analysis Laboratory, Lucile Salter Packard Children’s Hospital, Palo Alto, CA, USA
| | - E. Lowe
- Motion & Gait Analysis Laboratory, Lucile Salter Packard Children’s Hospital, Palo Alto, CA, USA
| | - K. Cahill-Rowley
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA and Motion & Gait Analysis Laboratory, Lucile Salter Packard Children’s Hospital, Palo Alto, CA, USA
| | - G. B. Mahtani
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA and Motion & Gait Analysis Laboratory, Lucile Salter Packard Children’s Hospital, Palo Alto, CA, USA
| | - J. L. Young
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA and Motion & Gait Analysis Laboratory, Lucile Salter Packard Children’s Hospital, Palo Alto, CA, USA
| | - J. Rose
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA and Motion & Gait Analysis Laboratory, Lucile Salter Packard Children’s Hospital, Palo Alto, CA, USA, Correspondence should be sent to J. Rose, PhD, Professor, Department of Orthopaedic Surgery, 770 Welch Road, Suite 400, Stanford, CA 94304, USA. E-mail:
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30
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Aycardi LF, Cifuentes CA, Múnera M, Bayón C, Ramírez O, Lerma S, Frizera A, Rocon E. Evaluation of biomechanical gait parameters of patients with Cerebral Palsy at three different levels of gait assistance using the CPWalker. J Neuroeng Rehabil 2019; 16:15. [PMID: 30691493 PMCID: PMC6350321 DOI: 10.1186/s12984-019-0485-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 01/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cerebral Palsy (CP) is the most common cause of permanent serious physical disability in childhood. Although many platforms have been developed, so far there are still not precise guidelines for the rehabilitation of the population with CP. The CPWalker is a robotic platform for the rehabilitation of children with CP, through which they can start experiencing autonomous locomotion in the rehabilitation environment. It allows the possibility of free movement and includes physical and cognitive interfaces into the therapy. The main objective of this work is to evaluate the effects of the CPWalker-based rehabilitation intervention in children with CP by comparing different gait parameters before, during and after the use of the platform. FINDINGS The evaluation was divided in three stages where the gait parameters and symmetry indexes of eight subjects with CP were evaluated. In the first stage patients walked only with the help they receive normally in daily life. During the second stage they walked with the CPWalker and finally, in the third stage, they repeated their gait without the platform. In all stages they wore an inertial G-Sensor Ⓡ while walking through the hospital facilities. The results showed statistical significant differences in several spatio-temporal parameters, pelvic angles and general gait cycle parameters, with and without the use of the robotic device. For the eight patients: cadence, speed and stride length presented similar values when comparing before and after the therapy. However, they decreased during the intervention (both means and standard deviations). No significant differences were found in the symmetry indexes with the use of the platform. In spite of this, a reduction in the pelvic angles ranges and propulsion was observed. CONCLUSIONS The effect of using the device was analyzed for spatio-temporal parameters, pelvic girdle angles and general gait cycle parameters. Among the eighteen initial parameters, seven presented a statistical significant difference when comparing stage 2 of the intervention with stages 1 and 3. Those changes showed the potential of the CPWalker to improve muscular strength and gait patterns of the patients with CP in the long term and to provide useful information for the design of the future generations of rehabilitation robotic devices.
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Affiliation(s)
- Luis Felipe Aycardi
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogotá, Colombia
| | - Carlos Andrés Cifuentes
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogotá, Colombia
| | - Marcela Múnera
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogotá, Colombia
| | - Cristina Bayón
- Neural and Cognitive Engineering Group, CAR of the Spanish National Research Council (CSIC), Arganda del Rey, Madrid, 28500, Spain
| | - Oscar Ramírez
- Neural and Cognitive Engineering Group, CAR of the Spanish National Research Council (CSIC), Arganda del Rey, Madrid, 28500, Spain
| | | | - Anselmo Frizera
- Department of Electrical Engineering, Federal University of Espirito Santo, ES, Vitória, 29075-910, Brazil
| | - Eduardo Rocon
- Neural and Cognitive Engineering Group, CAR of the Spanish National Research Council (CSIC), Arganda del Rey, Madrid, 28500, Spain.
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Pingel J, Andersen JD, Christiansen SL, Børsting C, Morling N, Lorentzen J, Kirk H, Doessing S, Wong C, Nielsen JB. Sequence variants in muscle tissue-related genes may determine the severity of muscle contractures in cerebral palsy. Am J Med Genet B Neuropsychiatr Genet 2019; 180:12-24. [PMID: 30467950 DOI: 10.1002/ajmg.b.32693] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 07/20/2018] [Accepted: 09/20/2018] [Indexed: 12/30/2022]
Abstract
Muscle contractures are a common complication to cerebral palsy (CP). The purpose of this study was to evaluate whether individuals with CP carry specific gene variants of important structural genes that might explain the severity of muscle contractures. Next-generation-sequencing (NGS) of 96 candidate genes associated with muscle structure and metabolism were analyzed in 43 individuals with CP (Gross Motor Function classification system [GMFCS] I, n=10; GMFCS II, n=14; GMFCS III, n=19) and four control participants. In silico analysis of the identified variants was performed. The variants were classified into four categories ranging from likely benign (VUS0) to highly likely functional effect (VUS3). All individuals with CP were classified and grouped according to their GMFCS level: Statistical comparisons were made between GMFCS groups. Kruskal-Wallis tests showed significantly more VUS2 variants in the genes COL4 (GMFCS I-III; 1, 1, 5, respectively [p < .04]), COL5 (GMFCS I-III; 1, 1, 5 [p < .04]), COL6 (GMFCS I-III; 0, 4, 7 [p < .003]), and COL9 (GMFCS I-III; 1, 1, 5 [p < .04]), in individuals with CP within GMFCS Level III when compared to the other GMFCS levels. Furthermore, significantly more VUS3 variants in COL6 (GMFCS I-III; 0, 5, 2 [p < .01]) and COL7 (GMFCS I-III; 0, 3, 0 [p < .04]) were identified in the GMFCS II level when compared to the other GMFCS levels. The present results highlight several candidate gene variants in different collagen types with likely functional effects in individuals with CP.
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Affiliation(s)
- Jessica Pingel
- Department of Neuroscience and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jeppe Dyrberg Andersen
- Department of Forensic Medicine, Section of Forensic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sofie Lindgren Christiansen
- Department of Forensic Medicine, Section of Forensic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Claus Børsting
- Department of Forensic Medicine, Section of Forensic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels Morling
- Department of Forensic Medicine, Section of Forensic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Lorentzen
- Department of Neuroscience and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Helene Elsass Center, Charlottenlund, Denmark
| | - Henrik Kirk
- Department of Neuroscience and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Helene Elsass Center, Charlottenlund, Denmark
| | - Simon Doessing
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Christian Wong
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Jens Bo Nielsen
- Department of Neuroscience and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Helene Elsass Center, Charlottenlund, Denmark
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32
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Noble JJ, Gough M, Shortland AP. Selective motor control and gross motor function in bilateral spastic cerebral palsy. Dev Med Child Neurol 2019; 61:57-61. [PMID: 30203469 DOI: 10.1111/dmcn.14024] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2018] [Indexed: 11/30/2022]
Abstract
AIM To investigate the relationship between selective motor control (SMC), muscle volume, and spasticity with gross motor function in adolescents and young adults with bilateral spastic cerebral palsy (CP). METHOD Eleven male participants with CP (mean age 15y 7mo, standard deviation 3y 6mo, range 12y 1mo-23y 1mo) in Gross Motor Function Classification System (GMFCS) levels I to IV took part in this cross-sectional study. Magnetic resonance imaging (MRI) of both lower limbs of all participants were acquired, from which 18 muscles were manually segmented and muscle volume calculated by a single assessor. Muscle volumes were normalized to body mass and averaged between limbs for each individual. SMC was assessed using Selective Control Assessment of the Lower Extremity (SCALE). Spasticity was assessed using the Modified Ashworth Scale (MAS), and gross motor functional ability was assessed using the Gross Motor Function Measure (GMFM-66). RESULTS GMFM-66 was strongly positively correlated to SCALE (r=0.901, p≤0.001) and lower limb muscle volume normalized to body mass (r=0.750, p=0.008). MAS was significantly correlated with GMFM-66 (r=-0.691, p=0.018). INTERPRETATION SMC is a major factor influencing gross motor function in individuals with CP. Lower limb muscle volume and spasticity also influence gross motor function. WHAT THIS PAPER ADDS Selective motor control is a major factor of gross motor function in adolescents and young adults with bilateral cerebral palsy (CP). Gross motor function is related to muscle size and level of spasticity in adolescents and young adults with bilateral CP.
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Affiliation(s)
- Jonathan J Noble
- One Small Step Gait Laboratory, Evelina London Children's Hospital, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Martin Gough
- One Small Step Gait Laboratory, Evelina London Children's Hospital, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Adam P Shortland
- One Small Step Gait Laboratory, Evelina London Children's Hospital, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,The Rayne Institute, St Thomas' Hospital, King's College London, London, UK
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33
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Balzer J, Marsico P, Mitteregger E, van der Linden ML, Mercer TH, van Hedel HJA. Influence of trunk control and lower extremity impairments on gait capacity in children with cerebral palsy. Disabil Rehabil 2017; 40:3164-3170. [PMID: 28944697 DOI: 10.1080/09638288.2017.1380719] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE We investigated the combined impact of trunk control and lower extremities impairments on predicting gait capacity in children with cerebral palsy (CP) and evaluated relationships between trunk control and lower extremities impairments. METHODS Data of 52 children with CP [29 boys, mean age 11 years 9 months (±4 years 6 months)] were included in this observational study. Gait capacity was measured by the "modified Time Up and Go test". Experienced therapists performed the "Modified Ashworth Scale", "Manual Muscle Test", the "Selective Control Assessment of the Lower Extremity", and the "Trunk Control Measurement Scale". We calculated Spearman correlations coefficients (ρ) and performed regression analyses. RESULTS Trunk control was the strongest predictor (β = -0.624, p < 0.001) when explaining the variance of gait capacity and remained in the model together with spasticity (R2 = 0.67). Muscle strength and selectivity correlated moderately to strongly with the trunk control and gait capacity (-0.68 ≤ ρ ≤ -0.78), but correlations for the spasticity were low (ρ<-0.3). CONCLUSIONS The interconnection between trunk control, leg muscle strength and selectivity for gait capacity in children with CP was shown. It indicates the significance of these impairments in gait assessment and, potentially, rehabilitation. Implications for Rehabilitation Trunk control was the strongest predictor for gait capacity in a regression model with lower extremity spasticity, muscle strength and selectivity and age as independent variables. Lower extremity muscle strength, selectivity, and trunk control explained a similar amount of gait capacity variance which is higher than that explained by lower extremity spasticity. Lower extremity muscle strength and selectivity correlated strongly with trunk control. Therefore, we cautiously suggest that a combined trunk control and lower extremity training might be promising for improving gait capacity in children with CP (Gross Motor Function Classification System level I-III), which needed to be tested in future intervention-studies.
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Affiliation(s)
- Julia Balzer
- a Pediatric Rehab Research Group , Rehabilitation Center Affoltern am Albis, University Children's Hospital Zurich , Affoltern am Albis , Switzerland
| | - Petra Marsico
- a Pediatric Rehab Research Group , Rehabilitation Center Affoltern am Albis, University Children's Hospital Zurich , Affoltern am Albis , Switzerland
| | - Elena Mitteregger
- a Pediatric Rehab Research Group , Rehabilitation Center Affoltern am Albis, University Children's Hospital Zurich , Affoltern am Albis , Switzerland.,b Regional Group Zurich Foundation Cerebral Palsy (RGZ) , Zurich , Switzerland.,c Institute for Physiotherapy, Zurich University of Applied Studies, ZHAW , Winterthur , Switzerland
| | - Marietta L van der Linden
- d Centre for Health, Activity and Rehabilitation Research, Queen Margaret University , Edinburgh , Scotland
| | - Thomas H Mercer
- d Centre for Health, Activity and Rehabilitation Research, Queen Margaret University , Edinburgh , Scotland
| | - Hubertus J A van Hedel
- a Pediatric Rehab Research Group , Rehabilitation Center Affoltern am Albis, University Children's Hospital Zurich , Affoltern am Albis , Switzerland
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Mailleux L, Jaspers E, Ortibus E, Simon-Martinez C, Desloovere K, Molenaers G, Klingels K, Feys H. Clinical assessment and three-dimensional movement analysis: An integrated approach for upper limb evaluation in children with unilateral cerebral palsy. PLoS One 2017; 12:e0180196. [PMID: 28671953 PMCID: PMC5495347 DOI: 10.1371/journal.pone.0180196] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 06/12/2017] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION The clinical application of upper limb (UL) three-dimensional movement analysis (3DMA) in children with unilateral cerebral palsy (uCP) remains challenging, despite its benefits compared to conventional clinical scales. Moreover, knowledge on UL movement pathology and how this relates to clinical parameters remains scarce. Therefore, we investigated UL kinematics across different manual ability classification system (MACS) levels and explored the relation between clinical and kinematic parameters in children with uCP. PATIENTS AND METHODS Fifty children (MACS: I = 15, II = 26, III = 9) underwent an UL evaluation of sensorimotor impairments (grip force, muscle strength, muscle tone, two-point discrimination, stereognosis), bimanual performance (Assisting Hand Assessment, AHA), unimanual capacity (Melbourne Assessment 2, MA2) and UL-3DMA during hand-to-head, hand-to-mouth and reach-to-grasp tasks. Global parameters (Arm Profile Score (APS), duration, (timing of) maximum velocity, trajectory straightness) and joint specific parameters (angles at task endpoint, ROM and Arm Variable Scores (AVS)) were extracted. The APS and AVS refer respectively to the total amount of movement pathology and movement deviations of wrist, elbow, shoulder, scapula and trunk. RESULTS Longer movement durations and increased APS were found with higher MACS-levels (p<0.001). Increased APS was also associated with more severe sensorimotor impairments (r = -0.30-(-0.73)) and with lower AHA and MA2-scores (r = -0.50-(-0.86)). For the joint specific parameters, stronger movement deviations distally were significantly associated with increased muscle weakness (r = -0.32-(-0.74)) and muscle tone (r = 0.33-(-0.61)); proximal movement deviations correlated only with muscle weakness (r = -0.35-0.59). Regression analysis exposed grip force as the most important predictor for the variability in APS (p<0.002). CONCLUSION We found increased movement pathology with increasing MACS-levels and demonstrated the adverse impact of especially muscle weakness. The lower correlations suggest that 3DMA provides additional information regarding UL motor function, particularly for the proximal joints. Integrating both methods seems clinically meaningful to obtain a comprehensive representation of all aspects of a child's UL functioning.
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Affiliation(s)
- Lisa Mailleux
- KU Leuven–University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- * E-mail:
| | - Ellen Jaspers
- KU Leuven–University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Els Ortibus
- KU Leuven–University of Leuven, Department of Development and Regeneration, Leuven, Belgium
| | | | - Kaat Desloovere
- KU Leuven–University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- University Hospitals Leuven, Clinical Motion Analysis Laboratory, Leuven, Belgium
| | - Guy Molenaers
- KU Leuven–University of Leuven, Department of Development and Regeneration, Leuven, Belgium
- University Hospitals Leuven, Department of Orthopaedic Medicine, Leuven, Belgium
| | - Katrijn Klingels
- KU Leuven–University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- UHasselt–Hasselt University, BIOMED, Rehabilitation Research Center (REVAL), Diepenbeek, Belgium
| | - Hilde Feys
- KU Leuven–University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
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Zhou J, Butler EE, Rose J. Neurologic Correlates of Gait Abnormalities in Cerebral Palsy: Implications for Treatment. Front Hum Neurosci 2017; 11:103. [PMID: 28367118 PMCID: PMC5355477 DOI: 10.3389/fnhum.2017.00103] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 02/20/2017] [Indexed: 01/17/2023] Open
Abstract
Cerebral palsy (CP) is the most common movement disorder in children. A diagnosis of CP is often made based on abnormal muscle tone or posture, a delay in reaching motor milestones, or the presence of gait abnormalities in young children. Neuroimaging of high-risk neonates and of children diagnosed with CP have identified patterns of neurologic injury associated with CP, however, the neural underpinnings of common gait abnormalities remain largely uncharacterized. Here, we review the nature of the brain injury in CP, as well as the neuromuscular deficits and subsequent gait abnormalities common among children with CP. We first discuss brain injury in terms of mechanism, pattern, and time of injury during the prenatal, perinatal, or postnatal period in preterm and term-born children. Second, we outline neuromuscular deficits of CP with a focus on spastic CP, characterized by muscle weakness, shortened muscle-tendon unit, spasticity, and impaired selective motor control, on both a microscopic and functional level. Third, we examine the influence of neuromuscular deficits on gait abnormalities in CP, while considering emerging information on neural correlates of gait abnormalities and the implications for strategic treatment. This review of the neural basis of gait abnormalities in CP discusses what is known about links between the location and extent of brain injury and the type and severity of CP, in relation to the associated neuromuscular deficits, and subsequent gait abnormalities. Targeted treatment opportunities are identified that may improve functional outcomes for children with CP. By providing this context on the neural basis of gait abnormalities in CP, we hope to highlight areas of further research that can reduce the long-term, debilitating effects of CP.
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Affiliation(s)
- Joanne Zhou
- Department of Orthopaedic Surgery, Stanford UniversityStanford, CA, USA; Motion and Gait Analysis Lab, Lucile Packard Children's HospitalPalo Alto, CA, USA
| | - Erin E Butler
- Thayer School of Engineering, Dartmouth CollegeHanover, NH, USA; Neukom Institute for Computational Sciences, Dartmouth CollegeHanover, NH, USA
| | - Jessica Rose
- Department of Orthopaedic Surgery, Stanford UniversityStanford, CA, USA; Motion and Gait Analysis Lab, Lucile Packard Children's HospitalPalo Alto, CA, USA
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