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Bowersock CD, Lerner ZF. Comparing the effectiveness of robotic plantarflexion resistance and biofeedback between overground and treadmill walking. J Biomech 2024; 175:112282. [PMID: 39182263 DOI: 10.1016/j.jbiomech.2024.112282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 07/22/2024] [Accepted: 08/16/2024] [Indexed: 08/27/2024]
Abstract
Individuals with diminished walking performance caused by neuromuscular impairments often lack plantar flexion muscle activity. Robotic devices have been developed to address these issues and increase walking performance. While these devices have shown promise in their ability to increase musculature engagement of the lower limbs when used on a treadmill, most have not been developed or validated for overground walking and community use. Overground walking may limit the effectiveness of robotic devices due to differences in gait characteristics between walking terrains and reduced user engagement. The purpose of this study was to validate our multimodal robotic gait training system for overground walking in individuals with neuromuscular gait impairments. This untethered wearable robotic device can provide an ankle resistive torque proportional to the users' biological ankle torque. The device can also provide audio biofeedback based on users' plantar pressure intending to increase ankle power and muscle activity of the plantar flexors. Seven individuals with cerebral palsy participated. Participants walked overground and on a treadmill with our robotic gait training system in a single testing session. Results showed all seven participants to increase peak plantar flexor muscle activity, 10.3% on average, when walking with the gait trainer overground compared to treadmill. When compared to typical baseline overground walking, overground gait trainer use caused individuals to have slightly less knee joint excursion (3°) and moderately more ankle joint excursion (7°). This work supports our vision of using the wearable robotic device as a gait aid and rehabilitation tool in the home and community settings.
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Affiliation(s)
- Collin D Bowersock
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ, United States.
| | - Zachary F Lerner
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ, United States; College of Medicine - Phoenix, University of Arizona, Phoenix, AZ, United States.
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Koller W, Wallnöfer E, Holder J, Kranzl A, Mindler G, Baca A, Kainz H. ESMAC Best Paper Award 2023: Increased knee flexion in participants with cerebral palsy results in altered stresses at the distal femoral growth plate compared to a typically developing cohort. Gait Posture 2024; 113:158-166. [PMID: 38905850 DOI: 10.1016/j.gaitpost.2024.06.012] [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: 12/09/2023] [Revised: 05/21/2024] [Accepted: 06/17/2024] [Indexed: 06/23/2024]
Abstract
INTRODUCTION Femoral deformities are highly prevalent in children with cerebral palsy (CP) and can have a severe impact on patients' gait abilities. While the mechanical stress regime within the distal femoral growth plate remains underexplored, understanding it is crucial given bone's adaptive response to mechanical stimuli. We quantified stresses at the distal femoral growth plate to deepen our understanding of the relationship between healthy and pathological gait patterns, internal loading, and femoral growth patterns. METHODS This study included three-dimensional motion capture data and magnetic resonance images of 13 typically developing children and twelve participants with cerebral palsy. Employing a multi-scale mechanobiological approach, integrating musculoskeletal simulations and subject-specific finite element analysis, we investigated the orientation of the distal femoral growth plate and the stresses within it. Limbs of participants with CP were grouped depending on their knee flexion kinematics during stance phase as this potentially changes the stresses induced by knee and patellofemoral joint contact forces. RESULTS Despite similar growth plate orientation across groups, significant differences were observed in the shape and distribution of growth values. Higher growth rates were noted in the anterior compartment in CP limbs with high knee flexion while CP limbs with normal knee flexion showed high similarity to the group of healthy participants. DISCUSSION Results indicate that the knee flexion angle during the stance phase is of high relevance for typical bone growth at the distal femur. The evaluated growth rates reveal plausible results, as long-term promoted growth in the anterior compartment leads to anterior bending of the femur which was confirmed for the group with high knee flexion through analyses of the femoral geometry. The framework for these multi-scale simulations has been made accessible on GitHub, empowering peers to conduct similar mechanobiological studies. Advancing our understanding of femoral bone development could ultimately support clinical decision-making.
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Affiliation(s)
- Willi Koller
- Department of Sport and Human Movement Science, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria; Neuromechanics Research Group, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria; Vienna Doctoral School of Pharmaceutical, Nutritional and Sport Sciences, University of Vienna, Vienna, Austria.
| | - Elias Wallnöfer
- Department of Sport and Human Movement Science, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria; Neuromechanics Research Group, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Jana Holder
- Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria
| | - Andreas Kranzl
- Laboratory for Gait and Human Movements, Orthopaedic Hospital Speising, Vienna, Austria; Vienna Bone and Growth Center, Vienna, Austria
| | - Gabriel Mindler
- Department of Pediatric Orthopaedics, Orthopaedic Hospital Speising, Vienna, Austria; Vienna Bone and Growth Center, Vienna, Austria
| | - Arnold Baca
- Department of Sport and Human Movement Science, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Hans Kainz
- Department of Sport and Human Movement Science, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria; Neuromechanics Research Group, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
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Al-masni MA, Marzban EN, Al-Shamiri AK, Al-antari MA, Alabdulhafith MI, Mahmoud NF, Abdel Samee N, Kadah YM. Gait Impairment Analysis Using Silhouette Sinogram Signals and Assisted Knowledge Learning. Bioengineering (Basel) 2024; 11:477. [PMID: 38790344 PMCID: PMC11118059 DOI: 10.3390/bioengineering11050477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
The analysis of body motion is a valuable tool in the assessment and diagnosis of gait impairments, particularly those related to neurological disorders. In this study, we propose a novel automated system leveraging artificial intelligence for efficiently analyzing gait impairment from video-recorded images. The proposed methodology encompasses three key aspects. First, we generate a novel one-dimensional representation of each silhouette image, termed a silhouette sinogram, by computing the distance and angle between the centroid and each detected boundary points. This process enables us to effectively utilize relative variations in motion at different angles to detect gait patterns. Second, a one-dimensional convolutional neural network (1D CNN) model is developed and trained by incorporating the consecutive silhouette sinogram signals of silhouette frames to capture spatiotemporal information via assisted knowledge learning. This process allows the network to capture a broader context and temporal dependencies within the gait cycle, enabling a more accurate diagnosis of gait abnormalities. This study conducts training and an evaluation utilizing the publicly accessible INIT GAIT database. Finally, two evaluation schemes are employed: one leveraging individual silhouette frames and the other operating at the subject level, utilizing a majority voting technique. The outcomes of the proposed method showed superior enhancements in gait impairment recognition, with overall F1-scores of 100%, 90.62%, and 77.32% when evaluated based on sinogram signals, and 100%, 100%, and 83.33% when evaluated based on the subject level, for cases involving two, four, and six gait abnormalities, respectively. In conclusion, by comparing the observed locomotor function to a conventional gait pattern often seen in healthy individuals, the recommended approach allows for a quantitative and non-invasive evaluation of locomotion.
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Affiliation(s)
- Mohammed A. Al-masni
- Department of Artificial Intelligence and Data Science, College of Software & Convergence Technology, Sejong University, Seoul 05006, Republic of Korea; (M.A.A.-m.); (M.A.A.-a.)
| | - Eman N. Marzban
- Biomedical Engineering Department, Cairo University, Giza 12613, Egypt;
| | - Abobakr Khalil Al-Shamiri
- School of Computer Science, University of Southampton Malaysia, Iskandar Puteri 79100, Johor, Malaysia;
| | - Mugahed A. Al-antari
- Department of Artificial Intelligence and Data Science, College of Software & Convergence Technology, Sejong University, Seoul 05006, Republic of Korea; (M.A.A.-m.); (M.A.A.-a.)
| | - Maali Ibrahim Alabdulhafith
- Department of Information Technology, College of Computer and Information Sciences, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia;
| | - Noha F. Mahmoud
- Rehabilitation Sciences Department, Health and Rehabilitation Sciences College, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia;
| | - Nagwan Abdel Samee
- Department of Information Technology, College of Computer and Information Sciences, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia;
| | - Yasser M. Kadah
- Electrical and Computer Engineering Department, King Abdulaziz University, Jeddah 22254, Saudi Arabia;
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Papageorgiou E, Peeters N, Staut L, Molenaers G, Ortibus E, Van Campenhout A, Desloovere K. Botulinum neurotoxin type A responders among children with spastic cerebral palsy: Pattern-specific effects. Eur J Paediatr Neurol 2024; 49:131-140. [PMID: 38518417 DOI: 10.1016/j.ejpn.2024.02.017] [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: 02/02/2023] [Revised: 10/31/2023] [Accepted: 02/29/2024] [Indexed: 03/24/2024]
Abstract
AIM To identify short-term effects of botulinum neurotoxin type A (BoNT) injections on gait and clinical impairments, in children with spastic cerebral palsy (CP), based on baseline gait pattern-specific subgroups. METHOD Short-term effects of BoNT injections in the medial hamstrings and gastrocnemius were defined in a retrospective convenience sample of 117 children with CP (median age: 6 years 4 months; GMFCS I/II/III: 70/31/16; unilateral/bilateral: 56/61) who had received gait analyses before and 2 months post-BoNT. First, baseline gait patterns were classified. Statistical and meaningful changes were calculated between pre- and post-BoNT lower limb sagittal plane kinematic waveforms, the gait profile score, and non-dimensional spatiotemporal parameters for the entire sample and for pattern-specific subgroups. These gait waveforms per CP subgroup at pre- and post-BoNT were also compared to typically developing gait and composite scores for spasticity, weakness, and selectivity were compared between the two conditions. RESULTS Kinematic improvements post-BoNT were identified at the ankle and knee for the entire sample, and for subgroups with apparent equinus and jump gait. Limbs with baseline patterns of dropfoot and to a lesser extent true equinus showed clear improvements only at the ankle. In apparent equinus, jump gait, and dropfoot, spasticity improved post-BoNT, without leading to increased weakness or diminished selectivity. Compared to typical gait, knee and hip motion improved in the crouch gait subgroup post-BoNT. CONCLUSION This comprehensive analysis highlighted the importance of investigating BoNT effects on gait and clinical impairments according to baseline gait patterns. These findings may help identify good treatment responders.
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Affiliation(s)
- E Papageorgiou
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium.
| | - N Peeters
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
| | - L Staut
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
| | - G Molenaers
- KU Leuven, Locomotor and Neurological Disorders, Department of Development and Regeneration, Leuven, Belgium; Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium
| | - E Ortibus
- KU Leuven, Locomotor and Neurological Disorders, Department of Development and Regeneration, Leuven, Belgium; Center for Developmental Disabilities, Leuven, Belgium
| | - A Van Campenhout
- KU Leuven, Locomotor and Neurological Disorders, Department of Development and Regeneration, Leuven, Belgium; Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium
| | - K Desloovere
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
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Goihl T, Rusaw DF, Roeleveld K, Brændvik SM. Provision of ankle foot orthoses for children with cerebral palsy in Norway. J Rehabil Assist Technol Eng 2024; 11:20556683241276804. [PMID: 39351287 PMCID: PMC11440621 DOI: 10.1177/20556683241276804] [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: 03/02/2024] [Revised: 07/30/2024] [Accepted: 08/06/2024] [Indexed: 10/04/2024] Open
Abstract
Introduction Practice of ankle-foot orthoses (AFO) provision for ambulatory children with cerebral palsy is underreported and the literature is not consistent on choice of AFO-design. This study describes clinical practice of AFO provision for children with cerebral palsy and evaluates how clinical practice aligns with existing recommendations. Methods An online, cross-sectional survey was conducted, inviting all Norwegian orthotists working with children with cerebral palsy. Orthotic practice was investigated using a self-reported survey design. Results From all eligible orthotists, 54% responded, revealing that AFO provision involves patients, physicians, and physiotherapists at different stages. Patient preference directly influenced the ultimate AFO-design. Shank vertical angle was evaluated by 79%. For children with crouch gait and those with short gastrocnemius, a majority preferred a combination of rigid and articulated/flexible AFO-designs. Instrumented gait analysis was conducted by 51% at AFO delivery stage. Conclusions The findings show that AFO provision in Norway is collaborative, involving clinical team members and consideration of patient preferences. A discrepancy between clinical practice and existing recommendations for children with crouch gait and those with short gastrocnemius is observed.
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Affiliation(s)
- Tobias Goihl
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
- Trøndelag Orthopaedic Workshop, TOV, Trondheim, Norway
| | - David F Rusaw
- Department of Rehabilitation, Jönköping University, Jönköping, Sweden
| | - Karin Roeleveld
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Siri Merete Brændvik
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
- Clinical services, St.Olavs University Hospital, Trondheim, Norway
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Gómez-Pérez C, Vidal Samsó J, Puig Diví A, Medina Casanovas J, Font-Llagunes JM, Martori JC. Relationship between spatiotemporal parameters and clinical outcomes in children with bilateral spastic cerebral palsy: Clinical interpretation proposal. J Orthop Sci 2023; 28:1136-1142. [PMID: 36216726 DOI: 10.1016/j.jos.2022.08.011] [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: 04/17/2022] [Revised: 08/10/2022] [Accepted: 08/31/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Understanding the links between gait disorders, impairments, and activity limitations is essential for correctly interpreting the instrumented gait analysis. We aimed to evaluate the relationships between spatiotemporal parameters and clinical outcomes in children with bilateral spastic cerebral palsy, and find out whether spatiotemporal parameters provide clinical information regarding gait pattern and walking. METHODS Data from 19 children with bilateral spastic cerebral palsy (nine males, ten females, 9.6 ± 2.8 years old) were collected retrospectively. All children underwent an instrumented gait analysis and a standardized clinical assessment. Seven spatiotemporal parameters were calculated: non-dimensional cadence, stride length, step width, gait speed, first double support, single support, and time of toe off. Clinical outcomes included measures of two different components of the International Classification of Functioning, Disability and Health - Children and Youth version: body functions and structures (spasticity, contractures and range of motion, and deformities), and activities and participation (gross motor function, and walking capacity). Pearson correlation, ANOVA, Student's t, Mann-Whitney U, and Kruskal-Wallis tests were used to analyze relationships. Spatiotemporal parameters related to clinical outcomes of body functions and structures were interpreted as outcome measures of gait pattern, while those related to clinical outcomes of activities and participation were interpreted as outcome measures of walking. RESULTS Non-dimensional cadence, stride length, and gait speed showed relationships (p < 0.05) with hip flexors spasticity and hindfoot deformity, ankle plantar flexors spasticity, and hindfoot deformity, respectively. All spatiotemporal parameters except non-dimensional cadence showed correlation (p < 0.05) with gross motor function and walking capacity. CONCLUSIONS Spatiotemporal parameters provide clinical information regarding both gait pattern and walking.
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Affiliation(s)
- Cristina Gómez-Pérez
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M(3)O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain.
| | - Joan Vidal Samsó
- Institut Guttmann, Hospital de Neurorehabilitació, Badalona, Spain; Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Albert Puig Diví
- Blanquerna School of Health Sciences - Ramon Llull University, Barcelona, Spain
| | - Josep Medina Casanovas
- Institut Guttmann, Hospital de Neurorehabilitació, Badalona, Spain; Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Josep M Font-Llagunes
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Joan Carles Martori
- Data Analysis and Modeling Research Group, Department of Economics and Business, Faculty of Business and Communication Studies, University of Vic - Central University of Catalonia (UVic-UCC), Vic, Spain
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Tavasoli S, Tavasoli M, Shojaeefard M, Farahmand F. Analysis of cerebral palsy gait based on movement primitives. Clin Biomech (Bristol, Avon) 2023; 104:105947. [PMID: 37030255 DOI: 10.1016/j.clinbiomech.2023.105947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/03/2023] [Accepted: 03/22/2023] [Indexed: 04/10/2023]
Abstract
BACKGROUND Cerebral palsy is the most prevalent motor disorder among children. Despite extensive studies on motor modularity of gait of children with cerebral palsy, kinematic modularity of their gait has not been addressed which is the main goal of this study. METHODS The kinematics of the gait of 13 typical development children and 188 children with cerebral palsy was captured and analyzed, where the cerebral palsy children were grouped into True, Jump, Apparent, and Crouch. Non-negative matrix factorization method was used to extract the kinematic modulus of each group, which were then clustered to find their characteristic movement primitives. The movement primitives of groups were then matched based on the similarity of their activation profiles. FINDINGS The number of movement primitives was three for the Crouch group, four for the other cerebral palsy groups, and five for the typical development group. Compared to the typical development children, the kinematic modules and activations of the cerebral palsy groups involved higher variability and co-activation, respectively (P < 0.05). Three temporally matched movement primitives were shared by all groups, but with altered structures. INTERPRETATION The gait of children with cerebral palsy involved lower complexity and higher variability due to the reduced and inconsistent kinematic modularity. Three basic movement primitives were sufficient to prodcue the overall gait kinematics, as observed in the Crouch group. Other movement primitives, were responsible for providing smooth transitions between basic movement primitives, as seen in more complex gait patterns.
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Affiliation(s)
- Shahab Tavasoli
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
| | - Marzieh Tavasoli
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
| | - Mahya Shojaeefard
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
| | - Farzam Farahmand
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran.
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Everaert L, Papageorgiou E, Van Campenhout A, Labey L, Desloovere K. The influence of ankle-foot orthoses on gait pathology in children with cerebral palsy: A retrospective study. Gait Posture 2023; 100:149-156. [PMID: 36528000 DOI: 10.1016/j.gaitpost.2022.11.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/26/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Ankle-foot orthoses (AFOs) are frequently prescribed in children with cerebral palsy (CP) to improve their gait. Due to the heterogeneous nature of CP and contradictions among previous studies, it is important to evaluate the AFO-specific effects, as well as explore their effects on different gait patterns. RESEARCH QUESTIONS a) What are the prevalence and specific features of AFOs in children with CP? b) How do AFOs affect gait pathology in children with CP? c) What are the pattern-specific effects of AFOs in children with CP? METHODS A group of 170 patients with CP underwent a three-dimensional gait analysis with and without AFOs (either carbon fiber, rigid, flexible or hinged). The gait profile score, the gait variable scores of the hip, knee and ankle joints, non-dimensional step length and walking speed were used as outcome measures. The AFO-specific effects on the kinematic and kinetic waveforms were investigated using statistical non-parametric mapping (SnPM). Effects were considered relevant when the minimal clinically important difference (MCID) or the standard errors of measurement, for the parameters or the waveforms respectively, were exceeded. RESULTS Rigid AFOs were prescribed for more than 80 % of the children. Significant beneficial effects were observed for non-dimensional step length and walking speed. Most changes in gait indices were not considered relevant. The SnPM-analyses on the total group and specific gait patterns revealed that walking with AFOs improved the kinematic and kinetic waveforms. These effects were relevant, and were most obvious for crouch, apparent equinus and the total group. SIGNIFICANCE The use of AFOs improves gait, whether we inspect a total -and thus heterogeneous- group or focus on specific gait patterns. However, focussing on specific parameters (i.e. general gait indices) does not provide a full picture of the AFO-effects.
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Affiliation(s)
- Laure Everaert
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation (eNRGy), Leuven, Belgium; University Hospitals Leuven, Clinical Motion Analysis Laboratory, Pellenberg, Belgium.
| | - Eirini Papageorgiou
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation (eNRGy), Leuven, Belgium; University Hospitals Leuven, Clinical Motion Analysis Laboratory, Pellenberg, Belgium
| | - Anja Van Campenhout
- KU Leuven, Department of Development and Regeneration, Organ Systems, Leuven, Belgium; University Hospitals Leuven, Department of Orthopedics, Leuven, Belgium
| | - Luc Labey
- KU Leuven, Department of Mechanical Engineering, Geel, Belgium
| | - Kaat Desloovere
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation (eNRGy), Leuven, Belgium; University Hospitals Leuven, Clinical Motion Analysis Laboratory, Pellenberg, Belgium
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Oudenhoven LM, Kerkum YL, Buizer AI, van der Krogt MM. How does a systematic tuning protocol for ankle foot orthosis-footwear combinations affect gait in children in cerebral palsy? Disabil Rehabil 2022; 44:6867-6877. [PMID: 34506245 DOI: 10.1080/09638288.2021.1970829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To investigate the effects of a systematic tuning protocol for ankle foot orthosis footwear combinations (AFO-FC) using incrementing heel height on gait in children with cerebral palsy (CP). METHODS Eighteen children with CP (10.8 ± 3 years, Gross Motor Function Classification System (GMFCS) I-II) underwent 3D gait analysis on a treadmill, while the AFO heel surface was systematically incremented with wedges. Children were subdivided based on their gait pattern, i.e., knee hyperextension (EXT) and excessive knee flexion (FLEX). Outcome measures included sagittal hip and knee angles and moments, shank to vertical angle (SVA), foot to horizontal angle, and gait profile score (GPS). RESULTS For both groups, incrementing heel height resulted in increased knee flexion, more inclined SVA, and increased knee extension moments. This resulted in gait improvements for some children of the EXT-group, but not in FLEX. High variation was found between individuals and within-subject effects were not always consistent for kinematic and kinetics. CONCLUSIONS A systematic AFO-FC tuning protocol using incremented heel height can be effective to improve gait in children with CP walking with EXT. The current results emphasise the importance of including kinematics as well as kinetics of multiple instances throughout the gait cycle for reliable interpretation of the effect of AFO tuning on gait.Implications for rehabilitationA systematic ankle foot orthosis footwear combinations (AFO-FC) tuning protocol using incremented heel height can improve gait in children walking with knee hyperextension.Tuning results in changes throughout the gait cycle.Little evidence is found for an optimal SVA of 10-12° at midstance.For clinical interpretation, both joint kinematic and kinetic parameters should be considered throughout the gait cycle and evaluation should not be based on SVA only.
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Affiliation(s)
- Laura M Oudenhoven
- Department of Rehabilitation Medicine, Amsterdam, Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Yvette L Kerkum
- Faculty of Rehabilitation Sciences, REVAL, Hasselt University, Hasselt University, Diepenbeek, Belgium.,Research & Development, OIM Orthopedie, Assen, The Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, Amsterdam, Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Marjolein M van der Krogt
- Department of Rehabilitation Medicine, Amsterdam, Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Melanda AG, Davids JR, Pauleto AC, Pelegrinelli ARM, Ferreira AEK, Knaut LA, Lucareli PRG, Smaili SM. Reliability and validity of the gait classification system in children with cerebral palsy (GCS-CP). Gait Posture 2022; 98:355-361. [PMID: 36308864 DOI: 10.1016/j.gaitpost.2022.09.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 09/12/2022] [Accepted: 09/21/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gait classification systems (GCS) may enable clinicians to differentiate gait patterns into clinically significant categories that assist in clinical decision-making and assessment of outcomes. Davids and Bagley in 2014 [1] described a GCS for children with cerebral palsy (GCS-CP). The purpose of our study was to use the GCS-CP for the first time on a sample of patients with CP and to evaluate the reliability and utility of the classification system. METHODS The gait of 131 children with CP was retrospectively reviewed and classified according to Davids and Bagley's classification using two-dimensional (2D) video and three-dimensional (3D) lower limb kinematics and kinetics. Gross Motor Function Classification System (GMFCS) levels were determined, and the Gait Profile Scores (GPS) calculated to characterize the sample concerning gait classification. The comparison between the groups was performed using the Kruskal-Wallis test with respect to the non-normal distribution of the data. The intrarater and interrater reliability was determined using the Kappa index (k) statistics with 95% CI. RESULTS All GCS-CP groups were represented within the evaluated sample. Of the 131 cases evaluated, 127 (96.95%) were able to be classified with respect to sagittal plane stance phase gait deviations. All patients in the sample were able to be classified with respect to sagittal plane swing phase and transverse plane gait deviations. The interrater reliability was 0.596 and 0.485 for the first and second levels of the classification, respectively, according to the Fleiss's Kappa statistics. Intrarater reliability was 0.776 and 0.714 for the raters one and two, respectively, according to the Cohen's Kappa statistics. SIGNIFICANCE The GCS-CP exhibited clinical utility, successfully classifying almost all subjects with CP in two planes, based upon kinematic and kinetic data. The classification is valid and has moderate interrater and moderate to substantial intrarater reliability.
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Affiliation(s)
- Alessandro G Melanda
- Department of Surgery, State University of Londrina, Paraná, Brazil; Master's and Doctoral degree program in Rehabilitation Sciences - State University of Londrina, Paraná, Brazil; Gait Analysis Laboratory, Ana Carolina Moura Xavier Hospital Rehabilitation Center, Curitiba, Brazil.
| | - Jon R Davids
- Shriners Hospitals for Children, Northern California, 2425 Stockton Blvd, Sacramento, CA 95817, USA.
| | - Ana Carolina Pauleto
- Gait Analysis Laboratory, Ana Carolina Moura Xavier Hospital Rehabilitation Center, Curitiba, Brazil.
| | | | | | - Luiz Alberto Knaut
- Gait Analysis Laboratory, Ana Carolina Moura Xavier Hospital Rehabilitation Center, Curitiba, Brazil.
| | - Paulo Roberto G Lucareli
- Department of Rehabilitation Sciences, Human Motion Analysis Laboratory, University Nove de Julho, São Paulo, Brazil.
| | - Suhaila Mahmoud Smaili
- Master's and Doctoral degree program in Rehabilitation Sciences - State University of Londrina, Paraná, Brazil; Department of Physiotherapy, Neurofunctional Physical Therapy Research Group (GPFIN) - State University of Londrina, Paraná State, Brazil.
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Effect of Functional Electrical Stimulation on Gait Parameters in Children with Cerebral Palsy: A Meta-Analysis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3972958. [PMID: 36238472 PMCID: PMC9553333 DOI: 10.1155/2022/3972958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/01/2022] [Indexed: 12/05/2022]
Abstract
Objective At present, there are controversies on the effectiveness of functional electrical stimulation devices in gait improvement in the clinic, and the results reported in limited literature are contradictory. This paper summarizes and analyzes the relationship between functional electrical stimulation treatment and gait parameter changes in children with cerebral palsy, thus exploring the above controversies' results. Methods Two researchers conducted a detailed search of the literature from the establishment of the database to June 2022. Literature retrieved from databases, including PubMed, Embase, Ovid, Cochrane Library, and Web of Science and the search process followed the principles of Cochrane. The search keywords were “cerebral palsy”, “functional electrical stimulation”, “gait”, or “walk”. Gait and balance parameters were extracted from the literature. Gait parameters, such as walking speed and step length, were included in the meta-analysis. The study used standard mean difference (STD) and 95% confidence interval (CI) to calculate the mean difference between the two groups. The statistic I2 was used to evaluate the heterogeneity between the evaluation studies. Begg's test detected publication bias and the funnel chart was used for visual analysis. Furthermore, Review Manager software was used to make a risk bias map for literature publication bias analysis. Results 9 literatures were included in the analysis, with a total of 282 children with cerebral palsy, including 142 patients in the functional electrical stimulation treatment group and 140 patients in the comfort treatment, general nursing, or other physical therapy. The randomization scheme and result report used in most studies were low risk, which was important for the credibility of this study. Most studies have limitations in the blinding method of participants and subjects, and most of them were single-blind studies, which might have a high risk. The results showed that functional electrical stimulation could increase the walking speed of children with cerebral palsy (SMD = 0.82, P < 0.0001) and increase the walking step length of children with cerebral palsy (SMD = 1.34, 95%CI = 1.07, 1.60, Z = 9.91, P < 0.0001). Funnel plot analysis showed that the literature distribution was uniform and symmetrical, and Begg's test showed no publication bias in included literature. Conclusion This study compared the effects of the functional nerve stimulation treatment group and control group on improving gait parameters of children with cerebral palsy. The results indicated that functional nerve stimulation treatment could increase the gait speed and step length of children with cerebral palsy, which could improve the walking of children with cerebral palsy. Furthermore, this study needs more research data to support our findings. The results of this study might better guide the clinical practice and better use of health as well as financial resources.
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Tsitlakidis S, Campos S, Beckmann NA, Wolf SI, Hagmann S, Renkawitz T, Götze M. Transversal Malalignment and Proximal Involvement Play a Relevant Role in Unilateral Cerebral Palsy Regardless the Subtype. J Clin Med 2022; 11:jcm11164816. [PMID: 36013051 PMCID: PMC9409971 DOI: 10.3390/jcm11164816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/09/2022] [Accepted: 08/13/2022] [Indexed: 11/16/2022] Open
Abstract
Classification of gait disorders in cerebral palsy (CP) remains challenging. The Winters, Gage, and Hicks (WGH) is a commonly used classification system for unilateral CP regarding the gait patterns (lower limb kinematics) solely in the sagittal plane. Due to the high number of unclassified patients, this classification system might fail to depict all gait disorders accurately. As the information on trunk/pelvic movements, frontal and transverse planes, and kinetics are disregarded in WGH, 3D instrumented gait analysis (IGA) for further characterization is necessary. The objective of this study was a detailed analysis of patients with unilateral CP using IGA taking all planes/degrees of freedom into account including pelvic and trunk movements. A total of 89 individuals with unilateral CP matched the inclusion criteria and were classified by WGH. Subtype-specific differences were analyzed. The most remarkable findings, in addition to the established WGH subtype-specific deviations, were pelvic obliquity and pelvic retraction in all WGH types. Furthermore, the unclassified individuals showed altered hip rotation moments and pelvic retraction almost throughout the whole gait cycle. Transversal malalignment and proximal involvement are relevant in all individuals with unilateral CP. Further studies should focus on WGH type-specific rotational malalignment assessment (static vs. dynamic, femoral vs. tibial) including therapeutic effects and potential subtype-specific compensation mechanisms and/or tertiary deviations of the sound limb.
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13
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GMFCS Level-Specific Differences in Kinematics and Joint Moments of the Involved Side in Unilateral Cerebral Palsy. J Clin Med 2022; 11:jcm11092556. [PMID: 35566682 PMCID: PMC9100606 DOI: 10.3390/jcm11092556] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/02/2022] [Accepted: 04/24/2022] [Indexed: 01/16/2023] Open
Abstract
A variety of gait pathologies is seen in cerebral palsy. Movement patterns between different levels of functional impairment may differ. The objective of this work was the evaluation of Gross Motor Function Classification System (GMFCS) level-specific movement disorders. A total of 89 individuals with unilateral cerebral palsy and no history of prior treatment were included and classified according to their functional impairment. GMFCS level-specific differences, kinematics and joint moments, exclusively of the involved side, were analyzed for all planes for all lower limb joints, including pelvic and trunk movements. GMFCS level I and level II individuals most relevantly showed equinus/reduced dorsiflexion moments, knee flexion/reduced knee extension moments, reduced hip extension moments with pronounced flexion, internal hip rotation and reduced hip abduction. Anterior pelvic tilt, obliquity and retraction were found. Individuals with GMFCS level II were characterized by an additional pronounced reduction in all extensor moments, pronounced rotational malalignment and reduced hip abduction. The most striking characteristics of GMFCS level II were excessive anterior pelvic/trunk tilt and excessive trunk obliquity. Pronounced reduction in extensor moments and excessive trunk lean are distinguishing features of GMFCS level II. These patients would benefit particularly from surgical treatment restoring pelvic symmetry and improving hip abductor leverage. Future studies exploring GMFCS level-specific compensation of the sound limb and GMFCS level-specific malalignment are of interest.
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Goudriaan M, Papageorgiou E, Shuman BR, Steele KM, Dominici N, Van Campenhout A, Ortibus E, Molenaers G, Desloovere K. Muscle synergy structure and gait patterns in children with spastic cerebral palsy. Dev Med Child Neurol 2022; 64:462-468. [PMID: 34614213 PMCID: PMC9292989 DOI: 10.1111/dmcn.15068] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 08/02/2021] [Accepted: 09/01/2021] [Indexed: 11/28/2022]
Abstract
AIM To determine if muscle synergy structure (activations and weights) differs between gait patterns in children with spastic cerebral palsy (CP). METHOD In this cross-sectional study, we classified 188 children with unilateral (n=82) or bilateral (n=106) spastic CP (mean age: 9y 5mo, SD: 4y 3mo, range: 3y 9mo-17y 7mo; 75 females; Gross Motor Function Classification System [GMFCS] level I: 106, GMFCS level II: 55, GMFCS level III: 27) into a minor deviations (n=34), drop foot (n=16), genu recurvatum (n=26), apparent equinus (n=53), crouch (n=39), and jump gait pattern (n=20). Surface electromyography recordings from eight lower limb muscles of the most affected side were used to calculate synergies with weighted non-negative matrix factorization. We compared synergy activations and weights between the patterns. RESULTS Synergy structure was similar between gait patterns, although weights differed in the more impaired children (crouch and jump gait) when compared to the other patterns. Variability in synergy structure between participants was high. INTERPRETATION The similarity in synergy structure between gait patterns suggests a generic motor control strategy to compensate for the brain lesion. However, the differences in weights and high variability between participants indicate that this generic motor control strategy might be individualized and dependent on impairment level.
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Affiliation(s)
- Marije Goudriaan
- Department of Human Movement SciencesVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Eirini Papageorgiou
- Department of Rehabilitation SciencesKU LeuvenLeuvenBelgium
- Clinical Motion Analysis LaboratoryUniversity Hospitals LeuvenPellenbergBelgium
| | - Benjamin R Shuman
- Department of Mechanical EngineeringUniversity of WashingtonSeattleWAUSA
- Henry M. Jackson Foundation for the Advancement of Military MedicineBethesdaMDUSA
| | - Katherine M Steele
- Department of Mechanical EngineeringUniversity of WashingtonSeattleWAUSA
| | - Nadia Dominici
- Department of Human Movement SciencesVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Anja Van Campenhout
- Clinical Motion Analysis LaboratoryUniversity Hospitals LeuvenPellenbergBelgium
- Department of Development and RegenerationUniversity of LeuvenLeuvenBelgium
- Department of OrthopedicsUniversity Hospitals LeuvenLeuvenBelgium
| | - Els Ortibus
- Department of Development and RegenerationUniversity of LeuvenLeuvenBelgium
| | - Guy Molenaers
- Clinical Motion Analysis LaboratoryUniversity Hospitals LeuvenPellenbergBelgium
- Department of Development and RegenerationUniversity of LeuvenLeuvenBelgium
- Department of OrthopedicsUniversity Hospitals LeuvenLeuvenBelgium
| | - Kaat Desloovere
- Department of Rehabilitation SciencesKU LeuvenLeuvenBelgium
- Clinical Motion Analysis LaboratoryUniversity Hospitals LeuvenPellenbergBelgium
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Bedla M, Pięta P, Kaczmarski D, Deniziak S. Estimation of Gross Motor Functions in Children with Cerebral Palsy Using Zebris FDM-T Treadmill. J Clin Med 2022; 11:954. [PMID: 35207227 PMCID: PMC8880133 DOI: 10.3390/jcm11040954] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 02/05/2022] [Accepted: 02/08/2022] [Indexed: 12/10/2022] Open
Abstract
A standardized observational instrument designed to measure change in gross motor function over time in children with cerebral palsy is the Gross Motor Function Measure (GMFM). The process of evaluating a value for the GMFM index can be time consuming. It typically takes 45 to 60 min for the patient to complete all tasks, sometimes in two or more sessions. The diagnostic procedure requires trained and specialized therapists. The paper presents the estimation of the GMFM measure for patients with cerebral palsy based on the results of the Zebris FDM-T treadmill. For this purpose, the regression analysis was used. Estimations based on the Generalized Linear Regression were assessed using different error metrics. The results obtained showed that the GMFM score can be estimated with acceptable accuracy. Because the Zebris FDM-T is a widely used device in gait rehabilitation, our method has the potential to be widely adopted for objective diagnostics of children with cerebral palsy.
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Affiliation(s)
- Mariusz Bedla
- Faculty of Electrical Engineering, Automatic Control and Computer Science, Kielce University of Technology, al. Tysiąclecia Państwa Polskiego 7, 25-314 Kielce, Poland; (P.P.); (D.K.); (S.D.)
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Huang B, Chen W, Liang J, Cheng L, Xiong C. Characterization and Categorization of Various Human Lower Limb Movements Based on Kinematic Synergies. Front Bioeng Biotechnol 2022; 9:793746. [PMID: 35127668 PMCID: PMC8812690 DOI: 10.3389/fbioe.2021.793746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/20/2021] [Indexed: 11/23/2022] Open
Abstract
A proper movement categorization reduces the complexity of understanding or reproducing human movements in fields such as physiology, rehabilitation, and robotics, through partitioning a wide variety of human movements into representative sub-motion groups. However, how to establish a categorization (especially a quantitative categorization) for various human lower limb movements is rarely investigated in literature and remains challenging due to the diversity and complexity of the lower limb movements (diverse gait modes and interaction styles with the environment). Here we present a quantitative categorization for the various lower limb movements. To this end, a similarity measure between movements was first built based on limb kinematic synergies that provide a unified and physiologically meaningful framework for evaluating the similarities among different types of movements. Then, a categorization was established via hierarchical cluster analysis for thirty-four lower limb movements, including walking, running, hopping, sitting-down-standing-up, and turning in different environmental conditions. According to the movement similarities, the various movements could be divided into three distinct clusters (cluster 1: walking, running, and sitting-down-standing-up; cluster 2: hopping; cluster 3: turning). In each cluster, cluster-specific movement synergies were required. Besides the uniqueness of each cluster, similarities were also found among part of the synergies employed by these different clusters, perhaps related to common behavioral goals in these clusters. The mix of synergies shared across the clusters and synergies for specific clusters thus suggests the coexistence of the conservation and augmentation of the kinematic synergies underlying the construction of the diverse and complex motor behaviors. Overall, the categorization presented here yields a quantitative and hierarchical representation of the various lower limb movements, which can serve as a basis for the understanding of the formation mechanisms of human locomotion and motor function assessment and reproduction in related fields.
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Affiliation(s)
| | | | | | | | - Caihua Xiong
- *Correspondence: Jiejunyi Liang, ; Caihua Xiong,
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Dimakopoulos R, Syrogiannopoulos G, Grivea I, Dailiana Z, Youroukos S, Spinou A. Kinematic and Temporospatial Changes in Children with Cerebral Palsy during the Initial Stages of Gait Development. Dev Neurorehabil 2022; 25:10-18. [PMID: 33872103 DOI: 10.1080/17518423.2021.1914763] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To identify changes in the gait kinematics and temporospatial parameters of children with bilateral Cerebral Palsy (CP) at 8 months after the onset of independent walking and identify differences to Typical Development (TD) children at the onset of independent walking and at 8 months follow up. METHOD Sixteen children with bilateral CP, GMFCS levels I and II, and 15 TD children were recruited. Gait kinematics and temporospatial parameters were recorded using a 3-D gait analysis system; the sagittal plane of the lower limb joints was analyzed. Baseline measurements were recorded at the individual's onset of independent walking and follow up was after 8 months. RESULTS Compared to baseline, children with bilateral CP demonstrated increased (mean difference ± SE) plantar flexion (11.79 ± 2.96), single support (0.04 ± 0.01), step length (0.2 ± 0.05) and stride length (0.4 ± 0.09), at follow up; all p < .05. Compared to TD children, they also had lower gait speed (0.16 ± 0.05), higher single support (0.02 ± 0.01) and lower maximum knee extension (9.14 ± 4.49) during the swing phase, at baseline and follow up (0.1 ± 0.04, 0.05 ± 0.01, 23.04 ± 4.17, respectively); all p < .05. CONCLUSION There are changes in the sagittal plane kinematics and temporospatial parameters of the gait during the first 8 months of independent walking. These indicate gait maturation changes and highlight the impact of walking experience on the gait characteristics of children with bilateral CP.
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Affiliation(s)
- Rigas Dimakopoulos
- Department of Pediatrics, University of Thessaly, Faculty of Medicine, Larissa, Greece.,Laboratory of Neuromuscular and Cardiovascular Study of Motion, Physiotherapy Department, University of West Attica, Greece
| | | | - Ioanna Grivea
- Department of Pediatrics, University of Thessaly, Faculty of Medicine, Larissa, Greece
| | - Zoe Dailiana
- Department of Orthopaedic Surgery, University of Thessaly, Faculty of Medicine, Larissa, Greece
| | - Sotirios Youroukos
- 1st Pediatric Clinic, University of Athens, "Agia Sofia" Children's Hospital, Athens, Greece
| | - Arietta Spinou
- Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Gómez-Pérez C, Martori JC, Puig Diví A, Medina Casanovas J, Vidal Samsó J, Font-Llagunes JM. Gait event detection using kinematic data in children with bilateral spastic cerebral palsy. Clin Biomech (Bristol, Avon) 2021; 90:105492. [PMID: 34627071 DOI: 10.1016/j.clinbiomech.2021.105492] [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: 03/09/2021] [Revised: 08/24/2021] [Accepted: 09/21/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ground reaction forces are the gold standard for detecting gait events, but they are not always applicable in cerebral palsy. Ghoussayni's algorithm is an event detection method based on the sagittal plane velocity of heel and toe markers. We aimed to evaluate whether Ghoussayni's algorithm, using two different thresholds, was a valid event detection method in children with bilateral spastic cerebral palsy. We also aimed to define a new adaptation of Ghoussayni's algorithm for detecting foot strike in cerebral palsy, and study the effect of event detection methods on spatiotemporal parameters. METHODS Synchronized kinematic and kinetic data were collected retrospectively from 16 children with bilateral spastic cerebral palsy (7 males and 9 females; age 8.9 ± 2.7 years) walking barefoot at self-selected speed. Gait events were detected using methods: 1) ground reaction forces, 2) Ghoussayni's algorithm with a threshold of 0.5 m/s, and 3) Ghoussayni's algorithm with a walking speed dependent threshold. The new adaptation distinguished how foot strikes were performed (heel and/or toe) comparing the timing when the foot markers velocities fell below the threshold. Differences between the three methods, and between spatiotemporal parameters calculated from the two Ghoussayni's thresholds were analyzed. FINDINGS There were statistically significant (P < 0.05) differences between methods 1 and 3, and between some spatiotemporal parameters calculated from methods 2 and 3. Ghoussayni's algorithm showed better performance for foot strike than for toe off. INTERPRETATION Ghoussayni's algorithm using 0.5 m/s is valid in children with bilateral spastic cerebral palsy. Event detection methods affect spatiotemporal parameters.
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Affiliation(s)
- Cristina Gómez-Pérez
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M(3)O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), C. Sagrada Família 7, 08500 Vic, Spain.
| | - Joan Carles Martori
- Data Analysis and Modeling Research Group, Department of Economics and Business, Faculty of Business and Communication Studies, University of Vic - Central University of Catalonia (UVic-UCC), C. Sagrada Família 7, 08500 Vic, Spain.
| | - Albert Puig Diví
- Blanquerna School of Health Sciences - Ramon Llull University, C. Padilla 326, 08025 Barcelona, Spain.
| | - Josep Medina Casanovas
- Institut Guttmann, Hospital de Neurorehabilitació, Camí de Can Ruti, 08916 Badalona, Spain; Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Cerdanyola del Vallès, Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Carretera Canyet, 08916 Badalona, Spain.
| | - Joan Vidal Samsó
- Institut Guttmann, Hospital de Neurorehabilitació, Camí de Can Ruti, 08916 Badalona, Spain; Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Cerdanyola del Vallès, Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Carretera Canyet, 08916 Badalona, Spain.
| | - Josep M Font-Llagunes
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Av. Diagonal 647, 08028 Barcelona, Spain; Institut de Recerca Sant Joan de Déu, C. Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain.
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Effects of Ankle Foot Orthoses on the Gait Patterns in Children with Spastic Bilateral Cerebral Palsy: A Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8100903. [PMID: 34682168 PMCID: PMC8534539 DOI: 10.3390/children8100903] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/30/2021] [Accepted: 10/07/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cerebral palsy (CP) is the most common cause of motor disability in children and can cause severe gait deviations. The sagittal gait patterns classification for children with bilateral CP is an important guideline for the planning of the rehabilitation process. Ankle foot orthoses should improve the biomechanical parameters of pathological gait in the sagittal plane. METHODS A systematic search of the literature was conducted to identify randomized controlled trials (RCT) and controlled clinical trials (CCT) which measured the effect of ankle foot orthoses (AFO) on the gait of children with spastic bilateral CP, with kinetic, kinematic, and functional outcomes. Five databases (Pubmed, Scopus, ISI Web of SCIENCE, SciELO, and Cochrane Library) were searched before February 2020. The PEDro Score was used to assess the methodological quality of the selected studies and alignment with the Cochrane approach was also reviewed. Prospero registration number: CRD42018102670. RESULTS We included 10 studies considering a total of 285 children with spastic bilateral CP. None of the studies had a PEDro score below 4/10, including five RCTs. We identified five different types of AFO (solid; dynamic; hinged; ground reaction; posterior leaf spring) used across all studies. Only two studies referred to a classification for gait patterns. Across the different outcomes, significant differences were found in walking speed, stride length and cadence, range of motion, ground force reaction and joint moments, as well as functional scores, while wearing AFO. CONCLUSIONS Overall, the use of AFO in children with spastic bilateral CP minimizes the impact of pathological gait, consistently improving some kinematic, kinetic, and spatial-temporal parameters, and making their gait closer to that of typically developing children. Creating a standardized protocol for future studies involving AFO would facilitate the reporting of new scientific data and help clinicians use their clinical reasoning skills to recommend the best AFO for their patients.
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Hou Y, Zheng H, Li J, Wang S, Zhang D, Tang T, Xu M, Zhou H. A New Method for Postural Misalignment of a 6-Year-Old Girl With Cerebral Palsy: A Case Report. Arch Rehabil Res Clin Transl 2021; 3:100116. [PMID: 34179752 PMCID: PMC8212001 DOI: 10.1016/j.arrct.2021.100116] [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] [Indexed: 11/05/2022] Open
Abstract
Objective To demonstrate the effects of a newly designed postural alignment relearning system on postural control dysfunction in a typical patient with cerebral palsy (CP). Design Evaluation before and after 8 weeks of Constraint Standing Training 3-dimensional postural alignment relearning system. Setting Department of Rehabilitation Medicine. Participant A 6-year-old girl with CP and postural misalignment on Gross Motor Function Classification System level I. Interventions Constraint Standing Training for 8 weeks to correct postural misalignment. Main Outcome Measures Parameters of lateral plain radiographs in static standing, posturography measurements in standing and walking, motor ability (Gross Motor Function Measure-88 [GMFM-88] scores, manual muscle testing [MMT] scores, muscle architecture), and gait kinematic parameters (40 3-dimensional parameters of arms, trunk, waist, and lower limbs). Results Knee hyperextension angle in static standing; peaks of knee flexion angle (KFA) when walking, hip flexion angle and ankle flexion angle in dynamic standing; and the KFA at initial contact in gait cycle all decreased significantly (P<.01). Scores of GMFM-88 sections D and E and MMT of 5 core stability muscles improved (P<.01). The velocities and range of motion of the arms, the 3-dimensinoal range of motion of the trunk and waist, and most of the parameters of the lower limbs showed statistically significant change (P<.01). Bilateral muscle thickness did not change significantly after the treatment (P=.738 left, P=.978 right), but the gluteus maximus morphology was changed: the muscle fibers became rounder, the interfiber space decreased, and the border lines of the muscle fibers got clearer. Conclusions Postural alignment, motor ability, and gait may be homologous external manifestations of more fundamental core abilities, referring to correct standing posture cognition, muscle activation, and postural unconsciousness. Constraint Standing Training 3-dimensional postural alignment relearning system aimed to improve the static and dynamic standing control ability, may fix postural misalignment and improve motor ability and flexed-knee gait. Future work should use Constraint Standing Training with patients with different kinds of misalignment, choose sensitive indicators, observe the duration of each step, and reveal the mechanism causes postural misalignment.
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Affiliation(s)
- Ying Hou
- Department of Rehabilitation Medicine, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou
| | - Huitian Zheng
- Department of Rehabilitation Medicine, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou
| | - Jinping Li
- Department of Rehabilitation Medicine, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou
| | - Shujia Wang
- Department of Rehabilitation Medicine, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou
| | - Dongmei Zhang
- Department of Rehabilitation Medicine, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou
| | - Tong Tang
- Department of Rehabilitation Medicine, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou
| | - Mindan Xu
- Neurological Rehabilitation Department, Zhangjiagang Gangcheng Rehabilitation Hospital, Zhangjiagang
| | - Hong Zhou
- Children Rehabilitation Department, Kunshan Rehabilitation Hospital, Kunshan, China
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Vandekerckhove I, Wesseling M, Kainz H, Desloovere K, Jonkers I. The effect of hip muscle weakness and femoral bony deformities on gait performance. Gait Posture 2021; 83:280-286. [PMID: 33227606 DOI: 10.1016/j.gaitpost.2020.10.022] [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: 05/25/2020] [Revised: 08/31/2020] [Accepted: 10/20/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Children with cerebral palsy (CP) present with a pathological gait pattern due to musculoskeletal impairments, such as muscle weakness and altered bony geometry. However, the effect of these impairments on gait performance is still unknown. Research aim:This study aimed to explore the effect of hip muscle weakness and femoral deformities on the gait performance of CP and typical developing (TD) subjects. METHODS 6400 musculoskeletal models were created by weakening the hip extensors, abductors, adductors and flexors from 0% to 75 % and increasing the femoral anteversion angle (FAA) and neck shaft angle (NSA) from 20° to 60° and 120° to 160°, respectively. One TD and five CP gait patterns were imposed to each model and muscle forces were calculated. The effect of weakness and bony deformities on the capability gap (CG) at the hip, i.e. the lack in hip moment generating capacity to perform the gait pattern, was investigated using regression analysis. RESULTS The CG of apparent equinus, stiff knee gait, TD gait, jump gait and true equinus increased with 0.080, 0.038, 0.015, 0.023 and 0.005 Nm/kg per 10 percent hip abductor weakness increase, with 0.211, 0.130, 0.056, 0.045 and 0.011 Nm/kg per 10 degrees FAA increase and with 0.163, 0.080, 0.036, 0.043 and 0.011 Nm/kg per 10 degrees NSA increase, respectively. Combined weakness and bony deformities explained 96 %, 85 %, 82 %, 65 %, 40 % and 35 % of the variance in the CG of apparent equinus, TD gait, stiff knee gait, jump gait, true equinus and crouch gait, respectively. SIGNIFICANCE The results suggest that surgical correction of femoral deformities is more likely to be effective than strength training of hip muscles in enhancing CP gait performance. Jump gait, true equinus and especially crouch were more robust, while apparent equinus and stiff knee gait were limited by hip weakness and femoral deformities.
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Affiliation(s)
- Ines Vandekerckhove
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium.
| | | | - Hans Kainz
- Department of Movement Sciences, KU Leuven, Leuven, Belgium; Centre for Sport Science and University Sports, Department of Biomechanics, Kinesiology and Computer Science in Sport, University of Vienna, Vienna, Austria
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium
| | - Ilse Jonkers
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
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22
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McLaughlin M, Inanoglu D. Decreased clinical response to therapy in pediatric patients with cerebral palsy: Current trends and challenges. J Pediatr Rehabil Med 2021; 14:307-314. [PMID: 34092663 DOI: 10.3233/prm-210028] [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)
- Matthew McLaughlin
- University of Missouri-Kansas City School of Medicine, Children's Mercy - Kansas City, Kansas City, MO, USA
| | - Didem Inanoglu
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Gait Indices for Characterization of Patients with Unilateral Cerebral Palsy. J Clin Med 2020; 9:jcm9123888. [PMID: 33265919 PMCID: PMC7760302 DOI: 10.3390/jcm9123888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/25/2020] [Accepted: 11/27/2020] [Indexed: 11/21/2022] Open
Abstract
As cerebral palsy (CP) is a complex disorder, classification of gait pathologies is difficult. It is assumed that unclassified patients show less functional impairment and less gait deviation. The aim of this study was to assess the different subgroups and the unclassified patients with unilateral CP using different gait indices. The Gillette Gait Index (GGI), Gait Deviation Index (GDI), Gait Profile Score (GPS) and spatiotemporal parameters derived from instrumented 3D-Gait Analysis (IGA) were assessed. Subgroups were defined using morphological and functional classification systems. Regarding the different gait indices, a ranking of the different gait patterns is evident. Significant differences were found between GMFCS level I and II, Winters et al. (Winters, Gage, Hicks; WGH) type IV and type I and the WGH-unclassified. Concerning the spatiotemporal parameters significant differences were found between GMFCS level I and II concerning velocity. The unclassified patients showed mean values for the different gait indices that were comparable to those of established subgroups. Established gait patterns cause different degrees of gait deviation and functional impairment. The unclassified patients do not differ from established gait patterns but from the unimpaired gait. Further evaluation using 3D-IGA is necessary to identify the underlying gait pathologies of the unclassified patients.
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Chakraborty S, Nandy A. Automatic Diagnosis of Cerebral Palsy Gait Using Computational Intelligence Techniques: A Low-Cost Multi-Sensor Approach. IEEE Trans Neural Syst Rehabil Eng 2020; 28:2488-2496. [PMID: 33001807 DOI: 10.1109/tnsre.2020.3028203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Automatic diagnosing of Cerebral Palsy (CP) gait is crucial in quantitative evaluation of a therapeutic intervention. Existing systems for such gait assessment are expensive and require user intervention. This study proposes a low-cost gait assessment system equipped with multiple Kinect sensors. Forty subjects (20 CP patients and 20 normal) were recruited for the experiment. To remove outlier frames from the combined gait signal of multiple sensors a data driven algorithm was proposed. Different supervised classifiers along with extreme learning machine were investigated to diagnose CP gait. In addition, a feature level analysis was also performed. Several spatio-temporal features (i.e. step length, stride length, stride time, etc.) were extracted. The strength of walking ratio, a speed invariant feature, to detect CP gait was thoroughly analyzed. The proposed system outperformed state-of-the-art with ≈98% of accuracy (sensitivity: 100%, and specificity: 96.87%). Results indicate a substantial improvement in abnormality detection performance after outlier removal. Based on ReliefF feature ranking algorithm, walking ratio ranked the best among other classical gait features. Performance of all classifiers increased substantially using walking ratio as a feature. Extreme learning machine demonstrated a competing performance in all cases. The higher classification accuracy of this low-cost system using only a single feature makes it attractive for CP gait detection.
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25
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Papageorgiou E, De Beukelaer N, Simon-Martinez C, Mailleux L, Van Campenhout A, Desloovere K, Ortibus E. Structural Brain Lesions and Gait Pathology in Children With Spastic Cerebral Palsy. Front Hum Neurosci 2020; 14:275. [PMID: 32733223 PMCID: PMC7363943 DOI: 10.3389/fnhum.2020.00275] [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: 11/28/2019] [Accepted: 06/18/2020] [Indexed: 12/19/2022] Open
Abstract
The interaction between brain damage and motor function is not yet fully understood in children with spastic cerebral palsy (CP). Therefore, a semi-quantitative MRI (sqMRI) scale was used to explore whether identified brain lesions related to functional abilities and gait pathology in this population. A retrospective cohort of ambulatory children with spastic CP was selected [N = 104; 52 bilateral (bCP) and 52 unilateral (uCP)]. Extent and location-specific scores were defined according to the sqMRI scale guidelines. The gross motor function classification system (GMFCS), the gait profile score (GPS), GPSs per motion plane, gait variable scores (GVS) and multiple-joint (MJ) gait patterns were related to brain lesion scores. In all groups, the global total brain scores correlated to the GPS (total: rs = 0.404, p ≤ 0.001; bCP: rs = 0.335, p ≤ 0.05; uCP: rs = 0.493, p ≤ 0.001). The global total hemispheric scores correlated to the GMFCS (total: rs = 0.392, p ≤ 0.001; bCP: rs = 0.316, p ≤ 0.05; uCP: rs = 0.331, p ≤ 0.05). The laterality scores of the hemispheres in the total group correlated negatively to the GMFCS level (rs = −0.523, p ≤ 0.001) and the GVS-knee sagittal (rs = −0.311, p ≤ 0.01). Lesion location, for the total group demonstrated positive correlations between parietal lobe involvement and the GPS (rs = 0.321, p ≤ 0.001) and between periventricular layer damage and the GMFCS (rs = 0.348, p ≤ 0.001). Involvement of the anterior part of the corpus callosum (CC) was associated with the GVS-hip sagittal in all groups (total: rpb = 0.495, p ≤ 0.001; bCP: rpb = 0.357, p ≤ 0.05; uCP: rpb = 0.641, p ≤ 0.001). The global total hemispheric and laterality of the hemispheres scores differentiated between the minor and both the extension (p ≤ 0.001 and p ≤ 0.001) and flexion (p = 0.016 and p = 0.013, respectively) MJ patterns in the total group. Maximal periventricular involvement and CC intactness were associated with extension patterns (p ≤ 0.05 and p ≤ 0.001, respectively). Current findings demonstrated relationships between brain structure and motor function as well as pathological gait, in this cohort of children with CP. These results might facilitate the timely identification of gait pathology and, ultimately, guide individualized treatment planning of gait impairments in children with CP.
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Affiliation(s)
- Eirini Papageorgiou
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
| | - Nathalie De Beukelaer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
| | - Cristina Simon-Martinez
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Institute of Information Systems, University of Applied Sciences Western Switzerland (HES-SO), Sierre, Switzerland
| | - Lisa Mailleux
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Anja Van Campenhout
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
| | - Els Ortibus
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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26
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Darbandi H, Baniasad M, Baghdadi S, Khandan A, Vafaee A, Farahmand F. Automatic classification of gait patterns in children with cerebral palsy using fuzzy clustering method. Clin Biomech (Bristol, Avon) 2020; 73:189-194. [PMID: 32007827 DOI: 10.1016/j.clinbiomech.2019.12.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 12/23/2019] [Accepted: 12/31/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Subjective classification of gait pattern in children with cerebral palsy depends on the assessor's experience, while mathematical methods produce virtual groups with no clinical interpretation. METHODS In a retrospective study, gait data from 66 children (132 limbs) with a mean age of 9.6 (SD 3.7) years with cerebral palsy and no history of surgery or botulinum toxin injection were reviewed. The gait pattern of each limb was classified in four groups according to Rodda using three methods: 1) a team of experts subjectively assigning a gait pattern, 2) using the plantarflexor-knee extension couple index introduced by Sangeux et al., and 3) employing a fuzzy algorithm to translate the experiences of experts into objective rules and execute a clustering tool. To define fuzzy repeated-measures, 75% of the members in each group were used, and the remaining were used for validation. Eight parameters were objectively extracted from kinematic data for each group and compared using repeated measure ANOVA and post-hoc analysis was performed. Finally, the results of the clustering of the latter two methods were compared to the subjective method. FINDINGS The plantarflexor-knee extension couple index achieved 86% accuracy while the fuzzy system yielded a 98% accuracy. The most substantial errors occurred between jump and apparent in both methods. INTERPRETATION The presented method is a fast, reliable, and objective fuzzy clustering system to classify gait patterns in cerebral palsy, which produces clinically-relevant results. It can provide a universal common language for researchers.
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Affiliation(s)
- Hamed Darbandi
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
| | - Mina Baniasad
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran.
| | - Soroush Baghdadi
- Department of Orthopaedic Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Aminreza Khandan
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
| | - Amirreza Vafaee
- Department of Orthopaedic Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzam Farahmand
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
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27
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Increasing level of neuromusculoskeletal model personalisation to investigate joint contact forces in cerebral palsy: A twin case study. Clin Biomech (Bristol, Avon) 2020; 72:141-149. [PMID: 31877532 DOI: 10.1016/j.clinbiomech.2019.12.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 11/15/2019] [Accepted: 12/16/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cerebral palsy is a complex neuromuscular disorder that affects the sufferers in multiple different ways. Neuromusculoskeletal models are promising tools that can be used to plan patient-specific treatments for cerebral palsy. However, current neuromusculoskeletal models are typically scaled from generic adult templates that poorly represent paediatric populations. Furthermore, muscle activations are commonly computed via optimisation methods, which may not reproduce co-contraction observed in cerebral palsy. Alternatively, calibrated EMG-informed approaches within OpenSim can capture pathology-related muscle activation abnormalities, possibly enabling more feasible estimations of muscle and joint contact forces. METHODS Two identical twin brothers, aged 13, one with unilateral cerebral palsy and the other typically developing, were enrolled in the study. Four neuromusculoskeletal models with increasing subject-specificity were built in OpenSim and CEINMS combining literature findings, experimental motion capture, EMG and MR data for both participants. The physiological and biomechanical validity of each model was assessed by quantifying its ability to track experimental joint moments and muscle excitations. FINDINGS All developed models accurately tracked external joint moments; however EMG-informed models better tracked muscle excitations compared to neural solutions generated by static optimisation. Calibrating muscle-tendon unit parameters with EMG data allowed for more physiologically plausible joint contact forces estimates. Further scaling the maximal isometric force of muscles with MR-derived muscle volumes did not affect model predictions. INTERPRETATION Given their ability to identify atypical joint contact forces profiles and accurately reproduce experimental data, calibrated EMG-informed models should be preferred over generic models using optimisation methods in informing the management of cerebral palsy.
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28
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Chakraborty S, Nandy A, Kesar TM. Gait deficits and dynamic stability in children and adolescents with cerebral palsy: A systematic review and meta-analysis. Clin Biomech (Bristol, Avon) 2020; 71:11-23. [PMID: 31677546 DOI: 10.1016/j.clinbiomech.2019.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/19/2019] [Accepted: 09/08/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Studies have demonstrated that ambulatory children and adolescents with cerebral palsy demonstrate atypical gait patterns. Out of numerous gait variables, identification of the most deteriorated gait parameters is important for targeted and effective gait rehabilitation. Therefore, this study aimed to identify the gait parameters with the most discriminating nature to distinguish cerebral palsy gait from normal gait. METHODS Multiple databases were searched to include studies on ambulatory children and adolescents with cerebral palsy that included gait (spatio-temporal, kinematic, and kinetic) and dynamic stability variables. FINDINGS Of 68 studies that met the inclusion criteria, 35 studies were included in the meta analysis. Effect size was used to assess the discriminative strength of each variable. A large effect (≥ 0.8) of cerebral palsy on double limb support time (Standardized Mean Difference = 0.98), step length (Standardized Mean Difference = 1.65), step width (Standardized Mean Difference = 1.21), stride length (Standardized Mean Difference = 1.75), and velocity (Standardized Mean Difference = 1.42) was observed at preferred-walking speed. At fast-walking speed, some gait variables (i.e. velocity and stride length) exhibited larger effect size compared to preferred-walking speed. For some kinematic variables (e.g. range of motion of pelvis), the effect size varied across the body planes. INTERPRETATION Our systematic review detects the most discriminative features of cerebral palsy gait. Non-uniform effects on joint kinematics across the anatomical planes support the importance of 3D gait analysis. Differential effects at fast versus preferred speeds emphasize the importance of measuring gait at a range of speeds.
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Affiliation(s)
- Saikat Chakraborty
- Machine Intelligence and Bio-motion Research Lab., Department of Computer Science and Engineering, National Institute of Technology, Rourkela, India. saikat.scgmail.com
| | - Anup Nandy
- Machine Intelligence and Bio-motion Research Lab., Department of Computer Science and Engineering, National Institute of Technology, Rourkela, India
| | - Trisha M Kesar
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, USA
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29
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Krzhizhanovskaya VV, Závodszky G, Lees MH, Dongarra JJ, Sloot PMA, Brissos S, Teixeira J. Gait Abnormality Detection in People with Cerebral Palsy Using an Uncertainty-Based State-Space Model. LECTURE NOTES IN COMPUTER SCIENCE 2020. [PMCID: PMC7303699 DOI: 10.1007/978-3-030-50423-6_40] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Assessment and quantification of feature uncertainty in modeling gait pattern is crucial in clinical decision making. Automatic diagnostic systems for Cerebral Palsy gait often ignored the uncertainty factor while recognizing the gait pattern. In addition, they also suffer from limited clinical interpretability. This study establishes a low-cost data acquisition set up and proposes a state-space model where the temporal evolution of gait pattern was recognized by analyzing the feature uncertainty using Dempster-Shafer theory of evidence. An attempt was also made to quantify the degree of abnormality by proposing gait deviation indexes. Results indicate that our proposed model outperformed state-of-the-art with an overall \documentclass[12pt]{minimal}
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\begin{document}$$100\%$$\end{document}). In a gait cycle of a Cerebral Palsy patient, first double limb support and left single limb support were observed to be affected mainly. Incorporation of feature uncertainty in quantifying the degree of abnormality is demonstrated to be promising. Larger value of feature uncertainty was observed for the patients having higher degree of abnormality. Sub-phase wise assessment of gait pattern improves the interpretability of the results which is crucial in clinical decision making.
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30
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Huang C, Chen Y, Chen G, Xie Y, Mo J, Li K, Huang R, Pan G, Cai Y, Zhou L. Efficacy and safety of core stability training on gait of children with cerebral palsy: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e18609. [PMID: 31914039 PMCID: PMC6959942 DOI: 10.1097/md.0000000000018609] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 12/05/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Cerebral palsy (CP) is a common disability in children featured with pathological gait and limb function limitation due to muscle weakness. Improving limb function and quality of life is currently considered to be highlighted. Physiotherapy is a chief component of rehabilitation for children with CP, correcting gait and improve walking capacity through muscle strength training. Standard rehabilitation programs for CP have not been determined. Core stability training (CST), which coordinates limb balance via trunk control, is widely used in sports competition. And it is gradually introduced into the rehabilitation of children with cerebral palsy with a positive impact on the patients' gait performance. By screening published literatures, this study aims to conduct a meta-analysis to systematically evaluate the effectiveness and safety of CST in gait of children with CP. METHODS Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) on CST in the treatment of children with CP were searched from 6 databases. Moreover, the reference lists of conference papers and included literatures will be manually searched to avoid omissions. Literature screening and data extraction were performed independently by 2 researchers. RCTs carry out the risk of bias analysis evaluation from seven aspects through the Cochrane Collaboration's risk of bias tool. Fixed or random effect model will be performed to analyze the outcomes. When higher heterogeneity occurs (I > 50%), the sensitivity or subgroup analysis will also be conducted to find potential factors. And the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach is used for assessing the quality of evidence. RESULTS The study will evaluate the effect of CST on gait of children with CP from multiple outcomes, including walking speed, endurance, stride length, and safety. CONCLUSION Based on evidence-based medicine, the conclusion of this study can demonstrate the effectiveness and safety of CST in gait correction for children with CP. PROSPERO REGISTRATION NUMBER PROSPERO CRD 42019134094.
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Affiliation(s)
| | - Yijun Chen
- First Affiliated Hospital of Guangzhou Medical University
- National Clinical Research Center for Respiratory Disease
| | | | - Yaying Xie
- Guangzhou University of Chinese Medicine
| | - Jiahao Mo
- Guangzhou University of Chinese Medicine
| | - Keyi Li
- Guangzhou University of Chinese Medicine
| | | | - Guanghua Pan
- First Affiliated Hospital of Guangzhou Medical University
| | - Yong Cai
- First Affiliated Hospital of Guangzhou Medical University
| | - Lei Zhou
- Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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31
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A Parametric Identification Method of Human Gait Differences and its Application in Rehabilitation. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9214581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In order to understand the regularity of human motion, characteristic description is widely used in gait analysis. For completely expressing gait information and providing more concise indicators, parametric description is also particularly significant as a means of analysis. Therefore, in this paper, the mathematical models of gait curves based on the generalized extension-Bézier curve were investigated, of which the shape parameters were used as individual gait characteristics to distinguish whether the gait is normal or not and to assist in judging rehabilitation. To evaluate the models, angle data from three joints (hip, knee, and ankle) were recorded with motion capture system when participants (10 healthy males and 6 male patients with ankle fracture) were walking at comfortable velocity along a walkway. Then, the shape parameters of each subject were obtained by applying the mathematical models, and the parameter range of the normal group was further summarized. Through comparison, it could be found that most shape parameters of patients exceed the normal ranges in varying degrees, and are concentrated on specific parameters. The results can not only help to judge the recovery stages of patients but also figure out the corresponding abnormal postures, so as to provide guidance for rehabilitation training.
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32
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Tsitlakidis S, Horsch A, Schaefer F, Westhauser F, Goetze M, Hagmann S, Klotz MCM. Gait Classification in Unilateral Cerebral Palsy. J Clin Med 2019; 8:jcm8101652. [PMID: 31614496 PMCID: PMC6832635 DOI: 10.3390/jcm8101652] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 09/29/2019] [Accepted: 10/08/2019] [Indexed: 12/02/2022] Open
Abstract
As unilateral cerebral palsy represents a complex disorder, gait classification is difficult. Knowledge of the most frequent gait patterns and functional impairment is crucial for proper decision-making. This study analyzes the prevalence of gait patterns as well as the relation of different gait patterns and the Gross Motor Function Classification System (GMFCS). Eighty-nine patients were classified retrospectively using the GMFCS, the classification of Winters, Gage, and Hicks (WGH), and Sutherland et al. The distribution of GMFCS levels among the different gait patterns was analyzed using Chi-squared test. The most common subtypes were GMFCS level I, WGH type I, and recurvatum knee. Seventeen percent (WGH) and 59% (Sutherland) of the patients did not match any criteria. Applying both classifications complementarily reduced the number of unclassified patients significantly. There was no significant difference concerning the distribution of GMFCS levels or age among the different gait patterns. A combined use of various classification systems is beneficial for proper decision-making. Unclassified patients seem to be a heterogeneous subgroup concerning functional impairment. There is a need of further characterization of the unclassifiable gait patterns and the caused functional impairment. Instrumented gait analysis remains the gold standard and should be broadly used for future studies and in clinical practice.
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Affiliation(s)
- Stefanos Tsitlakidis
- Clinic of Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
| | - Axel Horsch
- Clinic of Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
| | - Felix Schaefer
- Clinic of Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
| | - Fabian Westhauser
- Clinic of Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
| | - Marco Goetze
- Clinic of Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
| | - Sebastien Hagmann
- Clinic of Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
| | - Matthias C M Klotz
- Clinic for Orthopedic & Trauma Surgery, Kepler University Hospital, Krankenhausstr. 9, 4020 Linz, Austria.
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33
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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: 32] [Impact Index Per Article: 6.4] [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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