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Kazemi Z, Arjmand N, Mazloumi A, Karimi Z, Keihani A, Ghasemi MS. Effect of muscular fatigue on the cumulative lumbar damage during repetitive lifting task: a comparative study of damage calculation methods. ERGONOMICS 2024; 67:566-581. [PMID: 37418312 DOI: 10.1080/00140139.2023.2234678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/02/2023] [Indexed: 07/09/2023]
Abstract
Several methods have been put forward to quantify cumulative loads; however, limited evidence exists as to the subsequent damages and the role of muscular fatigue. The present study assessed whether muscular fatigue could affect cumulative damage imposed on the L5-S1 joint. Trunk muscle electromyographic (EMG) activities and kinematics/kinetics of 18 healthy male individuals were evaluated during a simulated repetitive lifting task. A traditional EMG-assisted model of the lumbar spine was modified to account for the effect of erector spinae fatigue. L5-S1 compressive loads for each lifting cycle were estimated based on varying (i.e. actual), fatigue-modified, and constant Gain factors. The corresponding damages were integrated to calculate the cumulative damage. Moreover, the damage calculated for one lifting cycle was multiplied by the lifting frequency, as the traditional approach. Compressive loads and the damages obtained through the fatigue-modified model were predicted in close agreement with the actual values. Similarly, the difference between actual damages and those driven by the traditional approach was not statistically significant (p = 0.219). However, damages based on a constant Gain factor were significantly greater than those based on the actual (p = 0.012), fatigue-modified (p = 0.017), and traditional (p = 0.007) approaches.Practitioner summary: In this study, we managed to include the effect of muscular fatigue on cumulative lumbar damage calculations. Including the effect of muscular fatigue leads to an accurate estimation of cumulative damages while eliminating computational complexity. However, using the traditional approach also appears to provide acceptable estimates for ergonomic assessments.
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Affiliation(s)
- Zeinab Kazemi
- Department of Industrial Engineering, Clemson University, Clemson, SC, USA
| | - Navid Arjmand
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Adel Mazloumi
- Department of Occupational Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zanyar Karimi
- Department of Ergonomics, School of Public Health, Urmia University of Medical Sciences, Tehran, Iran
| | - Ahmadreza Keihani
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Hora M, Struška M, Matějovská Z, Kubový P, Sládek V. Muscle activity during crouched walking. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2024; 183:79-91. [PMID: 37606347 DOI: 10.1002/ajpa.24834] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 07/04/2023] [Accepted: 08/01/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVES Muscle activity during crouched walking has been previously studied in the context of the evolution of hominin bipedalism and human movement disorders. However, crouched walking could also be used in approach hunting where postural height (actual height of the body from the ground to the top of the head during locomotion) is the limiting factor. Here, we aim to analyze the relationship between relative postural height (%stature), kinematics, and muscle activity during crouched walking. MATERIALS AND METHODS Adult males (n = 19) walked with extended limbs and at three degrees of crouch while their 3D motion capture kinematics and lower limb muscle electromyography were recorded. We measured activation of tibialis anterior, soleus, gastrocnemius medialis, gastrocnemius lateralis, vastus lateralis, rectus femoris, biceps femoris, and gluteus maximus. We analyzed the effects of postural height on kinematics and muscle activation using linear mixed effects model. RESULTS Flexion angles, individual muscle activation (except for medial gastrocnemius), and total muscle activation were negatively related to relative postural height, that is, were greater at more crouched postures. Relative postural height had a stronger effect on the activation of the thigh and gluteal muscles compared to shank muscles. DISCUSSION General increase in lower limb muscle activation at lower postural heights suggests a negative relationship between relative postural height and fatigue, and may indicate a possible mechanism by which short stature could benefit the hunter in approach hunting. Greater activation of thigh and gluteal muscles relative to shank muscles may help to identify crouched walking in past human populations.
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Affiliation(s)
- Martin Hora
- Department of Anthropology and Human Genetics, Charles University, Prague, Czech Republic
| | - Michal Struška
- Department of Anthropology and Human Genetics, Charles University, Prague, Czech Republic
| | - Zuzana Matějovská
- Department of Anthropology and Human Genetics, Charles University, Prague, Czech Republic
| | - Petr Kubový
- Department of Anatomy and Biomechanics, Charles University, Prague, Czech Republic
| | - Vladimír Sládek
- Department of Anthropology and Human Genetics, Charles University, Prague, Czech Republic
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Oudenhoven LM, Van Der Krogt MM, Ettema S, Roeleveld K, Brehm MA, Buizer AI. Fatigue-related gait adaptations in children with cerebral palsy. Dev Med Child Neurol 2023; 65:1629-1638. [PMID: 37243486 DOI: 10.1111/dmcn.15660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023]
Abstract
AIM To obtain insights into the effects of fatigue on the kinematics, kinetics, and energy cost of walking (ECoW) in children with cerebral palsy (CP). METHOD In this prospective observational study, 12 children with CP (mean age 12 years 9 months, SD 2 years 7 months; four females, eight males) and 15 typically developing children (mean age 10 years 8 months, SD 2 years 4 months; seven females, eight males) followed a prolonged intensity-based walking protocol on an instrumented treadmill, combined with gas analysis measurements. The protocol consisted of consecutive stages, including a 6-minute walking exercise (6MW) at comfortable speed, 2 minutes of moderate-intensity walking (MIW) (with a heart rate > 70% of its predicted maximal), and 4 minutes walking after MIW. If necessary, the speed and slope were incremented to reach MIW. Outcomes were evaluated at the beginning and end of the 6MW and after MIW. RESULTS With prolonged walking, Gait Profile Scores deteriorated slightly for both groups (p < 0.01). Knee flexion increased during early stance (p = 0.004) and ankle dorsiflexion increased during late stance (p = 0.034) in children with CP only. Negligible effects were found for kinetics. No demonstrable change in ECoW was found in either group (p = 0.195). INTERPRETATION Kinematic deviations in children with CP are progressive with prolonged walking. The large variation in adaptations indicates that an individual approach is recommended to investigate the effects of physical fatigue on gait in clinical practice.
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Affiliation(s)
- Laura M Oudenhoven
- Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Rehabilitation and Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Marjolein M Van Der Krogt
- Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Rehabilitation and Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Sanne Ettema
- Research and Development, Heliomare, Wijk aan Zee, the Netherlands
- Center for Human Movement Sciences, University of Groningen, UMCG, Groningen, the Netherlands
| | - Karin Roeleveld
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Merel A Brehm
- Rehabilitation and Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands
- Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Annemieke I Buizer
- Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Rehabilitation and Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands
- Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
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Takahashi K, Mizukami M, Watanabe H, Kuroda MM, Shimizu Y, Nakajima T, Mutsuzaki H, Kamada H, Tokeji K, Hada Y, Koseki K, Yoshikawa K, Nakayama T, Iwasaki N, Kawamoto H, Sankai Y, Yamazaki M, Matsumura A, Marushima A. Feasibility and safety study of wearable cyborg Hybrid Assistive Limb for pediatric patients with cerebral palsy and spinal cord disorders. Front Neurol 2023; 14:1255620. [PMID: 38020664 PMCID: PMC10656736 DOI: 10.3389/fneur.2023.1255620] [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: 07/09/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The wearable cyborg Hybrid Assistive Limb (HAL) is the world's first cyborg-type wearable robotic device, and it assists the user's voluntary movements and facilitates muscle activities. However, since the minimum height required for using the HAL is 150 cm, a smaller HAL (2S size) has been newly developed for pediatric use. This study aimed to (1) examine the feasibility and safety of a protocol for treatments with HAL (2S size) in pediatric patients and (2) explore the optimal method for assessing the efficacy of HAL. Methods This clinical study included seven pediatric patients with postural and motor function disorders, who received 8-12 sessions of smaller HAL (2S size) treatment. The primary outcome was the Gross Motor Function Measure-88 (GMFM-88). The secondary outcomes were GMFM-66, 10-m walk test, 2- and 6-min walking distances, Canadian Occupational Performance Measure (COPM), a post-treatment questionnaire, adverse events, and device failures. Statistical analyses were performed using the paired samples t-test or Wilcoxon signed-rank test. Results All participants completed the study protocol with no serious adverse events. GMFM-88 improved from 65.51 ± 21.97 to 66.72 ± 22.28 (p = 0.07). The improvements in the secondary outcomes were as follows: GMFM-66, 53.63 ± 11.94 to 54.96 ± 12.31, p = 0.04; step length, 0.32 ± 0.16 to 0.34 ± 0.16, p = 0.25; 2-MWD, 59.1 ± 57.0 to 62.8 ± 63.3, p = 0.54; COPM performance score, 3.7 ± 2.0 to 5.3 ± 1.9, p = 0.06; COPM satisfaction score, 3.3 ± 2.1 to 5.1 ± 2.1, p = 0.04. Discussion In this exploratory study, we applied a new size of wearable cyborg HAL (2S size), to children with central nervous system disorders. We evaluated its safety, feasibility, and identified an optimal assessment method for multiple treatments. All participants completed the protocol with no serious adverse events. This study suggested that the GMFM would be an optimal assessment tool for validation trials of HAL (2S size) treatment in pediatric patients with posture and motor function disorders.
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Affiliation(s)
- Kazushi Takahashi
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami, Japan
- Graduate School of Health Science, Ibaraki Prefectural University of Health Sciences, Ami, Japan
| | - Masafumi Mizukami
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ami, Japan
| | - Hiroki Watanabe
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Mayumi Matsuda Kuroda
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ami, Japan
| | - Yukiyo Shimizu
- Department of Rehabilitation Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Takashi Nakajima
- Department of Neurology, National Hospital Organization Niigata National Hospital, Kashiwazaki, Japan
| | - Hirotaka Mutsuzaki
- Center for Medical Science, Ibaraki Prefectural University of Health Sciences, Ami, Japan
| | - Hiroshi Kamada
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kayo Tokeji
- Department of Rehabilitation Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Kazunori Koseki
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami, Japan
| | - Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami, Japan
| | - Tomohiro Nakayama
- Department of Pediatric, Ibaraki Prefectural University of Health Sciences Hospital, Ami, Japan
| | - Nobuaki Iwasaki
- Department of Pediatric Neurology, Tsuchiura Rehabilitation Hospital, Tsuchiura, Japan
| | - Hiroaki Kawamoto
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Yoshiyuki Sankai
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akira Matsumura
- Graduate School of Health Science, Ibaraki Prefectural University of Health Sciences, Ami, Japan
| | - Aiki Marushima
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
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Moll I, Essers JMN, Marcellis RGJ, Senden RHJ, Janssen-Potten YJM, Vermeulen RJ, Meijer K. Lower limb muscle fatigue after uphill walking in children with unilateral spastic cerebral palsy. PLoS One 2022; 17:e0278657. [PMID: 36473000 PMCID: PMC9725134 DOI: 10.1371/journal.pone.0278657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
Fatigue during walking is a common complaint in cerebral palsy (CP). The primary purpose of this study is to investigate muscle fatigue from surface electromyography (sEMG) measurements after a treadmill-based fatigue protocol with increasing incline and speed in children with CP with drop foot. The secondary purpose is to investigate whether changes in sagittal kinematics of hip, knee and ankle occur after fatigue. Eighteen subjects with unilateral spastic CP performed the protocol while wearing their ankle-foot orthosis and scored their fatigue on the OMNI scale of perceived exertion. The median frequency (MF) and root mean square (RMS) were used as sEMG measures for fatigue and linear mixed effects model were applied. The MF was significantly decreased in fatigued condition, especially in the affected leg and in the tibialis anterior and peroneus longus muscle. The RMS did not change significantly in fatigued condition, while the OMNI fatigue score indicated patients felt really fatigued. No changes in sagittal kinematics of hip, knee and ankle were found using statistical non-parametric mapping. In conclusion, the current fatigue protocol seems promising in inducing fatigue in a population with CP with drop foot and it could be used to expand knowledge on muscle fatigue during walking in CP.
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Affiliation(s)
- I. Moll
- School of Mental Health and Neurosciences (MHeNs), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, the Netherlands
- Department of Nutrition and Movement Sciences, FHML, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
- Department of Neurology, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
- * E-mail:
| | - J. M. N. Essers
- Department of Nutrition and Movement Sciences, FHML, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
| | | | - R. H. J. Senden
- Department of Physiotherapy, MUMC+, Maastricht, the Netherlands
| | - Y. J. M. Janssen-Potten
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
| | - R. J. Vermeulen
- School of Mental Health and Neurosciences (MHeNs), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, the Netherlands
- Department of Neurology, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - K. Meijer
- Department of Nutrition and Movement Sciences, FHML, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
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Das R, Paul S, Mourya GK, Kumar N, Hussain M. Recent Trends and Practices Toward Assessment and Rehabilitation of Neurodegenerative Disorders: Insights From Human Gait. Front Neurosci 2022; 16:859298. [PMID: 35495059 PMCID: PMC9051393 DOI: 10.3389/fnins.2022.859298] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/01/2022] [Indexed: 12/06/2022] Open
Abstract
The study of human movement and biomechanics forms an integral part of various clinical assessments and provides valuable information toward diagnosing neurodegenerative disorders where the motor symptoms predominate. Conventional gait and postural balance analysis techniques like force platforms, motion cameras, etc., are complex, expensive equipment requiring specialist operators, thereby posing a significant challenge toward translation to the clinics. The current manuscript presents an overview and relevant literature summarizing the umbrella of factors associated with neurodegenerative disorder management: from the pathogenesis and motor symptoms of commonly occurring disorders to current alternate practices toward its quantification and mitigation. This article reviews recent advances in technologies and methodologies for managing important neurodegenerative gait and balance disorders, emphasizing assessment and rehabilitation/assistance. The review predominantly focuses on the application of inertial sensors toward various facets of gait analysis, including event detection, spatiotemporal gait parameter measurement, estimation of joint kinematics, and postural balance analysis. In addition, the use of other sensing principles such as foot-force interaction measurement, electromyography techniques, electrogoniometers, force-myography, ultrasonic, piezoelectric, and microphone sensors has also been explored. The review also examined the commercially available wearable gait analysis systems. Additionally, a summary of recent progress in therapeutic approaches, viz., wearables, virtual reality (VR), and phytochemical compounds, has also been presented, explicitly targeting the neuro-motor and functional impairments associated with these disorders. Efforts toward therapeutic and functional rehabilitation through VR, wearables, and different phytochemical compounds are presented using recent examples of research across the commonly occurring neurodegenerative conditions [viz., Parkinson's disease (PD), Alzheimer's disease (AD), multiple sclerosis, Huntington's disease (HD), and amyotrophic lateral sclerosis (ALS)]. Studies exploring the potential role of Phyto compounds in mitigating commonly associated neurodegenerative pathologies such as mitochondrial dysfunction, α-synuclein accumulation, imbalance of free radicals, etc., are also discussed in breadth. Parameters such as joint angles, plantar pressure, and muscle force can be measured using portable and wearable sensors like accelerometers, gyroscopes, footswitches, force sensors, etc. Kinetic foot insoles and inertial measurement tools are widely explored for studying kinematic and kinetic parameters associated with gait. With advanced correlation algorithms and extensive RCTs, such measurement techniques can be an effective clinical and home-based monitoring and rehabilitation tool for neuro-impaired gait. As evident from the present literature, although the vast majority of works reported are not clinically and extensively validated to derive a firm conclusion about the effectiveness of such techniques, wearable sensors present a promising impact toward dealing with neurodegenerative motor disorders.
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Affiliation(s)
- Ratan Das
- Department of Biomedical Engineering, North-Eastern Hill University, Shillong, India
| | - Sudip Paul
- Department of Biomedical Engineering, North-Eastern Hill University, Shillong, India
| | - Gajendra Kumar Mourya
- Department of Biomedical Engineering, North-Eastern Hill University, Shillong, India
| | - Neelesh Kumar
- Biomedical Applications Unit, Central Scientific Instruments Organisation, Chandigarh, India
| | - Masaraf Hussain
- Department of Neurology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India
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Min JJ, Kwon SS, Sung KH, Lee KM, Lee H, Chung CY, Park MS. What happens to the patella height in patients with cerebral palsy as they age. J Pediatr Orthop B 2022; 31:188-193. [PMID: 34561382 DOI: 10.1097/bpb.0000000000000917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We aimed to investigate the progression of patella alta (PA) in patients with cerebral palsy (CP) using the Koshino-Sugimoto (KS) index and assess associated risk factors. Participants in our retrospective study met the following inclusion criteria: patients with CP who visited our institute from May 2003 to December 2019, were ≤18 years of age, were followed up for >2 years and had at least two lateral knee radiographs. KS indices of both knee radiographs were measured for each patient. A linear mixed model was implemented. Our participants included 222 CP patients. KS index values were measured via 652 knee radiographs. Reference values of the KS index for those between 4 and 18 years of age were determined according to Gross Motor Function Classification System (GMFCS) levels. In all GMFCS levels, the KS index decreased with patients' ages (P < 0.0001). In groups where the KS index increased, GMFCS levels IV (P = 0.0045) and V (P = 0.0040) were statistically significant. Change in the KS index values indicates that PA improves as patients age within all GMFCS levels. However, in patients with GMFCS levels of IV and V, progressive PA is expected.
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Affiliation(s)
- Jae Jung Min
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital
| | - Soon-Sun Kwon
- Department of Mathematics, College of Natural Sciences, Ajou University, Gyeonggi, Korea
| | - Ki Hyuk Sung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital
| | - Kyoung Min Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital
| | - Hansang Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital
| | - Chin Youb Chung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital
| | - Moon Seok Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital
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Li S, Luo X, Zhang S, Tang Y, Sun J, Meng Q, Yu H, Sun C. Evaluation of Multilevel Surgeries in Children With Spastic Cerebral Palsy Based on Surface Electromyography. Front Neurosci 2021; 15:680645. [PMID: 34335161 PMCID: PMC8319621 DOI: 10.3389/fnins.2021.680645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/25/2021] [Indexed: 11/17/2022] Open
Abstract
The root mean square (RMS) of the surface electromyography (sEMG) signal can respond to neuromuscular function, which displays a positive correlation with muscle force and muscle tension under positive and passive conditions, respectively. The purpose of this study was to investigate the changes in muscle force and tension after multilevel surgical treatments, functional selective posterior rhizotomy (FSPR) and tibial anterior muscle transfer surgery, and evaluate their clinical effect in children with spastic cerebral palsy (SCP) during walking. Children with diplegia (n = 13) and hemiplegia (n = 3) with ages from 4 to 18 years participated in this study. They were requested to walk barefoot at a self-selected speed on a 15-m-long lane. The patient's joints' range of motion (ROM) and sEMG signal of six major muscles were assessed before and after the multilevel surgeries. The gait cycle was divided into seven phases, and muscle activation state can be divided into positive and passive conditions during gait cycle. For each phase, the RMS of the sEMG signal amplitude was calculated and also normalized by a linear envelope (10-ms running RMS window). The muscle tension of the gastrocnemius decreased significantly during the loading response, initial swing, and terminal swing (p < 0.05), which helped the knee joint to get the maximum extension when the heel is on the ground and made the heel land smoothly. The muscle force of the gastrocnemius increased significantly (p < 0.05) during the mid-stance, terminal stance, and pre-swing, which could generate the driving force for the human body to move forward. The muscle tension of the biceps femoris and semitendinosus decreased significantly (p < 0.05) during the terminal stance, pre-swing, and initial swing. The decreased muscle tension could relieve the burden of the knee flexion when the knee joint was passively flexed. At the terminal swing, the muscle force of the tibial anterior increased significantly (p < 0.05), which could improve the ankle dorsiflexion ability and prevent foot drop and push forward. Thus, the neuromuscular function of cerebral palsy during walking can be evaluated by the muscle activation state and the RMS of the sEMG signal, which showed that multilevel surgical treatments are feasible and effective to treat SCP.
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Affiliation(s)
- Sujiao Li
- Institute of Rehabilitation Engineering and Technology, School of Medical Device and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China.,Shanghai Engineering Research Center of Assistive Devices, University of Shanghai for Science and Technology, Shanghai, China
| | - Xueqin Luo
- Institute of Rehabilitation Engineering and Technology, School of Medical Device and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China.,Shanghai Engineering Research Center of Assistive Devices, University of Shanghai for Science and Technology, Shanghai, China
| | - Song Zhang
- Department of Functional Neurosurgery, Shanghai Punan Hospital, Shanghai Eber Medical Group, Shanghai, China.,Department of Pediatric Neurosurgery, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yuanmin Tang
- Institute of Rehabilitation Engineering and Technology, School of Medical Device and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China.,Shanghai Engineering Research Center of Assistive Devices, University of Shanghai for Science and Technology, Shanghai, China
| | - Jiming Sun
- Department of Functional Neurosurgery, Shanghai Punan Hospital, Shanghai Eber Medical Group, Shanghai, China
| | - Qingyun Meng
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Hongliu Yu
- Institute of Rehabilitation Engineering and Technology, School of Medical Device and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China.,Shanghai Engineering Research Center of Assistive Devices, University of Shanghai for Science and Technology, Shanghai, China
| | - Chengyan Sun
- Department of Functional Neurosurgery, Shanghai Punan Hospital, Shanghai Eber Medical Group, Shanghai, China
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Goubault E, Verdugo F, Pelletier J, Traube C, Begon M, Dal Maso F. Exhausting repetitive piano tasks lead to local forearm manifestation of muscle fatigue and negatively affect musical parameters. Sci Rep 2021; 11:8117. [PMID: 33854088 PMCID: PMC8047012 DOI: 10.1038/s41598-021-87403-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 03/23/2021] [Indexed: 02/02/2023] Open
Abstract
Muscle fatigue is considered as a risk factor for developing playing-related muscular disorders among professional pianists and could affect musical performance. This study investigated in 50 pianists the effect of fatiguing repetitive piano sequences on the development of forearm muscle fatigue and on piano performance parameters. Results showed signs of myoelectric manifestation of fatigue in the 42-electromyographic bipolar electrodes positioned on the forearm to record finger and wrist flexor and extensor muscles, through a significant non-constant decrease of instantaneous median frequency during two repetitive Digital (right-hand 16-tones sequence) and Chord (right-hand chords sequence) excerpts, with extensor muscles showing greater signs of fatigue than flexor muscles. In addition, muscle fatigue negatively affected key velocity, a central feature of piano sound intensity, in both Digital and Chord excerpts, and note-events, a fundamental aspect of musicians' performance parameter, in the Chord excerpt only. This result highlights that muscle fatigue may alter differently pianists' musical performance according to the characteristics of the piece played.
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Affiliation(s)
- Etienne Goubault
- grid.14848.310000 0001 2292 3357Laboratoire de Simulation et Modélisation du Mouvement, École de Kinésiologie et des Sciences de l’activité Physique, Université de Montréal, 1700 Rue Jacques-Tétreault, Laval, QC Canada
| | - Felipe Verdugo
- grid.14709.3b0000 0004 1936 8649Input Devices and Music Interaction Laboratory, Centre for Interdisciplinary Research in Music Media and Technology, Schulich School of Music, McGill University, Montreal, QC Canada ,grid.267180.a0000 0001 2168 0285EXPRESSION Team, Université Bretagne-Sud, Vannes, France
| | - Justine Pelletier
- grid.38678.320000 0001 2181 0211Laboratoire Arts vivants et interdisciplinarité, Département de danse, Université du Québec à Montréal, Montreal, QC Canada
| | - Caroline Traube
- grid.14848.310000 0001 2292 3357Laboratoire de recherche sur le geste musicien, Faculté de musique, Université de Montréal, Montreal, QC Canada
| | - Mickaël Begon
- grid.14848.310000 0001 2292 3357Laboratoire de Simulation et Modélisation du Mouvement, École de Kinésiologie et des Sciences de l’activité Physique, Université de Montréal, 1700 Rue Jacques-Tétreault, Laval, QC Canada ,grid.411418.90000 0001 2173 6322Sainte-Justine Hospital Research Center, Montreal, QC Canada
| | - Fabien Dal Maso
- grid.14848.310000 0001 2292 3357Laboratoire de Simulation et Modélisation du Mouvement, École de Kinésiologie et des Sciences de l’activité Physique, Université de Montréal, 1700 Rue Jacques-Tétreault, Laval, QC Canada ,Centre interdisciplinaire de recherche sur le cerveau et l’apprentissage, Montréal, QC Canada
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Short walking exercise leads to gait changes and muscle fatigue in children with cerebral palsy who walk with jump gait. Am J Phys Med Rehabil 2021; 100:1093-1099. [PMID: 33587452 DOI: 10.1097/phm.0000000000001713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate kinematic changes and muscle fatigue in jump gait during a walking exercise, and the relationship between kinematic changes and muscle fatigue and strength. DESIGN This preliminary study included ten children with cerebral palsy (CP) who walk with jump gait. Hip and knee maximal isometric muscle strength were measured using a dynamometer. Then, lower-limb kinematics and electromyography were collected while children walked continuously for 6-min at their self-selected speed. Electromyography median frequency and lower-limb joint angles were compared between the first and the sixth minute of the walking exercise using T-test and Wilcoxon rank test. Relationship between kinematic changes and muscle strength and changes in electromyography median frequency were assessed using correlation analyses. RESULTS During stance, maximal knee flexion significantly increased at the sixth minute (P=0.01) and was associated with knee extensor muscle weakness (rho=-0.504, P=0.03). Muscle fatigue was only observed in gluteus medius muscle (P=0.01). CONCLUSIONS Children with CP who walked with jump gait and who had knee extensor weakness were more prone to an increase in knee flexion during a continuous walk. The fatigue in the gluteus medius muscle suggests that physical intervention should target the endurance of this muscle to improve jump gait.
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Roostaei M, Raji P, Morone G, Razi B, Khademi-Kalantari K. The effect of dual-task conditions on gait and balance performance in children with cerebral palsy: A systematic review and meta-analysis of observational studies. J Bodyw Mov Ther 2020; 26:448-462. [PMID: 33992282 DOI: 10.1016/j.jbmt.2020.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 10/29/2020] [Accepted: 12/07/2020] [Indexed: 02/07/2023]
Abstract
Dual-task conditions are commonly experienced in daily routines. The aim of the present systematic review is to investigate the effect of dual-task conditions on gait and balance performance in children with cerebral palsy (CP) and to perform meta-analyses where applicable. Five databases, "ProQuest", "PubMed", "OTSeeker", "Scopus", and "PEDro" from the incipient date of databases up to Aug 24, 2020 were searched for studies focusing on the effects of dual-task conditions on gait and balance performance in children with CP. After removing irrelevant articles and applying inclusion and exclusion criteria, nine articles were included in the present systematic review and meta-analysis. The results of the meta-analysis showed that walking speed was slower during dual-task conditions compared to single-task conditions in children with CP (WMD = -0.29 m/s, 95% CI = -0.34, -0.24, P ≤ 0.001) and walking speed decreased in children with CP during dual-task conditions in comparison with the typical development (TD) control group (WMD = -0.19 m/s, 95% CI = -0.23 to -0.15, P ≤ 0.001). The results of subgroup analysis based on the type of task indicated that adding concurrent tasks to walking degrades walking speed under varied dual-task conditions. Additionally, theoretical synthesis of the literature demonstrated that other gait and balance variables are changed by performing cognitive and motor secondary tasks differently. Although these changes may be compensatory strategies to retain their stability, there was not sufficient evidence to reach a firm conclusion. Research gaps and recommendations for future studies are discussed.
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Affiliation(s)
- Meysam Roostaei
- Department of Occupational Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Parvin Raji
- Department of Occupational Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | | | - Bahman Razi
- Department of Hematology, School of Medicine, Tarbiat Modares University, Tehran, Iran.
| | - Khosro Khademi-Kalantari
- Department of Physiotherapy, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Cherni Y, Ballaz L, Lemaire J, Dal Maso F, Begon M. Effect of low dose robotic-gait training on walking capacity in children and adolescents with cerebral palsy. Neurophysiol Clin 2020; 50:507-519. [DOI: 10.1016/j.neucli.2020.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/04/2020] [Accepted: 09/05/2020] [Indexed: 12/01/2022] Open
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O'Sullivan R, Marron A, Brady K. Crouch gait or flexed-knee gait in cerebral palsy: Is there a difference? A systematic review. Gait Posture 2020; 82:153-160. [PMID: 32927222 DOI: 10.1016/j.gaitpost.2020.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/11/2020] [Accepted: 09/01/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Crouch or flexed-knee gait is one of the most common pathological gait patterns in cerebral palsy (CP). Differences exist in definitions used; the degree of knee flexion, inclusion of hip or ankle position, and timing in the gait cycle. This ambiguity may be responsible for variations in prevalence rates and difficulty comparing data across studies. RESEARCH QUESTION What are the kinematic parameters used to define crouch or flexed-knee gait in CP gait? A secondary aim was to examine the quality of data reporting, focusing on the sample characteristics, inclusion/exclusion criteria and the choice of limb included for analysis. METHODS Articles included in this review reported on a specified cohort of adults or children with crouch or flexed-knee gait assessed with 3-dimensional gait analysis. A customised data extraction and quality assessment table was designed specific to the research question. RESULTS The majority (75 %) of included studies used the term crouch gait. Where the pattern was defined, 80 % of crouch papers and 94 % of flexed-knee gait papers based this solely on knee position. Kinematic parameters were clearly defined when they provided objective values of knee flexion, supported this with rationale and provided a reference point in the gait cycle. Only 22 % of crouch papers and 19 % of flexed-knee gait papers provided this information. The majority of studies (67 % crouch; 90 % flexed-knee) specified which limb(s) were included for analysis with the majority including both limbs. Objective values of knee flexion ranged from 8 o to 30 o. SIGNIFICANCE This review highlights that crouch and flexed knee are synonymous and ambiguity exists in the kinematic definition making it difficult to make compare data amongst study cohorts. Future research should provide detailed definitions including the threshold value of knee flexion, how it was derived, the timing in the gait cycle and the limb(s) included in analysis.
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Affiliation(s)
- R O'Sullivan
- Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland.
| | - A Marron
- Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland
| | - K Brady
- Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland
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Pouliot-Laforte A, Parent A, Hamdy R, Marois P, Lemay M, Ballaz L. Relationship between lower limb strength and walking capacities in children with spastic bilateral cerebral palsy. Disabil Rehabil 2020; 44:1916-1922. [DOI: 10.1080/09638288.2020.1813819] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Annie Pouliot-Laforte
- Sainte-Justine UHC Research Center, Marie Enfant Rehabilitation Center, Montreal, Canada
- Department of Biological Sciences, Université du Québec à Montréal (UQAM), Montreal, Canada
| | - Audrey Parent
- Sainte-Justine UHC Research Center, Marie Enfant Rehabilitation Center, Montreal, Canada
- Department of Biological Sciences, Université du Québec à Montréal (UQAM), Montreal, Canada
| | - Reggie Hamdy
- Shriners Hospital for Children-Canada, Montreal, Canada
| | - Pierre Marois
- Sainte-Justine UHC Research Center, Marie Enfant Rehabilitation Center, Montreal, Canada
| | - Martin Lemay
- Sainte-Justine UHC Research Center, Marie Enfant Rehabilitation Center, Montreal, Canada
- Department of Physical Activity Sciences, Université du Québec à Montréal (UQAM), Montreal, Canada
| | - Laurent Ballaz
- Sainte-Justine UHC Research Center, Marie Enfant Rehabilitation Center, Montreal, Canada
- Department of Physical Activity Sciences, Université du Québec à Montréal (UQAM), Montreal, Canada
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Zhan Q, Yu X, Jiang W, Shen M, Jiang S, Mei R, Wang J, Xiao B. Whether the newly modified rhizotomy protocol is applicable to guide single-level approach SDR to treat spastic quadriplegia and diplegia in pediatric patients with cerebral palsy? Childs Nerv Syst 2020; 36:1935-1943. [PMID: 31502037 PMCID: PMC7434794 DOI: 10.1007/s00381-019-04368-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/02/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Our aim was to test whether the newly modified rhizotomy protocol which could be effectively used to guide single-level approach selective dorsal rhizotomy (SL-SDR) to treat spastic hemiplegic cases by mainly releasing those spastic muscles (target muscles) marked pre-operatively in their lower limbs was still applicable in spastic quadriplegic or diplegic cerebral palsy (CP) cases in pediatric population. METHODS In the current study, we retrospectively conducted a cohort review of cases younger than 14 years of age diagnosed with spastic quadriplegic or diplegic CP who undergone our modified protocol-guided SL-SDR in the Department of Neurosurgery, Children's Hospital of Shanghai since July 2016 to November 2017 with at least 12 months post-op intensive rehabilitation program (pre-op GMFCS level-based). Clinical data including demographics, intra-operative EMG responses interpretation, and relevant assessment of included cases were taken from the database. Inclusion and exclusion criteria were set for the selection of patients in the current study. Muscle tone (modified Ashworth scale) and strength of those spastic muscles (muscle strength grading scale), range of motion (ROM) of those joints involved, the level of Gross Motor Function Classification System (GMFCS), and Gross Motor Function Measure 66 items (GMFM-66) score of those cases were our focus. RESULTS A total of 86 eligible cases were included in our study (62 boys). Among these patients, 61.6% were quadriplegic. Pre-operatively, almost 2/3 of our cases were with GMFCS levels II and III. Mean age at the time of surgery in these cases was 6.2 (3.5-12) years. Pre-op assessment marked 582 target muscles in these patients. Numbers of nerve rootlets tested during SDR procedure were between 52 and 84 across our cases, with a mean of 66.5 ± 6.7/case. Among those tested (5721 in 86 cases), 47.9% (2740) were identified as lower limb-related sensory rootlets. Our protocol successfully differentiated sensory rootlets which were considered to be associated with spasticity of target muscles across all our 86 cases (ranged from 3 to 21). Based on our protocol, 871 dorsal nerve rootlets were sectioned 50%, and 78 were cut 75%. Muscle tone of those target muscles reduced significantly right after SL-SDR procedure (3 weeks post- vs. pre-op, 1.7 ± 0.5 vs. 2.6 ± 0.7). After an intensive rehabilitation program for 19.9 ± 6.0 months, muscle tone continued to decrease to 1.4 ± 0.5. With the reduction of muscle tone, strength of those target muscles in our cases improved dramatically with statistical significance achieved (3.9 ± 1.0 at the time of last follow-up vs. 3.3 ± 0.8 pre-op), and as well as ROM. Increase in GMFCS level and GMFM-66 score was observed at the time of last follow-up with a mean of 0.4 ± 0.6 and 6.1 ± 3.2, respectively, when compared with that at pre-op. In 81 cases with their pre-op GMFCS levels II to V, 27 (33.3%) presented improvement with regard to GMFCS level upgrade, among which 4 (4.9%) even upgraded over 2 levels. Better results with regard to upgrading in level of GMFCS were observed in cases with pre-op levels II and III when compared with those with levels IV and V (24/57 vs. 3/24). Upgrading percentage in cases younger than 6 years at surgery was significantly greater than in those older (23/56 vs. 4/25). Cases with their pre-op GMFM-66 score ≥ 50 had greater score increase of GMFM-66 when compared with those less (7.1 ± 3.4 vs. 5.1 ± 2.8). In the meanwhile, better score improvement was revealed in cases when SDR performed at younger age (6.9 ± 3.3 in case ≤ 6 years vs. 4.7 ± 2.7 in case > 6 years). No permanent surgery-related complications were recorded in the current study. CONCLUSION SL-SDR when guided by our newly modified rhizotomy protocol was still feasible to treat pediatric CP cases with spastic quadriplegia and diplegia. Cases in this condition could benefit from such a procedure when followed by our intensive rehabilitation program with regard to their motor function.
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Affiliation(s)
- Qijia Zhan
- grid.16821.3c0000 0004 0368 8293Department of Neurosurgery, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xidan Yu
- Department of Rehabilitation Medicine, Shanghai Rehabilitation and Vocational Training Center for the Disabled, Shanghai, China
| | - Wenbin Jiang
- grid.16821.3c0000 0004 0368 8293Department of Neurosurgery, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Min Shen
- Department of Rehabilitation Medicine, Shanghai Rehabilitation and Vocational Training Center for the Disabled, Shanghai, China
| | - Shuyun Jiang
- grid.412540.60000 0001 2372 7462Gait and Motion Analysis Center, Yueyang Hospital of Integrated Traditional and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Rong Mei
- grid.16821.3c0000 0004 0368 8293Department of Neurosurgery, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Junlu Wang
- grid.16821.3c0000 0004 0368 8293Department of Neurosurgery, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Bo Xiao
- Department of Neurosurgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.
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Chagas PS, Peixoto JG, Ortis MDDC, Ribeiro LC, Alves JWF, Defilipo EC. Comprimento de isquiotibiais, função motora grossa e marcha em crianças e adolescentes com paralisia cerebral. FISIOTERAPIA E PESQUISA 2019. [DOI: 10.1590/1809-2950/18018026042019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O objetivo desse estudo é verificar se há relação entre o comprimento dos isquiotibiais, função motora grossa e marcha em crianças e adolescentes com paralisia cerebral (PC). Os participantes, entre 6 e 18 anos, foram classificados pelo Sistema de Classificação da Função Motora Grossa (GMFCS) nos níveis I, II e III através da escala Tardieu modificada, para avaliar o comprimento dos músculos isquiotibiais, sendo identificados em: R1 (primeira resistência da extensão da perna), R2 (segunda resistência da extensão da perna) e R2-R1 (diferença entre R1 e R2) do membro inferior esquerdo e direito. Para avaliar a função motora grossa, foi utilizado o teste gross motor function measure (GMFM-88), e a escala physicians rating scale modificada (PRS) foi utilizada para avaliar a marcha. Vinte e três participantes foram incluídos e os resultados evidenciaram correlações moderadas entre R1, R2 e PRS do membro inferior esquerdo e GMFM. As demais variáveis apresentaram uma correlação fraca.
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