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Fierro-Marrero J, Corujo-Merino A, La Touche R, Lerma-Lara S. Motor imagery ability in children and adolescents with cerebral palsy: a systematic review and evidence map. Front Neurol 2024; 15:1325548. [PMID: 38379703 PMCID: PMC10876901 DOI: 10.3389/fneur.2024.1325548] [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: 11/11/2023] [Accepted: 01/11/2024] [Indexed: 02/22/2024] Open
Abstract
Background Cerebral palsy (CP) refers to a group of permanent movement and posture disorders. Motor imagery (MI) therapy is known to provide potential benefits, but data on MI ability in children and adolescents with CP is lacking. Objective A systematic review was performed to explore MI abilities in children and adolescents with CP compared to typically developed (TD) subjects. Methods We searched on PubMed, Web of Science (WOS), EBSCO, Google Scholar, and PEDro including observational studies. Methodological quality was assessed with the modified Newcastle-Ottawa Scale and evidence map was created to synthesize the evidence qualitatively and quantitatively. Results Seven cross-sectional studies were selected, which included 174 patients with CP and 321 TD subjects. Three studies explored explicit MI, two MI-execution synchrony, and four implicit MI domains. Methodological quality ranged from 6 to 8 stars. Moderate evidence supported the absence of differences in vividness between the groups. As there was only limited evidence, establishing a clear direction for the results was not possible, especially for the capacity to generate MI, mental chronometry features, and MI-execution synchrony domains. Moderate evidence supported a lower efficiency in cases for hand recognition, derived from a lower accuracy rate, while reaction time remained similar between the two groups. Moderate evidence indicated that patients with CP and TD controls showed similar features on whole-body recognition. Conclusion Moderate evidence suggests that patients with CP present a reduced ability in hand recognition, which is not observed for whole-body recognition compared to healthy controls. Severe limitations concerning sample size calculations and validity of assessment tools clearly limits establishing a direction of results, especially for explicit MI and MI-Execution synchrony domains. Further research is needed to address these limitations to enhance our comprehension of MI abilities in children, which is crucial for prescribing suitable MI-based therapies in this child population.
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Affiliation(s)
- José Fierro-Marrero
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
| | - Alejandro Corujo-Merino
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
| | - Roy La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), Madrid, Spain
| | - Sergio Lerma-Lara
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
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Ippersiel P, Dussault-Picard C, Mohammadyari SG, De Carvalho GB, Chandran VD, Pal S, Dixon PC. Muscle coactivation during gait in children with and without cerebral palsy. Gait Posture 2024; 108:110-116. [PMID: 38029482 DOI: 10.1016/j.gaitpost.2023.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/10/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Children with Cerebral Palsy (CP) walk with an uncoordinated gait compared to Typically Developing (TD) children. This behavior may reflect greater muscle co-activation in the lower limb; however, findings are inconsistent, and the determinants of this construct are unclear. RESEARCH OBJECTIVES (i) Compare lower-limb muscle co-activation during gait in children with, and without CP, and (ii) determine the extent to which muscle co-activation is influenced by electromyography normalization procedures and Gross Motor Function Classification System (GMFCS) class. METHODS An electromyography system measured muscle activity in the rectus femoris, semitendinosus, gastrocnemius, and tibialis anterior muscles during walking in 46 children (19 CP, 27 TD). Muscle co-activation was calculated for the tibialis anterior-gastrocnemius (TA-G), rectus femoris-gastrocnemius (RF-G), and rectus femoris-semitendinosus (RF-S) pairings, both using root mean squared (RMS)-averaged and dynamically normalized data, during stance and swing. Mann-Whitney U and independent t-tests examined differences in muscle co-activation by group (CP vs. TD) and GMFCS class (CP only), while mean difference 95% bootstrapped confidence intervals compared electromyography normalization procedures. RESULTS Using dynamically normalized data, the CP group had greater muscle co-activation for the TA-G and RF-G pairs during stance (p < 0.01). Using RMS-averaged data, the CP group had greater muscle co-activation for TA-G (stance and swing, p < 0.01), RF-G (stance, p < 0.05), and RF-S (swing, p < 0.01) pairings. Muscle co-activation calculated with dynamically normalized, compared to RMS-averaged data, were larger in the RF-S and RF-G (stance) pairs, but smaller during swing (RF-G). Children with CP classified as GMFCS II had greater muscle co-activation during stance in the TA-G pair (p < 0.05). SIGNIFICANCE Greater muscle co-activation observed in children with CP during stance may reflect a less robust gait strategy. Although data normalization procedures influence muscle co-activation ratios, this behavior was observed independent of normalization technique.
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Affiliation(s)
- P Ippersiel
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Canada; Research Center of the CHU Sainte-Justine, Montreal, Canada.
| | - C Dussault-Picard
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Canada; Research Center of the CHU Sainte-Justine, Montreal, Canada
| | - S G Mohammadyari
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Canada; Research Center of the CHU Sainte-Justine, Montreal, Canada
| | - G B De Carvalho
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States
| | - V D Chandran
- Department of Rehabilitation, Hospital for Special Surgery, New York, New York, U.S.A
| | - S Pal
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States
| | - P C Dixon
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Canada; Research Center of the CHU Sainte-Justine, Montreal, Canada; Institute of Biomedical Engineering, Faculty of Medicine, University of Montreal, Canada
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Li L, Zhang L, Cui H, Zhao Y, Zhu C, Fan Q, Li W. Gait and sEMG characteristics of lower limbs in children with unilateral spastic cerebral palsy during walking. Gait Posture 2024; 108:177-182. [PMID: 38100956 DOI: 10.1016/j.gaitpost.2023.12.007] [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: 04/23/2023] [Revised: 08/19/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Children with unilateral spastic cerebral palsy (USCP) have muscle hypertonia, balance, and coordination defects that affect gross motor skills, especially walking. Understanding the gait characteristics and lower limb muscle activation patterns of USCP children can provide an objective and quantitative basis for patient assessment and treatment plan formulation. OBJECTIVE This study compared the gait and lower limb muscle activation characteristics of children with USCP and with typical development (TD) during walking. METHODS We recorded gait and sEMG data of 20 children with USCP, and 20 with typical development. sEMG signals were acquired from the bilateral tibialis anterior (TA) and lateral gastrocnemius muscles (LG) during walking. The root mean square (RMS) value, integrated electromyographic (iEMG) value and co-contraction ratio (CR) were used to evaluate muscle activity. Student's t Test and non-parametric rank sum Test were used to compare the differences between the data groups (significance level of 0.05). RESULTS The stance time, step length, speed, single leg support time ratio, ground impact, pre-swing angle, and muscle strength of the affected side were significantly decreased compared to those of the unaffected side in children with USCP (P < 0.05), while the swing phase, muscle tonus of LG were significantly prolonged (P < 0.05). Compared with TD children, children with USCP exhibited reduced bilateral walking ability, particularly noticeable in their smaller pre-swing angle(P < 0.05), diminished muscle strength of the TA and LG, as well as LG spasms(P < 0.05). SIGNIFICANCE Children with USCP have decreased ambulatory gait stability. Step length, pull acceleration, pre-swing angle, and CR can be used as sensitive indicators for gait assessment. Strengthening the TA muscle and reducing ankle spasm may help improve gait and postural stability in children with USCP.
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Affiliation(s)
- Longfei Li
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai, Shandong 264003, China
| | - Lina Zhang
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, Shandong 256603, China
| | - Hongxing Cui
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, Shandong 256603, China
| | - Yixuan Zhao
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai, Shandong 264003, China
| | - Chuanhua Zhu
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, Shandong 256603, China
| | - Qianqian Fan
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, Shandong 256603, China.
| | - Wei Li
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, Shandong 256603, China.
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Vezér M, Gresits O, Engh MA, Szabó L, Molnar Z, Hegyi P, Terebessy T. Evidence for gait improvement with robotic-assisted gait training of children with cerebral palsy remains uncertain. Gait Posture 2024; 107:8-16. [PMID: 37703782 DOI: 10.1016/j.gaitpost.2023.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 08/22/2023] [Accepted: 08/26/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Cerebral palsy (CP) is a group of neuromotor diseases that develops as a result of damage to the developing central nervous system during the perinatal period. The condition is usually accompanied by musculoskeletal problems resulting in movement disorders. Gait improvement therefore, is an important part of its treatment. Roboticassisted gait training (RAGT) is a new potential rehabilitation tool for CP patients, however there is no clear evidence for the effectiveness of this method. RESEARCH QUESTION Can robotic-assisted gait training improve walking function in children with CP? METHODS A systematic search was performed in five databases: MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), Embase, Scopus, and Web of Science. Eligible studies were randomized controlled trials (RCT) with CP patients under the age of 18. Gross motor function and kinematic gait parameters of patients were the main outcomes. Two authors determined the risk of bias of the RCTs independently using the revised Risk of Bias 2 (ROB 2) tool. Mean Differences (MDs) along with their 95% Confidence Interval (CI) were calculated when at least three studies were present for an outcome, subgroup analysis was performed based on the treatment of the control group. RESULTS Of the 7363 screened articles, 13 papers met our inclusion criteria and among them, 7 studies could be used in our meta-analyses. The results related to RAGT suggest nonsignificant improvement in standing and walking function (Gross Motor Function Measure D, E), moreover changes in gait speed, step length, and in cadence were also only comparable to controls. SIGNIFICANCE The results indicate that there is a trend in some gait parameters where the improvement was higher in the intervention group than in control group. The therapeutic effect of RAGT was probably not superior to physiotherapy combined with treadmill training.
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Affiliation(s)
- Mátyás Vezér
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary; Department of Orthopaedics, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary
| | - Orsolya Gresits
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary; Department of Orthopaedics, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary
| | - Marie Anne Engh
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary
| | - Laszlo Szabó
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary
| | - Zsolt Molnar
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary; Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary; Department of Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland
| | - Peter Hegyi
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary; Department of Orthopaedics, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary; Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Baross út 22-24, 1085 Budapest, Hungary
| | - Tamás Terebessy
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary; Department of Orthopaedics, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary.
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Sudlow A, Galantine P, Vercruyssen F, Peyrot N, Raymond JJ, Duché P. Which Factors Influence Running Gait in Children and Adolescents? A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20054621. [PMID: 36901631 PMCID: PMC10001902 DOI: 10.3390/ijerph20054621] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/23/2023] [Accepted: 03/03/2023] [Indexed: 06/01/2023]
Abstract
In recent years, running has dramatically increased in children and adolescents, creating a need for a better understanding of running gait in this population; however, research on this topic is still limited. During childhood and adolescence multiple factors exist that likely influence and shape a child's running mechanics and contribute to the high variability in running patterns. The aim of this narrative review was to gather together and assess the current evidence on the different factors that influence running gait throughout youth development. Factors were classified as organismic, environmental, or task-related. Age, body mass and composition, and leg length were the most researched factors, and all evidence was in favour of an impact on running gait. Sex, training, and footwear were also extensively researched; however, whereas the findings concerning footwear were all in support of an impact on running gait, those concerning sex and training were inconsistent. The remaining factors were moderately researched with the exception of strength, perceived exertion, and running history for which evidence was particularly limited. Nevertheless, all were in support of an impact on running gait. Running gait is multifactorial and many of the factors discussed are likely interdependent. Caution should therefore be taken when interpreting the effects of different factors in isolation.
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Affiliation(s)
- Anthony Sudlow
- Impact of Physical Activity on Health Research Unit, Faculty of Sport Sciences, University of Toulon, Campus La Garde, 83160 Toulon, France
| | - Paul Galantine
- Impact of Physical Activity on Health Research Unit, Faculty of Sport Sciences, University of Toulon, Campus La Garde, 83160 Toulon, France
| | - Fabrice Vercruyssen
- Impact of Physical Activity on Health Research Unit, Faculty of Sport Sciences, University of Toulon, Campus La Garde, 83160 Toulon, France
| | - Nicolas Peyrot
- Mouvement-Interactions-Performance, MIP, UR 4334, Faculty of Sport Sciences, Le Mans University, 72000 Le Mans, France
| | - Jean-Jacques Raymond
- Impact of Physical Activity on Health Research Unit, Faculty of Sport Sciences, University of Toulon, Campus La Garde, 83160 Toulon, France
- Unité de Médecine et de traumatologie du Sport, CHITS Hôpital Sainte Musse, 83100 Toulon, France
| | - Pascale Duché
- Impact of Physical Activity on Health Research Unit, Faculty of Sport Sciences, University of Toulon, Campus La Garde, 83160 Toulon, France
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Pouliot-Laforte A, Tabard-Fougère A, Bonnefoy-Mazure A, De Coulon G, Armand S. Running capacity in children with bilateral cerebral palsy: What are the biomechanical and neuromotor differences between runners and walkers? Clin Biomech (Bristol, Avon) 2022; 100:105817. [PMID: 36435078 DOI: 10.1016/j.clinbiomech.2022.105817] [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: 02/14/2022] [Revised: 10/13/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Running is a high-level locomotor activity requiring more from joints, muscles and a more complex interaction of the neuromuscular system than walking. High-level locomotor activity has the potential to shed light on motor function deficits that lower-level activity does not reveal. Therefore, the study aimed to compare biomechanical and neuromotor function between a group of children with bilateral cerebral palsy who are able and unable to run. METHODS Retrospectively, children with bilateral cerebral palsy aged between 6 and 18 years who completed a clinical gait analysis between 2006 and 2019 were included. Participants were categorized as walkers or runners based on the presence of a double floating phase. Spasticity, selectivity, muscle weakness, and passive range of motion of the lower limbs were measured and dichotomized as «normal» or «abnormal» based on reference values. Functional tasks reflecting balance (standing on one leg) and power (single leg and two-legged jumps) were realized and evaluated as failure or success. FINDINGS 75 children with bilateral cerebral palsy (53 runners/22 walkers) were included. Children classified as runners were stronger (hip flexors, p = 0.006; hip abductors, p = 0.022; knee flexors, p = 0.001; dorsiflexors, p = 0.014), had greater selectivity (hip flexors, p = 0.011; dorsiflexors, p = 0.001; plantiflexors, p = 0.043) and lower spasticity at the knee extensors (p = 0.045). No differences were observed in the passive range of motion between the two groups. Children classified as runners performed better at all tasks of balance and power (p < 0.05). INTERPRETATION Flexors muscles strength and selectivity and knee extensor spasticity are key points for running ability in children with bilateral cerebral palsy.
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Affiliation(s)
- Annie Pouliot-Laforte
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
| | - Anne Tabard-Fougère
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Alice Bonnefoy-Mazure
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Geraldo De Coulon
- Pediatric Orthopedic Service, Department of Child and Adolescent, Geneva University Hospitals, Geneva, Switzerland
| | - Stéphane Armand
- Pediatric Orthopedic Service, Department of Child and Adolescent, Geneva University Hospitals, Geneva, Switzerland
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Özal C, Aksoy S, Kerem Günel M. Postural Control Alterations in Children with Mild Forms of Spastic Cerebral Palsy. Pediatric Health Med Ther 2022; 13:367-376. [DOI: 10.2147/phmt.s378451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/13/2022] [Indexed: 11/24/2022] Open
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8
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Kazanski ME, Cusumano JP, Dingwell JB. Rethinking margin of stability: Incorporating step-to-step regulation to resolve the paradox. J Biomech 2022; 144:111334. [PMID: 36244320 PMCID: PMC10474615 DOI: 10.1016/j.jbiomech.2022.111334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 08/04/2022] [Accepted: 09/24/2022] [Indexed: 11/17/2022]
Abstract
Derived from inverted pendulum dynamics, mediolateral Margin of Stability (MoSML) is a mechanically-grounded measure of instantaneous frontal-plane stability. However, average MoSML measures yield paradoxical results. Gait pathologies or perturbations often induce larger (supposedly "more stable") average MoSML, despite clearly destabilizing factors. However, people do not walk "on average" - they walk (and sometimes lose balance) one step at a time. We assert the paradox arises because averaging MoSML discards crucial step-to-step dynamics. We present a framework unifying the inverted pendulum with Goal-Equivalent Manifold (GEM) analyses. We identify in the pendulum's center-of-mass dynamics constant-MoSML manifolds, including one candidate "stability GEM" signifying the goal to maintain some constant MoSML∗. We used this framework to assess step-to-step MoSML dynamics of humans walking in destabilizing environments. While goal-relevant deviations were readily corrected, people did not exploit equifinality by allowing deviations to persist along this GEM. Thus, maintaining a constant MoSML∗ is inconsistent with observed step-to-step fluctuations in center-of-mass states. Conversely, the extent to which participants regulated fluctuations in mediolateral foot placements strongly predicted their regulation of center-of-mass fluctuations. Thus, center-of-mass dynamics may arise indirectly as a consequence of regulating mediolateral foot placements. To help resolve the paradox caused by averaging MoSML, we present a new statistic, Probability of Instability (PoIL), used here to predict lateral instability likelihood. Participants exhibited increased PoIL when destabilized (p = 9.45 × 10-34), despite exhibiting larger ("more stable") average MoSML (p = 1.70 × 10-15). Thus, PoIL correctly captured people's increased risk of losing lateral balance, whereas average MoSML did not. PoIL also helps explain why people's average MoSML increased in destabilizing contexts.
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Affiliation(s)
- Meghan E Kazanski
- Department of Kinesiology, Pennsylvania State University, University Park, PA 16802, USA.
| | - Joseph P Cusumano
- Department of Engineering Science & Mechanics, Pennsylvania State University, University Park, PA 16802, USA
| | - Jonathan B Dingwell
- Department of Kinesiology, Pennsylvania State University, University Park, PA 16802, USA
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Camuncoli F, Barbonetti A, Piccinini L, Di Stanislao E, Corbetta C, Dell’Orto G, Bertozzi F, Galli M. Analysis of Running Gait in Children with Cerebral Palsy: Barefoot vs. a New Ankle Foot Orthosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14203. [PMID: 36361083 PMCID: PMC9654245 DOI: 10.3390/ijerph192114203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 06/16/2023]
Abstract
Running is an essential activity for children with cerebral palsy (CP). This study aims to characterize the locomotor pattern of running in hemiplegic children with new generation ankle foot orthosis (AFOs) conceived to foster intense motor activities such as running. A group of 18 children with spastic hemiplegia was recruited. A biomechanical multivariable comparison was made between barefoot and with AFO running trials. The focus was devoted to bilateral sagittal plane hip, knee, ankle kinematics and kinetics, and three-dimensional ground reaction forces. Wearing the orthoses, the children were found to reduce cadence and the duration of the stance phase as well as increase the step and stride length. The new AFO resulted in significant changes in kinematics of affected ankle both at initial contact 0-3% GC (p < 0.017) and during the entire swing phase 31-100%GC (p < 0.001) being the ankle more dorsiflexed with AFO compared to barefoot condition. Ankle power was found to differ significantly both in absorption and generation 5-10%GC (p < 0.001); 21-27%GC (p < 0.001) with a reduction in both cases when the AFO was worn. No statistical differences were recorded in the GRF components, in the affected ankle torque and hip and knee kinematics and kinetics.
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Affiliation(s)
- Federica Camuncoli
- Department of Electronics Information Technology and Bioengineering, Politecnico di Milano, 20133 Milan, Italy
| | - Alessia Barbonetti
- Department of Electronics Information Technology and Bioengineering, Politecnico di Milano, 20133 Milan, Italy
| | - Luigi Piccinini
- Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, 23842 Lecco, Italy
| | | | - Claudio Corbetta
- Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, 23842 Lecco, Italy
| | - Gabriele Dell’Orto
- Department of Mechanical Engineering, Politecnico di Milano, 20156 Milan, Italy
| | - Filippo Bertozzi
- Department of Mechanical Engineering, Politecnico di Milano, 20156 Milan, Italy
| | - Manuela Galli
- Department of Electronics Information Technology and Bioengineering, Politecnico di Milano, 20133 Milan, Italy
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Dussault-Picard C, Mohammadyari SG, Arvisais D, Robert MT, Dixon PC. Gait adaptations of individuals with cerebral palsy on irregular surfaces: A scoping review. Gait Posture 2022; 96:35-46. [PMID: 35567895 DOI: 10.1016/j.gaitpost.2022.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 03/25/2022] [Accepted: 05/05/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Individuals with cerebral palsy (CP) have a reduced ability to perform motor tasks such as walking. During daily walking, they are confronted with environmental constraints such as irregular surfaces (e.g., relief and uneven surfaces) which may require adaptations to maintain stability and avoid falls. Laboratory gait assessments are conventionally conducted under ideal conditions (e.g., regular and even surfaces) and may overlook subtle problems which may only present in challenging walking environments. Increased knowledge of adaptations to successfully navigate irregular surfaces may contribute to a better understanding of everyday walking barriers. RESEARCH QUESTION This scoping review aims to describe gait adaptations to irregular surfaces in individuals with CP and contrast adaptations with those of healthy individuals. METHODS This review followed the 6-stage Joanna Briggs Institute methodology and respected the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews statement. The MEDLINE, EMBASE, CINAHL, SPORTDiscus, and Web of Science databases were searched on March 2021. RESULTS The research strategy identified 1616 studies published between 2014 and 2020, of which 10 were included after abstract and full-text screening. This review reported on 152 individuals with CP (diplegia: n = 117, hemiplegia: n = 35) and 159 healthy individuals. The included studies focused on spatial-temporal, kinematic, kinetic, and muscle activity parameters over relief, inclined, and staircase surfaces. 7/10 studies were conducted in laboratories, often using surfaces that are not representative of the real-world. The results suggest that for individuals with CP, adaptations on irregular surfaces differ from flat surface walking and across CP subtype. Moreover, individuals with CP present with typical and pathology-specific adaptations to irregular surfaces compared to healthy individuals. SIGNIFICANCE This review highlights the clinical and research interest of focusing future studies on more ecologically valid data collection approaches and provides important recommendations to overcome research gaps in the existing literature.
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Affiliation(s)
- C Dussault-Picard
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Canada; Research Center of the Sainte-Justine University Hospital (CRCHUSJ), Canada.
| | - S G Mohammadyari
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Canada; Research Center of the Sainte-Justine University Hospital (CRCHUSJ), Canada
| | - D Arvisais
- Health Sciences Libraries, University of Montreal, Canada
| | - M T Robert
- Department of Rehabilitation, Faculty of Medicine, Laval University, Canada
| | - P C Dixon
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Canada; Research Center of the Sainte-Justine University Hospital (CRCHUSJ), Canada
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Marron A, Brady K, Kiernan D. Parental subjective assessment of gait limitations: Comparison with objective gait variables. Gait Posture 2022; 92:218-222. [PMID: 34871926 DOI: 10.1016/j.gaitpost.2021.11.039] [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: 08/05/2021] [Revised: 11/16/2021] [Accepted: 11/28/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Subjective assessment is an important part of clinical examination providing quality insights into impairments of body structure and functions. Research into the associations between parental perceptions of gait in children with cerebral palsy (CP) and objective clinical gait measures is limited. RESEARCH QUESTION What are the parental perceived gait limitations in children with CP and are these perceptions associated with objective clinical gait analysis? METHODS Parent questionnaires were retrospectively analysed for children with CP who attended our gait analysis laboratory over a 24-month period. Perceived walking limitations caused by pain, weakness, lack of endurance, mental ability, safety concerns, and balance were recorded on a 5-point Likert scale. Normalised gait speed, normalised step length and the Gait Deviation Index (GDI) were calculated. Differences between responses were assessed using Chi-squared tests with Dunn's post hoc test with Bonferroni adjustment. Spearman's rank correlations were performed to determine the relationship between responses and gait parameters. RESULTS Data from 251 participants were included, mean age 9 ± 3.4 years, Gross Motor Function Classification System (GMFCS) level I = 158, II = 64 and III = 29. Balance was perceived to limit walking to the greatest extent, followed by weakness, lack of endurance, safety concerns, pain and mental ability. This rank was consistent across GMFCS levels I, II and III. Perceived balance limitations showed the strongest correlations with objective gait variables, GDI (r = -0.31 p = 0.000), normalised step length (r = -0.30 p = 0.0000) and normalised gait speed (r = -0.24 p = 0.0001). SIGNIFICANCE Subjective gait perceptions provide a valuable indication of gait function but are weakly associated with objective clinical gait analysis. Outcome measures that are sensitive to changes in balance may be more responsive to parental concerns and help to satisfy their goals and expectations.
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Affiliation(s)
- A Marron
- Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland.
| | - K Brady
- Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland
| | - D Kiernan
- Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland
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Belizón-Bravo N, Romero-Galisteo RP, Cano-Bravo F, Gonzalez-Medina G, Pinero-Pinto E, Luque-Moreno C. Effects of Dynamic Suit Orthoses on the Spatio-Temporal Gait Parameters in Children with Cerebral Palsy: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8111016. [PMID: 34828729 PMCID: PMC8621824 DOI: 10.3390/children8111016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/28/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022]
Abstract
Dynamic suit orthoses (DSO) are currently used as a complementary treatment method in children with Cerebral Palsy (cwCP). The aim of this review was to assess the effects of interventions with DSO on the altered spatio-temporal gait parameters (STGPs) in cwCP. An electronic search was conducted in the Web of Science, Scopus, PEDro, Cochrane Library, MEDLINE/PubMed, and CINAHL databases up to July 2021. We included a total of 12 studies, which showed great heterogeneity in terms of design type, sample size, and intervention performed (two employed a Therasuit, three employed the Adeli suit, three employed Theratogs, one employed elastomeric tissue dynamic orthosis, one employed a full-body suit, one employed external belt orthosis, and one employed dynamic orthosis composed of trousers and T-shirt). The Cochrane collaboration’s tool and the Checklist for Measuring Study Quality were used to assess the risk of bias and the methodological quality of the studies. It was variable according to the Checklist for Measuring Study Quality, and it oscillated between eight and 23. The studies of higher methodological quality showed significant post-intervention changes in walking speed (which is the most widely evaluated parameter), cadence, stride length, and step length symmetry. Although the evidence is limited, the intervention with DSO combined with a programme of training/physical therapy seems to have positive effects on the STGPs in cwCP, with the functional improvements that it entails. Despite the immediate effect after one session, a number of sessions between 18 and 60 is recommended to obtain optimum results. Future studies should measure all STGPs, and not only the main ones, such as gait speed, in order to draw more accurate conclusions on the functional improvement of gait after the use of this type of intervention.
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Affiliation(s)
- Natalia Belizón-Bravo
- Department of Nursing and Physiotherapy, University of Cádiz, 11009 Cádiz, Spain; (N.B.-B.); (G.G.-M.); (C.L.-M.)
| | - Rita Pilar Romero-Galisteo
- Department of Physiotherapy, Biomedical Research Institute of Malaga (IBIMA), University of Málaga, 29071 Málaga, Spain
- Correspondence: ; Tel.: +0034-951-052-862
| | - Fatima Cano-Bravo
- Pediatric Rehabilitation Unit, Virgen del Rocío Hospital, 41013 Sevilla, Spain;
| | - Gloria Gonzalez-Medina
- Department of Nursing and Physiotherapy, University of Cádiz, 11009 Cádiz, Spain; (N.B.-B.); (G.G.-M.); (C.L.-M.)
| | - Elena Pinero-Pinto
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41004 Sevilla, Spain;
| | - Carlos Luque-Moreno
- Department of Nursing and Physiotherapy, University of Cádiz, 11009 Cádiz, Spain; (N.B.-B.); (G.G.-M.); (C.L.-M.)
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41004 Sevilla, Spain;
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Does Ankle Exoskeleton Assistance Impair Stability During Walking in Individuals with Cerebral Palsy? Ann Biomed Eng 2021; 49:2522-2532. [PMID: 34189633 DOI: 10.1007/s10439-021-02822-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/22/2021] [Indexed: 10/21/2022]
Abstract
Lower-limb exoskeletons have the potential to improve mobility in individuals with movement disabilities, such as cerebral palsy (CP). The goal of this study was to assess the impact of plantar-flexor assistance from an untethered ankle exoskeleton on dynamic stability during unperturbed and perturbed walking in individuals with CP. Seven participants with CP (Gross Motor Function Classification System levels I-III, ages 6-31 years) completed a treadmill walking protocol under their normal walking condition and while wearing an ankle exoskeleton that provided adaptive plantar-flexor assistance. Pseudo-randomized treadmill perturbations were delivered during stance phase by accelerating one side of a split-belt treadmill. Treadmill perturbations resulted in a significant decrease in anteroposterior minimum margin-of-stability (- 32.1%, p < 0.001), and a significant increase in contralateral limb step length (8.1%, p = 0.005), integrated soleus activity during unassisted walking (23.4%, p = 0.02), and peak biological ankle moment (9.6%, p = 0.03) during stance phase. Plantar-flexor assistance did not significantly alter margin-of-stability, step length, soleus activity, or ankle moments during both unperturbed and perturbed walking. These results indicate that adaptive plantar-flexor assistance from an untethered ankle exoskeleton does not significantly alter dynamic stability maintenance during unperturbed and perturbed walking for individuals with CP, supporting future research in real-world environments.
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Kelly DK, McMulkin ML, Franklin C, Cooney KM. Children with Cerebral Palsy Have Similar Walking and Running Quality Assessed by an Overall Kinematic Index. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094683. [PMID: 33924873 PMCID: PMC8124669 DOI: 10.3390/ijerph18094683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/22/2021] [Accepted: 04/24/2021] [Indexed: 01/19/2023]
Abstract
Running ability is critical to maintaining activity participation with peers. Children and adolescents with cerebral palsy (CP) are often stated to run better than they walk, but running is not often quantitatively measured. The purpose of this study was to utilize overall gait deviation indices to determine if children with diplegic CP run closer to typically developing children than they walk. This retrospective comparative study utilized 3D running kinematics that were collected after walking data at two clinical motion analysis centers for children with diplegic cerebral palsy. Separate walking and running Gait Deviation Indices (GDI Walk and GDI* Run), overall indices of multiple plane/joint motions, were calculated and scaled for each participant so that a typically developing mean was 100 with standard deviation of 10. An analysis of variance was used to compare the variables Activity (walking vs running) and Center (data collected at two different motion analysis laboratories). Fifty participants were included in the study. The main effect of Activity was not significant, mean GDI Walk = 76.4 while mean GDI* Run = 77.1, p = 0.84. Mean GDI scores for walking and running were equivalent, suggesting children with diplegic cerebral palsy as a group have similar walking and running quality. However, individual differences varied between activities, emphasizing the need for individual assessment considering specific goals related to running.
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Affiliation(s)
- Devin K. Kelly
- Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, NV 89154, USA;
| | - Mark L. McMulkin
- Shriners Hospitals for Children®, Spokane, WA 99204, USA
- Correspondence: ; Tel.: +1-509-623-0413
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