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Keren D, Goudriaan M, Springer S, Sorek G, Dominici N, van der Krogt MM, Buizer AI, Schless SH. The impact of ankle-foot orthotics on selective motor control during gait in children and adolescents with cerebral palsy. Gait Posture 2024; 114:48-54. [PMID: 39236422 DOI: 10.1016/j.gaitpost.2024.08.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 07/09/2024] [Accepted: 08/22/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND Children with cerebral palsy (CP) often exhibit altered selective motor control during gait (SMCg). Ankle-foot-orthoses (AFOs) are used in this population to improve gait, by reducing the degrees of freedom at the ankle joint. However, the specific impact of AFOs on SMCg and whether this effect is more related to gait deviations or motor development remains unclear. RESEARCH QUESTION Do AFOs impact SMCg, and is the change related to joint kinematics or age? METHODS Gait analysis data from 53 children and adolescents with spastic CP, walking both barefoot and with AFOs, were included. Electromyography data from six lower-limb muscles, and lower limb joint kinematics were analyzed for both walking conditions. SMCg was quantified by the total variance in electromyography activity accounted for by one synergy (tVAF1), where an increase in tVAF1 indicates a decrease in SMCg. Kinematic gait deviation was assessed using the Gait-Profile-Score (GPS) and sagittal plane ankle Gait-Variable-Score (ankle-GVS). All analyses were performed for the more clinically involved leg only. RESULTS Walking with AFOs resulted in a mean increase in tVAF1 of 0.02±0.07 (p=0.015) and a median increase in ankle-GVS of 3.4º (p>0.001). No significant changes were observed in GPS, and no correlation was found between the changes in tVAF1 and ankle-GVS. A significant positive moderate correlation was found between the change in tVAF1 and age, even with ankle-GVS as a covariate (r=0.45; p>0.001). SIGNIFICANCE Walking with an AFO resulted in a small decrease in SMCg, with large inter-participant variability. Younger participants showed a greater decrease in SMCg, which may indicate greater neuromuscular plasticity in early developmental stages.
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Affiliation(s)
- Dan Keren
- The Helmsley Pediatric and Adolescent Rehabilitation Research Center (PARC) at ALYN Hospital, Jerusalem, Israel; Faculty of Health Sciences, Department of Physical Therapy, The Neuromuscular and Human Performance Laboratory, Ariel University, Ariel, Israel
| | - Marije Goudriaan
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Institute for Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Utrecht University, University corporate offices, student & academic affairs, Utrecht, the Netherlands; Amsterdam UMC location, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam, the Netherlands
| | - Shmuel Springer
- Faculty of Health Sciences, Department of Physical Therapy, The Neuromuscular and Human Performance Laboratory, Ariel University, Ariel, Israel
| | - Gilad Sorek
- The Helmsley Pediatric and Adolescent Rehabilitation Research Center (PARC) at ALYN Hospital, Jerusalem, Israel
| | - Nadia Dominici
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Institute for Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
| | - Marjolein M van der Krogt
- Amsterdam UMC location, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
| | - Annemieke I Buizer
- Amsterdam UMC location, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands; Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
| | - Simon-Henri Schless
- The Helmsley Pediatric and Adolescent Rehabilitation Research Center (PARC) at ALYN Hospital, Jerusalem, Israel; ALYN Pediatric and Adolescent Rehabilitation Center, Clinical Motion Analysis Laboratory, Jerusalem, Israel.
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Wishaupt K, Schallig W, van Dorst MH, Buizer AI, van der Krogt MM. The applicability of markerless motion capture for clinical gait analysis in children with cerebral palsy. Sci Rep 2024; 14:11910. [PMID: 38789587 PMCID: PMC11126730 DOI: 10.1038/s41598-024-62119-7] [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: 01/26/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
The aim of this comparative, cross-sectional study was to determine whether markerless motion capture can track deviating gait patterns in children with cerebral palsy (CP) to a similar extent as marker-based motion capturing. Clinical gait analysis (CGA) was performed for 30 children with spastic CP and 15 typically developing (TD) children. Marker data were processed with the Human Body Model and video files with Theia3D markerless software, to calculate joint angles for both systems. Statistical parametric mapping paired t-tests were used to compare the trunk, pelvis, hip, knee and ankle joint angles, for both TD and CP, as well as for the deviation from the norm in the CP group. Individual differences were quantified using mean absolute differences. Markerless motion capture was able to track frontal plane angles and sagittal plane knee and ankle angles well, but individual deviations in pelvic tilt and transverse hip rotation as present in CP were not captured by the system. Markerless motion capture is a promising new method for CGA in children with CP, but requires improvement to better capture several clinically relevant deviations especially in pelvic tilt and transverse hip rotation.
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Affiliation(s)
- Koen Wishaupt
- Department of Rehabilitation Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Wouter Schallig
- Department of Rehabilitation Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
| | - Marleen H van Dorst
- Department of Rehabilitation Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
- Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marjolein M van der Krogt
- Department of Rehabilitation Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
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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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Veerkamp K, Carty CP, Waterval NFJ, Geijtenbeek T, Buizer AI, Lloyd DG, Harlaar J, van der Krogt MM. Predicting Gait Patterns of Children With Spasticity by Simulating Hyperreflexia. J Appl Biomech 2023; 39:334-346. [PMID: 37532263 DOI: 10.1123/jab.2023-0022] [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: 01/20/2023] [Revised: 06/24/2023] [Accepted: 06/24/2023] [Indexed: 08/04/2023]
Abstract
Spasticity is a common impairment within pediatric neuromusculoskeletal disorders. How spasticity contributes to gait deviations is important for treatment selection. Our aim was to evaluate the pathophysiological mechanisms underlying gait deviations seen in children with spasticity, using predictive simulations. A cluster analysis was performed to extract distinct gait patterns from experimental gait data of 17 children with spasticity to be used as comparative validation data. A forward dynamic simulation framework was employed to predict gait with either velocity- or force-based hyperreflexia. This framework entailed a generic musculoskeletal model controlled by reflexes and supraspinal drive, governed by a multiobjective cost function. Hyperreflexia values were optimized to enable the simulated gait to best match experimental gait patterns. Three experimental gait patterns were extracted: (1) increased knee flexion, (2) increased ankle plantar flexion, and (3) increased knee flexion and ankle plantar flexion when compared with typical gait. Overall, velocity-based hyperreflexia outperformed force-based hyperreflexia. The first gait pattern could mostly be explained by rectus femoris and hamstrings velocity-based hyperreflexia, the second by gastrocnemius velocity-based hyperreflexia, and the third by gastrocnemius, soleus, and hamstrings velocity-based hyperreflexia. This study shows how velocity-based hyperreflexia from specific muscles contributes to different spastic gait patterns, which may help in providing targeted treatment.
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Affiliation(s)
- Kirsten Veerkamp
- Department of Rehabilitation Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam,The Netherlands
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam,The Netherlands
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD,Australia
- Griffith Centre of Biomedical & Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD,Australia
- Advanced Design and Prototyping Technologies Institute (ADAPT), Griffith University, Gold Coast, QLD,Australia
| | - Christopher P Carty
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD,Australia
- Griffith Centre of Biomedical & Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD,Australia
- Advanced Design and Prototyping Technologies Institute (ADAPT), Griffith University, Gold Coast, QLD,Australia
- Department of Orthopaedics, Children's Health Queensland Hospital and Health Service, Queensland Children's Hospital, Brisbane, QLD,Australia
| | - Niels F J Waterval
- Department of Rehabilitation Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam,The Netherlands
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam,The Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam,The Netherlands
| | - Thomas Geijtenbeek
- Department of Biomechanical Engineering, Delft University of Technology, Delft,The Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam,The Netherlands
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam,The Netherlands
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam,The Netherlands
| | - David G Lloyd
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD,Australia
- Griffith Centre of Biomedical & Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD,Australia
- Advanced Design and Prototyping Technologies Institute (ADAPT), Griffith University, Gold Coast, QLD,Australia
| | - Jaap Harlaar
- Department of Biomechanical Engineering, Delft University of Technology, Delft,The Netherlands
- Department of Orthopedics and Sports Medicine, Erasmus Medical Center, Rotterdam,The Netherlands
| | - Marjolein M van der Krogt
- Department of Rehabilitation Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam,The Netherlands
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam,The Netherlands
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Jing Z, Han J, Zhang J. Comparison of biomechanical analysis results using different musculoskeletal models for children with cerebral palsy. Front Bioeng Biotechnol 2023; 11:1217918. [PMID: 37823025 PMCID: PMC10562727 DOI: 10.3389/fbioe.2023.1217918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 09/15/2023] [Indexed: 10/13/2023] Open
Abstract
Introduction: Musculoskeletal model-based simulations have gained popularity as a tool for analyzing human movement biomechanics. However, when examining the same gait, different models with varying anatomical data and assumptions may produce inconsistent biomechanical results. This inconsistency is particularly relevant for children with cerebral palsy, who often exhibit multiple pathological gait patterns that can impact model outputs. Methods: The aim of this study was to investigate the effect of selecting musculoskeletal models on the biomechanical analysis results in children with cerebral palsy. Gait data were collected from multiple participants at slow, medium, and fast velocities. Joint kinematics, joint dynamics, and muscle activation were calculated using six popular musculoskeletal models within a biomechanical simulation environment. Results: The degree of inconsistency, measured as the root-mean-square deviation, in kinematic and kinetic results produced by the different models ranged from 4% to 40% joint motion range and 0%-28% joint moment range, respectively. The correlation between the results of the different models (both kinematic and kinetic) was good (R> 0.85, P < 0.01), with a stronger correlation observed in the kinetic results. Four of the six models showed a positive correlation between the simulated muscle activation of rectus femoris and the surface EMG, while all models exhibited a positive correlation between the activation of medial gastrocnemius and the surface EMG (P < 0.01). Discussion: These results provide insights into the consistency of model results, factors influencing consistency, characteristics of each model's outputs, mechanisms underlying these characteristics, and feasible applications for each model. By elucidating the impact of model selection on biomechanical analysis outcomes, this study advances the field's understanding of musculoskeletal modeling and its implications for clinical gait analysis model decision-making in children with cerebral palsy.
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Affiliation(s)
- Zhibo Jing
- Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin, China
- Institute of Robotics and Automatic Information System, Nankai University, Tianjin, China
- College of Artificial Intelligence, Nankai University, Tianjin, China
| | - Jianda Han
- Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin, China
- Institute of Robotics and Automatic Information System, Nankai University, Tianjin, China
- College of Artificial Intelligence, Nankai University, Tianjin, China
- Smart Sensing Interdisciplinary Science Center, Nankai University, Tianjin, China
| | - Juanjuan Zhang
- Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin, China
- Institute of Robotics and Automatic Information System, Nankai University, Tianjin, China
- College of Artificial Intelligence, Nankai University, Tianjin, China
- Smart Sensing Interdisciplinary Science Center, Nankai University, Tianjin, China
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Sorek G, Goudriaan M, Schurr I, Schless SH. A longitudinal analysis of selective motor control during gait in individuals with cerebral palsy and the relation to gait deviations. PLoS One 2023; 18:e0289124. [PMID: 37523363 PMCID: PMC10389713 DOI: 10.1371/journal.pone.0289124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/12/2023] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE To investigate longitudinal changes in selective motor control during gait (SMCg) in individuals with cerebral palsy (CP), and to assess if they are related to changes in gait deviations. METHOD Twenty-three children/adolescents with spastic CP (mean ± SD age = 9.0±2.5 years) and two 3D gait assessments (separated by 590±202 days) with no interim surgical intervention, were included. SMCg was assessed using muscle synergy analysis to determine the dynamic motor control index (walk-DMC). Gait deviation was assessed using the Gait profile score (GPS) and Gait variable scores (GVS). RESULTS There were no mean changes in walk-DMC score, GPS or GVS between assessments. However, changes in walk-DMC scores in the more involved leg related to changes in hip flexion-extension and hip internal-external GVS (rp = -0.56; p = 0.017 and rp = 0.65; p = 0.004, respectively). CONCLUSIONS On average, there were no significant longitudinal changes in SMCg. However, there was considerable variability between individuals, which may relate to changes in hip joint kinematics. This suggests that a combination of neural capacity and biomechanical factors influence lower limb muscle co-activation in individuals with CP, with a potential important role for the hip muscles. These findings highlight the importance of taking an individualized approach when evaluating SMCg in individuals with CP.
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Affiliation(s)
- Gilad Sorek
- Laboratory for Paediatric Motion Analysis and Biofeedback Rehabilitation, ALYN Helmsley Paediatric and Adolescent Rehabilitation Research Centre, Jerusalem, Israel
| | - Marije Goudriaan
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Itai Schurr
- Clinical Motion Analysis Laboratory, ALYN Paediatric and Adolescent Rehabilitation Centre, Jerusalem, Israel
| | - Simon-Henri Schless
- Laboratory for Paediatric Motion Analysis and Biofeedback Rehabilitation, ALYN Helmsley Paediatric and Adolescent Rehabilitation Research Centre, Jerusalem, Israel
- Clinical Motion Analysis Laboratory, ALYN Paediatric and Adolescent Rehabilitation Centre, Jerusalem, Israel
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Linder SM, Learman K, Miller Koop M, Espy D, Haupt M, Streicher M, Davidson S, Bethoux F, Nadler N, Alberts JL. Increased Comfortable Gait Speed Is Associated With Improved Gait Biomechanics in Persons With Chronic Stroke Completing an 8-Week Forced-Rate Aerobic Cycling Intervention: A Preliminary Study. Am J Phys Med Rehabil 2023; 102:619-624. [PMID: 37026847 PMCID: PMC10272085 DOI: 10.1097/phm.0000000000002248] [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] [Indexed: 04/08/2023]
Abstract
ABSTRACT Task-specific gait training is recommended to improve locomotor function after stroke. Our objective was to determine the effects of a forced-rate aerobic exercise intervention on gait velocity and biomechanics in the absence of task-specific gait training. Individuals with chronic stroke ( N = 14) underwent 24 sessions of forced-rate aerobic exercise, at a targeted aerobic intensity of 60%-80% of their heart rate reserve. Change in comfortable walking speed in addition to spatiotemporal, kinematic, and kinetic variables were measured using three-dimensional motion capture. Overground walking capacity was measured by the 6-min walk test. To determine gait biomechanics associated with increased walking speed, spatiotemporal, kinematic, and kinetic variables were analyzed separately for those who met the minimal clinically important difference for change in gait velocity compared with those who did not. Participants demonstrated a significant increase in gait velocity from 0.61 to 0.70 m/sec ( P = 0.004) and 6-min walk test distance from 272.1 to 325.1 meters ( P < 0.001). Those who met the minimal clinically important difference for change in gait velocity demonstrated significantly greater improvements in spatiotemporal parameters ( P = 0.041), ground reaction forces ( P = 0.047), and power generation ( P = 0.007) compared with those who did not. Improvements in gait velocity were accompanied by normalization of gait biomechanics.
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Affiliation(s)
- Susan M Linder
- From the Cleveland Clinic, Department of Physical Medicine and Rehabilitation, Cleveland, Ohio (SML, MH, FB, NN); Cleveland Clinic, Department of Biomedical Engineering, Cleveland, Ohio (SML, MMK, JLA); Youngstown State University, Youngstown, Ohio (SML, KL); Cleveland State University, Cleveland, Ohio (DE); Cleveland Clinic, Concussion Center, Cleveland, Ohio (MS, SD, JLA); and Cleveland Clinic, Center for Neurologic Restoration, Cleveland, Ohio (JLA)
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Senden R, Marcellis R, Meijer K, Willems P, Lenssen T, Staal H, Janssen Y, Groen V, Vermeulen RJ, Witlox M. Dataset of 3D gait analysis in typically developing children walking at three different speeds on an instrumented treadmill in virtual reality. Data Brief 2023; 48:109142. [PMID: 37113500 PMCID: PMC10126839 DOI: 10.1016/j.dib.2023.109142] [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: 01/05/2023] [Revised: 03/17/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
In this article, gait data of typically developing (TD) children (24 boys/31 girls, mean (95% confidence interval) age 9.38 (8.51 - 10.25) years, body mass 35.67 (31.40 - 39.94) kg, leg length 0.73 (0.70 - 0.76) m, and height 1.41 (1.35 - 1.46) m) walking at different walking speeds is shared publicly. Raw and processed data is presented for each child separately and includes data of each single step of both legs. Beside, the subject demographics and the results from the physical examination are presented allowing to select TD children from the database to create a matched group, based on specific parameters (e.g. sex and body weight). For clinical application, gait data is also presented per age group, which provides quick insight into the normal gait pattern of TD children of varying age. Gait analysis was performed during treadmill walking in a virtual environment using the Computer Assisted Rehabilitation Environment (CAREN). The human body lower limb model with trunk markers (HBM2) was used as biomechanical model. Children walked at comfortable walking speed, 30% slower and 30% faster (random sequence) while wearing gymnastic shoes and a safety harness to prevent falling. For each speed condition, 250 steps were recorded. Data quality check, step detection and the calculation of gait parameters was done by custom made Matlab algorithms. Raw data files are provided per walking speed, for each child separately. The raw data is exported from the CAREN software (D-flow) and is provided in .mox and .txt files. It includes the output from the models such as subject data, marker and force data, kinematic data (joint angles), kinetic data (joint moments, GRFs, joint powers), as well as CoM data and EMG data (the last two are not described in this manuscript), for each speed condition and each child. Unfiltered and filtered data are included. C3D files with raw marker and GRF data were recorded in Nexus (Vicon software) and are available upon request. After analyzing the raw data into Matlab (R2016a, Mathworks) using custom made Matlab algorithms, processed data is obtained. The processed data is provided in .xls files and is also presented for each child separately. It contains spatiotemporal parameters, 3D joint angles, anterior-posterior and vertical ground reaction forces (GRF), 3D joint moments and sagittal joint power of each step of the left and right leg. In addition to each individual's data, overview files (.xls) are created per walking speed condition. These overviews present the averaged gait parameter (e.g. joint angle), calculated over all valid steps, of each child.
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Affiliation(s)
- Rachel Senden
- Department of Physical Therapy, Maastricht University Medical Center, Postbus 5800 AZ, Maastricht 6020, the Netherlands
- Corresponding author. @Rachel_Senden
| | - Rik Marcellis
- Department of Physical Therapy, Maastricht University Medical Center, Postbus 5800 AZ, Maastricht 6020, the Netherlands
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Paul Willems
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Ton Lenssen
- Department of Physical Therapy, Maastricht University Medical Center, Postbus 5800 AZ, Maastricht 6020, the Netherlands
| | - Heleen Staal
- Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
- Research School CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Yvonne Janssen
- Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, the Netherlands
- Department of Rehabilitation Medicine, School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Vincent Groen
- Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Marianne Witlox
- Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
- Research School CAPHRI, Maastricht University, Maastricht, the Netherlands
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Mooijekind B, Flux E, Buizer AI, van der Krogt MM, Bar-On L. The influence of wearing an ultrasound device on gait in children with cerebral palsy and typically developing children. Gait Posture 2023; 101:138-144. [PMID: 36841120 DOI: 10.1016/j.gaitpost.2023.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/25/2023] [Accepted: 02/09/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Ultrasonography with motion analysis enables dynamic imaging of medial gastrocnemius (MG) muscles and tendons during gait. This revealed pathological muscle-tendon dynamics in children with spastic cerebral palsy (CP) compared to typically developing (TD) children. However, wearing an ultrasound probe on the lower leg could interfere with gait and bias muscle length changes observed with ultrasound. RESEARCH QUESTION Does wearing an ultrasound probe on the MG influence gait in children with CP and TD children? METHODS Eighteen children with spastic CP and 16 age-matched TD children walked at comfortable walking speed on an instrumented treadmill. One baseline gait condition (BASE) and two conditions with an ultrasound probe and custom-made probe holder were measured: on the mid-muscle fascicles (FAS) and on the muscle-tendon junction (MTJ). The effect of condition and group on spatiotemporal parameters, hip, knee and ankle kinematics, ankle moment, ankle power, and modeled MG muscle-tendon unit (MTU) length was assessed using two-way repeated measures ANOVA's. Statistical non-parametric mapping was applied for time-series. Post-hoc paired-samples t-tests were conducted, and the root mean square difference was calculated for significant parts. RESULTS Children took wider steps during FAS (CP, TD) and MTJ (TD) compared to BASE, and during FAS compared to MTJ (CP). Hip extension was lower (2.7°) during terminal stance for MTJ compared to FAS for TD only. There was less swing knee flexion (FAS 4.9°; MTJ 4.0°) and ankle plantarflexion around toe-off (FAS 3.0°; MTJ 2.4°) for both ultrasound placements, with no group effect. Power absorption during loading response was slightly increased for both ultrasound placements (0.12 W/kg), with no group effect. MTU shortened less in swing for both ultrasound placements (FAS 3.6 mm; MTJ 3.7 mm), with no group effect. SIGNIFICANCE Wearing an ultrasound probe causes minimal lower-limb gait alterations and MTU length changes that are mostly similar in CP and TD.
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Affiliation(s)
- Babette Mooijekind
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands; Ghent University, Department of Rehabilitation Sciences, Ghent, Belgium.
| | - Eline Flux
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
| | - Annemieke I Buizer
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands; Emma Children's Hospital Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Marjolein M van der Krogt
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
| | - Lynn Bar-On
- Ghent University, Department of Rehabilitation Sciences, Ghent, Belgium
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10
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Electromyographic biofeedback-driven gaming to alter calf muscle activation during gait in children with spastic cerebral palsy. Gait Posture 2023; 102:10-17. [PMID: 36870265 DOI: 10.1016/j.gaitpost.2023.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/20/2023] [Accepted: 02/18/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Children with cerebral palsy often show deviating calf muscle activation patterns during gait, with excess activation during early stance and insufficient activation during push-off. RESEARCH QUESTION Can children with cerebral palsy improve their calf muscle activation patterns during gait using one session of biofeedback-driven gaming? METHODS Eighteen children (6-17 y) with spastic cerebral palsy received implicit game-based biofeedback on electromyographic activity of the calf muscle (soleus or gastrocnemius medialis) while walking on a treadmill during one session. Biofeedback alternately aimed to reduce early stance activity, increase push-off activity, and both combined. Early stance and push-off activity and the double-bump-index (early stance divided by push-off activity) were determined during baseline and walking with feedback. Changes were assessed at group level using repeated measures ANOVA with simple contrast or Friedman test with post-hoc Wilcoxon signed rank test, as well as individually using independent t-tests or Wilcoxon rank sum tests. Perceived competence and interest-enjoyment were assessed through a questionnaire. RESULTS Children successfully decreased their electromyographic activity during early stance feedback trials (relative decrease of 6.8 ± 12.2 %, P = 0.025), with a trend during the combined feedback trials (6.5 ± 13.9 %, P = 0.055), and increased their electromyographic activity during push-off feedback trials (8.1 ± 15.8 %, P = 0.038). Individual improvements were seen in twelve of eighteen participants. All children experienced high levels of interest-enjoyment (8.4/10) and perceived competence (8.1/10). SIGNIFICANCE This exploratory study suggests that children with cerebral palsy can achieve small within-session improvements of their calf muscle activation pattern when provided with implicit biofeedback-driven gaming in an enjoyable manner. Follow-up gait training studies can incorporate this method to assess retention and long-term functional benefits of electromyographic biofeedback-driven gaming.
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11
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Sandberg GS, Torres BT, Budsberg SC. Comparison of Canine Forelimb Kinematic Joint Angles Collected with 2D and 3D Models. Vet Comp Orthop Traumatol 2023; 36:139-147. [PMID: 36690024 DOI: 10.1055/s-0042-1760666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The aim of this study was to compare a Joint Coordinate System (JCS) three-dimensional (3D) kinematic model of the canine forelimb with more widely used linear (LIN) and segmental (SEG) 2D models. STUDY DESIGN It was an in vivo biomechanical study. ANIMALS Normal adult mixed breed dogs were used in this study (n = 6). METHODS Nineteen retroreflective markers were applied to the skin of dogs' right forelimbs. Dogs were trotted and walked through the calibrated testing space. The first five good trials were used to generate sagittal plane (flexion and extension angle) waveforms from 3 different models (JCS, LIN and SEG) for the shoulder, elbow and carpal joints. The JCS model also generated transverse and frontal plane joint angular data (internal/external and abduction/adduction angles) for all three joints. Minimum, maximum and total angular displacement was calculated for each joint. Comparison of sagittal plane waveforms was performed before and after waveform alignment using statistical parametric mapping. RESULTS Each model produced similar sagittal plane waveforms, though the LIN model had a greater vertical shift along the y-axis for the shoulder and elbow. Before waveform alignment, differences were revealed between the LIN model when compared to JCS or SEG model at a trot. No differences were revealed at a walk. After waveform alignment, no differences were revealed between models at a walk or trot. There were no differences in angular displacement measurements between models before or after waveform alignment at a walk or trot. CONCLUSIONS The 3D JCS model reported in this study produced sagittal plane waveforms comparable to conventional 2D models while also providing joint specific information from other planes of motion.
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Affiliation(s)
- Gabriella S Sandberg
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, Georgia, United States
| | - Bryan T Torres
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, Missouri, United States
| | - Steven C Budsberg
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, Georgia, United States.,Department of Comparative Physiology and Pharmacology, University of Georgia, Athens, Georgia, United States
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12
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Moayedi M, Arshi AR, Salehi M, Akrami M, Javadi Asl N, Naemi R. An investigation into the hammer toe effects on the lower extremity mechanics and plantar fascia tension: A case for a vicious cycle and progressive damage. Comput Biol Med 2023; 152:106381. [PMID: 36563541 DOI: 10.1016/j.compbiomed.2022.106381] [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: 08/10/2022] [Revised: 10/14/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022]
Abstract
Hammer toes are one of the common deformities of the forefoot that can lead to compensatory changes during walking in individuals with this condition. Predicting the adverse effects of tissue damage on the performance of other limbs is very important in the prevention of progressive damage. Finite element (FE) and musculoskeletal modeling can be helpful by allowing such effects to be studied in a way where the internal stresses in the tissue could be investigated. Hence, this study aims to investigate the effects of the hammer toe deformity on the lower extremity, especially on the plantar fascia functions. To compare the joint reactions of the hammer toe foot (HTF) and healthy foot (HF), two musculoskeletal models (MSM) of the feet of a healthy individual and that of a participant with hammer toe foot were developed based on gait analysis. A previously validated 3D finite element model which was constructed using Magnetic Resonance Imaging (MRI) of the diabetic participant with the hammer toe deformity was processed at five different events during the stance phase of gait. It was found that the hammer toe deformity makes dorsiflexion of the toes and the windlass mechanism less effective during walking. Specifically, the FE analysis results showed that plantar fascia (PF) in HTF compared to HF played a less dominant role in load bearing with both medial and lateral parts of PF loaded. Also, the results indicated that the stored elastic energy in PF was less in HTF than the HF, which can indicate a higher metabolic cost during walking. Internal stress distribution shows that the majority of ground reaction forces are transmitted through the lateral metatarsals in hammer toe foot, and the probability of fifth metatarsal fracture and also progressive deformity was subsequently increased. The MSM results showed that the joint reaction forces and moments in the hammer toe foot have deviated from normal, where the metatarsophalangeal joint reactions in the hammer toe were less than the values in the healthy foot. This can indicate a vicious cycle of foot deformity, leading to changes in body weight force transmission line, and deviation of joint reactions and plantar fascia function from normal. These in turn lead to increased internal stress concentration, which in turn lead to further foot deformities. This vicious cycle cause progressive damage and can lead to an increase in the risk of ulceration in the diabetic foot.
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Affiliation(s)
- M Moayedi
- Department of Mechanical Engineering, Amirkabir University of Technology, Iran.
| | - A R Arshi
- Biomechanics and Sports Engineering Groups, Biomedical Engineering Department, Amirkabir University of Technology, Iran.
| | - M Salehi
- Department of Mechanical Engineering, Amirkabir University of Technology, Iran.
| | - M Akrami
- Department of Engineering, College of Engineering, Mathematics, and Physical Sciences, University of Exeter, UK.
| | - N Javadi Asl
- Department of Mechanical Engineering, Amirkabir University of Technology, Iran.
| | - R Naemi
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, UK.
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Oudenhoven LM, Kerkum YL, Buizer AI, van der Krogt MM. How does a systematic tuning protocol for ankle foot orthosis-footwear combinations affect gait in children in cerebral palsy? Disabil Rehabil 2022; 44:6867-6877. [PMID: 34506245 DOI: 10.1080/09638288.2021.1970829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To investigate the effects of a systematic tuning protocol for ankle foot orthosis footwear combinations (AFO-FC) using incrementing heel height on gait in children with cerebral palsy (CP). METHODS Eighteen children with CP (10.8 ± 3 years, Gross Motor Function Classification System (GMFCS) I-II) underwent 3D gait analysis on a treadmill, while the AFO heel surface was systematically incremented with wedges. Children were subdivided based on their gait pattern, i.e., knee hyperextension (EXT) and excessive knee flexion (FLEX). Outcome measures included sagittal hip and knee angles and moments, shank to vertical angle (SVA), foot to horizontal angle, and gait profile score (GPS). RESULTS For both groups, incrementing heel height resulted in increased knee flexion, more inclined SVA, and increased knee extension moments. This resulted in gait improvements for some children of the EXT-group, but not in FLEX. High variation was found between individuals and within-subject effects were not always consistent for kinematic and kinetics. CONCLUSIONS A systematic AFO-FC tuning protocol using incremented heel height can be effective to improve gait in children with CP walking with EXT. The current results emphasise the importance of including kinematics as well as kinetics of multiple instances throughout the gait cycle for reliable interpretation of the effect of AFO tuning on gait.Implications for rehabilitationA systematic ankle foot orthosis footwear combinations (AFO-FC) tuning protocol using incremented heel height can improve gait in children walking with knee hyperextension.Tuning results in changes throughout the gait cycle.Little evidence is found for an optimal SVA of 10-12° at midstance.For clinical interpretation, both joint kinematic and kinetic parameters should be considered throughout the gait cycle and evaluation should not be based on SVA only.
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Affiliation(s)
- Laura M Oudenhoven
- Department of Rehabilitation Medicine, Amsterdam, Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Yvette L Kerkum
- Faculty of Rehabilitation Sciences, REVAL, Hasselt University, Hasselt University, Diepenbeek, Belgium.,Research & Development, OIM Orthopedie, Assen, The Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, Amsterdam, Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Marjolein M van der Krogt
- Department of Rehabilitation Medicine, Amsterdam, Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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14
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Senden R, Marcellis R, Meijer K, Willems P, Lenssen T, Staal H, Janssen Y, Groen V, Vermeulen RJ, Witlox M. Comparison of sagittal plane gait characteristics between the overground and treadmill approach for gait analysis in typically developing children. PeerJ 2022; 10:e13752. [PMID: 35898943 PMCID: PMC9310770 DOI: 10.7717/peerj.13752] [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: 01/14/2022] [Accepted: 06/28/2022] [Indexed: 01/17/2023] Open
Abstract
Background Instrumented treadmills have become more mainstream in clinical assessment of gait disorders in children, and are increasingly being applied as an alternative to overground gait analysis. Both approaches differ in multiple elements of set-up (e.g., overground versus treadmill, Pug-in Gait versus Human Body Model-II), workflow (e.g., limited amount of steps versus many successive steps) and post-processing of data (e.g., different filter techniques). These individual elements have shown to affect gait. Since the approaches are used in parallel in clinical practice, insight into the compound effect of the multiple different elements on gait is essential. This study investigates whether the outcomes of two approaches for 3D gait analysis are interchangeable in typically developing children. Methods Spatiotemporal parameters, sagittal joint angles and moments, and ground reaction forces were measured in typically developing children aged 3-17 years using the overground (overground walking, conventional lab environment, Plug-In Gait) and treadmill (treadmill walking in virtual environment, Human Body Model-II) approach. Spatiotemporal and coefficient of variation parameters, and peak values in kinematics and kinetics of both approaches were compared using repeated measures tests. Kinematic and kinetic waveforms from both approaches were compared using statistical parametric mapping (SPM). Differences were quantified by mean differences and root mean square differences. Results Children walked slower, with lower stride and stance time and shorter and wider steps with the treadmill approach than with the overground approach. Mean differences ranged from 0.02 s for stride time to 3.3 cm for step width. The patterns of sagittal kinematic and kinetic waveforms were equivalent for both approaches, but significant differences were found in amplitude. Overall, the peak joint angles were larger during the treadmill approach, showing mean differences ranging from 0.84° (pelvic tilt) to 6.42° (peak knee flexion during swing). Mean difference in peak moments ranged from 0.02 Nm/kg (peak knee extension moment) to 0.32 Nm/kg (peak hip extension moment), showing overall decreased joint moments with the treadmill approach. Normalised ground reaction forces showed mean differences ranging from 0.001 to 0.024. Conclusion The overground and treadmill approach to 3D gait analysis yield different sagittal gait characteristics. The systematic differences can be due to important changes in the neuromechanics of gait and to methodological choices used in both approaches, such as the biomechanical model or the walkway versus treadmill. The overview of small differences presented in this study is essential to correctly interpret the results and needs to be taken into account when data is interchanged between approaches. Together with the research/clinical question and the context of the child, the insight gained can be used to determine the best approach.
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Affiliation(s)
- Rachel Senden
- Department of Physical Therapy, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
| | - Rik Marcellis
- Department of Physical Therapy, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
| | - Paul Willems
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
| | - Ton Lenssen
- Department of Physical Therapy, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
| | - Heleen Staal
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
| | - Yvonne Janssen
- Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, Limburg, The Netherlands,Department of Rehabilitation Medicine, School for Public Health and Primary Care, Maastricht University, Maastricht, Limburg, The Netherlands,Department of Neurology, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
| | - Vincent Groen
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
| | - Roland Jeroen Vermeulen
- Department of Neurology, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
| | - Marianne Witlox
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
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15
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Moayedi M, Naemi R, Arshi AR, Akrami M, Salehi M. An investigation of the ankle contact forces in a foot with hammer toe deformity. A comparison of patient-specific approaches using finite element modeling and musculoskeletal simulation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:2552-2555. [PMID: 36086202 DOI: 10.1109/embc48229.2022.9871049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The internal forces and stresses in the tissue are important as they are linked to the risk of mechanical trauma and injuries. Despite their value, the internal stresses and forces cannot be directly measured in-vivo. A previously validated 3D finite element model (FEM) was constructed using Magnetic Resonance Imaging (MRI) of a person with diabetes and hammer toe deformity. The foot model simulated at five different instances during the stance phase of gait. The internal stress distribution on the talus that was obtained using the FEM simulation, was used to calculate the joint reaction force at the ankle joint. In addition, the musculoskeletal model (MSM) of the participant with hammer toe foot was developed based on the gait analysis and was used to determine the muscle forces and joint reactions. The result showed that the vertical reaction forces obtained from the FEM and MSM follow a similar trend through the stance phase of gait cycle and are significantly correlated ( R=0.99). The joint reaction forces obtained through the two methods do not differ for the first 25% of the gait cycle, while the maximum difference was ∼0.7 Body weight that was observed at 50% of the stance phase. Clinical Relevance: Finite element modeling and musculoskeletal simulation can shed light on the internal forces at the ankle in pathological conditions such as hammer toe. The similarities and differences observed in the joint reaction forces calculated from the two methods can have implications in assessing the effect of clinical interventions.
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Ziziene J, Daunoraviciene K, Juskeniene G, Raistenskis J. Comparison of kinematic parameters of children gait obtained by inverse and direct models. PLoS One 2022; 17:e0270423. [PMID: 35749351 PMCID: PMC9231751 DOI: 10.1371/journal.pone.0270423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 06/10/2022] [Indexed: 11/19/2022] Open
Abstract
The purpose of this study is to compare differences between kinematic parameters of pediatric gait obtained by direct kinematics (DK) (Plug-in-Gait) and inverse kinematics (IK) (AnyBody) models. Seventeen healthy children participated in this study. Both lower extremities were examined using a Vicon 8-camera motion capture system and a force plate. Angles of the hip, knee, and ankle joints were obtained based on DK and IK models, and ranges of motion (ROMs) were identified from them. The standard error of measurement, root-mean-squared error, correlation r, and magnitude-phase (MP) metrics were calculated to compare differences between the models’ outcomes. The determined standard error of measurement between ROMs from the DK and IK models ranged from 0.34° to 0.58°. A significant difference was found in the ROMs with the exception of the left hip’s internal/external rotation. The mean RMSE of all joints’ amplitudes exceeded the clinical significance limit and was 13.6 ± 4.0°. The best curve angles matching nature were found in the sagittal plane, where r was 0.79 to 0.83 and MP metrics were 0.05 to 0.30. The kinematic parameters of pediatric gait obtained by IK and DK differ significantly. Preferably, all of the results obtained by DK must be validated/verified by IK, in order to achieve a more accurate functional assessment of the individual. Furthermore, the use of IK expands the capabilities of gait analysis and allows for kinetic characterisation.
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Affiliation(s)
- Jurgita Ziziene
- Department of Biomechanical Engineering, Vilnius Gediminas Technical University, Vilnius, Lithuania
| | - Kristina Daunoraviciene
- Department of Biomechanical Engineering, Vilnius Gediminas Technical University, Vilnius, Lithuania
| | - Giedre Juskeniene
- Faculty of Medicine, Department of Rehabilitation, Physical and Sports Medicine, Health Science Institute, Vilnius University, Vilnius, Lithuania
| | - Juozas Raistenskis
- Faculty of Medicine, Department of Rehabilitation, Physical and Sports Medicine, Health Science Institute, Vilnius University, Vilnius, Lithuania
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17
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Ren X, Lutter C, Kebbach M, Bruhn S, Yang Q, Bader R, Tischer T. Compensatory Responses During Slip-Induced Perturbation in Patients With Knee Osteoarthritis Compared With Healthy Older Adults: An Increased Risk of Falls? Front Bioeng Biotechnol 2022; 10:893840. [PMID: 35782515 PMCID: PMC9240265 DOI: 10.3389/fbioe.2022.893840] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/30/2022] [Indexed: 02/03/2023] Open
Abstract
Background: Functional impairment of the knee joint affected by osteoarthritis and loss of muscle strength leads to a significant increase in the number of falls. Nevertheless, little is known about strategies for coping with gait perturbations in patients with knee osteoarthritis (KOA). Thus, this study aimed to examine the compensatory strategies of patients with KOA in response to a backward slip perturbation compared with healthy older adults. Methods: An automated perturbation program was developed by using D-Flow software based on the Gait Real-time Analysis Interactive Lab, and an induced backward slip perturbation was implemented on nine patients with severe KOA (68.89 ± 3.59 years) and 15 age-matched healthy older adults (68.33 ± 3.29 years). Step length, gait speed, range of motion, vertical ground reaction forces, lower extremity joint angles, and joint moments were computed and analyzed. Results: Compared with older adults, patients with KOA had significantly lower step length, gait speed, and vertical ground reaction forces in both normal walking and the first recovery step following backward slip perturbations. Inadequate flexion and extension of joint angles and insufficient generation of joint moments predispose patients with KOA to fall. Hip extension angle and flexion moment, knee range of motion, and vertical ground reaction forces are key monitoring variables. Conclusion: The risk of falls for patients with KOA in response to backward slip perturbations is higher. Patients with KOA should focus not only on quadriceps muscle strength related to knee range of motion but also on improving hip extensor strength and activation through specific exercises. Targeted resistance training and perturbation-based gait training could be better options.
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Affiliation(s)
- Xiping Ren
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - Christoph Lutter
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - Maeruan Kebbach
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - Sven Bruhn
- Institute of Sport Science, Faculty of Philosophy, University of Rostock, Rostock, Germany
| | - Qining Yang
- Department of Joint Surgery, The affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Rainer Bader
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - Thomas Tischer
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
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Godwin EM, Salem Y, States RA, Krzak JJ, McMulkin M, Bodkin-Winter A. Instrumented Gait Analysis (IGA) for Management of Children With Cerebral Palsy: A Needs Assessment Survey. Pediatr Phys Ther 2022; 34:221-228. [PMID: 35184074 DOI: 10.1097/pep.0000000000000876] [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
PURPOSE This needs assessment survey identifies the priorities of the clinical and research communities involved with the use of instrumented gait analysis (IGA) for a clinical practice guideline on IGA use with children with cerebral palsy (CP). METHODS Thirteen Likert scale questions asked about the importance of topics related to IGA. Other questions addressed respondents' demographics, experience with IGA, patient populations, and gait laboratory characteristics. Several open-ended questions were included and analyzed. RESULTS The survey was completed by 43 physical therapists and 53 non-physical therapists involved with IGA. More than 90% rated the following as critically or highly important: reliability and validity of IGA to identify gait pathology (94%); ability to longitudinally track gait pathology (93%); use in planning interventions (93%); use in evaluating outcomes (93%); and definition of IGA (90%). CONCLUSIONS AND RECOMMENDATIONS FOR CLINICAL PRACTICE This needs assessment survey identified the topic priorities of clinicians and practitioners who use IGA for the management of children with CP. These results will guide the development of a clinical practice guideline on the use of IGA for the management of CP.
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Affiliation(s)
- Ellen M Godwin
- Department of Physical Therapy (Drs Godwin and States), Long Island University Brooklyn, Brooklyn, New York; Department of Allied Health and Kinesiology (Dr Salem), School of Health Professions and Human Services, Hofstra University, Hempstead New York; Faculty of Physiotherapy (Dr Salem), Cairo University, Midwestern University (Dr Krzak), Downers Grove, Illinois; Shriners Hospitals for Children-Chicago (Dr Krzak), Chicago, Illinois; Walter E. & Agnes M. Griffin Motion Analysis Center (Dr McMulkin), Shriners Hospital for Children-Spokane, Spokane, Washington; Department of Physical Medicine & Rehabilitation (Dr Bodkin-Winter), University of Colorado Anschutz Medical Campus, Aurora
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19
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Žarković D, Šorfová M, Tufano JJ, Kutílek P, Vítečková S, Ravnik D, Groleger-Sršen K, Cikajlo I, Otáhal J. Gait changes following robot-assisted gait training in children with cerebral palsy. Physiol Res 2021; 70:S397-S408. [PMID: 35099258 DOI: 10.33549/physiolres.934840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study investigated changes of gait pattern induced by a 4-week robot-assisted gait training (RAGT) in twelve ambulatory spastic diparesis children with cerebral palsy (CP) aged 10.4+/-3.2 years old by using computerized gait analysis (CGA). Pre-post intervention CGA data of children with CP was contrasted to the normative data of typically developing children by using cross-correlation and statistically evaluated by a Wilcoxon test. Significant pre-post intervention changes (p<0.01) include: decreased muscle activity of biceps femoris, rectus femoris, and tibialis anterior; a decrease in range of internal hip joint rotation, higher cadence, step length, and increased stride time. This study suggests that RAGT can be used in muscle reeducation and improved hip joint motion range in ambulatory children with CP.
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Affiliation(s)
- D Žarković
- Department of Anatomy and Biomechanics, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic.
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20
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Flux E, van der Krogt MM, Harlaar J, Buizer AI, Sloot LH. Functional assessment of stretch hyperreflexia in children with cerebral palsy using treadmill perturbations. J Neuroeng Rehabil 2021; 18:151. [PMID: 34663392 PMCID: PMC8522046 DOI: 10.1186/s12984-021-00940-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/08/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND As hyperactive muscle stretch reflexes hinder movement in patients with central nervous system disorders, they are a common target of treatment. To improve treatment evaluation, hyperactive reflexes should be assessed during activities as walking rather than passively. This study systematically explores the feasibility, reliability and validity of sudden treadmill perturbations to evoke and quantify calf muscle stretch reflexes during walking in children with neurological disorders. METHODS We performed an observational cross-sectional study including 24 children with cerebral palsy (CP; 6-16 years) and 14 typically developing children (TD; 6-15 years). Short belt accelerations were applied at three different intensities while children walked at comfortable speed. Lower leg kinematics, musculo-tendon lengthening and velocity, muscle activity and spatiotemporal parameters were measured to analyze perturbation responses. RESULTS We first demonstrated protocol feasibility: the protocol was completed by all but three children who ceased participation due to fatigue. All remaining children were able to maintain their gait pattern during perturbation trials without anticipatory adaptations in ankle kinematics, spatiotemporal parameters and muscle activity. Second, we showed the protocol's reliability: there was no systematic change in muscle response over time (P = 0.21-0.54) and a bootstrapping procedure indicated sufficient number of perturbations, as the last perturbation repetition only reduced variability by ~ 2%. Third, we evaluated construct validity by showing that responses comply with neurophysiological criteria for stretch reflexes: perturbations superimposed calf muscle lengthening (P < 0.001 for both CP and TD) in all but one participant. This elicited increased calf muscle activity (359 ± 190% for CP and 231 ± 68% for TD, both P < 0.001) in the gastrocnemius medialis muscle, which increased with perturbation intensity (P < 0.001), according to the velocity-dependent nature of stretch reflexes. Finally, construct validity was shown from a clinical perspective: stretch reflexes were 1.7 times higher for CP than TD for the gastrocnemius medialis muscle (P = 0.017). CONCLUSIONS The feasibility and reliability of the protocol, as well as the construct validity-shown by the exaggerated velocity-dependent nature of the measured responses-strongly support the use of treadmill perturbations to quantify stretch hyperreflexia during gait. We therefore provided a framework which can be used to inform clinical decision making and treatment evaluation.
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Affiliation(s)
- Eline Flux
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, PO Box 7057, 1007MB, Amsterdam, The Netherlands.
| | - Marjolein M van der Krogt
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, PO Box 7057, 1007MB, Amsterdam, The Netherlands
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, PO Box 7057, 1007MB, Amsterdam, The Netherlands
- Department Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
- Department Orthopedics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, PO Box 7057, 1007MB, Amsterdam, The Netherlands
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
| | - Lizeth H Sloot
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, PO Box 7057, 1007MB, Amsterdam, The Netherlands
- Institute for Computer Engineering, Heidelberg University, Heidelberg, Germany
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21
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Moayedi M, Arshi AR, Salehi M, Akrami M, Naemi R. Associations between changes in loading pattern, deformity, and internal stresses at the foot with hammer toe during walking; a finite element approach. Comput Biol Med 2021; 135:104598. [PMID: 34346320 DOI: 10.1016/j.compbiomed.2021.104598] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
Over the past decade, Finite Element (FE) modelling has been used as a method to understand the internal stresses within the diabetic foot. Foot deformities such as hammer toe have been associated with increased risk of foot ulcers in diabetic patients. Hence the aim of this study is to investigate the influence of hammer toe deformity on internal stresses during walking. A 3D finite element model of the human foot was constructed based on capturing Magnetic Resonance Imaging (MRI) of a diabetic neuropathic volunteer exhibiting hammer toe. 3D gait measurements and a multi-body musculoskeletal model for the same participant were used to define muscle forces. FE simulations were run at five different instances during the stance phase of gait. Peak plantar pressure and pressure distribution results calculated from the model showed a good agreement with the experimental measurement having less than 11% errors. Maximum von Mises internal stresses in the forefoot hard tissue were observed at the 3rd and 5th metatarsals and 4th proximal phalanx. Moreover, presence of hammer toe deformity was found to shift the location of maximum internal stresses on the soft tissue to the forefoot by changing the location of centre of pressure with internal stress 1.64 times greater than plantar pressure. Hammer toe deformity also showed to reduce the involvement of the first phalanx in internal/external load-bearing during walking. The findings of this study support the association between changes in loading pattern, deformity, and internal stresses in the soft tissue that lead to foot ulceration.
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Affiliation(s)
- M Moayedi
- Department of Mechanical Engineering, Amirkabir University of Technology, Iran.
| | - A R Arshi
- Biomechanics and Sports Engineering Groups, Biomedical Engineering Department, Amirkabir University of Technology, Iran.
| | - M Salehi
- Department of Mechanical Engineering, Amirkabir University of Technology, Iran.
| | - M Akrami
- Department of Engineering, College of Engineering, Mathematics, and Physical Sciences, University of Exeter, UK.
| | - R Naemi
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, UK.
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22
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The Effectiveness of Robot- vs. Virtual Reality-Based Gait Rehabilitation: A Propensity Score Matched Cohort. Life (Basel) 2021; 11:life11060548. [PMID: 34208009 PMCID: PMC8230650 DOI: 10.3390/life11060548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 01/05/2023] Open
Abstract
Robot assisted gait training (RAGT) and virtual reality plus treadmill training (VRTT) are two technologies that can support locomotion rehabilitation in children and adolescents affected by acquired brain injury (ABI). The literature provides evidence of their effectiveness in this population. However, a comparison between these methods is not available. This study aims at comparing the effectiveness of RAGT and VRTT for the gait rehabilitation of children and adolescents suffering from ABI. This is a prospective cohort study with propensity score matching. Between October 2016 and September 2018, all patients undergoing an intensive gait rehabilitation treatment based on RAGT or VRTT were prospectively observed. To minimize selection bias associated with the study design, patients who underwent RAGT or VRTT were retrospectively matched for age, gender, time elapsed from injury, level of impairment, and motor impairment using propensity score in a matching ratio of 1:1. Outcome measures were Gross Motor Function Mesure-88 (GMFM-88), six-min walking test (6MWT), Gillette Functional Assessment Questionnaire (FAQ), and three-dimensional gait analysis (GA). The FAQ and the GMFM-88 had a statistically significant increase in both groups while the 6MWT improved in the RAGT group only. GA highlighted changes at the proximal level in the RAGT group, and at the distal district in the VRTT group. Although preliminary, this work suggests that RAGT and VRTT protocols foster different motor improvements, thus recommending to couple the two therapies in the paediatric population with ABI.
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