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Fitzgerald JJ, Zhou W, Chase SM, Joiner WM. Dissociating the Influence of Limb Posture and Visual Feedback Shifts on the Adaptation to Novel Movement Dynamics. Neuroscience 2024; 549:24-41. [PMID: 38484835 DOI: 10.1016/j.neuroscience.2024.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 12/01/2023] [Accepted: 02/23/2024] [Indexed: 03/24/2024]
Abstract
Accurate movements of the upper limb require the integration of various forms of sensory feedback (e.g., visual and postural information). The influence of these different sensory modalities on reaching movements has been largely studied by assessing endpoint errors after selectively perturbing sensory estimates of hand location. These studies have demonstrated that both vision and proprioception make key contributions in determining the reach endpoint. However, their influence on motor output throughout movement remains unclear. Here we used separate perturbations of posture and visual information to dissociate their effects on reaching dynamics and temporal force profiles during point-to-point reaching movements. We tested human subjects (N = 32) and found that vision and posture modulate select aspects of reaching dynamics. Specifically, altering arm posture influences the relationship between temporal force patterns and the motion-state variables of hand position and acceleration, whereas dissociating visual feedback influences the relationship between force patterns and the motion-state variables of velocity and acceleration. Next, we examined the extent these baseline motion-state relationships influence motor adaptation based on perturbations of movement dynamics. We trained subjects using a velocity-dependent force-field to probe the extent arm posture-dependent influences persisted after exposure to a motion-state dependent perturbation. Changes in the temporal force profiles due to variations in arm posture were not reduced by adaptation to novel movement dynamics, but persisted throughout learning. These results suggest that vision and posture differentially influence the internal estimation of limb state throughout movement and play distinct roles in forming the response to external perturbations during movement.
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Affiliation(s)
- Justin J Fitzgerald
- Department of Biomedical Engineering, University of California, Davis, CA, USA; Department of Neurobiology, Physiology and Behavior, University of California, Davis, CA, USA; Clinical and Translational Science Center, University of California Davis Health, Sacramento, CA, USA
| | - Weiwei Zhou
- Department of Neurobiology, Physiology and Behavior, University of California, Davis, CA, USA
| | - Steven M Chase
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA; Center for Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Wilsaan M Joiner
- Department of Neurobiology, Physiology and Behavior, University of California, Davis, CA, USA; Department of Neurology, University of California, Davis, CA, USA; Department of Bioengineering, George Mason University, Fairfax, VA, USA.
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Koussou A, Dumas R, Desailly E. A Velocity Stretch Reflex Threshold Based on Muscle-Tendon Unit Peak Acceleration to Detect Possible Occurrences of Spasticity during Gait in Children with Cerebral Palsy. SENSORS (BASEL, SWITZERLAND) 2023; 24:41. [PMID: 38202903 PMCID: PMC10780611 DOI: 10.3390/s24010041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024]
Abstract
Spasticity might affect gait in children with cerebral palsy. Quantifying its occurrence during locomotion is challenging. One approach is to determine kinematic stretch reflex thresholds, usually on the velocity, during passive assessment and to search for their exceedance during gait. These thresholds are determined through EMG-Onset detection algorithms, which are variable in performance and sensitive to noisy data, and can therefore lack consistency. This study aimed to evaluate the feasibility of determining the velocity stretch reflex threshold from maximal musculotendon acceleration. Eighteen children with CP were recruited and underwent clinical gait analysis and a full instrumented assessment of their soleus, gastrocnemius lateralis, semitendinosus, and rectus femoris spasticity, with EMG, kinematics, and applied forces being measured simultaneously. Using a subject-scaled musculoskeletal model, the acceleration-based stretch reflex velocity thresholds were determined and compared to those based on EMG-Onset determination. Their consistencies according to physiological criteria, i.e., if the timing of the threshold was between the beginning of the stretch and the spastic catch, were evaluated. Finally, two parameters designed to evaluate the occurrence of spasticity during gait, i.e., the proportion of the gait trial time with a gait velocity above the velocity threshold and the number of times the threshold was exceeded, were compared. The proposed method produces velocity stretch reflex thresholds close to the EMG-based ones. For all muscles, no statistical difference was found between the two parameters designed to evaluate the occurrence of spasticity during gait. Contrarily to the EMG-based methods, the proposed method always provides physiologically consistent values, with median electromechanical delays of between 50 and 130 ms. For all subjects, the semitendinosus velocity during gait usually exceeded its stretch reflex threshold, while it was less frequent for the three other muscles. We conclude that a velocity stretch reflex threshold, based on musculotendon acceleration, is a reliable substitute for EMG-based ones.
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Affiliation(s)
- Axel Koussou
- Pôle Recherche & Innovation, Fondation Ellen Poidatz, 77310 Saint-Fargeau-Ponthierry, France;
- Laboratoire de Biomécanique et Mécanique des Chocs UMR T9406, University Lyon, University Gustave Eiffel, University Claude Bernard Lyon 1, 69622 Lyon, France;
| | - Raphaël Dumas
- Laboratoire de Biomécanique et Mécanique des Chocs UMR T9406, University Lyon, University Gustave Eiffel, University Claude Bernard Lyon 1, 69622 Lyon, France;
| | - Eric Desailly
- Pôle Recherche & Innovation, Fondation Ellen Poidatz, 77310 Saint-Fargeau-Ponthierry, France;
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Özden F, Uysal İ, Tümtürk İ, Özkeskin M. Investigation of Motor Activity, Movement Kinematics and Forward-Backwards Gait in Children with Cerebral Palsy. Percept Mot Skills 2023; 130:2000-2014. [PMID: 37490931 DOI: 10.1177/00315125231191152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Our aim in this study was to examine relationships between the motor activity ability, sensor-based kinematics and forward-backwards gait characteristics of children with cerebral palsy (CP). In this prospective cross-sectional study we studied 40 children with CP. We used the Pediatric Motor Activity Log Revised (PMAL-R) to assess motor activity, evaluated motion kinematics (acceleration and angular velocity) with a sensor-based application, applied the Edinburgh Visual Gait Score (EVGS) and the Timed Up and Go Test (TUG) to observe gait performance, and used the Three Meter Backward Walk Test (3MBWT) to assess backward gait. We found moderately positive significant correlations (r1 = 0.416, r2 = 0.418, p < 0.05) between the chilidren's minimum angular velocity on PMAL-R motor activity frequency (how often) and quality (how well) scores, respectively. We also found moderately negative significant correlations (r1 = -0.529, r2 = -0.521, p < 0.05) between PMAL-R frequency (how often) and quality (how well) scores with TUG, respectively. There were moderately high positive correlations (r1 = 0.415, r2 = 0.726, p < 0.05) between EVGS scores and 3MBWT and TUG scores, respectively. We concluded that angular velocity ability was moderately related to children's motor activity and showed that physical performance tests (TUG and 3MBWT) could monitor gait function and upper extremity motor activity level, including both forward and backward walking tasks, in children with CP.
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Affiliation(s)
- Fatih Özden
- Köyceğiz Vocational School of Health Services, Health Care Services Department, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - İsmail Uysal
- Fethiye Vocational School of Health Services, Health Care Services Department, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - İsmet Tümtürk
- Institute of Health Sciences, Physiotherapy and Rehabilitation Department, Ege University, İzmir, Turkey
| | - Mehmet Özkeskin
- Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Ege University, İzmir, Turkey
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Chang MC, Choo YJ, Kwak SG, Nam K, Kim SY, Lee HJ, Kwak S. Effectiveness of Extracorporeal Shockwave Therapy on Controlling Spasticity in Cerebral Palsy Patients: A Meta-Analysis of Timing of Outcome Measurement. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020332. [PMID: 36832460 PMCID: PMC9954893 DOI: 10.3390/children10020332] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/09/2023] [Accepted: 01/29/2023] [Indexed: 02/12/2023]
Abstract
Extracorporeal shockwave therapy (ESWT) has been suggested as an alternative treatment for reducing spasticity in patients with cerebral palsy (CP). However, the duration of its effect was rarely known. A meta-analysis was performed to investigate the effectiveness of ESWT at controlling spasticity in patients with CP according to the follow-up period. We included studies in which ESWT was used to manage spasticity in patients with CP, and the effect was compared with that in a control group. Finally, three studies were included. In the meta-analysis, spasticity, measured using the modified Ashworth scale (MAS), was significantly reduced after ESWT compared with that in the control group; however, it was sustained for only 1 month. After ESWT, significant increases in passive ankle range of motion (ROM) and plantar surface area in the standing position were observed compared with those in the control group and sustained for up to 3 months. Although spasticity measured using MAS was significantly reduced for only 1 month, improvement in spasticity-associated symptoms, such as ankle ROM and plantar surface area contacting the ground, persisted for over 3 months. ESWT appears to be a useful and effective therapeutic option for managing spasticity in patients with CP.
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Affiliation(s)
- Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea
| | - You Jin Choo
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea
| | - Sang Gyu Kwak
- Department of Medical Statistics, College of Medicine, Catholic University of Daegu, Daegu 42472, Republic of Korea
| | - Kiyeun Nam
- Department of Rehabilitation Medicine, Dongguk University College of Medicine, Goyang 10326, Republic of Korea
| | - Sae Yoon Kim
- Department of Pediatrics, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea
| | - Hee Jin Lee
- Department of Pediatrics, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea
| | - Soyoung Kwak
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea
- Correspondence: ; Tel.: +82-53-620-3270
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Guo X, Wallace R, Tan Y, Oetomo D, Klaic M, Crocher V. Technology-assisted assessment of spasticity: a systematic review. J Neuroeng Rehabil 2022; 19:138. [PMID: 36494721 PMCID: PMC9733065 DOI: 10.1186/s12984-022-01115-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Spasticity is defined as "a motor disorder characterised by a velocity dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks". It is a highly prevalent condition following stroke and other neurological conditions. Clinical assessment of spasticity relies predominantly on manual, non-instrumented, clinical scales. Technology based solutions have been developed in the last decades to offer more specific, sensitive and accurate alternatives but no consensus exists on these different approaches. METHOD A systematic review of literature of technology-based methods aiming at the assessment of spasticity was performed. The approaches taken in the studies were classified based on the method used as well as their outcome measures. The psychometric properties and usability of the methods and outcome measures reported were evaluated. RESULTS 124 studies were included in the analysis. 78 different outcome measures were identified, among which seven were used in more than 10 different studies each. The different methods rely on a wide range of different equipment (from robotic systems to simple goniometers) affecting their cost and usability. Studies equivalently applied to the lower and upper limbs (48% and 52%, respectively). A majority of studies applied to a stroke population (N = 79). More than half the papers did not report thoroughly the psychometric properties of the measures. Analysis identified that only 54 studies used measures specific to spasticity. Repeatability and discriminant validity were found to be of good quality in respectively 25 and 42 studies but were most often not evaluated (N = 95 and N = 78). Clinical validity was commonly assessed only against clinical scales (N = 33). Sensitivity of the measure was assessed in only three studies. CONCLUSION The development of a large diversity of assessment approaches appears to be done at the expense of their careful evaluation. Still, among the well validated approaches, the ones based on manual stretching and measuring a muscle activity reaction and the ones leveraging controlled stretches while isolating the stretch-reflex torque component appear as the two promising practical alternatives to clinical scales. These methods should be further evaluated, including on their sensitivity, to fully inform on their potential.
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Affiliation(s)
- Xinliang Guo
- grid.1008.90000 0001 2179 088XUoM and Fourier Intelligence Joint Robotics Laboratory, Mechanical Engineering Department, The University of Melbourne, Melbourne, Australia
| | - Rebecca Wallace
- grid.416153.40000 0004 0624 1200Allied Health Department, The Royal Melbourne Hospital, Melbourne, Australia
| | - Ying Tan
- grid.1008.90000 0001 2179 088XUoM and Fourier Intelligence Joint Robotics Laboratory, Mechanical Engineering Department, The University of Melbourne, Melbourne, Australia
| | - Denny Oetomo
- grid.1008.90000 0001 2179 088XUoM and Fourier Intelligence Joint Robotics Laboratory, Mechanical Engineering Department, The University of Melbourne, Melbourne, Australia
| | - Marlena Klaic
- grid.1008.90000 0001 2179 088XSchool of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Vincent Crocher
- grid.1008.90000 0001 2179 088XUoM and Fourier Intelligence Joint Robotics Laboratory, Mechanical Engineering Department, The University of Melbourne, Melbourne, Australia
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Contribution of Different Impairments to Restricted Knee Flexion during Gait in Individuals with Cerebral Palsy. J Pers Med 2022; 12:jpm12101568. [PMID: 36294708 PMCID: PMC9604873 DOI: 10.3390/jpm12101568] [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: 08/24/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/29/2022] Open
Abstract
The coexistence of overlapping impairments modulates the knee pattern in the swing phase of walking in children with cerebral palsy (CP). The impact and contribution of each impairment to the reduction of knee range-of-motion is unknown. The aim of the study was to establish the gradation of the impact of individual coexisting impairments on the knee flexion range-of-motion. Passive range-of-motion, selective motor control, strength, and spasticity from 132 patients (Male = 76, Female = 56, age:11 ± 4 years) with spastic CP were tested with clinical tools. Knee flexion range-of-motion at terminal stance, pre-swing, and initial swing phases were assessed by gait analysis. Hypertonia (β = −5.75) and weakness (β = 2.76) of knee extensors were associated with lower range of knee flexion (R2 = 0.0801, F = 11.0963, p < 0.0001). The predictive factors (R2 = 0.0744, F = 7.2135, p < 0.0001) were strength (β = 4.04) and spasticity (β = −2.74) of knee extensors and strength of hip flexors (β = −2.01); in swing those were knee extensors hypertonia (β = −2.55) and passive range of flexion (β = 0.16) (R2 = 0.0398, F = 3.4010, p = 0.01). Hypertonia of knee extensors has the strongest impact on knee flexion range-of-motion; secondary is the strength of knee extensors. The knee extensors strength with knee extensors hypertonia and strength of hip flexors contributes in stance. Knee extensors hypertonia with passive knee flexion range-of-motion contributes in swing.
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Bulea TC, Molazadeh V, Thurston M, Damiano DL. Interleaved Assistance and Resistance for Exoskeleton Mediated Gait Training: Validation, Feasibility and Effects. PROCEEDINGS OF THE ... IEEE/RAS-EMBS INTERNATIONAL CONFERENCE ON BIOMEDICAL ROBOTICS AND BIOMECHATRONICS. IEEE/RAS-EMBS INTERNATIONAL CONFERENCE ON BIOMEDICAL ROBOTICS AND BIOMECHATRONICS 2022; 2022:10.1109/biorob52689.2022.9925419. [PMID: 37650006 PMCID: PMC10466479 DOI: 10.1109/biorob52689.2022.9925419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Strength and selective motor control are primary determinants of pathological gait in children with cerebral palsy (CP) and other neuromotor disorders. Emerging evidence suggests robotic application of task-specific resistance to functional movements may provide the opportunity to strengthen muscles and improve neuromuscular function during walking in children with CP. Such a strategy could be most beneficial to children who are more severely affected by the pathology but their ability to overcome such resistance and maintain functional ambulation remains unclear. The goal of this study was to design, validate and evaluate initial feasibility and effects of a novel exoskeleton strategy that provides interleaved assistance and resistance to knee extension during overground walking. One participant with CP (GMFCS III) was recruited and completed ten total visits, nine walking with the exoskeleton. Our results validated the controller's ability to parse the gait cycle into five discrete phases (mean accuracy 91%) and provide knee extension assistance during stance and resistance during swing. Following acclimation to the interleaved strategy, peak knee extension was significantly improved in both the left (mean 7.9 deg) and right (15.2 deg) limbs when walking with the exoskeleton. Knee extensor EMG during late swing phase increased to 2.7 (left leg) and 1.7 (right leg) times the activation level during baseline exoskeleton walking without resistance. These results indicate that this interleaved strategy warrants further investigation in a longitudinal intervention study, particularly in individuals who may be more severely affected such that they are unable to ambulate overground using an exoskeleton training strategy that only deploys targeted resistance to limb motion.
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Affiliation(s)
- Thomas C Bulea
- Functional & Applied Biomechanics Section of the Rehabilitation Medicine Department at the National Institutes of Health Clinical Center, Bethesda, MD 20892 USA
| | - Vahidreza Molazadeh
- Functional & Applied Biomechanics Section of the Rehabilitation Medicine Department at the National Institutes of Health Clinical Center, Bethesda, MD 20892 USA
| | - Maxwell Thurston
- Functional & Applied Biomechanics Section of the Rehabilitation Medicine Department at the National Institutes of Health Clinical Center, Bethesda, MD 20892 USA
| | - Diane L Damiano
- Functional & Applied Biomechanics Section of the Rehabilitation Medicine Department at the National Institutes of Health Clinical Center, Bethesda, MD 20892 USA
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Ali MS. Does spasticity affect the postural stability and quality of life of children with cerebral palsy? J Taibah Univ Med Sci 2021; 16:761-766. [PMID: 34690659 PMCID: PMC8498706 DOI: 10.1016/j.jtumed.2021.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/16/2021] [Accepted: 04/18/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Cerebral palsy is a unique physical disability that primarily affects children's gross motor functions and postural control. Cerebral palsy has a direct impact on children's daily activities and quality of life. This study aims to determine the relationship between spasticity, motor function, postural stability, and the quality life of children with cerebral palsy. METHODS Forty-five children (age range 4-6 years) diagnosed with spasticity from cerebral palsy participated in this study. Spasticity was evaluated by the modified Ashwarth scale; the children's functions were evaluated by gross motor functional measures, postural stability was evaluated by biodex balance system, and quality of life was measured with the pediatric quality of life inventory. RESULTS There was a strong positive correlation between the degree of spasticity and quality of life. Additionally, there was a significantly strong association between spasticity and gross motor function. In contrast, there was no correlation between spasticity and postural stability indices. Moreover, there was a strong positive correlation between quality of life and gross motor function. Lastly, there was no association between quality of life and the postural stability index. CONCLUSION The findings highlight the impact of spasticity on motor function and the quality of life of a cohort of children with cerebral palsy. These findings may determine therapeutic interventions and priorities to plan physical therapy programs. Such measures may overcome the main cause of disorders that delay and undermine the daily routines of the affected children.
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Affiliation(s)
- Mostafa S. Ali
- Department of Pediatrics, Faculty of Physical Therapy, Cairo University, Egypt
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Hegazy FA, Aboelnasr EA, Salem YT. Effect of lidocaine iontophoresis combined with exercise intervention on gait and spasticity in children with spastic hemiplegic cerebral palsy: A randomized controlled trial. NeuroRehabilitation 2020; 47:133-141. [PMID: 32716326 DOI: 10.3233/nre-203152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Gait deviations and spasticity are common impairments seen in children with cerebral palsy (CP) and may interfere with functional performance and effective walking pattern. Lidocaine iontophoresis is effective for reducing muscle spasticity in adults. PURPOSE To investigate the effect of lidocaine epinephrine iontophoresis combined with exercises on gait and spasticity in children with spastic hemiplegic cerebral palsy (HCP). METHODS Thirty children with spastic HCP aged 4-6 (5.20±0.32) years were randomly assigned to the experimental group (n = 15) and control group (n = 15). Children in both groups received one hour of exercises, three times a week for three months. Children in the experimental group received 2% lidocaine iontophoresis immediately before the exercises. The lidocaine iontophoresis was delivered for 20 minutes (1mA/min). Spatio-temporal gait parameters were assessed within one week before and after the intervention using 3D motion analysis. Surface electromyography was used to assess muscle tone using H/M ratio of the soleus muscle. ANOVA was used to investigate the differences between experimental and control groups. Statistical significance was set at P value less than 0.05. RESULTS There was no difference between groups at baseline. Post-intervention, the experimental group showed significant improvements when compared to the control group for gait speed (p = 0.03), stride length (p = 0.04), cadence (p = 0.0001), cycle time (p = 0.0001), and H/M ratio (p = 0.02). CONCLUSION Lidocaine iontophoresis combined with exercises was effective in improving gait spatiotemporal parameters and reducing spasticity in children with CP.
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Affiliation(s)
- Fatma A Hegazy
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | | | - Yasser T Salem
- Faculty of Physical Therapy, Cairo University, Cairo, Egypt.,Department of Physical Therapy, University of North Texas Health Science Center, Texas, USA
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Bar-On L, Aertbeliën E, Van Campenhout A, Molenaers G, Desloovere K. Treatment Response to Botulinum Neurotoxin-A in Children With Cerebral Palsy Categorized by the Type of Stretch Reflex Muscle Activation. Front Neurol 2020; 11:378. [PMID: 32581991 PMCID: PMC7280486 DOI: 10.3389/fneur.2020.00378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 04/14/2020] [Indexed: 11/13/2022] Open
Abstract
While Botulinum NeuroToxin-A (BoNT-A) injections are frequently used to reduce the effects of hyperactive stretch reflexes in children with cerebral palsy (CP), the effects of this treatment vary strongly. Previous research, combining electromyography (EMG) with motion analysis, defined different patterns of stretch reflex muscle activation in muscles, those that reacted more to a change in velocity (velocity dependent -VD), and those that reacted more to a change in length (length dependent -LD). The aim of this study was to investigate the relation between the types of stretch reflex muscle activation in the semitendinosus with post-BoNT-A outcome as assessed passively and with 3D gait analysis in children with spastic CP. Eighteen children with spastic CP (10 bilaterally involved) between the ages of 12 and 18 years were assessed before and on average, 8 weeks post-treatment. EMG and motion analysis were used to assess the degree and type of muscle activation dependency in the semitendinosus during passive knee extensions performed at different joint angular velocities. Three-dimensional gait analysis was used to assess knee gait kinematics as a measure of functional outcome. Pre-treatment, 9 muscles were classified as VD and 9 as LD, but no differences between the groups were evident in the baseline knee gait kinematics. Post-treatment, stretch reflex muscle activation decreased significantly in both groups but the reduction was more pronounced in those muscles classified pre-treatment as VD (-72% vs. -50%, p = 0.005). In the VD group, these changes were accompanied by greater knee extension at initial contact and during the swing phase of gait. In the LD group, there was significantly increased post-treatment knee hyperextension in late stance. Although results vary between patients, the reduction of stretch reflex muscle activation in the semitendinosus generally translated to an improved functional outcome, as assessed with 3D gait analysis. However, results were less positive for those muscles with pre-treatment length-dependent type of stretch reflex muscle activation. The study demonstrates the relevance of categorizing the type of stretch reflex muscle activation as a possible predictor of treatment response.
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Affiliation(s)
- Lynn Bar-On
- Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam Movement Sciences, Amsterdam, Netherlands.,Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Erwin Aertbeliën
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium.,ROB Core Lab, Flanders Make, Leuven, Belgium
| | - Anja Van Campenhout
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospital Leuven, Leuven, Belgium
| | - Guy Molenaers
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospital Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospital Leuven, Leuven, Belgium
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11
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Chow JW, Yablon SA, Stokic DS. Knee Muscle Stretch Reflex Responses After an Intrathecal Baclofen Bolus in Neurological Patients With Moderate-to-Severe Hypertonia. Neuromodulation 2020; 23:1018-1028. [PMID: 32023360 DOI: 10.1111/ner.13112] [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: 09/03/2019] [Revised: 12/13/2019] [Accepted: 01/10/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine the prevalence, onset threshold, and response magnitude of stretch reflex response (SRR) in the knee extensors and flexors before and after an intrathecal baclofen (ITB) bolus injection in patients with moderate-to-severe hypertonia. MATERIALS AND METHODS SRRs were elicited by reciprocal passive knee extension/flexion movements at preset angular velocities of 5, 60, 120, 180, 240, and 300°/s using an isokinetic dynamometer and recorded with surface electromyographic (EMG) electrodes placed over the knee extensors and flexors in 53 neurologic patients before and at 2.5 and 5 hours after an ITB injection via lumbar puncture. Outcome measures included the number of patients with presence/absence of SRRs, the number of SRRs per session, SRR onset threshold angle and velocity, and response magnitudes (peak EMG and area under the EMG curve) for each muscle. Pre-post comparisons were completed using the Fisher's exact and Wilcoxon signed rank tests. RESULTS For both knee extensors and flexors, the proportion of patients with present SRRs (p < 0.0001) and the number of SRRs per session (p ≤ 0.027) decreased from pre- to post-ITB. The threshold velocity significantly increased post-injection in both muscles (p ≤ 0.001) without significant changes in the threshold angle. The response magnitudes significantly decreased in the knee extensors (p ≤ 0.016) but not the knee flexors after the injection. CONCLUSIONS The prevalence and threshold velocity of SRR emerged as the most robust and practical parameters for assessing hyperreflexia during ITB bolus trial that can complement clinical assessment of muscle hypertonia.
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Affiliation(s)
- John W Chow
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, Mississippi, USA
| | - Stuart A Yablon
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, Mississippi, USA
| | - Dobrivoje S Stokic
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, Mississippi, USA
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Chakraborty S, Nandy A, Kesar TM. Gait deficits and dynamic stability in children and adolescents with cerebral palsy: A systematic review and meta-analysis. Clin Biomech (Bristol, Avon) 2020; 71:11-23. [PMID: 31677546 DOI: 10.1016/j.clinbiomech.2019.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/19/2019] [Accepted: 09/08/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Studies have demonstrated that ambulatory children and adolescents with cerebral palsy demonstrate atypical gait patterns. Out of numerous gait variables, identification of the most deteriorated gait parameters is important for targeted and effective gait rehabilitation. Therefore, this study aimed to identify the gait parameters with the most discriminating nature to distinguish cerebral palsy gait from normal gait. METHODS Multiple databases were searched to include studies on ambulatory children and adolescents with cerebral palsy that included gait (spatio-temporal, kinematic, and kinetic) and dynamic stability variables. FINDINGS Of 68 studies that met the inclusion criteria, 35 studies were included in the meta analysis. Effect size was used to assess the discriminative strength of each variable. A large effect (≥ 0.8) of cerebral palsy on double limb support time (Standardized Mean Difference = 0.98), step length (Standardized Mean Difference = 1.65), step width (Standardized Mean Difference = 1.21), stride length (Standardized Mean Difference = 1.75), and velocity (Standardized Mean Difference = 1.42) was observed at preferred-walking speed. At fast-walking speed, some gait variables (i.e. velocity and stride length) exhibited larger effect size compared to preferred-walking speed. For some kinematic variables (e.g. range of motion of pelvis), the effect size varied across the body planes. INTERPRETATION Our systematic review detects the most discriminative features of cerebral palsy gait. Non-uniform effects on joint kinematics across the anatomical planes support the importance of 3D gait analysis. Differential effects at fast versus preferred speeds emphasize the importance of measuring gait at a range of speeds.
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Affiliation(s)
- Saikat Chakraborty
- Machine Intelligence and Bio-motion Research Lab., Department of Computer Science and Engineering, National Institute of Technology, Rourkela, India. saikat.scgmail.com
| | - Anup Nandy
- Machine Intelligence and Bio-motion Research Lab., Department of Computer Science and Engineering, National Institute of Technology, Rourkela, India
| | - Trisha M Kesar
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, USA
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Abstract
BACKGROUND Children's ability to control the speed of gait is important for a wide range of activities. It is thought that the ability to increase the speed of gait for children with cerebral palsy (CP) is common. This study considered 3 hypotheses: (1) most ambulatory children with CP can increase gait speed, (2) the characteristics of free (self-selected) and fast walking are related to motor impairment level, and (3) the strategies used to increase gait speed are distinct among these levels. METHODS A retrospective review of time-distance parameters (TDPs) for 212 subjects with CP and 34 typically developing subjects walking at free and fast speeds was performed. Only children who could increase their gait speed above the minimal clinically important difference were defined as having a fast walk. Analysis of variance was used to compare TDPs of children with CP, among Gross Motor Function Classification System (GMFCS) levels, and children in typically developing group. RESULTS Eight-five percent of the CP group (GMFCS I, II, III; 96%, 99%, and 34%, respectively) could increase gait speed on demand. At free speed, children at GMFCS I and II were significantly faster than children at GMFCS level III. At free speed, children at GMFCS I and II had significantly greater stride length than those at GMFCS levels III. At free speed, children at GMFCS level III had significantly lower cadence than those at GMFCS I and II. There were no significant differences in cadence among GMFCS levels at fast speeds. There were no significant differences among GMFCS levels for percent change in any TDP between free and fast walking. DISCUSSION Almost all children with CP at GMFCS levels I and II can control the speed of gait, however, only one-third at GMFCS III level have this ability. This study suggests that children at GMFCS III level can be divided into 2 groups based on their ability to control gait speed; however, the prognostic significance of such categorization remains to be determined. LEVEL OF EVIDENCE Diagnostic level II.
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Cherni Y, Ballaz L, Girardin-Vignola G, Begon M. Intra- and inter-tester reliability of spasticity assessment in standing position in children and adolescents with cerebral palsy using a paediatric exoskeleton. Disabil Rehabil 2019; 43:1001-1007. [PMID: 31368379 DOI: 10.1080/09638288.2019.1646814] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The L-STIFF tool of the Lokomat evaluates the hip and knee flexors and extensors spasticity in a standing position. It moves the lower limb at a controlled velocity, measuring joint resistance to passive movements. Since its reliability in children with cerebral palsy remains unknown, our goal was to evaluate the relative and absolute reliability of L-STIFF in children with cerebral palsy. METHODS Reliability was determined in 16 children with cerebral palsy by two experienced therapists. The changes in resistive torque in hip and knee in both flexion and extension were measured. Relative and absolute reliability were estimated using the intraclass correlation coefficient, standard error of measurement, and minimal detectable change. Reliability was assessed on three levels: (1) intra- and (2) inter-tester within session, and (3) intra-tester between sessions. RESULTS Intraclass correlation coefficients were moderate to excellent for intra-tester reliability (all p ≤ 0.01). The standard error of measurement ranged from 0.005 to 0.021 Nm/° (i.e., 7-16%) and minimal detectable change from 0.014 to 0.059 Nm/°. Inter-tester intraclass correlation coefficients ranged from 0.32 to 0.70 (all p ≤ 0.01), standard error of measurement ranged from 0.012 to 0.029 Nm/° (i.e., 6-39%), and minimal detectable change ranged from 0.033 to 0.082 Nm/°. L-STIFF reliability was better during fast and medium movement speeds compared to slow speeds. CONCLUSIONS The assessment tool L-STIFF is a promising tool for quantifying lower limb spasticity in children with cerebral palsy in a standing position. However, the results should be interpreted carefully.Implications for RehabilitationL-STIFF is a promising tool for evaluating lower limb spasticity in standing position.A special care must be given to the installation and alignment of the participant into the Lokomat to minimize erroneous spasticity measurement.Relative standard error of measurement and minimal detectable change should be used to analyze changes spasticity.
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Affiliation(s)
- Yosra Cherni
- École de kinésiologie et des sciences de l'activité physique, Faculté de Médecine, Université de Montréal, Montréal, Canada.,Centre de réadaptation Marie-Enfant, CHU Sainte-Justine, Montréal, Canada
| | - Laurent Ballaz
- Centre de réadaptation Marie-Enfant, CHU Sainte-Justine, Montréal, Canada.,Département des sciences de l'activité physique, Université de Québec à Montréal, Montréal, Canada
| | | | - Mickael Begon
- École de kinésiologie et des sciences de l'activité physique, Faculté de Médecine, Université de Montréal, Montréal, Canada.,Centre de réadaptation Marie-Enfant, CHU Sainte-Justine, Montréal, Canada
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15
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Tirosh O, Rutz E. Quantifying the velocity-dependent muscle response during gait of children with Cerebral Palsy. J Electromyogr Kinesiol 2019; 48:76-83. [PMID: 31252283 DOI: 10.1016/j.jelekin.2019.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 04/04/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022] Open
Abstract
A new method is introduced quantifying the velocity-dependent muscle response during gait in spastic muscles of children with Cerebral Palsy. The velocity-dependent muscle activation Index is calculated during a 3-dimensional gait analysis using segment angular velocity and the Instantaneous Mean Frequency calculated from surface electromyography. Typical developed children (n = 11) and children with hemiplegia (n = 11) aging from 8 to 19 years participated in the study. The rectus femoris and the medial gastrocnemius were assessed by calculating the velocity dependent muscle activation Index and the modified Ashworth Scale. Greater velocity-dependent muscle activation Index values for both medial gastrocnemius and rectus femoris muscles were associated with greater Ashworth Scale. Post hoc analysis revealed significant lower velocity-dependent muscle activation Index means in the Typical developed group compared with Ashworth Scale scores of 1, 2, 3, and 5. In addition, velocity-dependent muscle activation Index for Ashworth Scale 0, 1, and 2 were significantly lower than for Ashworth Scale 3 and 5. The velocity dependent muscle activation Index showed negative low correlation with walking speed and cadence. Findings show that spastic muscles can be quantified during dynamic functional task such as walking. Future studies should investigate the reliability of the velocity-dependent muscle activation Index that may be used for the assessment of spasticity management such as Botulinum toxin A interventions.
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Affiliation(s)
- Oren Tirosh
- Department of Health and Medical Science, Swinburne University of Technology, Melbourne, Australia.
| | - Erich Rutz
- Department of Orthopedic Surgery, University Children's Hospital Basel, Spitalstrasse 33, 4056 Basel, Switzerland; Murdoch Children's Research Institute, Melbourne, Australia
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16
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Noble JJ, Gough M, Shortland AP. Selective motor control and gross motor function in bilateral spastic cerebral palsy. Dev Med Child Neurol 2019; 61:57-61. [PMID: 30203469 DOI: 10.1111/dmcn.14024] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2018] [Indexed: 11/30/2022]
Abstract
AIM To investigate the relationship between selective motor control (SMC), muscle volume, and spasticity with gross motor function in adolescents and young adults with bilateral spastic cerebral palsy (CP). METHOD Eleven male participants with CP (mean age 15y 7mo, standard deviation 3y 6mo, range 12y 1mo-23y 1mo) in Gross Motor Function Classification System (GMFCS) levels I to IV took part in this cross-sectional study. Magnetic resonance imaging (MRI) of both lower limbs of all participants were acquired, from which 18 muscles were manually segmented and muscle volume calculated by a single assessor. Muscle volumes were normalized to body mass and averaged between limbs for each individual. SMC was assessed using Selective Control Assessment of the Lower Extremity (SCALE). Spasticity was assessed using the Modified Ashworth Scale (MAS), and gross motor functional ability was assessed using the Gross Motor Function Measure (GMFM-66). RESULTS GMFM-66 was strongly positively correlated to SCALE (r=0.901, p≤0.001) and lower limb muscle volume normalized to body mass (r=0.750, p=0.008). MAS was significantly correlated with GMFM-66 (r=-0.691, p=0.018). INTERPRETATION SMC is a major factor influencing gross motor function in individuals with CP. Lower limb muscle volume and spasticity also influence gross motor function. WHAT THIS PAPER ADDS Selective motor control is a major factor of gross motor function in adolescents and young adults with bilateral cerebral palsy (CP). Gross motor function is related to muscle size and level of spasticity in adolescents and young adults with bilateral CP.
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Affiliation(s)
- Jonathan J Noble
- One Small Step Gait Laboratory, Evelina London Children's Hospital, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Martin Gough
- One Small Step Gait Laboratory, Evelina London Children's Hospital, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Adam P Shortland
- One Small Step Gait Laboratory, Evelina London Children's Hospital, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,The Rayne Institute, St Thomas' Hospital, King's College London, London, UK
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17
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Falisse A, Bar-On L, Desloovere K, Jonkers I, De Groote F. A spasticity model based on feedback from muscle force explains muscle activity during passive stretches and gait in children with cerebral palsy. PLoS One 2018; 13:e0208811. [PMID: 30532154 PMCID: PMC6286045 DOI: 10.1371/journal.pone.0208811] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 11/24/2018] [Indexed: 11/19/2022] Open
Abstract
Muscle spasticity is characterized by exaggerated stretch reflexes and affects about 85% of the children with cerebral palsy. However, the mechanisms underlying spasticity and its influence on gait are not well understood. Here, we first aimed to model the response of spastic hamstrings and gastrocnemii in children with cerebral palsy to fast passive stretches. Then, we evaluated how the model applied to gait. We developed three models based on exaggerated proprioceptive feedback. The first model relied on feedback from muscle fiber length and velocity (velocity-related model), the second model relied on feedback from muscle fiber length, velocity, and acceleration (acceleration-related model), and the third model relied on feedback from muscle force and its first time derivative (force-related model). The force-related model better reproduced measured hamstrings and gastrocnemii activity during fast passive stretches (coefficients of determination (R2): 0.73 ± 0.10 and 0.60 ± 0.13, respectively, and root mean square errors (RMSE): 0.034 ± 0.031 and 0.009 ± 0.007, respectively) than the velocity-related model (R2: 0.46 ± 0.15 and 0.07 ± 0.13, and RMSE: 0.053 ± 0.051 and 0.015 ± 0.009), and the acceleration-related model (R2: 0.47 ± 0.15 and 0.09 ± 0.14, and RMSE: 0.052 ± 0.050 and 0.015 ± 0.008). Additionally, the force-related model predicted hamstrings and gastrocnemii activity that better correlated with measured activity during gait (cross correlations: 0.82 ± 0.09 and 0.85 ± 0.06, respectively) than the activity predicted by the velocity-related model (cross correlations: 0.49 ± 0.17 and 0.71 ± 0.22) and the acceleration-related model (cross correlations: 0.51 ± 0.16 and 0.67 ± 0.20). Our results therefore suggest that force encoding in muscle spindles in combination with altered feedback gains and thresholds underlie activity of spastic muscles during passive stretches and gait. Our model of spasticity opens new perspectives for studying movement impairments due to spasticity through simulation.
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Affiliation(s)
- Antoine Falisse
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
- * E-mail:
| | - Lynn Bar-On
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Ilse Jonkers
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
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18
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Mentiplay BF, Banky M, Clark RA, Kahn MB, Williams G. Lower limb angular velocity during walking at various speeds. Gait Posture 2018; 65:190-196. [PMID: 30558929 DOI: 10.1016/j.gaitpost.2018.06.162] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/20/2018] [Accepted: 06/23/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although it is well established that lower limb joint angles adapt to walking at various speeds, limited research has examined the modifications in joint angular velocity. There is currently no normative dataset for joint angular velocity during walking, which would be useful to allow comparisons for patient cohorts. Additionally, understanding normal joint angular velocity may assist clinical assessment and treatment procedures to incorporate methods that replicate the movement speed of the lower limb joints during walking. RESEARCH QUESTION This study aimed to examine lower limb joint angles and angular velocities in a healthy population walking at various gait speeds. METHODS Thirty-six healthy adult participants underwent three-dimensional gait analysis while walking at various speeds during habitual and slowed walking. The peak joint angles and angular velocities during important phases of the gait cycle were examined for the hip, knee and ankle in the sagittal plane. Data were grouped in 0.2 m/s increments from a walking speed of 0.4 m/s to 1.6 m/s to represent the range of walking speeds reported in studies of people with gait impairments. RESULTS For joint angles and angular velocities, the shape of the gait traces were consistent regardless of the walking speed. However as walking speed increased, so did the peak joint angles and angular velocities for the hip, knee and ankle. The largest angular velocity occurred when the knee joint extended at the terminal swing phase of gait. For the ankle and hip joints, the largest angular velocity occurred during the push-off phase. SIGNIFICANCE This study examined how lower limb joint angular velocities change with various walking speeds. These data can be used as a comparator for data from clinical cohorts, and has the potential to be used to match clinical assessment and treatment methods to joint angular velocity during walking.
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Affiliation(s)
- Benjamin F Mentiplay
- Department of Physiotherapy, Epworth HealthCare, Australia; La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia; Victorian Infant Brain Studies, Murdoch Children's Research Institute, Australia.
| | - Megan Banky
- Department of Physiotherapy, Epworth HealthCare, Australia; School of Health and Sport Sciences, University of the Sunshine Coast, Australia
| | - Ross A Clark
- School of Health and Sport Sciences, University of the Sunshine Coast, Australia
| | - Michelle B Kahn
- Department of Physiotherapy, Epworth HealthCare, Australia; School of Health and Sport Sciences, University of the Sunshine Coast, Australia
| | - Gavin Williams
- Department of Physiotherapy, Epworth HealthCare, Australia; Department of Physiotherapy, University of Melbourne, Australia
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19
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Brændvik SM, Elkamil AI, Klund-Hansen SL, Roeleveld K. Physiological responses during clinical spasticity evaluation in elbow flexors in children with cerebral palsy. Physiother Theory Pract 2018; 36:691-700. [PMID: 30028217 DOI: 10.1080/09593985.2018.1491079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The Tardieu test is often used to identify and evaluate the severity of spasticity for clinical decision-making and treatment evaluation in cerebral palsy (CP). Objective: The study's objective was to gain further insight into the construct validity of clinical spasticity evaluation in children with CP. Methods: The kinematics and neuromuscular response of the biceps brachii (BB) during passive elbow extension were studied when performing the Tardieu test with its corresponding clinical interpretation. Fifteen children with unilateral spastic CP and 15 typically developing (TD) peers 15 (median/interquartile range age; 13/4 and 12/5 years, respectively) participated. Results: A clinical catch was detected in 9 of the 15 children with CP. During fast passive elbow extension, the CP group had higher BB activation (p = 0.041), lower fast maximal angular velocity (p = 0.001), and decelerated earlier in the extension movement (p = 0.001). Discussion: On average, the CP group without a clinical detected catch were closer to TD for all those variables, but this only reached statistical 20 significance in the latter variable (p = 0.018). This inconsistency also shows in possibly one false positive and three false negative catch observations. Conclusion: The Tardieu test should be carried out with caution on individual level and more studies including kinematic and neuromuscular measures are necessary.
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Affiliation(s)
- Siri Merete Brændvik
- Faculty of Medicine and Health, Department of Neuromedicine and Movement Science , Norwegian University of Science and Technology, NTNU, Trondheim, Norway.,Clinical Services, St. Olavs University Hospital , Trondheim, Norway
| | - Areej I Elkamil
- Faculty of Medicine and Health, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, NTNU , Trondheim, Norway
| | - Sandra Linnea Klund-Hansen
- Faculty of Medicine and Health, Department of Neuromedicine and Movement Science , Norwegian University of Science and Technology, NTNU, Trondheim, Norway.,Sunnaas Rehabilitation Hospital, Nesodden , Norway
| | - Karin Roeleveld
- Faculty of Medicine and Health, Department of Neuromedicine and Movement Science , Norwegian University of Science and Technology, NTNU, Trondheim, Norway
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20
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Park EY. Path analysis of strength, spasticity, gross motor function, and health-related quality of life in children with spastic cerebral palsy. Health Qual Life Outcomes 2018; 16:70. [PMID: 29673348 PMCID: PMC5907740 DOI: 10.1186/s12955-018-0891-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 04/05/2018] [Indexed: 02/26/2023] Open
Abstract
Background Measures of health-related quality of life may predict the future status of individuals with illnesses, and could therefore be a good indicator in children with cerebral palsy (CP). This study examines the causal relationship between spasticity, weakness, gross motor function, and health-related quality of life (QOL) in school-aged children with spastic CP and tests models of functional outcome mediated by gross motor function. Methods A total of 62 children (44 males, 18 females) with spastic CP were recruited. Strength was assessed with the Manual Muscle Test, spasticity with the Modified Ashworth Scale, and the Gross Motor Function Measure was also employed. Health-related QOL was assessed using the Korean version of the Childhood Health Assessment Questionnaire. Physical therapists interviewed the parents and assessed the children. Results The proposed path model showed good fit indices. The direct effects were significant between spasticity and gross motor function, strength and gross motor function, gross motor function and health-related QOL, and strength and health-related quality of life. Spasticity had a significant positive indirect effect and strength a significant negative indirect effect on health-related QOL through gross motor function. Conclusion This is an initial study of the causal relationship between strength, spasticity, gross motor function, and health-related QOL.
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Affiliation(s)
- Eun-Young Park
- Department of Secondary Special Education, College of Education, Jeonju University, 1200 3-ga, Hyoja-dong, Wansan-gu, Jeonju, 560-759, South Korea.
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21
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Ritzmann R, Stark C, Krause A. Vibration therapy in patients with cerebral palsy: a systematic review. Neuropsychiatr Dis Treat 2018; 14:1607-1625. [PMID: 29950843 PMCID: PMC6018484 DOI: 10.2147/ndt.s152543] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The neurological disorder cerebral palsy (CP) is caused by unprogressive lesions of the immature brain and affects movement, posture, and the musculoskeletal system. Vibration therapy (VT) is increasingly used to reduce the signs and symptoms associated with this developmental disability. The purpose of this narrative review was systematically to appraise published research regarding acute and long-term effects of VT on functional, neuromuscular, and structural parameters. Systematic searches of three electronic databases identified 28 studies that fulfilled the inclusion criteria. Studies were analyzed to determine participant characteristics, VT-treatment protocols, effect on gross motor function (GMF), strength, gait, posture, mobility, spasticity, reflex excitability, muscle tone, mass, and bone strength within this population, and outcome measures used to evaluate effects. The results revealed that one acute session of VT reduces reflex excitability, spasticity, and coordination deficits. Subsequently, VT has a positive effect on the ability to move, manifested for GMF, strength, gait, and mobility in patients with CP. Effects persist up to 30 minutes after VT. Long-term effects of VT manifest as reduced muscle tone and spasticity occurring concomitantly with improved movement ability in regard to GMF, strength, gait, and mobility, as well as increased muscle mass and bone-mineral density. Posture control remained unaffected by VT. In conclusion, the acute and chronic application of VT as a nonpharmacological approach has the potential to ameliorate CP symptoms, achieving functional and structural adaptations associated with significant improvements in daily living. Even though further studies including adult populations validating the neuromuscular mechanisms underlying the aforementioned adaptations should be fostered, growing scientific evidence supports the effectiveness of VT in regard to supplementing conventional treatments (physiotherapy and drugs). Therefore, VT could reduce CP-associated physical disability and sensorimotor handicaps. Goals for patients and their caregivers referring to greater independence and improved safety may be achieved more easily and time efficiently.
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Affiliation(s)
- Ramona Ritzmann
- Department of Sport Science, University of Freiburg, Freiburg, Germany
| | - Christina Stark
- Children's and Adolescent's Hospital, University of Cologne, Cologne, Germany.,Cologne Centre for Musculoskeletal Biomechanics (CCMB), University of Cologne, Cologne, Germany
| | - Anne Krause
- Institute of Training and Computer Science in Sport, German Sport University Cologne, Cologne, Germany
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22
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Jalaleddini K, Nagamori A, Laine CM, Golkar MA, Kearney RE, Valero-Cuevas FJ. Physiological tremor increases when skeletal muscle is shortened: implications for fusimotor control. J Physiol 2017; 595:7331-7346. [PMID: 29023731 DOI: 10.1113/jp274899] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 09/25/2017] [Indexed: 01/11/2023] Open
Abstract
KEY POINTS In tonic, isometric, plantarflexion contractions, physiological tremor increases as the ankle joint becomes plantarflexed. Modulation of physiological tremor as a function of muscle stretch differs from that of the stretch reflex amplitude. Amplitude of physiological tremor may be altered as a function of reflex pathway gains. Healthy humans likely increase their γ-static fusimotor drive when muscles shorten. Quantification of physiological tremor by manipulation of joint angle may be a useful experimental probe of afferent gains and/or the integrity of automatic fusimotor control. ABSTRACT The involuntary force fluctuations associated with physiological (as distinct from pathological) tremor are an unavoidable component of human motor control. While the origins of physiological tremor are known to depend on muscle afferentation, it is possible that the mechanical properties of muscle-tendon systems also affect its generation, amplification and maintenance. In this paper, we investigated the dependence of physiological tremor on muscle length in healthy individuals. We measured physiological tremor during tonic, isometric plantarflexion torque at 30% of maximum at three ankle angles. The amplitude of physiological tremor increased as calf muscles shortened in contrast to the stretch reflex whose amplitude decreases as muscle shortens. We used a published closed-loop simulation model of afferented muscle to explore the mechanisms responsible for this behaviour. We demonstrate that changing muscle lengths does not suffice to explain our experimental findings. Rather, the model consistently required the modulation of γ-static fusimotor drive to produce increases in physiological tremor with muscle shortening - while successfully replicating the concomitant reduction in stretch reflex amplitude. This need to control γ-static fusimotor drive explicitly as a function of muscle length has important implications. First, it permits the amplitudes of physiological tremor and stretch reflex to be decoupled. Second, it postulates neuromechanical interactions that require length-dependent γ drive modulation to be independent from α drive to the parent muscle. Lastly, it suggests that physiological tremor can be used as a simple, non-invasive measure of the afferent mechanisms underlying healthy motor function, and their disruption in neurological conditions.
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Affiliation(s)
- Kian Jalaleddini
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Akira Nagamori
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Christopher M Laine
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Mahsa A Golkar
- Department of Biomedical Engineering, McGill University, Montréal, QC, Canada
| | - Robert E Kearney
- Department of Biomedical Engineering, McGill University, Montréal, QC, Canada
| | - Francisco J Valero-Cuevas
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.,Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
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23
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Krause A, Schönau E, Gollhofer A, Duran I, Ferrari-Malik A, Freyler K, Ritzmann R. Alleviation of Motor Impairments in Patients with Cerebral Palsy: Acute Effects of Whole-body Vibration on Stretch Reflex Response, Voluntary Muscle Activation and Mobility. Front Neurol 2017; 8:416. [PMID: 28861038 PMCID: PMC5561012 DOI: 10.3389/fneur.2017.00416] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 07/31/2017] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Individuals suffering from cerebral palsy (CP) often have involuntary, reflex-evoked muscle activity resulting in spastic hyperreflexia. Whole-body vibration (WBV) has been demonstrated to reduce reflex activity in healthy subjects, but evidence in CP patients is still limited. Therefore, this study aimed to establish the acute neuromuscular and kinematic effects of WBV in subjects with spastic CP. METHODS 44 children with spastic CP were tested on neuromuscular activation and kinematics before and immediately after a 1-min bout of WBV (16-25 Hz, 1.5-3 mm). Assessment included (1) recordings of stretch reflex (SR) activity of the triceps surae, (2) electromyography (EMG) measurements of maximal voluntary muscle activation of lower limb muscles, and (3) neuromuscular activation during active range of motion (aROM). We recorded EMG of m. soleus (SOL), m. gastrocnemius medialis (GM), m. tibialis anterior, m. vastus medialis, m. rectus femoris, and m. biceps femoris. Angular excursion was recorded by goniometry of the ankle and knee joint. RESULTS After WBV, (1) SOL SRs were decreased (p < 0.01) while (2) maximal voluntary activation (p < 0.05) and (3) angular excursion in the knee joint (p < 0.01) were significantly increased. No changes could be observed for GM SR amplitudes or ankle joint excursion. Neuromuscular coordination expressed by greater agonist-antagonist ratios during aROM was significantly enhanced (p < 0.05). DISCUSSION The findings point toward acute neuromuscular and kinematic effects following one bout of WBV. Protocols demonstrate that pathological reflex responses are reduced (spinal level), while the execution of voluntary movement (supraspinal level) is improved in regards to kinematic and neuromuscular control. This facilitation of muscle and joint control is probably due to a reduction of spasticity-associated spinal excitability in favor of giving access for greater supraspinal input during voluntary motor control.
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Affiliation(s)
- Anne Krause
- Department of Sport Science, University of Freiburg, Freiburg, Germany
| | - Eckhard Schönau
- Center of Prevention and Rehabilitation, University of Cologne, Cologne, Germany
| | - Albert Gollhofer
- Department of Sport Science, University of Freiburg, Freiburg, Germany
| | - Ibrahim Duran
- Center of Prevention and Rehabilitation, University of Cologne, Cologne, Germany
| | - Anja Ferrari-Malik
- Center of Prevention and Rehabilitation, University of Cologne, Cologne, Germany
| | - Kathrin Freyler
- Department of Sport Science, University of Freiburg, Freiburg, Germany
| | - Ramona Ritzmann
- Department of Sport Science, University of Freiburg, Freiburg, Germany
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Barber L, Carty C, Modenese L, Walsh J, Boyd R, Lichtwark G. Medial gastrocnemius and soleus muscle-tendon unit, fascicle, and tendon interaction during walking in children with cerebral palsy. Dev Med Child Neurol 2017; 59:843-851. [PMID: 28369824 DOI: 10.1111/dmcn.13427] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2017] [Indexed: 11/28/2022]
Abstract
AIM This study investigates the in vivo function of the medial gastrocnemius and soleus muscle-tendon units (MTU), fascicles, and tendons during walking in children with cerebral palsy (CP) and an equinus gait pattern. METHOD Fourteen children with CP (9 males, 5 females; mean age 10y 6mo, standard deviation [SD] 2y 11mo; GMFCS level I=8, II=6), and 10 typically developing (6 males, 4 females; mean age 10y, SD 2y 1mo) undertook full body 3D gait analysis and simultaneous B-mode ultrasound images of the medial gastrocnemius and soleus fascicles during level walking. Fascicle lengths were analysed using a semi-automated tracking algorithm and MTUs using OpenSim. Statistical parametric mapping (two-sample t-test) was used to compare differences between groups (p<0.05). RESULTS In the CP group medial gastrocnemius fascicles lengthened during mid-stance gait and remained longer into late-stance compared to the typically developing group (p<0.001). CP medial gastrocnemius fascicles shortened less during stance (1.16mm [SD 1.47mm]) compared to the typically developing group (4.48mm [SD 1.94mm], p<0.001). In the CP group the medial gastrocnemius and soleus MTU and tendon were longer during early- and mid-stance (p<0.001). Ankle power during push-off (p=0.015) and positive work (p<0.002) and net work (p<0.001) were significantly lower in the CP group. INTERPRETATION Eccentric action of the CP medial gastrocnemius muscle fascicles during mid-stance walking is consistent with reduced volume and neuromuscular control of impaired muscle. Reduced ankle push-off power and positive work in the children with CP may be attributed to reduced active medial gastrocnemius fascicle shortening. These findings suggest a reliance on passive force generation for forward propulsion during equinus gait.
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Affiliation(s)
- Lee Barber
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Chris Carty
- Queensland Children's Motion Analysis Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia.,Centre for Musculoskeletal Research, Menzies Health Institute Queensland, Gold Coast, Australia
| | - Luca Modenese
- Centre for Musculoskeletal Research, Menzies Health Institute Queensland, Gold Coast, Australia.,Department of Mechanical Engineering and INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield, UK
| | - John Walsh
- Queensland Children's Motion Analysis Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Roslyn Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Glen Lichtwark
- School of Human Movement Studies, The University of Queensland, St Lucia, Australia
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Banky M, Ryan HK, Clark R, Olver J, Williams G. Do clinical tests of spasticity accurately reflect muscle function during walking: A systematic review. Brain Inj 2017; 31:440-455. [DOI: 10.1080/02699052.2016.1271455] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Megan Banky
- Physiotherapy Department, Epworth Hospital, Melbourne, Australia
- Faculty of Science, Health, Education and Engineering, The University of Sunshine Coast, Queensland, Australia
- Epworth Monash Rehabilitation Medicine Unit, Melbourne, Australia
| | - Hannah K. Ryan
- Physiotherapy Department, Epworth Hospital, Melbourne, Australia
| | - Ross Clark
- Faculty of Science, Health, Education and Engineering, The University of Sunshine Coast, Queensland, Australia
| | - John Olver
- Physiotherapy Department, Epworth Hospital, Melbourne, Australia
- Epworth Monash Rehabilitation Medicine Unit, Melbourne, Australia
| | - Gavin Williams
- Physiotherapy Department, Epworth Hospital, Melbourne, Australia
- Epworth Monash Rehabilitation Medicine Unit, Melbourne, Australia
- Physiotherapy Department, The University of Melbourne, Melbourne, Australia
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Do Three Different Passive Assessments of Quadriceps Spasticity Relate to the Functional Activity of Walking for Children Diagnosed with Cerebral Palsy? NEUROSCIENCE JOURNAL 2015; 2015:872015. [PMID: 26576411 PMCID: PMC4630411 DOI: 10.1155/2015/872015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 08/03/2015] [Accepted: 09/21/2015] [Indexed: 11/18/2022]
Abstract
A stiff-knee gait pattern is frequently associated with several impairments including quadriceps spasticity in children diagnosed with cerebral palsy (CP). The relationship of clinical measures of quadriceps spasticity and the stiff-knee gait pattern in children diagnosed with CP has not been well established. Therefore, the purpose of this study was to determine the ability of clinical measures of quadriceps spasticity (modified Ashworth scale [MAS], Ely tests, and pendulum test) to categorize a stiff-knee gait pattern in children with CP. Children were categorized as having a stiff-knee gait pattern based on kinematic and EMG gait data. Results of a logistic regression model revealed that the only significant measure was A1 of the pendulum test. Discriminant analysis functions were used to predict group membership (stiff-knee, not stiff-knee gait pattern) for each measure. The A1 of the pendulum test demonstrated the highest classification accuracy and the highest sensitivity compared to the other measures. Therefore, a negative pendulum test (indicated by an A1 value of 45 degrees or more) is more useful for ruling out a stiff-knee gait pattern compared to the other clinical measures.
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Cheng HYK, Yu YC, Wong AMK, Tsai YS, Ju YY. Effects of an eight-week whole body vibration on lower extremity muscle tone and function in children with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 38:256-261. [PMID: 25575288 DOI: 10.1016/j.ridd.2014.12.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 12/09/2014] [Indexed: 06/04/2023]
Abstract
The aim of this study was to evaluate the effect of an eight-week whole body vibration (WBV) on lower extremity spasticity and ambulatory function in children with cerebral palsy with a complete crossover design. Sixteen participants aged 9.2 (2.1) years participated in this study. Half of the participants received a 10-min WBV, 3 times a week for 8 weeks. Then a 4-week washout period followed, after which they received a sham WBV 3 times a week for 8 weeks. The other half received the intervention in a reversed order. The participants were evaluated via variables measuring range-of-motion, muscle tone, and ambulatory function before, immediately after, 1 day after, and 3 days after each intervention. Repeated-measures analyses revealed significant beneficial effects on most variables expect the passive range-of-motion measurement. Significant correlations were found between timed up-and-go and relaxation index, and between timed up-and-go and six-minute walk test. The results suggested that an 8-week WBV intervention normalized muscle tone, improved active joint range and enhanced ambulatory performance in children with cerebral palsy for at least 3 days. These indicated that regular WBV can serve as an alternative, safe, and efficient treatment for these children in both clinical and home settings.
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Affiliation(s)
- Hsin-Yi Kathy Cheng
- Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
| | - Yu-Chun Yu
- National Taoyuan Special School, 10 Te-Shou St., Tao-Yuan 330, Taiwan.
| | - Alice May-Kuen Wong
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Tao-Yuan 330, Taiwan.
| | - Yung-Shen Tsai
- Graduate Institute of Sports Equipment Technology, University of Taipei, Taipei, Taiwan.
| | - Yan-Ying Ju
- Department of Adapted Physical Education, National Taiwan Sport University, 250 Wen-Hua 1st Rd., Kwei-Shan, Tao-Yuan 333, Taiwan.
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Cheng HYK, Ju YY, Chen CL, Chuang LL, Cheng CH. Effects of whole body vibration on spasticity and lower extremity function in children with cerebral palsy. Hum Mov Sci 2015; 39:65-72. [DOI: 10.1016/j.humov.2014.11.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 10/22/2014] [Accepted: 11/04/2014] [Indexed: 10/24/2022]
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Szopa A, Domagalska–Szopa M, Kidoń Z, Syczewska M. Quadriceps femoris spasticity in children with cerebral palsy: measurement with the pendulum test and relationship with gait abnormalities. J Neuroeng Rehabil 2014; 11:166. [PMID: 25516151 PMCID: PMC4277843 DOI: 10.1186/1743-0003-11-166] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 12/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Development of a reliable and objective test of spasticity is important for assessment and treatment of children with cerebral palsy. The pendulum test has been reported to yield reliable measurements of spasticity and to be sensitive to variations in spasticity in these children. However, the relationship between the pendulum test scores and other objective measures of spasticity has not been studied. The present study aimed to assess the effectiveness of an accelerometer-based pendulum test as a measurement of spasticity in CP, and to explore the correlation between the measurements of this test and the global index of deviation from normal gait in in children with cerebral palsy. METHODS We studied thirty-six children with cerebral palsy, including 18 with spastic hemiplegia and 18 with spastic diplegia, and a group of 18 typically-developing children. Knee extensor spasticity was assessed bilaterally using the accelerometer-based pendulum test and three-dimensional gait analysis. The Gillette Gait Index was calculated from the results of the gait analysis. RESULTS The data from the accelerometer-based pendulum test could be used to distinguish between able-bodied children and children with cerebral palsy. Additionally, two of the measurements, first swing excursion and relaxation index, could be used to differentiate the degree of knee extensor spasticity in the children with cerebral palsy. Only a few moderate correlations were found between the Gillette Gait Index and the pendulum test data. CONCLUSIONS This study demonstrates that the pendulum test can be used to discriminate between typically developing children and children with CP, as well as between various degrees of spasticity, such as spastic hemiplegia and spastic diplegia, in the knee extensor muscle of children with CP. Deviations from normal gait in children with CP were not correlated with the results of the pendulum test.
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Affiliation(s)
- Andrzej Szopa
- />School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | | | - Zenon Kidoń
- />Institute of Electronics, Silesian University of Technology, Gliwice, Poland
| | - Małgorzata Syczewska
- />Paediatric Rehabilitation Department, The Children’s Memorial Health Institute, Warszawa, Poland
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Bar-On L, Molenaers G, Aertbeliën E, Monari D, Feys H, Desloovere K. The relation between spasticity and muscle behavior during the swing phase of gait in children with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:3354-3364. [PMID: 25240217 DOI: 10.1016/j.ridd.2014.07.053] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 07/25/2014] [Accepted: 07/29/2014] [Indexed: 06/03/2023]
Abstract
There is much debate about how spasticity contributes to the movement abnormalities seen in children with spastic cerebral palsy (CP). This study explored the relation between stretch reflex characteristics in passive muscles and markers of spasticity during gait. Twenty-four children with CP underwent 3D gait analysis at three walking velocity conditions (self-selected, faster and fastest). The gastrocnemius (GAS) and medial hamstrings (MEHs) were assessed at rest using an instrumented spasticity assessment that determined the stretch-reflex threshold, expressed in terms of muscle lengthening velocity. Muscle activation was quantified with root mean square electromyography (RMS-EMG) during passive muscle stretch and during the muscle lengthening periods in the swing phase of gait. Parameters from passive stretch were compared to those from gait analysis. In about half the children, GAS peak muscle lengthening velocity during the swing phase of gait did not exceed its stretch reflex threshold. In contrast, in the MEHs the threshold was always exceeded. In the GAS, stretch reflex thresholds were positively correlated to peak muscle lengthening velocity during the swing phase of gait at the faster (r = 0.46) and fastest (r = 0.54) walking conditions. In the MEHs, a similar relation was found, but only at the faster walking condition (r = 0.43). RMS-EMG during passive stretch showed moderate correlations to RMS-EMG during the swing phase of gait in the GAS (r = 0.46-0.56) and good correlations in the MEHs (r = 0.69-0.77) at all walking conditions. RMS-EMG during passive stretch showed no correlations to peak muscle lengthening velocity during gait. We conclude that a reduced stretch reflex threshold in the GAS and MEHs constrains peak muscle lengthening velocity during gait in children with CP. With increasing walking velocity, this constraint is more marked in the GAS, but not in the MEHs. Hyper-activation of stretch reflexes during passive stretch is related to muscle activation during the swing phase of gait, but has a limited contribution to reduced muscle lengthening velocity during swing. Larger studies are required to confirm these results, and to investigate the contribution of other impairments such as passive stiffness and weakness to reduced muscle lengthening velocity during the swing phase of gait.
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Affiliation(s)
- Lynn Bar-On
- KU Leuven Department of Rehabilitation Sciences, Tervuursevest 101, 3001 Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospital, Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium.
| | - Guy Molenaers
- Clinical Motion Analysis Laboratory, University Hospital, Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium; KU Leuven Department of Development and Regeneration, Herestraat 49 box 7003, 3000 Leuven, Belgium; Department of Orthopedics, University Hospital, Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium.
| | - Erwin Aertbeliën
- KU Leuven Department of Mechanical Engineering, Celestijnenlaan 300b box 2420, 3001 Leuven, Belgium.
| | - Davide Monari
- Clinical Motion Analysis Laboratory, University Hospital, Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium; KU Leuven Department of Mechanical Engineering, Celestijnenlaan 300b box 2420, 3001 Leuven, Belgium.
| | - Hilde Feys
- KU Leuven Department of Rehabilitation Sciences, Tervuursevest 101, 3001 Leuven, Belgium.
| | - Kaat Desloovere
- KU Leuven Department of Rehabilitation Sciences, Tervuursevest 101, 3001 Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospital, Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium.
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Dreher T, Brunner R, Vegvari D, Heitzmann D, Gantz S, Maier MW, Braatz F, Wolf SI. The effects of muscle-tendon surgery on dynamic electromyographic patterns and muscle tone in children with cerebral palsy. Gait Posture 2013; 38:215-20. [PMID: 23228624 DOI: 10.1016/j.gaitpost.2012.11.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 11/07/2012] [Accepted: 11/13/2012] [Indexed: 02/02/2023]
Abstract
During multilevel surgery, muscle-tendon lengthening (MTL) is commonly carried out in children with cerebral palsy. However, it is unclear if MTL also modifies increased muscle tone and if pathologic activation patterns are changed as an indirect effect of the biomechanical changes. Since investigations addressing this issue are limited, this study aimed at evaluating the effects of MTL on muscle tone and activation pattern. Forty-two children with spastic diplegia who were treated by MTL underwent standardized muscle tone testing (modified Ashworth and Tardieu test), dynamic EMG and three-dimensional gait analysis before, one and three years after MTL. For the evaluation of muscle activation patterns the norm-distance of dynamic EMG data was analyzed. Range of motion and joint alignment in clinical examination were found to be significantly improved one year after MTL. However, deterioration of these parameters was noted after three years. Muscle tone was significantly reduced one year postoperatively but showed an increase after three years. Joint kinematics were found significantly closer to reference data of age matched controls initially after surgery, but deteriorated until three years postoperatively. However, the EMG patterns of the muscles which were surgically addressed were found to be unchanged in either follow-up. These findings suggest that despite the influence of MTS on biomechanics and physiology (muscle tone reduction and improvements of joint mobility and gait pattern) MTS does not change abnormal patterns of muscle activation. Recurrence of increased muscle tone and deterioration of kinematic parameters three years after surgery may be attributed to these persistent pathologic activation patterns.
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Affiliation(s)
- T Dreher
- Department of Orthopaedic and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany.
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Park EY, Kim WH. Structural equation modeling of motor impairment, gross motor function, and the functional outcome in children with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:1731-1739. [PMID: 23500167 DOI: 10.1016/j.ridd.2013.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 02/04/2013] [Accepted: 02/05/2013] [Indexed: 06/01/2023]
Abstract
Physical therapy intervention for children with cerebral palsy (CP) is focused on reducing neurological impairments, improving strength, and preventing the development of secondary impairments in order to improve functional outcomes. However, relationship between motor impairments and functional outcome has not been proved definitely. This study confirmed the construct of motor impairment and performed structural equation modeling (SEM) between motor impairment, gross motor function, and functional outcomes of regarding activities of daily living in children with CP. 98 children (59 boys, 39 girls) with CP participated in this cross-sectional study. Mean age was 11 y 5 mo (SD 1 y 9 mo). The Manual Muscle Test (MMT), the Modified Ashworth Scale (MAS), range of motion (ROM) measurement, and the selective motor control (SMC) scale were used to assess motor impairments. Gross motor function and functional outcomes were measured using the Gross Motor Function Measure (GMFM) and the Functional Skills domain of the Pediatric Evaluation of Disability Inventory (PEDI) respectively. Measurement of motor impairment was consisted of strength, spasticity, ROM, and SMC. The construct of motor impairment was confirmed though an examination of a measurement model. The proposed SEM model showed good fit indices. Motor impairment effected gross motor function (β=-.0869). Gross motor function and motor impairment affected functional outcomes directly (β=0.890) and indirectly (β=-0.773) respectively. We confirmed that the construct of motor impairment consist of strength, spasticity, ROM, and SMC and it was identified through measurement model analysis. Functional outcomes are best predicted by gross motor function and motor impairments have indirect effects on functional outcomes.
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Affiliation(s)
- Eun-Young Park
- Department of Secondary Special Education, College of Education, Jeonju University, Jeonju, South Korea
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Fonseca LA, Grecco LAC, Politti F, Frigo C, Pavan E, Corrêa JCF, Oliveira CS. Use a Portable Device for Measuring Spasticity in Individuals with Cerebral Palsy. J Phys Ther Sci 2013. [DOI: 10.1589/jpts.25.271] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Letícia Alves Fonseca
- Program in Rehabilitation Sciences and Physical Therapy Course, Universidade Nove de Julho: Avenida Adolpho Pinto 109, Barra Funda, São Paulo - SP, Brazil
| | - Luanda André Collange Grecco
- Program in Rehabilitation Sciences and Physical Therapy Course, Universidade Nove de Julho: Avenida Adolpho Pinto 109, Barra Funda, São Paulo - SP, Brazil
| | - Fabiano Politti
- Program in Rehabilitation Sciences and Physical Therapy Course, Universidade Nove de Julho: Avenida Adolpho Pinto 109, Barra Funda, São Paulo - SP, Brazil
| | - Carlo Frigo
- Movement Biomechanics and Motor Control Lab, Bioengineering Department, Politecnico di Milano, Milan, Italy
| | - Esteban Pavan
- Movement Biomechanics and Motor Control Lab, Bioengineering Department, Politecnico di Milano, Milan, Italy
| | - João Carlos Ferrari Corrêa
- Program in Rehabilitation Sciences and Physical Therapy Course, Universidade Nove de Julho: Avenida Adolpho Pinto 109, Barra Funda, São Paulo - SP, Brazil
| | - Cláudia Santos Oliveira
- Program in Rehabilitation Sciences and Physical Therapy Course, Universidade Nove de Julho: Avenida Adolpho Pinto 109, Barra Funda, São Paulo - SP, Brazil
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Cheng HYK, Ju YY, Chen CL, Chang YJ, Wong AMK. Managing lower extremity muscle tone and function in children with cerebral palsy via eight-week repetitive passive knee movement intervention. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:554-561. [PMID: 23123868 DOI: 10.1016/j.ridd.2012.09.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Revised: 09/27/2012] [Accepted: 09/27/2012] [Indexed: 06/01/2023]
Abstract
This study used a repeated measures design to assess the effect of an eight-week repetitive passive movement (RPM) intervention on lower extremity muscle tone and function in children with cerebral palsy (CP). Eighteen children (aged 9.5 ± 2.1 years) with spastic CP were randomly assigned to a knee RPM intervention condition of 3 times a week for 8 weeks or a control condition. The 8 weeks were followed by 4 weeks of washout period, after which the participants were crossed over to the other group. In the RPM condition, each subject's knees were intervened with continuous passive motion device (at a velocity of 15°/s) for 20 min. The subjects were evaluated via variables measuring range-of-motion, muscle tone, and ambulatory function before, after, 1 day after, and 3 days after each intervention. Repeated-measures statistical analyses found significant differences between condition variable on active range-of-motion of the knee (AROM, increased), relaxation index (RI, increased), Modified Ashworth Scale (MAS, decreased), timed up-and-go (TUG, decreased), 6-min walk test (6 MWT, increased); and significant differences among time variable including RI, MAS, and 6 MWT. No difference was found in passive range-of-motion measurements. Repetitive passive movement reduced lower extremity spastic hypertonia in children with cerebral palsy, and it also improved ambulatory function in terms of walking speed. Effects of this treatment protocol on ambulation lasted up to 3 days post intervention. Findings of this study provide clinicians and patients an alternative, effective and efficient strategy for spastic control and ambulatory improvement.
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Affiliation(s)
- Hsin-Yi Kathy Cheng
- Graduate Institute of Early Intervention, Chang Gung University, Tao-Yuan, Taiwan.
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Chrysagis N, Skordilis EK, Tsiganos G, Koutsouki D. Validity evidence of the Lateral Step Up (LSU) test for adolescents with spastic cerebral palsy. Disabil Rehabil 2012; 35:875-80. [PMID: 22991983 DOI: 10.3109/09638288.2012.711896] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The present study examined the concurrent and construct validity of the Lateral Step Up (LSU) test, for adolescents with CP. METHOD A total of 35 adolescents, classified as GMFCS Levels I, II and III, were examined using LSU, GMFM - 88 (D & E), other functional mobility measures (TUG, STS, TUDS), body structures and functions (strength, ROM and spasticity). RESULTS LSU inter-correlations with: (i) GMFM - 88 (D & E) (r = 0.656), (ii) functional mobility measures (r = -0.567 to 0.721) and (iii) body structures and functions (r = 0.155 to 0.563) were at the appropriate range. The LSU differentiated adolescents with CP (F = 16.185, p = 0.000, η(2) = 0.503), according to their GMFCS (I > II, II > III, I > III). Finally, 50.27% of the LSU variability was explained by GMFCS differences, with 65.7% of adolescents classified correctly across the three levels. CONCLUSIONS The LSU may be perceived as a valid instrument for assessing the functional mobility of adolescents with CP. IMPLICATIONS FOR REHABILITATION • LSU is valid for assessing functional mobility and strength in CP adolescents. • LSU may be used in accordance with other functional mobility measures in the school environment. • The LSU may be used from physical therapists to predict the functional mobility of CP adolescents at GMFCS Levels I–III.
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Affiliation(s)
- Nikolaos Chrysagis
- Department of Physical Education and Sport Sciences, Laboratory of Adapted Physical Activity/Developmental and Physical Disabilities, National and Kapodistrian University of Athens, Greece.
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Lorentzen J, Nielsen D, Holm K, Baagøe S, Grey MJ, Nielsen JB. Neural tension technique is no different from random passive movements in reducing spasticity in patients with traumatic brain injury. Disabil Rehabil 2012; 34:1978-85. [PMID: 22423894 DOI: 10.3109/09638288.2012.665132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Neural tension technique (NTT) is a therapy believed to reduce spasticity and to increase range of motion (ROM). This study compared the ability of NTT and random passive movements (RPMs) to reduce spasticity in the knee flexors in 10 spastic patients with brain injury. METHODS An RCT study with crossover design evaluated muscle tone measured by: 1) hand-held dynamometer; 2) Modified Ashworth Scale (MAS); 3) and ROM by; 4) angles of resistance onset "catch" (R1) compensatory movement (R2); and 5) 'subjectively perceived reduction in muscle tone'. Outcome measures were recorded by three raters before and after a single treatment session. RESULTS Objective stiffness measured with the hand-held device showed no significant changes for the NTT or RPM (p ≥ 0.09-0.79). The subjective measures showed significant changes after the NTT for the non-blinded rater (MAS: p < 0.05: R1: p < 0.05; R2: p < 0.05), but for the blinded rater a significant reduction was found only for R1 (p < 0.05) and R2 (p < 0.05). For the non-blinded rater intervention effects were found for R1 (p < 0.01), R2 (p < 0.01) and subjectively perceived tone reduction (p < 0.01). For the blinded rater no intervention effect was found. CONCLUSIONS An objective evaluation of NTT demonstrates that it does not reduce spasticity. However, it does increase ROM with the same effect as RPM. IMPLICATIONS FOR REHABILITATION • Neural tension techniques does not reduce spasticity in patients with traumatic brain injury when evaluated with objective biomechanical evaluation methods. • Neural tension techniques may improve range of motion with the same effect as random passive movements.
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Affiliation(s)
- Jakob Lorentzen
- Department of Physiotherapy, Hvidovre Hospital/Department of Neurorehabilitation TBI Unit, Copenhagen University Hospital, Glostrup, Denmark.
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dos Santos AN, Pavão SL, de Campos AC, Rocha NACF. International Classification of Functioning, Disability and Health in children with cerebral palsy. Disabil Rehabil 2011; 34:1053-8. [PMID: 22107334 DOI: 10.3109/09638288.2011.631678] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE We intended to describe how concepts from recent models of disability have been studied for evaluation of children with cerebral palsy (CP) and their clinical implications. METHOD We revised studies that focused on the components of the International Classification of Functioning, Disability and Health (ICF) in children with CP. RESULTS Researchers have reported that children with CP exhibit impairments in various body functions/structures, limitations in functional activities performance and experience poorer participation outcomes than their typical peers. Moreover, it has been showed that participation of children with CP was affected by environmental factors. CONCLUSION Therefore, evaluation and rehabilitation processes should be focused on the quality of life improvement by emphasizing what a child can and wants to execute within the environment. Also, environmental factors should be recognized so that barriers could be minimized and adaptations to the environment achieved. However, few studies have verified the interrelationship between contextual factors and the functioning and disability domains in children with CP. This would allow us to know about approaches specifically designed for these children's needs.
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Affiliation(s)
- Adriana Neves dos Santos
- Department of Physiotherapy, Neuropediatrics Section, Universidade Federal de São Carlos, Rod. Washington Luis, São Carlos-SP, Brazil.
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The gait of children with and without cerebral palsy: work, energy, and angular momentum. J Appl Biomech 2011; 27:99-107. [PMID: 21576717 DOI: 10.1123/jab.27.2.99] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper describes a method to characterize gait pathologies like cerebral palsy using work, energy, and angular momentum. For a group of 24 children, 16 with spastic diplegic cerebral palsy and 8 typically developed, kinematic data were collected at the subjects self selected comfortable walking speed. From the kinematics, the work-internal, external, and whole body; energy-rotational and relative linear; and the angular momentum were calculated. Our findings suggest that internal work represents 53% and 40% respectively of the whole body work in gait for typically developed children and children with cerebral palsy. Analysis of the angular momentum of the whole body, and other subgroupings of body segments, revealed a relationship between increased angular momentum and increased internal work. This relationship allows one to use angular momentum to assist in determining the kinetics and kinematics of gait which contribute to increased internal work. Thus offering insight to interventions which can be applied to increase the efficiency of bipedal locomotion, by reducing internal work which has no direct contribution to center of mass motion, in both normal and pathologic populations.
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Schmartz AC, Meyer-Heim AD, Müller R, Bolliger M. Measurement of muscle stiffness using robotic assisted gait orthosis in children with cerebral palsy: a proof of concept. Disabil Rehabil Assist Technol 2011; 6:29-37. [DOI: 10.3109/17483107.2010.509884] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Healy MT, Schwartz MH, Stout JL, Gage JR, Novacheck TF. Is simultaneous hamstring lengthening necessary when performing distal femoral extension osteotomy and patellar tendon advancement? Gait Posture 2011; 33:1-5. [PMID: 21145748 DOI: 10.1016/j.gaitpost.2010.08.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 08/30/2010] [Indexed: 02/02/2023]
Abstract
Crouch gait is common in individuals with cerebral palsy. Recently published data has shown that distal femoral extension osteotomy with patellar tendon advancement (DFEO/PTA) is an effective procedure to correct crouch gait in the presence of a knee flexion contracture and quadriceps insufficiency. Short length and slow lengthening rate (velocity) of the hamstrings are indications for hamstrings surgery. We empirically believed that hamstrings surgery would not be necessary to improve hamstring function when DFEO/PTA are performed. This hypothesis was examined in a retrospective review of hamstrings length and velocity before and after DFEO/PTA. 51 limbs in 32 individuals with a diagnosis of CP who underwent DFEO/PTA without concomitant hamstring surgery were included in the study. Pre and post-operative peak medial hamstring length and velocity z-scores were calculated using a musculoskeletal model. A subset of limbs with pre-operative values above or below two SD from the control mean emerged and were called long or short respectively. Members of this subset would often be considered candidates for hamstrings surgery. Categorical length outcomes were derived, with analogous categories for velocity. The mean peak hamstring length z-score improved pre- to post-operatively from -2.2 to -0.76 (p<0.001). The mean peak velocity z-score improved from -3.1 to -1.5 (p<0.001) [Figure 1]. DFEO/PTA surgery without concomitant hamstrings surgery led to significantly longer or faster hamstrings. Specifically, we saw 94% good or neutral results for length correction and 80% good or neutral results for velocity correction. Because crouch improved without posterior pelvic tilting, and because both hamstring length and velocity increased substantially, we conclude that concomitant hamstring surgery is rarely needed when performing DFEO/PTA.
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Kim WH, Park EY. Causal relation between spasticity, strength, gross motor function, and functional outcome in children with cerebral palsy: a path analysis. Dev Med Child Neurol 2011; 53:68-73. [PMID: 21126242 DOI: 10.1111/j.1469-8749.2010.03777.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This study examined the causal relation between spasticity, weakness, gross motor function, and functional outcome (expressed as activity limitation) in children with cerebral palsy (CP) and tested models of functional outcome mediated by gross motor function. METHOD Eighty-one children (50 males, 31 females) with CP were recruited for this cross-sectional study. Their mean age was 10 years 4 months (SD 1y 9mo). Strength was assessed using the Manual Muscle Test. Spasticity was assessed by the Modified Ashworth Scale. The Gross Motor Function Measure assessed gross motor function. The Functional Skills domain of the Pediatric Evaluation of Disability Inventory assessed functional outcome. Twenty-eight children (34.6%) had quadriplegia, 44 children (54.3%) had diplegia, and nine children (11.1%) had hemiplegia. Children were classified using the Gross Motor Function Classification System with 14 (17.3%) in level I, 9 (11.1%) in level II, 13 (16.0%) in level III, 5 (6.2%) in level IV, and 40 (49.4%) in level V. RESULTS The proposed path model showed good fit indices. The direct effects were significant between spasticity and gross motor function (β=-0.339), between strength and gross motor function (β=0.447), and between gross motor function and functional outcome (β=0.708). Spasticity had a significant negative indirect effect (β=-0.240) and strength had a significant positive indirect effect (β=0.317) on functional outcome through effects on gross motor function. INTERPRETATION Activity-based rather than impairment-based intervention is more important for reducing activity limitation in children with CP. The study established a base from which researchers can further develop a causal model between motor impairments and functional outcome.
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Affiliation(s)
- Won Ho Kim
- Department of Physical Therapy, Ulsan College, Ulsan, South Korea
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Goldberg EJ, Requejo PS, Fowler EG. Joint moment contributions to swing knee extension acceleration during gait in individuals with spastic diplegic cerebral palsy. Gait Posture 2011; 33:66-70. [PMID: 21036047 DOI: 10.1016/j.gaitpost.2010.09.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 08/17/2010] [Accepted: 09/24/2010] [Indexed: 02/02/2023]
Abstract
The mechanisms contributing to swing phase knee acceleration in individuals with spastic diplegic cerebral palsy (CP) are not well understood, but evidence suggests that selective voluntary motor control (SVMC) may play a role. The purpose of this study was to examine the relationship between lower limb SVMC, measured using Selective Control Assessment of the Lower Extremity (SCALE), and joint moment contributions to swing knee extension acceleration in participants with spastic diplegic CP. Eighteen participants were recruited (mean age=13.8 years, range=6-30 years, Gross Motor Function Classification System Levels I-III). Induced acceleration analysis was performed during the swing phase of gait. Average joint moment contributions to swing knee extension acceleration were calculated. Contributions from stance limb and swing limb joint moments were correlated with SCALE scores using Pearson's correlations. A strong correlation was found (p<0.0001, r=0.85) between SCALE score and the total swing joint moment contributions to swing knee extension acceleration. As SCALE score increased, swing joint moments provided less resistance to knee extension acceleration. No relationship (p=0.18) was found between stance moment contributions to swing knee acceleration and stance limb SCALE scores. Excessive contributions from swing limb joint moments appear to be the factor limiting swing knee extension in spastic diplegic CP gait. Interventions that address negative contributions due to spasticity may not be effective in patients who cannot generate adequate knee extension due to poor SVMC.
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Affiliation(s)
- Evan J Goldberg
- Department of Orthopaedic Surgery, University of California at Los Angeles, 1000 Veteran Avenue, Los Angeles, CA 90095, USA
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Nunez-Wallace KR, Gill CE, Harrison CH, Taylor HM, Charles PD. Discordance in informed consent response on the basis of demographic factors: brief report. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2010; 48:175-179. [PMID: 20597728 DOI: 10.1352/1944-7558-48.3.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
During an outcomes study of spasticity treatment at a developmental center for 62 residents with profound intellectual disabilities, either botulinum toxin A (BTX-A), intrathecal baclofen (ITB), or both were recommended with physical and occupational therapy. Conservators consented to BTX-A more than ITB (p = .021). Court-appointed conservators were more likely to provide consent for treatment than family members (p = .026). Nonparents consented more than parents (p = .009). Finally, Caucasian conservators were more likely to consent to treatment than African American conservators (p = .036), but ethnicity of the resident did not influence consent. Gender of resident or conservator did not influence rate of consent. This report highlights disparities in surrogate consent giving for individuals with intellectual disabilities and indicates a need for more research to ensure that this vulnerable population has access to appropriate treatments.
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van den Noort JC, Scholtes VA, Becher JG, Harlaar J. Evaluation of the catch in spasticity assessment in children with cerebral palsy. Arch Phys Med Rehabil 2010; 91:615-23. [PMID: 20382296 DOI: 10.1016/j.apmr.2009.12.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 12/24/2009] [Accepted: 12/29/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate whether the catch in clinical spasticity assessment in cerebral palsy (CP) is the consequence of a sudden velocity-dependent increase in muscle activity, resulting from hyperexcitability of the stretch reflex in spasticity. DESIGN Cross-sectional study. SETTING A special school for children with physical disabilities. PARTICIPANTS Children with CP (N=20; age range, 5-14y; mean weight +/- SD, 35+/-14kg; mean length +/- SD, 139+/-19cm). INTERVENTIONS Spasticity assessment tests (using slow and fast passive stretch) were performed in the medial hamstrings, soleus, and medial gastrocnemius muscles of the children by 2 experienced examiners. MAIN OUTCOME MEASURES Surface electromyography (EMG) was recorded and joint motion was simultaneously measured using 2 inertial sensors. The encounter of a catch by the examiner was compared with the presence of a sudden increase in muscle activity ("burst"). The average rectified value (ARV) of the EMG signal was calculated for each test. RESULTS The study shows a sudden increase in muscle activity in fast passive stretch, followed by a catch (hamstrings 100%, soleus 95%, gastrocnemius 84%). The ARV in slow passive stretch was significantly lower. CONCLUSIONS The results confirm that in children with CP, an increase in muscle activity is primarily responsible for a catch in fast passive muscle stretch.
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Affiliation(s)
- Josien C van den Noort
- Department of Rehabilitation Medicine, Research Institute MOVE, Vrije Universiteit University Medical Center, 1007 MB Amsterdam, The Netherlands.
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Joint moment contributions to swing knee extension acceleration during gait in children with spastic hemiplegic cerebral palsy. J Biomech 2010; 43:893-9. [DOI: 10.1016/j.jbiomech.2009.11.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Revised: 11/02/2009] [Accepted: 11/04/2009] [Indexed: 11/19/2022]
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Effect of Intrathecal Baclofen Bolus Injection on Lower Extremity Joint Range of Motion During Gait in Patients With Acquired Brain Injury. Arch Phys Med Rehabil 2010; 91:30-4. [DOI: 10.1016/j.apmr.2009.08.148] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2009] [Revised: 07/25/2009] [Accepted: 08/28/2009] [Indexed: 11/17/2022]
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Fee JW, Miller F, Lennon N. EMG reaction in muscles about the knee to passive velocity, acceleration, and jerk manipulations. J Electromyogr Kinesiol 2009; 19:467-75. [PMID: 18032067 DOI: 10.1016/j.jelekin.2007.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Revised: 07/23/2007] [Accepted: 07/23/2007] [Indexed: 10/22/2022] Open
Abstract
Twenty subjects, ten adults and ten children were tested in this study. Each test consisted of applying an ensemble of velocities to the lower limb using a torque motor in such a way that the entire range of motion of the knee was traversed. Eight velocities between 60 degrees/s and 280 degrees/s were reached at 2-3 different acceleration rates and 1-2 different rates of jerk. EMG from three muscles, vastus, rectus, and hamstring were recorded during each move. Regression and correlation coefficients between EMG and kinematic parameters indicated different reactions in both muscle groups and age groups to each of the three kinematic parameters. Adult muscle was dominated by a reaction to the velocity kinematic while children's muscles were dominated by either acceleration or jerk. The extensor muscles of adults seem to be slightly more sensitive to acceleration and jerk than the flexors. In the muscle responses of children the exact opposite pattern is seen. The small sample size in this study does not allow for a meaningful statistical analysis.
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Affiliation(s)
- James W Fee
- Alfred I. duPont Hospital for Children, Gait Laboratory, 1600 Rockland Road, Wilmington, DE 19899, USA.
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Quantifying repeatability of the Wartenberg pendulum test parameters in children with spasticity. J Neurosci Methods 2009; 178:340-4. [DOI: 10.1016/j.jneumeth.2008.12.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Revised: 12/30/2008] [Accepted: 12/31/2008] [Indexed: 11/17/2022]
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The effect of lower extremity selective voluntary motor control on interjoint coordination during gait in children with spastic diplegic cerebral palsy. Gait Posture 2009; 29:102-7. [PMID: 18786827 DOI: 10.1016/j.gaitpost.2008.07.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 07/07/2008] [Accepted: 07/09/2008] [Indexed: 02/02/2023]
Abstract
Damage to motor tracts in the periventricular white matter is a primary etiology in spastic diplegic cerebral palsy (CP). These tracts are responsible for the production of selective voluntary motor control (SVMC). Lower extremity motor control has been suggested as being an important predictor of improvement following interventions. While there are multiple impairments in spastic CP, the inability to perform purposeful voluntary movement is a critical factor in determining functional ability that merits investigation. The purpose of this study was to examine the relationship between SVMC ability and hip and knee coordination during the swing phase of gait in participants with spastic CP. Gait analysis and SVMC assessments were conducted for 15 participants with CP. Relative phase analysis was used to calculate the minimum relative phase (MRP) angle during swing; a measurement of interjoint coordination between the hip and the knee. SVMC ability was measured using the Selective Control Assessment of the Lower Extremity (SCALE) tool. Significant correlations were found between SCALE scores and both MRP values (p<0.0001) and duration of out-of-phase movement (p<0.005) during swing. These findings supported our hypothesis that SVMC ability is related to a patient's ability to move in an uncoupled pattern during the swing phase of gait (i.e., extending the knee while flexing the hip). An understanding of influence of SVMC on swing phase gait mechanics may help establish appropriate goals for interventions, in particular hamstring lengthenings.
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Faber IR, Nienhuis B, Rijs NPAM, Geurts ACH, Duysens J. Is the modified Tardieu scale in semi-standing position better associated with knee extension and hamstring activity in terminal swing than the supine Tardieu? Dev Med Child Neurol 2008; 50:382-7. [PMID: 18384387 DOI: 10.1111/j.1469-8749.2008.02056.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this study was to investigate whether the modified Tardieu scale (MTS) in a semi-standing position, used for the assessment of hamstrings spasticity, was better associated with knee extension and hamstrings activity in terminal swing than the MTS in a supine position in children with cerebral palsy (CP). Seven children diagnosed with spastic CP (Gross Motor Function Classification System Levels I-II) and seven healthy comparison children participated in the study. An instrumented MTS in supine and semi-standing position and an instrumented gait assessment were conducted. Results showed that spasticity-related outcomes of the semi-standing MTS do not show better associations with terminal swing characteristics of gait than the same outcomes of the supine MTS in children with spastic CP. Only the passive restricted knee angle from the supine MTS was strongly associated with the maximum knee extension during gait (r(s)=0.99; p <0.001), suggesting that hamstrings length is more important for terminal swing behaviour than hamstrings spasticity.
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Affiliation(s)
- Irene R Faber
- Department of Rehabilitation, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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