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Duis J, Skinner A, Carson R, Gouelle A, Annoussamy M, Silverman JL, Apkon S, Servais L, Carollo J. Quantitative measures of motor development in Angelman syndrome. Am J Med Genet A 2023; 191:1711-1721. [PMID: 37019838 PMCID: PMC11068498 DOI: 10.1002/ajmg.a.63192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/10/2023] [Accepted: 03/10/2023] [Indexed: 04/07/2023]
Abstract
Angelman Syndrome is a rare neurodevelopmental disorder characterized by developmental delay, lack of speech, seizures, intellectual disability, characteristic behavior, and movement disorders. Clinical gait analysis provides the opportunity for movement quantification to investigate an observed maladaptive change in gait pattern and offers an objective outcome of change. Pressure-sensor-based technology, inertial and activity monitoring, and instrumented gait analysis (IGA) were employed to define motor abnormalities in Angelman syndrome. Temporal-spatial gait parameters of persons with Angelman Syndrome (pwAS) show deficiencies in gait performance through walking speed, step length, step width, and walk ratio. pwAS walk with reduced step lengths, increased step width, and greater variability. Three-dimensional motion kinematics showed increased anterior pelvic tilt, hip flexion, and knee flexion. PwAS have a walk ratio more than two standard deviations below controls. Dynamic electromyography showed prolonged activation of knee extensors, which was associated with a decreased range of motion and the presence of hip flexion contractures. Use of multiple gait tracking modalities revealed that pwAS exhibit a change in gait pattern to a flexed knee gait pattern. Cross-sectional studies of individuals with AS show a regression toward this maladaptive gait pattern over development in pwAS ages 4-11. PwAS unexpectedly did not have spasticity associated with change in gait pattern. Multiple quantitative measures of motor patterning may offer early biomarkers of gait decline consistent with critical periods of intervention, insight into appropriate management strategies, objective primary outcomes, and early indicators of adverse events.
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Affiliation(s)
- Jessica Duis
- Center for Gait & Movement Analysis (CGMA), Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Section of Genetics and Inherited Metabolic Disease, Department of Pediatrics, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Section of Pediatrics, Special Care Clinic, Department of Pediatrics, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Austin Skinner
- Center for Gait & Movement Analysis (CGMA), Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Robert Carson
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Arnaud Gouelle
- Université de Reims Champagne-Ardenne, PSMS (Performance, Santé, Métrologie, Société), Reims, France
- Gait and Balance Academy, ProtoKinetics, Havertown, Pennsylvania, USA
| | | | - Jill L. Silverman
- MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, California, USA
| | - Susan Apkon
- Department of Physical Medicine & Rehabilitation, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Laurent Servais
- Department of Paediatrics, Oxford University, Oxford, UK
- Division of Child Neurology, Centre de References des Maladies Neuromusculaires, Department of Pediatrics, University Hospital Liege & University of Liege, Liege, Belgium
| | - James Carollo
- Center for Gait & Movement Analysis (CGMA), Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Physical Medicine & Rehabilitation, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Rahyussalim AJ, Zufar MLL, Kurniwati T. A holistic approach for severe flexion contracture of bilateral hip, knee, and ankle joints in a neglected patient with prolonged knee-chest positioning on extreme undernourishment: a case report and review of the literature. J Med Case Rep 2022; 16:225. [PMID: 35610728 PMCID: PMC9128234 DOI: 10.1186/s13256-022-03439-y] [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: 05/21/2020] [Accepted: 03/09/2022] [Indexed: 11/30/2022] Open
Abstract
Background Flexion contracture in the lower extremity is a common finding in the patient with neuromusculoskeletal disorders. However, severe cases due to prolonged immobilization in knee–chest position are rarely established and remain underreported. This condition is associated with high morbidity and reduced quality of life, especially when it comes to neglected cases with missed injury and late presentation for adequate primary care and rehabilitative program. It remains a difficult challenge to treat, with no established treatment protocol. In addition, other factors related to psychological and socioeconomic conditions may interfere and aggravate the health state of such patients. Case presentation A 19-year-old Javanese man presented with flexion contracture of bilateral hip, knee, and ankle joints due to prolonged immobilization in knee–chest position for almost 2 years following a traffic accident and falling in the bathroom. The condition had persisted for the last 3 years due to irrecoverable condition and lack of awareness. In addition, the patient also presented with paraplegia at level L2–S1, dermatitis neglecta, multiple pressure ulcers, community-acquired pneumonia, and severe malnutrition. Prolonged and sustained passive stretching with serial plastering were performed in the patient. By the time of discharge, patient was able to move and ambulate using wheelchair. Progressive improvement of range of motion and good sitting balance were observed by 3-month follow-up. Conclusion A combination of surgery and rehabilitative care is required in the setting of severe flexion contracture. Passive prolonged stretching showed a better outcome and efficacy in the management of flexion contracture, whether the patient undergoes surgery or not. However, evaluation of residual muscle strength, changes in bone density and characteristic, and the patient’s general and comorbid conditions must always be considered when determining the best treatment of choice for each patient to achieve good outcome and result. A holistic approach with comprehensive assessment is important when treating such patients.
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Affiliation(s)
- Ahmad Jabir Rahyussalim
- Department of Orthopaedic and Traumatology, Cipto Mangunkusumo National Central General Hospital and Faculty of Medicine, Universitas Indonesia, Jl. Pangeran Diponegoro No.71, RW.5, Kenari, Kec. Senen, Kota Jakarta Pusat, Daerah Khusus Ibukota, Jakarta, 10310, Indonesia.
| | - Muhammad Luqman Labib Zufar
- Department of Orthopaedic and Traumatology, Cipto Mangunkusumo National Central General Hospital and Faculty of Medicine, Universitas Indonesia, Jl. Pangeran Diponegoro No.71, RW.5, Kenari, Kec. Senen, Kota Jakarta Pusat, Daerah Khusus Ibukota, Jakarta, 10310, Indonesia
| | - Tri Kurniwati
- Stem Cell and Tissue Engineering, IMERI Universitas, Jakarta, Indonesia
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Abstract
Paraplegic flexion contracture of hip joints beyond 90° is a difficult condition to treat for any orthopedic surgeon. There is no fixed protocol of treatment described, by and large it is individualized. A 20 year old female presented with paraplegia for last 15 years due to irrecoverable spinal cord disease with complete sensory and motor loss of both lower extremities and was admitted with acute flexion contracture of both hip joints with trunk resting on thighs. She underwent bilateral proximal femoral resection. Both hip joints were straight immediately after surgery and patient could lie on her back. In a course of time, she started sitting on her buttocks, led a comfortable wheelchair life with a sitting balance. Proximal femoral resection is an effective method to treat long standing irrecoverable paraplegic acute flexion deformity of the hip joint.
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Affiliation(s)
- Sailendra Bhattacharyya
- Department of Orthopaedics, Bhattacharyya Orthopaedics and Related Research Centre, Narayanpur, Kolkata, West Bengal, India,Address for correspondence: Dr. Sailendra Bhattacharyya, Bhattacharyya Orthopaedics and Related Research Centre, Narayanpur, P.O Rajarhat-Gopalpur, Kolkata - 700 136, West Bengal, India. E-mail:
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de Souza RC, Mansano MV, Bovo M, Yamada HH, Rancan DR, Fucs PMDMB, Svartman C, de Assumpção RMC. Hip salvage surgery in cerebral palsy cases: a systematic review. Rev Bras Ortop 2015; 50:254-9. [PMID: 26229926 PMCID: PMC4519665 DOI: 10.1016/j.rboe.2015.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 05/14/2014] [Indexed: 12/27/2022] Open
Abstract
Imbalance and muscle spasticity, in association with coxa valga and persistent femoral anteversion, compromises hip development in cases of cerebral palsy and may result in chronic pain and even dislocation. Some of these hips undergo salvage surgery because of the severe impact of their abnormalities in these patients’ quality of life. We conducted a systematic review of the literature to compare the results from the main hip salvage techniques applied to these individuals. The literature search focused on studies that evaluated results from hip salvage surgery in cases of cerebral palsy, published from 1970 to 2011, which are present in the Embase, Medline, PubMed, Cochrane Library and SciELO databases. Although the results were not statistically comparable, this systematic review demonstrates that hip salvage surgery should be indicated after individual evaluation on each patient, due to the wide spectrum of presentations of cerebral palsy. Therefore, it seems that no surgical technique is superior to any other. Rather, there are different indications.
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Affiliation(s)
| | | | - Miguel Bovo
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Helder Henzo Yamada
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | | | | | - Celso Svartman
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
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