Use of a dynamic foot pressure index to monitor the effects of treatment for equinus gait in children with cerebral palsy

Pedobarographic evaluations in physical medicine and rehabilitation practice

The feet are complex structures that transmit loads transferred by other parts of the body to the ground and are involved in many static and dynamic activities, such as standing and walking. The contact area and pressure changes between the feet and the ground surface can be measured using pedobarographic devices. With pedobarographic examinations, it is possible to obtain a wide range of information needed to support clinical evaluation and diagnostic tests in physical medicine and rehabilitation practice. Foot structure and function, postural stability, lower extremity biomechanics, and gait analysis are among the areas that can be further investigated using pedobarography.

Pedobarographic changes during first month after subtalar extra-articular screw arthroereisis (SESA) operation of juvenile flexible flatfoot

BACKGROUND

Juvenile flexible flatfoot deformity is a common problem in childhood. In severe cases, the subtalar extra-articular screw arthroereisis (SESA) according to De Pellegrin is a viable and effective option. There are just a few retrospective studies showing long-term outcomes, but the interval right after the surgery has not been described so far, even though the short time of healing is one of the great benefits of this technique. In this study, we examined if the pedobarographic measurements are able to demonstrate functional changes in the month after surgery.

METHODS

Data were analyzed for seven patients (13 feet). Measurements were performed before surgery, as well as 3, 14 and 28 days after. For analysis, the foot was comparted in six areas-fore-, mid- and hindfoot, each split in their lateral and medial parts. Plantar forces and contact area were measured under static and dynamic conditions. Time-dependent changes of plantar acting forces and the contact area were compared.

RESULTS

During bipedal stance, the ground force increased significantly in lateral foot areas (p < 0.001) and decreased in medial areas (p < 0.001). While the force in the medial midfoot remained reduced, in the medial forefoot, the force increased 14 days after surgery (p < 0.05) CONCLUSION: The functional changes after SESA can be accurately assessed using pedobarography. The results indicate morphologic changes of the foot, in particular the development of a longitudinal arch. Post-surgical progression can be monitored and success of the surgery can be verified.

The effect of plantar flexor lengthening on foot pressure in ambulatory children with cerebral palsy

This study aimed to assess the effects of plantar flexor lengthening (PFL) on dynamic foot pressures of children with cerebral palsy using pedobarographs. Of 97 enrolled, 13 children with 18 legs had PFL. Age at surgery was 4.7 (2.8-8.8) years. A significant increase in ankle dorsiflexion and heel impulse was achieved postoperatively and was maintained at 5 years. The coronal plane pressure index increased postoperatively, but reverted to preoperative levels at the 5-year follow-up. Children tend to have more valgus after PFL. In young children, there caution should be exercised to avoid over treating varus at the time of equinus correction to avoid overcorrection.

Real-time feedback of dynamic foot pressure index for gait training of toe-walking children with spastic diplegia

PURPOSE

The aim of this study was to determine whether and how real-time feedback of dynamic foot pressure index (DFPI) could be used to correct toe-walking gait in spastic diplegic children with dynamic equinus.

METHODS

Thirteen spastic diplegic children with dynamic equinus were asked to wear a monitoring device to record their ambulation during daily gait, conventional training gait, and feedback training gait. Parameters based on their DFPI and stride duration were compared among the three test conditions.

RESULTS

The results with feedback training were significantly better for all DFPI parameters in comparison to patients' daily gait and showed significant improvements in DFPI for toe-walking gait and percentage of normal gait in comparison to conventional training methods. Moreover, stride duration under two training gaits was longer than patient's daily gait, but there was no significant difference between the two training gaits.

CONCLUSIONS

Although the stride duration for the two training gaits was similar, gait training with real-time feedback of DFPI did produce noticeably superior results by increasing heel-loading impulse of toe-walking gait and percentage of normal gait in comparison to convention training methods. However, its effectiveness was still impacted by the motion limitations of diplegic children. Implications for Rehabilitation The DFPI-based gait training feedback system introduced in this study was shown to be more effective at toe-walking gait rehabilitation training over conventional training methods. The feedback system accomplished superior improvement in correcting toe-walking gait, but its effectiveness in an increasing heel-loading impulse in normal gait was still limited by the motion limitations of diplegic children. Stride duration of normal gait and toe-walking gait was similar under conventional and feedback gait training.

Botulinum Toxin Type A Injection for Spastic Equinovarus Foot in Children with Spastic Cerebral Palsy: Effects on Gait and Foot Pressure Distribution

PURPOSE

To investigate the effect of intramuscular Botulinum toxin type A (BoNT-A) injection on gait and dynamic foot pressure distribution in children with spastic cerebral palsy (CP) with dynamic equinovarus foot.

MATERIALS AND METHODS

Twenty-five legs of 25 children with CP were investigated in this study. BoNT-A was injected into the gastrocnemius (GCM) and tibialis posterior (TP) muscles under the guidance of ultrasonography. The effects of the toxin were clinically assessed using the modified Ashworth scale (MAS) and modified Tardieu scale (MTS), and a computerized gait analysis and dynamic foot pressure measurements using the F-scan system were also performed before injection and at 1 and 4 months after injection.

RESULTS

Spasticity of the ankle plantar-flexor in both the MAS and MTS was significantly reduced at both 1 and 4 months after injection. On dynamic foot pressure measurements, the center of pressure index and coronal index, which represent the asymmetrical weight-bearing of the medial and lateral columns of the foot, significantly improved at both 1 and 4 months after injection. The dynamic foot pressure index, total contact area, contact length and hind foot contact width all increased at 1 month after injection, suggesting better heel contact. Ankle kinematic data were significantly improved at both 1 and 4 months after injection, and ankle power generation was significantly increased at 4 months after injection compared to baseline data.

CONCLUSION

Using a computerized gait analysis and foot scan, this study revealed significant benefits of BoNT-A injection into the GCM and TP muscles for dynamic equinovarus foot in children with spastic CP.

Effects of combined Adeli suit and neurodevelopmental treatment in children with spastic cerebral palsy with gross motor function classification system levels I and II

Background:

Children with cerebral palsy (CP) exhibit diverse gait patterns depending on their neurological deficits and musculoskeletal problems. The Adeli suit treatment (AST) has been proposed as an intensive exercise protocol in the management of CP.

Objectives:

The aim of this study was to compare the effects of a 6-week programme of combined AST and neurodevelopment treatment (NDT) with those of NDT alone on Gross Motor Function Measure (GMFM), balance, and gait in children with CP.

Methods:

Twenty children with CP of Gross Motor Function Classification System levels I and II were randomly assigned to one of the following two groups: (1) NDT or (2) AST/NDT. The participants were assessed using the GMFM, Pediatric Balance Scale (PBS), Timed Up and Go (TUG) test, and spatiotemporal gait parameters.

Results:

The GMFM, PBS, and TUG test for both groups showed a statistically significant increase (p < 0.05). Three children were excluded. Compared to the NDT group (n = 9), the AST/NDT group (n = 8) demonstrated a significant increase in spatiotemporal gait parameters (p < 0.05).

Conclusion:

These results provide evidence for the greater effectiveness of combined AST/NDT than NDT alone in improving spatiotemporal gait parameters but not GMFM, PBS, and TUG test.

Dynamic pedobarography and radiographic evaluation of surgically treated cavovarus foot deformity in children with Charcot-Marie-Tooth disease

Pedobarography is a common tool for the evaluation of foot deformity. We describe our radiographic and pedobarographic outcomes of surgical treatment of cavovarus foot deformity in children with Charcot-Marie-Tooth disease. Nineteen patients for a total of 30 feet were included. Preoperative and postoperative dynamic pedobarographic measurements were made and analyzed using the five-mask technique. Pedobarographic measures showed statistical significance for increased contact area and decreased peak forces in most mask areas after surgical treatment. Peak pressure and redistribution of varus pressure patterns trended toward improvement. We found pedobarographic studies helpful; however, pedobarographic data are somewhat difficult to interpret and should be used in addition to clinical and radiographic examination.

Gait training facilitates central drive to ankle dorsiflexors in children with cerebral palsy

Foot drop and toe walking are frequent concerns in children with cerebral palsy. The main underlying cause of these problems is early damage and lack of maturation of the corticospinal tract. In the present study we investigated whether 4 weeks of daily treadmill training with an incline may facilitate corticospinal transmission and improve the control of the ankle joint in children with cerebral palsy. Sixteen children with cerebral palsy (Gross Motor Classification System I:6, II:6, III:4) aged 5-14 years old, were recruited for the study. Evaluation of gait ability and intramuscular coherence was made twice before and twice after training with an interval of 1 month. Gait kinematics were recorded by 3D video analysis during treadmill walking with a velocity chosen by the child at the first evaluation. Foot pressure was measured by force sensitive foot soles during treadmill and over ground walking. EMG-EMG coherence was calculated from two separate electrode recordings placed over the tibialis anterior muscle. Training involved 30 min of walking daily on a treadmill with an incline for 30 days. Gait training was accompanied by significant increases in gait speed, incline on the treadmill, the maximal voluntary dorsiflexion torque, the number and amplitude of toe lifts late in the swing phase during gait and the weight exerted on the heel during the early stance phase of the gait cycle. EMG-EMG coherence in the beta and gamma frequency bands recorded from tibialis anterior muscle increased significantly when compared to coherence before training. The largest changes in coherence with training were observed for children <10 years of age. Importantly, in contrast to training-induced EMG increases, the increase in coherence was maintained at the follow-up measurement 1 month after training. Changes in the strength of coherence in the beta and gamma band were positively correlated with improvements in the subjects' ability to lift the toes in the swing phase. These data show that daily intensive gait training increases beta and gamma oscillatory drive to ankle dorsiflexor motor neurons and that it improves toe lift and heel strike in children with cerebral palsy. We propose that intensive gait training may produce plastic changes in the corticospinal tract, which are responsible for improvements in gait function.