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Hu Y, Zheng Y, Yang Y, Fang W, Huang M, Li D, Xu Z, Xu F, Wang J. A bibliometric analysis of cerebral palsy from 2003 to 2022. Front Neurol 2024; 15:1292587. [PMID: 38628701 PMCID: PMC11018907 DOI: 10.3389/fneur.2024.1292587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 03/11/2024] [Indexed: 04/19/2024] Open
Abstract
Purpose This bibliometric study explores cerebral palsy (CP) research from 2003 to 2022 to reveal the topic hotspots and collaborations. Methods We retrieved studies on CP from the Web of Science Core Collection from 2003 to 2022 and then used CiteSpace and Bibliometrix to perform a bibliometric analysis and attain knowledge mapping, including publication outputs, funding, journals, authors, institutions, countries/territories, keywords, collaborative relationships, and topic hotspots. Results In total, 8,223 articles were published from 2003 to 2022. During this period, the number of publications increased continuously. Developmental Medicine and Child Neurology was the most productive and frequently co-cited journal. Boyd was the most productive and influential author, with 143 publications and 4,011 citations. The United States and Vrije Universiteit Amsterdam were the most productive countries and institutions, respectively. Researchers and institutions from the USA, Australia, and Canada constituted the core research forces, with extensive collaborations worldwide. The most common keywords were gait (553), rehabilitation (440), spasticity (325), botulinum toxin (174), therapy (148), upper extremity (141), quality of life (140), disability (115), pain (98), electromyography (97), kinematics (90), balance (88), participation (85), and walking (79). Conclusion This study provides a systematic and comprehensive analysis of the CP-related literature. It reveals that Developmental Medicine and Child Neurology is the most active journal in this field. The USA, Vrije Universiteit Amsterdam, and Boyd are the top countries, institutions, and authors, respectively. Emerging treatment methods, complication management, and functional recovery comprise the future research directions and potential topic hotspots for CP.
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Affiliation(s)
- Yue Hu
- Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Yadan Zheng
- Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Yue Yang
- Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Wenfeng Fang
- Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Maomao Huang
- Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Dan Li
- Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Zhangyu Xu
- Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Fangyuan Xu
- Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Jianxiong Wang
- Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Department of Rehabilitation Medicine, Southwest Medical University, Luzhou, Sichuan, China
- Rehabilitation Medicine and Engineering Key Laboratory of Luzhou, Luzhou, Sichuan, China
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Horsch A, Kleiber S, Ghandour M, Deisenhofer J, Klotz M, Putz C. Reconsidering the Gold Standard for the Assessment of Spastic Equinus Foot. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202404000-00001. [PMID: 38530946 DOI: 10.5435/jaaosglobal-d-24-00039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION To determine whether differences exist in the measured range of motion (ROM) by the goniometer, equinometer, and 3-dimensional (3D) gait analysis in different settings (under general anesthesia (GA) or in the clinic) among patients with cerebral palsy. METHODS A prospective comparative cohort study was conducted at our orthopaedics center, where 15 patients with diplegic cerebral palsy (30 limbs) were evaluated, all of whom had Gross Motor Function Classification System (GMFCS) level I and II. ROM was measured by (1) goniometer under GA (benchmark), (2) goniometer analysis during clinical examination, (3) equinometer under GA, (4) equinometer in the clinic, and (5) 3D gait analysis. ROM was measured during both knee flexion and extension. Subgroup analysis based on the GMFCS level was performed. RESULTS Nine patients were male with GMFCS level I and a mean age of 14.3 (SD=7.2) years. Statistically significant differences were noted between all studied measurement techniques in terms of ROM, dorsiflexion, and plantarflexion during both knee flexion and extension. The GMFCS level was an effect modifier of ROM measurements. DISCUSSION The ROM parameters during both knee flexion and extension differed from one measurement device/technique to another. The GMFCS level played a notable effect-modifying role on the ROM parameters.
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Affiliation(s)
- Axel Horsch
- From the Department of Orthopedics, Heidelberg University Hospital, Heidelberg, Germany. (Dr. Horsch, Dr. Kleiber, Dr. Ghandour, Dr. Deisenhofer, and Dr. Putz); Department Orthopedics and Trauma Surgery, Marienkrankenhaus Soest, Soest, Germany (Dr. Klotz); Department of Orthopaedics and Traumatology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany (Dr. Klotz)
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Horsch A, Petzinger L, Deisenhofer J, Ghandour M, Klotz M, Renkawitz T, Putz C. The Impact of Operative Correction of Equinus in Cerebral Palsy on Gait Patterns. Foot Ankle Int 2024; 45:130-140. [PMID: 38156624 DOI: 10.1177/10711007231217273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND This study aimed to evaluate gait outcomes and strength following the surgical correction of equinus in cerebral palsy (CP) based on different surgical procedures. We included the Baumann and Strayer procedures, as well as the Achilles tendon lengthening (ATL). METHODS A retrospective analysis was performed in patients with infantile, bilateral CP who received instrumental 3D gait analysis before and after surgical correction (18.66 months postoperatively). Patients were divided into 3 groups: Strayer surgery, Baumann surgery, and ATL. Gait performance and muscle strengths were compared between studied surgeries. RESULTS A total population of 204 patients (15.43 years) with 341 operated lower limbs (LLs) was analyzed. Dorsiflexion in swing and stance phases significantly improved in all groups postoperatively. The Strayer and the ATL group showed higher postoperative dorsiflexion than the Baumann group. However, no loss of strength was observed with the Baumann method. Maximum power improved in this group postoperatively. An 8.2% loss in calf muscle strength was recorded in the Strayer group. CONCLUSION Operative pes equinus treatment successfully improved the gait of children and adults with CP postoperatively. There were differences in postoperative results between studied operative techniques regarding range of motion and power. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Axel Horsch
- Department of Orthopedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Lara Petzinger
- Department of Orthopedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Julian Deisenhofer
- Department of Orthopedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Maher Ghandour
- Department of Orthopedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Klotz
- Orthopedics and Trauma Surgery, Marienkrankenhaus Soest, Soest, Germany
| | - Tobias Renkawitz
- Department of Orthopedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Cornelia Putz
- Department of Orthopedics, Heidelberg University Hospital, Heidelberg, Germany
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Chrea B, Anderson DD, Roach K, Wilken J. Research Toward Understanding the Benefits and Limitations of Orthotic Use To Improve Mobility and Balance for Individuals With Neuropathic Conditions. THE IOWA ORTHOPAEDIC JOURNAL 2024; 44:37-45. [PMID: 38919344 PMCID: PMC11195889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Background Walking is a vital activity often compromised in individuals with neuropathic conditions. Charcot-Marie-Tooth (CMT) disease and Cerebral Palsy (CP) are two common neurodevelopmental disabilities affecting gait, predisposing to the risk of falls. With guiding scientific evidence limited, there is a critical need to better understand how surgical correction affects mobility, balance confidence, and gait compared to ankle foot orthosis (AFO) bracing. A systematic approach will enable rigorous collaborative research to advance clinical care. Methods Key elements of this vision include 1) prospective studies in select patient cohorts to systematically compare conservative vs. surgical management, 2) objective laboratory-based evaluation of patient mobility, balance, and gait using reliable methods, and 3) use of patient-centric outcome measures related to health and mobility. Results Valid and reliable standardized tests of physical mobility and balance confidence have been described in the literature. They include 1) the four-square step test, a widely used test of balance and agility that predicts fall risk, 2) the self-selected walking velocity, a measure of general mobility able to detect function change with orthosis use, and 3) the activity specific balance confidence scale, a survey instrument that assesses an individual's level of balance confidence during activity. Additionally, motion capture and ground reaction force data can be used to evaluate whole-body motion and loading, with discriminative biomechanical measures including toe clearance during the swing phase of gait, plantarflexion at 50% of swing, peak ankle plantarflexor moment, and peak ankle push-off power. Conclusion The tools needed to support evidence-based practice and inform clinical decision making in these challenging patient populations are all available. Research must now be conducted to better understand the potential benefits and limitations of AFO use in the context of mobility and balance during gait for individuals with neuropathic conditions, particularly relative to those offered by surgical correction. Clinical Relevance Following this path of research will provide comparative baseline data on mobility, balance confidence, and gait that can be used to inform an objective criterion-based approach to AFO prescription and the impact of surgical intervention.
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Affiliation(s)
- Bopha Chrea
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Donald D. Anderson
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Koren Roach
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Jason Wilken
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Nakamura S, Kimoto M, Okada K, Kawanobe U, Sakamoto H. Impact of lower muscle stiffness on ankle dorsiflexion restriction in children with cerebral palsy evaluated using ultrasound elastography. Clin Biomech (Bristol, Avon) 2023; 109:106092. [PMID: 37738919 DOI: 10.1016/j.clinbiomech.2023.106092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 08/21/2023] [Accepted: 09/12/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Plantar flexor muscles always contribute to limiting the range of motion of ankle dorsiflexion in children with spastic cerebral palsy, but the individual contributions of these muscles are not well defined. This study aimed to identify which muscles' stiffness impacts the dorsiflexion range of motion in children with cerebral palsy. METHODS Twenty-five children with cerebral palsy were included. The maximum passive dorsiflexion range of motion was measured in two positions: hip and knee joints in flexion, and both joints in full extension. Strain ratios indicating muscle stiffness were measured using strain elastography of the lateral and medial gastrocnemius, soleus, flexor hallucis longus, peroneus longus, peroneus brevis, and tibialis posterior muscles. To analyze which muscles impact the limitation of the dorsiflexion range, multiple regression analyses were conducted. The values of muscle stiffness were included as independent valuables, and the values of the dorsiflexion range were included as dependent valuables. A p-value <0.05 was considered statistically significant. FINDINGS In the analyses, the soleus and flexor hallucis longus muscle stiffness were significant independent factors for the dorsiflexion range of motion of hip and knee flexion (adjusted R2: 0.50). The lateral gastrocnemius muscle stiffness was a significant independent factor for the dorsiflexion range of motion with both joints in full extension (adjusted R2: 0.61). INTERPRETATION Flexor hallucis longus muscle stiffness, in addition to triceps surae muscle stiffness, was shown to impact dorsiflexion range; attention should be paid to muscle stiffness in children with cerebral palsy.
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Affiliation(s)
- Shinya Nakamura
- Department of Rehabilitation, Akita Prefectural Center on Development and Disability, 1-1-2, Minamigaoka, Akita 010-1409, Japan; Department of Physical Therapy, Akita University Graduate School of Health Sciences, 1-1-1 Hondo, Akita 010-8543, Japan.
| | - Minoru Kimoto
- Department of Rehabilitation, Akita Prefectural Center on Development and Disability, 1-1-2, Minamigaoka, Akita 010-1409, Japan; Department of Physical Therapy, Akita University Graduate School of Health Sciences, 1-1-1 Hondo, Akita 010-8543, Japan
| | - Kyoji Okada
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, 1-1-1 Hondo, Akita 010-8543, Japan
| | - Uki Kawanobe
- Department of Rehabilitation, Akita Prefectural Center on Development and Disability, 1-1-2, Minamigaoka, Akita 010-1409, Japan
| | - Hitoshi Sakamoto
- Department of Medicine, Akita Prefectural Center on Development and Disability, 1-1-2, Minamigaoka, Akita 010-1409, Japan
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Ghandour M, Klotz M, Horsch A. Research trends in the orthopedic surgical management of cerebral palsy: a cross-analytical study of publications in the past decade. Front Neurol 2023; 14:1200893. [PMID: 37681012 PMCID: PMC10482432 DOI: 10.3389/fneur.2023.1200893] [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: 04/05/2023] [Accepted: 08/07/2023] [Indexed: 09/09/2023] Open
Abstract
Little is known about the trends in orthopedic surgical management of cerebral palsy (CP). In this cross-analytical study we examined alterations in research publications in this field in the past 10 years through four databases. Thus, we divided publications into old (2012-2017) and recent (2018-2022). To determine if the focus of research in this field has changed, we compared both periods based on publication's (authors' number, journal, country, design), patients' (number, gender, age, CP type), and surgery-related (indication, number, category, type) characteristics. Publications showed a positive trend over the past 10 years with a peak in 2020. The number of publications was similar between old and recent ones (47.58% vs. 52.42%). Most research outputs were from the United States and Germany. Differences were noted between recent and old publications regarding journals (p = 0.0001), journal category (p = 0.023), authors' number (p = 0.006), and patients' age (p = 0.02). The impact factor was also different (p = 0.0001). However, no differences were noted regarding other characteristics (p > 0.05). The research output regarding surgical orthopedic management in CP has increased in the past decade with no difference between 2012-2017 and 2018-2022. Except for the number of authors, journal name, and patients' age, no significant differences were noted between both periods.
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Affiliation(s)
- Maher Ghandour
- Department of Orthopedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Klotz
- Marienkrankenhaus Soest, Orthopedics and Trauma Surgery, Soest, Germany
| | - Axel Horsch
- Department of Orthopedics, Heidelberg University Hospital, Heidelberg, Germany
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Ghandour M, Klotz M, Horsch A. Orthopedics and Trauma in Children: Key Problems and Future Insights. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10010119. [PMID: 36670669 PMCID: PMC9856766 DOI: 10.3390/children10010119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 01/08/2023]
Abstract
Orthopedic disorders among children are frequently encountered in clinical practice [...].
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Affiliation(s)
- Maher Ghandour
- Department of Orthopedics, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Matthias Klotz
- Orthopedics and Trauma Surgery, Marienkrankenhaus Soest, 59494 Soest, Germany
| | - Axel Horsch
- Department of Orthopedics, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Correspondence:
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Klaewkasikum K, Patathong T, Woratanarat P, Woratanarat T, Thadanipon K, Rattanasiri S, Thakkinstian A. Efficacy of conservative treatment for spastic cerebral palsy children with equinus gait: a systematic review and meta-analysis. J Orthop Surg Res 2022; 17:411. [PMID: 36076293 PMCID: PMC9461190 DOI: 10.1186/s13018-022-03301-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 08/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background Comparisons between various conservative managements of spastic equinus deformity in cerebral palsy demonstrated limited evidences, to evaluate the efficacy of conservative treatment among cerebral palsy children with spastic equinus foot regarding gait and ankle motion. Methods Studies were identified from PubMed and Scopus up to February 2022. Inclusion criteria were randomized controlled trial (RCT), conducted in spastic cerebral palsy children with equinus deformity, aged less than 18 years, compared any conservative treatments (Botulinum toxin A; BoNT-A, casting, physical therapy, and orthosis), and evaluated gait improvement (Physician Rating Scale or Video Gait Analysis), Observational Gait Scale, Clinical Gait Assessment Score, ankle dorsiflexion (ankle dorsiflexion at initial contact, and passive ankle dorsiflexion), or Gross Motor Function Measure. Any study with the participants who recently underwent surgery or received BoNT-A or insufficient data was excluded. Two authors were independently selected and extracted data. Risk of bias was assessed using a revised Cochrane risk-of-bias tool for randomized trials. I2 was performed to evaluate heterogeneity. Risk ratio (RR), the unstandardized mean difference (USMD), and the standardized mean difference were used to estimate treatment effects with 95% confidence interval (CI). Results From 20 included studies (716 children), 15 RCTs were eligible for meta-analysis (35% had low risk of bias). BoNT-A had higher number of gait improvements than placebo (RR 2.64, 95% CI 1.71, 4.07, I2 = 0). Its combination with physical therapy yielded better passive ankle dorsiflexion at knee extension than physical therapy alone (USMD = 4.16 degrees; 95% CI 1.54, 6.78, I2 = 36%). Casting with or without BoNT-A had no different gait improvement and ankle dorsiflexion at knee extension when compared to BoNT-A. Orthosis significantly increased ankle dorsiflexion at initial contact comparing to control (USMD 10.22 degrees, 95 CI% 5.13, 15.31, I2 = 87%). Conclusion BoNT-A and casting contribute to gait improvement and ankle dorsiflexion at knee extension. BoNT-A specifically provided gait improvement over the placebo and additive effect to physical therapy for passive ankle dorsiflexion. Orthosis would be useful for ankle dorsiflexion at initial contact. Trial registration PROSPERO number CRD42019146373. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-03301-3.
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Affiliation(s)
- Krongkaew Klaewkasikum
- Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Tanyaporn Patathong
- Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Patarawan Woratanarat
- Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
| | - Thira Woratanarat
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Kunlawat Thadanipon
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Sasivimol Rattanasiri
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
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Martinez-Lozano E, Beeram I, Yeritsyan D, Grinstaff MW, Snyder BD, Nazarian A, Rodriguez EK. Management of arthrofibrosis in neuromuscular disorders: a review. BMC Musculoskelet Disord 2022; 23:725. [PMID: 35906570 PMCID: PMC9336011 DOI: 10.1186/s12891-022-05677-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 07/20/2022] [Indexed: 11/20/2022] Open
Abstract
Arthrofibrosis, or rigid contracture of major articular joints, is a significant morbidity of many neurodegenerative disorders. The pathogenesis depends on the mechanism and severity of the precipitating neuromuscular disorder. Most neuromuscular disorders, whether spastic or hypotonic, culminate in decreased joint range of motion. Limited range of motion precipitates a cascade of pathophysiological changes in the muscle-tendon unit, the joint capsule, and the articular cartilage. Resulting joint contractures limit functional mobility, posing both physical and psychosocial burdens to patients, economic burdens on the healthcare system, and lost productivity to society. This article reviews the pathophysiology of arthrofibrosis in the setting of neuromuscular disorders. We describe current non-surgical and surgical interventions for treating arthrofibrosis of commonly affected joints. In addition, we preview several promising modalities under development to ameliorate arthrofibrosis non-surgically and discuss limitations in the field of arthrofibrosis secondary to neuromuscular disorders.
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Affiliation(s)
- Edith Martinez-Lozano
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA
| | - Indeevar Beeram
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA
| | - Diana Yeritsyan
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA
| | - Mark W Grinstaff
- Departments of Biomedical Engineering, Chemistry, and Medicine, Boston University, 330 Brookline Avenue, Stoneman 10, Boston, MA, 02215, USA
| | - Brian D Snyder
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA.,Department of Orthopaedic Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02215, USA
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA.,Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, 0025, Armenia
| | - Edward K Rodriguez
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA.
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Defining Equinus Foot in Cerebral Palsy. CHILDREN 2022; 9:children9070956. [PMID: 35883940 PMCID: PMC9320304 DOI: 10.3390/children9070956] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/18/2022] [Accepted: 06/22/2022] [Indexed: 11/26/2022]
Abstract
Background: Equinus foot is the deformity most frequently observed in patients with cerebral palsy (CP). While there is widespread agreement on the treatment of equinus foot, a clear clinical definition has been lacking. Therefore, we conducted this study to evaluate functional changes in gait analysis in relation to maximum possible dorsiflexion (0°, 5°, 10° and 15°) and in two subgroups of CP patients (unilateral and bilateral). Methods: In this retrospective study, CP patients with different degrees of clinically measured maximum dorsiflexion were included. We further subdivided patients into unilaterally and bilaterally affected individuals and also included a healthy control group. All participants underwent a 3D gait analysis. Our goal was to determine the degree of maximum clinical dorsiflexion where the functional changes in range of motion (ROM) and ankle moment and power during gait were most evident. Then, a subgroup analysis was performed according to the affected side. Results: In all, 71 and 84 limbs were analyzed in unilaterally and bilaterally affected subgroups. The clinically 0° dorsiflexion group barely reached a plantigrade position in the 3D gait analysis. Differences in ROM were observed between subgroups. Ankle moment was quite similar between different subgroups but to a lower extent in the unilateral group. All CP patients had reduced ankle power compared to controls. Conclusions: A cutoff value of clinical ≤ 5° dorsiflexion is the recommended value for defining a functionally relevant equinus foot in CP patients.
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ABDEL GHAFAR MA, ABDELRAOUF OR, ABDEL-AZIEM AA, SAMIR MOUSA G, SELIM AO, MOHAMED ME. Combination taping technique versus ankle foot orthosis on improving gait parameters in spastic cerebral palsy: A controlled randomized study. J Rehabil Med 2021; 53:jrm00240. [PMID: 34812472 PMCID: PMC8646843 DOI: 10.2340/jrm.v53.900] [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] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND One of the important goals in the treatment of spastic cerebral palsy is to maintain efficient and effective walking in order to be independent in activities and participate in society. OBJECTIVE To compare the efficacy of foot combination taping of kinesio tape and athletic tape vs ankle foot orthosis in correcting spatiotemporal gait parameters in children with spastic diplegia. METHODS Thirty-six children with spastic diplegia were randomly assigned into 3 groups; control, combination taping, and ankle foot orthosis groups. Children in the control group, in addition to those in both experimental groups, continued with conventional physical therapy, 1 h, 3 times per week for 4 weeks. Spatiotemporal gait parameters were assessed with the GAITRite system before and after the application of interventions. RESULTS Significant increases in walking velocity, step length, stride length, right single support duration, and left single support duration of the ankle foot orthosis and combination taping groups than pre-intervention values. [AQ9] Moreover, the post--intervention values of the double support duration of the ankle foot orthosis and combination taping groups were significantly lower than pre-intervention values. There were no significant differences between the post-intervention values of the ankle foot orthosis and combination taping groups for all parameters. CONCLUSION The results demonstrated that combination taping is an effective alternative technique to ankle foot orthosis to improve spatiotemporal parameters in children with spastic diplegic in combination with conventional physiotherapy.
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Affiliation(s)
| | - Osama R. ABDELRAOUF
- Physical Therapy Program, Batterjee Medical College, Jeddah, Saudi Arabia,Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Amr A. ABDEL-AZIEM
- Department of Physical Therapy, College of Applied Medical Sciences, Taif University
| | - Gihan SAMIR MOUSA
- Physical Therapy Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Saudi Arabia,Department of Physical Therapy for Cardiovacular/Respiratory Disorders and Geriatrics, Faculty of Physical Therapy, Cairo University, Egypt
| | - Ali O. SELIM
- Physical Therapy for Surgery Department, Faculty of Physical Therapy, Cairo University, Giza and
| | - Mariam E. MOHAMED
- Department of Physical Therapy for Cardiovacular/Respiratory Disorders and Geriatrics, Faculty of Physical Therapy, Cairo University, Egypt
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