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Jaatela J, Nurmi T, Vallinoja J, Mäenpää H, Sairanen V, Piitulainen H. Altered corpus callosum structure in adolescents with cerebral palsy: connection to gait and balance. Brain Struct Funct 2023; 228:1901-1915. [PMID: 37615759 PMCID: PMC10516810 DOI: 10.1007/s00429-023-02692-1] [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: 11/17/2022] [Accepted: 07/24/2023] [Indexed: 08/25/2023]
Abstract
Cerebral palsy (CP) is the most common motor disorder in childhood. Recent studies in children with CP have associated weakened sensorimotor performance with impairments in the major brain white-matter (WM) structure, corpus callosum (CC). However, the relationship between CC structure and lower extremity performance, specifically gait and balance, remains unknown. This study investigated the transcallosal WM structure and lower limb motor stability performance in adolescents aged 10-18 years with spastic hemiplegic (n = 18) or diplegic (n = 13) CP and in their age-matched controls (n = 34). The modern diffusion-weighted MRI analysis included the diffusivity properties of seven CC subparts and the transcallosal lower limb sensorimotor tract of the dominant hemisphere. Children with CP had comprehensive impairments in the cross-sectional area, fractional anisotropy, and mean diffusivity of the CC and sensorimotor tract. Additionally, the extent of WM alterations varied between hemiplegic and diplegic subgroups, which was seen especially in the fractional anisotropy values along the sensorimotor tract. The diffusion properties of transcallosal WM were further associated with static stability in all groups, and with dynamic stability in healthy controls. Our novel results clarify the mechanistic role of the corpus callosum in adolescents with and without CP offering valuable insight into the complex interplay between the brain's WM organization and motor performance. A better understanding of the brain basis of weakened stability performance could, in addition, improve the specificity of clinical diagnosis and targeted rehabilitation in CP.
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Affiliation(s)
- Julia Jaatela
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, 02150, Espoo, Finland.
| | - Timo Nurmi
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, 02150, Espoo, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40014, Jyväskylä, Finland
| | - Jaakko Vallinoja
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, 02150, Espoo, Finland
| | - Helena Mäenpää
- Department of Neurology, New Children's Hospital, Helsinki University Central Hospital, 00029, Helsinki, Finland
| | - Viljami Sairanen
- Department of Clinical Neurophysiology, BABA Center, Pediatric Research Center, Children's Hospital and HUS Imaging, Helsinki University Central Hospital, 00029, Helsinki, Finland
- Department of Radiology, Kanta-Häme Central Hospital, 13530, Hämeenlinna, Finland
| | - Harri Piitulainen
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, 02150, Espoo, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40014, Jyväskylä, Finland
- Department of Neurology, New Children's Hospital, Helsinki University Central Hospital, 00029, Helsinki, Finland
- Aalto NeuroImaging, Aalto University, 02150, Espoo, Finland
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Choi JY, Ha SW, Jeong DE, Lee J, Kim D, Min JY, Min KB. Association Between the Loss of Gait Harmony and Cognitive Impairment: Cross-Sectional Study. JMIR Public Health Surveill 2023; 9:e46264. [PMID: 37428538 PMCID: PMC10366667 DOI: 10.2196/46264] [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: 02/04/2023] [Revised: 03/20/2023] [Accepted: 06/15/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Functional limitations and disabilities have been associated with a decrease in cognitive function due to increasing age. Gait performance and cognitive function have been associated with gait variability in executive function, the phase domain in memory, and gait abnormalities in cognitive decline. OBJECTIVE Our study aimed to investigate whether gait harmony was associated with cognitive function in the older adult population. Moreover, we aimed to investigate whether gait harmony was associated with cognitive function and explore each cognitive function in a specific harmonic state. METHODS The study population included 510 adults aged ≥60 years who visited the Department of Neurology at the Veterans Health Service Medical Center, Seoul, South Korea. Gait data were collected using a 3D motion capture device with a wireless inertial measurement unit system. For cognitive function assessments, we used the Seoul Neuropsychological Screening Battery-Core test, which evaluates the level of cognitive function or impairment in 5 cognitive domains. RESULTS In general, the association between the Seoul Neuropsychological Screening Battery-Core tests and the stance-to-swing ratio in the >1.63 ratio group yielded lower β coefficients than those in the 1.50-1.63 ratio group. After adjustment for confounders, the odds ratio (OR) for the Digit Symbol Coding test (adjusted OR 0.42, 95% CI 0.20-0.88) and the Korean version of the Color Word Stroop Test: 60 seconds (adjusted OR 0.51, 95% CI 0.29-0.89) for frontal and executive function were significantly lower for the >1.63 ratio group than the reference group. CONCLUSIONS Our findings suggest that the gait phase ratio is a valuable indicator of walking deficits and may also be associated with cognitive impairment in older adults.
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Affiliation(s)
- Ju-Young Choi
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Sang-Won Ha
- Department of Neurology, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Da-Eun Jeong
- Department of Neurology, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Jaeho Lee
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
- Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, Republic of Korea
| | - Donghoon Kim
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
- Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, Republic of Korea
| | - Jin-Young Min
- Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Kyoung-Bok Min
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
- Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, Republic of Korea
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Republic of Korea
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Zhang SY, Jeffers MS, Lagace DC, Kirton A, Silasi G. Developmental and Interventional Plasticity of Motor Maps after Perinatal Stroke. J Neurosci 2021; 41:6157-6172. [PMID: 34083257 PMCID: PMC8276736 DOI: 10.1523/jneurosci.3185-20.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/14/2021] [Accepted: 05/20/2021] [Indexed: 02/07/2023] Open
Abstract
Within the perinatal stroke field, there is a need to establish preclinical models where putative biomarkers for motor function can be examined. In a mouse model of perinatal stroke, we evaluated motor map size and movement latency following optogenetic cortical stimulation against three factors of post-stroke biomarker utility: (1) correlation to chronic impairment on a behavioral test battery; (2) amenability to change using a skilled motor training paradigm; and (3) ability to distinguish individuals with potential to respond well to training. Thy1-ChR2-YFP mice received a photothrombotic stroke at postnatal day 7 and were evaluated on a battery of motor tests between days 59 and 70. Following a cranial window implant, mice underwent longitudinal optogenetic motor mapping both before and after 3 weeks of skilled forelimb training. Map size and movement latency of both hemispheres were positively correlated with impaired spontaneous forelimb use, whereas only ipsilesional hemisphere map size was correlated with performance in skilled reaching. Map size and movement latency did not show groupwise changes with training; however, mice with the smallest pretraining map sizes and worst impairments demonstrated the greatest expansion of map size in response to skilled forelimb training. Overall, motor map size showed utility as a potential biomarker for impairment and training-induced modulation in specific individuals. Future assessment of the predictive capacity of post-stroke motor representations for behavioral outcome in animal models opens the possibility of dissecting how plasticity mechanisms contribute to recovery following perinatal stroke.SIGNIFICANCE STATEMENT We investigated the utility of two cortical motor representation measures (motor map size and movement onset latency) as potential biomarkers for post-stroke motor recovery in a mouse model of perinatal stroke. Both motor map size and movement latency were associated with functional recovery after perinatal stroke, with map size showing an additional association between training responsiveness and severity of impairment. Overall, both motor map size and movement onset latency show potential as neurophysiological correlates of recovery. As such, future studies of perinatal stroke rehabilitation and neuromodulation should include these measures to help explain neurophysiological changes that might be occurring in response to treatment.
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Affiliation(s)
- Sarah Y Zhang
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada K1H 8M5
| | - Matthew S Jeffers
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada K1H 8M5
| | - Diane C Lagace
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada K1H 8M5
- Ottawa Hospital Research Institute, Neuroscience Program, Ottawa, Ontario, Canada K1H 8L6
- Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada K1H 8M5
| | - Adam Kirton
- Alberta Children's Hospital, Calgary Pediatric Stroke Program, Calgary, Alberta, Canada K1H 8M5
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada T2N 1N4
- Hotchkiss Brain Institute, Calgary, Alberta, Canada T2N 4N1
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada T2N 4N1
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada T2N 4N1
| | - Gergely Silasi
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada K1H 8M5
- Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada K1H 8M5
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Joanna M, Magdalena S, Katarzyna BM, Daniel S, Ewa LD. The Utility of Gait Deviation Index (GDI) and Gait Variability Index (GVI) in Detecting Gait Changes in Spastic Hemiplegic Cerebral Palsy Children Using Ankle-Foot Orthoses (AFO). CHILDREN (BASEL, SWITZERLAND) 2020; 7:children7100149. [PMID: 32992683 PMCID: PMC7600809 DOI: 10.3390/children7100149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/03/2022]
Abstract
Background: Cerebral palsy (CP) children present complex and heterogeneous motor disorders that cause gait deviations. Clinical gait analysis (CGA) is used to identify, understand and support the management of gait deviations in CP. Children with CP often use ankle–foot orthosis (AFO) to facilitate and optimize their walking ability. The aim of this study was to assess whether the gait deviation index (GDI) and the gait variability index (GVI) results can reflect the changes of spatio-temporal and kinematic gait parameters in spastic hemiplegic CP children wearing AFO. Method: The study group consisted of 37 CP children with hemiparesis. All had undergone a comprehensive, instrumented gait analysis while walking, both barefoot and with their AFO, during the same CGA session. Kinematic and spatio-temporal data were collected and GVI and GDI gait indexes were calculated. Results: Significant differences were found between the barefoot condition and the AFO conditions for selected spatio-temporal and kinematic gait parameters. Changes in GVI and GDI were also statistically significant. Conclusions: The use of AFO in hemiplegic CP children caused a statistically significant improvement in spatio-temporal and kinematic gait parameters. It was found that these changes were also reflected by GVI and GDI. These findings might suggest that gait indices, such as GDI and GVI, as clinical outcome measures, may reflect the effects of specific therapeutic interventions in CP children.
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Guzik A, Drużbicki M, Kwolek A, Przysada G, Bazarnik-Mucha K, Szczepanik M, Wolan-Nieroda A, Sobolewski M. The paediatric version of Wisconsin gait scale, adaptation for children with hemiplegic cerebral palsy: a prospective observational study. BMC Pediatr 2018; 18:301. [PMID: 30219044 PMCID: PMC6139123 DOI: 10.1186/s12887-018-1273-x] [Citation(s) in RCA: 6] [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: 11/04/2017] [Accepted: 08/31/2018] [Indexed: 11/24/2022] Open
Abstract
Background In clinical practice there is a need for a specific scale enabling detailed and multifactorial assessment of gait in children with spastic hemiplegic cerebral palsy. The practical value of the present study is linked with the attempts to find a new, affordable, easy-to-use tool for gait assessment in children with spastic hemiplegic cerebral palsy. The objective of the study is to evaluate the Wisconsin Gait Scale (WGS) in terms of its inter- and intra-rater reliability in observational assessment of walking in children with hemiplegic cerebral palsy. Methods The study was conducted in a group of 34 patients with hemiplegic cerebral palsy. At the first stage, the original version of the ordinal WGS was used. The WGS, consisting of four subscales, evaluates fourteen gait parameters which can be observed during consecutive gait phases. At the second stage, a modification was introduced in the kinematics description of the knee and weight shift, in relation to the original scale. The same video recordings were rescored using the new, paediatric version of the WGS. Three independent examiners performed the assessment twice. Inter and intra-observer reliability of the modified WGS were determined. Results The findings show very high inter- and intra-observer reliability of the modified WGS. This was reflected by a lack of systematically oriented differences between the repeated measurements, very high value of Spearman’s rank correlation coefficient 0.9 ≤ |R| < 1, very high value of ICC > 0.9, and low value of CV < 2.5% for the specific physical therapists. Conclusions The new, ordinal, paediatric version of WGS, proposed by the authors, seems to be useful as an additional tool that can be used in qualitative observational gait assessment of children with spastic hemiplegic cerebral palsy. Practical dimension of the study lies in the fact that it proposes a simple, easy-to-use tool for a global gait assessment in children with spastic hemiplegic cerebral palsy. However, further research is needed to validate the modified WGS by comparing it to other observational scales and objective 3-dimensional spatiotemporal and kinematic gait parameters. Trial registration anzctr.org.au, ID: ACTRN12617000436370. Registered 24 March 2017.
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Affiliation(s)
- Agnieszka Guzik
- Institute of Physiotherapy, University of Rzeszów, Warszawska 26 a, 35-205, Rzeszów, Poland.
| | - Mariusz Drużbicki
- Institute of Physiotherapy, University of Rzeszów, Warszawska 26 a, 35-205, Rzeszów, Poland
| | - Andrzej Kwolek
- Institute of Physiotherapy, University of Rzeszów, Warszawska 26 a, 35-205, Rzeszów, Poland
| | - Grzegorz Przysada
- Institute of Physiotherapy, University of Rzeszów, Warszawska 26 a, 35-205, Rzeszów, Poland
| | | | - Magdalena Szczepanik
- Institute of Physiotherapy, University of Rzeszów, Warszawska 26 a, 35-205, Rzeszów, Poland
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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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The golden ratio of gait harmony: repetitive proportions of repetitive gait phases. BIOMED RESEARCH INTERNATIONAL 2013; 2013:918642. [PMID: 23862161 PMCID: PMC3687768 DOI: 10.1155/2013/918642] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 05/16/2013] [Accepted: 05/19/2013] [Indexed: 11/18/2022]
Abstract
In nature, many physical and biological systems have structures showing harmonic properties. Some of them were found related to the irrational number φ known as the golden ratio that has important symmetric and harmonic properties. In this study, the spatiotemporal gait parameters of 25 healthy subjects were analyzed using a stereophotogrammetric system with 25 retroreflective markers located on their skin. The proportions of gait phases were compared with φ, the value of which is about 1.6180. The ratio between the entire gait cycle and stance phase resulted in 1.620 ± 0.058, that between stance and the swing phase was 1.629 ± 0.173, and that between swing and the double support phase was 1.684 ± 0.357. All these ratios did not differ significantly from each other (F = 0.870, P = 0.422, repeated measure analysis of variance) or from φ (P = 0.670, 0.820, 0.422, resp., t-tests). The repetitive gait phases of physiological walking were found in turn in repetitive proportions with each other, revealing an intrinsic harmonic structure. Harmony could be the key for facilitating the control of repetitive walking. Harmony is a powerful unifying factor between seemingly disparate fields of nature, including human gait.
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