1
|
Eriksson M, Bartonek Å. Orthosis use and ambulation in adults with myelomeningocele after orthotic management from childhood. Prosthet Orthot Int 2024; 48:196-203. [PMID: 37725508 PMCID: PMC11005670 DOI: 10.1097/pxr.0000000000000279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/08/2023] [Accepted: 07/20/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Orthotic devices are required for walking in many individuals with myelomeningocele. Evidence concerning orthosis use is sparse, partly because of heterogeneity among groups and different definitions of the neurological level. OBJECTIVES The objective of this study was to investigate ambulation regarding orthosis use and satisfaction with orthoses after intense orthotic management during childhood. STUDY DESIGN The study design is a retrospective follow-up with a cross-sectional study at adult age. METHODS Participants comprised 59 persons born in 1985 or later. Ambulation was categorized as community (Ca), household (Ha), nonfunctional (N-f), and nonambulation (N-a) groups. Orthosis use was registered at approximately 5 (Age5) and 12 (Age12) years of age and in adulthood (AdultAge). Satisfaction with orthoses was evaluated at AdultAge. RESULTS At Age5, Age12, and AdultAge, orthoses were used by 100%, 98%, and 78% of participants, respectively. Ambulation deteriorated between Age5 and Age12 in 17% of participants and between Age12 and AdultAge in 46%. At AdultAge, 63% maintained their ambulatory function; and muscle function and hip and knee flexion contractures were strongly correlated with ambulation. The ambulation groups did not differ regarding satisfaction with device or services, except in 2 single items where the Ha group differed in ratings from the N-f and N-a groups. CONCLUSION The high frequency of orthosis use and similar satisfaction in all ambulation groups emphasize that early planning and follow-up of orthosis treatment during growth are important for mobility in adulthood. Our results also underline the importance of a close assessment of each individual's condition.
Collapse
Affiliation(s)
- Marie Eriksson
- Division of Paediatric Neurology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Åsa Bartonek
- Division of Paediatric Neurology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
2
|
Lidbeck C, Bartonek Å, Ferrari A, Alboresi S, Örtqvist M. Signs of perceptual disorder during movement were reliably assessed in children with cerebral palsy in Sweden. Acta Paediatr 2024; 113:344-352. [PMID: 37874018 DOI: 10.1111/apa.17012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 10/03/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023]
Abstract
AIM The aim of this Swedish study was to evaluate the assessment of clinical signs of perceptual disorder in children with cerebral palsy (CP). METHODS Three experienced raters assessed 56 videos of 19 children from 1 to 18 years of age with bilateral spastic CP, which were recorded by colleagues at an Italian hospital. Six signs were evaluated for inter-rater reliability and criterion validity. Clinical applicability was evaluated by assessing inter-rater reliability between 47 Swedish clinicians, who examined 15 of the videos during face-to-face and online education seminars. There were 41 physiotherapists, two occupational therapists and four doctors, with 1-37 years of clinical experience and a median of 10 years. RESULTS The experienced raters demonstrated moderate to almost perfect inter-rater reliability (kappa 0.54-0.81) and criterion validity (0.54-0.87) for startle reaction, upper limbs in startle position, averted eye gaze and eye blinking. The clinicians recognised these signs with at least moderate reliability (0.56-0.88). Grimacing and posture freezing were less reliable (0.22-0.35) and valid (0.09-0.50). CONCLUSION Four of the six signs of perceptual disorder were reliably recognised by experienced raters and by clinicians after education seminars. Extended education and larger study samples are needed to recognise all the signs.
Collapse
Affiliation(s)
- Cecilia Lidbeck
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Åsa Bartonek
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Adriano Ferrari
- Department of Neuroscience, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Alboresi
- Children Rehabilitation Unit of S. M. Nuova Hospital, AUSL-IRCCS, Reggio Emilia, Italy
| | - Maria Örtqvist
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
3
|
Bartonek Å, Lidbeck C. Knee Flexion While Walking Exceeds Knee Flexion Contracture in Children with Spastic Cerebral Palsy. Children (Basel) 2023; 10:1867. [PMID: 38136069 PMCID: PMC10741394 DOI: 10.3390/children10121867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/17/2023] [Accepted: 11/26/2023] [Indexed: 12/24/2023]
Abstract
Flexed knee gait is commonly related to contractures in children with cerebral palsy (CP). Therefore, knee position while walking was compared with passive knee extension and explored with respect to functional mobility. Gait was assessed with 3D motion analysis in 30 children with bilateral spastic CP, Gross Motor Function Classification System (GMFCS) levels I-III, and in 22 typically developing (TD) children. Knee angle at initial contact (KneeAngleIC) was greater than knee flexion in stance (MinKneeFlexSt) in all groups. MinKneeFlexSt exceeded knee contractures at GMFCS levels II and III. Both KneeAngleIC and MinKneeFlexSt were greater at GMFCS II and III than at GMFCS I and the TD group. The excessive knee flexion while walking at GMFCS II and III could not be explained by knee joint contractures. Functional mobility measured with the timed-up-and-go test took longer in children at GMFCS level III compared to the other groups, assumed to be explained by the energy-requiring flexed knee gait and spatial insecurity. Discriminating between passive knee extension at the physical assessment and maximum knee extension while weight bearing may contribute to further understanding of flexed knee gait and its causes in ambulating children with spastic bilateral CP.
Collapse
Affiliation(s)
- Åsa Bartonek
- Division of Paediatric Neurology, Department of Women’s and Children’s Health, Karolinska Institutet, SE-17176 Stockholm, Sweden;
| | - Cecilia Lidbeck
- Division of Paediatric Neurology, Department of Women’s and Children’s Health, Karolinska Institutet, SE-17176 Stockholm, Sweden;
- Motion Analysis Laboratory, Karolinska University Hospital, QA:27, Karolinska vägen 37A, SE-17176 Stockholm, Sweden
| |
Collapse
|
4
|
Bartonek Å, Eriksson M. Physical function and activity, pain, and health status in adults with myelomeningocele after orthotic management from childhood: a descriptive study. BMC Musculoskelet Disord 2023; 24:545. [PMID: 37400860 DOI: 10.1186/s12891-023-06673-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/28/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Individuals with myelomeningocele (MMC) exhibit neurological deficits below the lesion level involving both motor and sensory functions. Ambulation and functional outcomes in patients offered orthotic management since childhood were investigated. METHODS Physical function, physical activity, pain, and health status were assessed in a descriptive study. RESULTS Of 59 adults with MMC, aged 18-33 years, 12 were in the community ambulation (Ca), 19 in the household ambulation (Ha), six in the non-functional (N-f), and 22 in the non-ambulation (N-a) groups. Orthoses were used by 78% (n = 46), i.e., by 10/12 in the Ca, 17/19 in the Ha, 6/6 in the N-f, and 13/22 in the N-a groups. In the ten-metre walking test, the non-orthosis group (NO) walked faster than those wearing ankle-foot orthoses (AFOs) or free-articulated knee-ankle-foot orthoses (KAFO-Fs), the Ca group faster than the Ha and N-f groups, and the Ha group faster than the N-f group. In the six-minute walking test, the Ca group walked farther than the Ha group. In the five times sit-to-stand test, the AFO and KAFO-F groups required longer than the NO group, and the KAFO-F group longer than the foot orthosis (FO) group. Lower extremity function with orthoses was higher in the FO than the AFO and KAFO-F groups, higher in the KAFO-F than the AFO group, and higher in the AFO group than in those using trunk-hip-knee-ankle-foot orthoses. Functional independence increased with ambulatory function. Time spent in physical recreation was higher in the Ha than the Ca and N-a groups. There were no differences between the ambulation groups in rated pain or reported health status. CONCLUSION The physical function results in persons with MMC improve our understanding of this population's heterogeneity and shed light on the importance of individualized orthotic management. The similarities between the various ambulatory levels in physical activity, pain, and health status may mirror opportunities to achieve equal results regardless of disability level. A clinical implication of the study is that orthotic management is likely to be beneficial for the patient with MMC of which the majority used their orthoses for most time of the day.
Collapse
Affiliation(s)
- Åsa Bartonek
- Division of Paediatric Neurology, Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Motoriklab QA: 27, Karolinska vägen 37 A, S-17176, Stockholm, Sweden.
| | - Marie Eriksson
- Division of Paediatric Neurology, Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Motoriklab QA: 27, Karolinska vägen 37 A, S-17176, Stockholm, Sweden
| |
Collapse
|
5
|
Ericson A, Bartonek Å, Tedroff K, Lidbeck C. Responses to Sensory Events in Daily Life in Children with Cerebral Palsy from a Parent Reported Perspective and in a Swedish Context. Children (Basel) 2023; 10:1139. [PMID: 37508634 PMCID: PMC10378633 DOI: 10.3390/children10071139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/22/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023]
Abstract
The motor disorders of cerebral palsy (CP) are often accompanied by sensory disturbances, but knowledge of their relationship to motor functioning is sparse. This study explored responses to sensory events in relation to spastic subtype and motor functioning in children with CP. Parents of 60 children with CP (unilateral: 18, bilateral: 42) with GMFCS levels I:29, II:13, III:15 and IV:3 of mean age 12.3 years (3.7 SD) participated. The parents (n = 55) rated their children´s responses with the norm-referenced questionnaire Child Sensory Profile-2© (CSP-2©), Swedish version, incorporating nine sections and four sensory processing patterns/quadrants, and replied (n = 57) to two additional questions. On the CSP-2©, thirty (55%) of the children were reported to have responses "much more than others" (>2 SD) in one or more of the sections and/or quadrants and 22 (40%) in the section of Body Position, overrepresented by the children with bilateral CP. The additional questions revealed that a greater proportion of children at GMFCS levels III-IV compared to level I frequently were requested to sit/stand up straight (14/17 versus 6/26, p < 0.001) and were sound sensitive at a younger age (14/17 versus 10/26, p = 0.005). The findings of this study highlight the sensory aspects of motor functioning in children with spastic CP.
Collapse
Affiliation(s)
- Annika Ericson
- Department of Women's and Children´s Health, Karolinska Institutet, S-171 76 Stockholm, Sweden
- Neuropediatric Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, S-171 76 Stockholm, Sweden
| | - Åsa Bartonek
- Department of Women's and Children´s Health, Karolinska Institutet, S-171 76 Stockholm, Sweden
| | - Kristina Tedroff
- Department of Women's and Children´s Health, Karolinska Institutet, S-171 76 Stockholm, Sweden
- Neuropediatric Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, S-171 76 Stockholm, Sweden
| | - Cecilia Lidbeck
- Department of Women's and Children´s Health, Karolinska Institutet, S-171 76 Stockholm, Sweden
- Neuropediatric Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, S-171 76 Stockholm, Sweden
| |
Collapse
|
6
|
Bartonek Å, Eriksson M, Ericson A, Reimeringer M, Lidbeck C. Evaluation of Knee Position Sense in Children with Motor Disabilities and Children with Typical Development: A Cross-Sectional Study. Children (Basel) 2023; 10:1056. [PMID: 37371287 DOI: 10.3390/children10061056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND In children with motor disabilities, knee position during walking is often of concern in rehabilitation. This study aimed to investigate knee joint position sense. Thirty-seven children with Cerebral Palsy (CP), 21 with Myelomeningocele (MMC), 19 with Arthrogryposis (AMC), and 42 TD children participated in the study. Knee joint position sense, i.e., the difference between the criterion angle and the reproduced angle (JPS-error), was assessed in sitting while 3D motion capture was recorded at flexed knee 70 (Knee70), 45 (Knee45), and 20 (Knee20) degrees, and after three seconds at maintained criterion angle (CAM) and maintained reproduced angle (RAM). No differences were found between the groups in JPS-error, CAM, and RAM. At Knee70, CAM differed between the right and left legs in the TD group (p = 0.014) and RAM in the MMC group (p = 0.021). In the CP group, CAM was greater than RAM at Knee70 in the left leg (p = 0.002), at Knee45 in both legs (p = 0.004, p = 0.025), and at Knee20 in the right leg (p = 0.038). Difficulties in maintaining the knee position at CAM in the CP group sheds light on the need for complementary judgments of limb proprioception in space to explore the potential influence on knee position during walking.
Collapse
Affiliation(s)
- Åsa Bartonek
- Division of Paediatric Neurology, Department of Women's and Children's Health, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Marie Eriksson
- Division of Paediatric Neurology, Department of Women's and Children's Health, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Annika Ericson
- Division of Paediatric Neurology, Department of Women's and Children's Health, Karolinska Institutet, 17176 Stockholm, Sweden
- Motor Control Laboratory QA:27, Astrid Lindgren's Children's Hospital, Karolinska University Hospital, Karolinska Vägen 37A, 17176 Stockholm, Sweden
| | - Mikael Reimeringer
- Division of Paediatric Neurology, Department of Women's and Children's Health, Karolinska Institutet, 17176 Stockholm, Sweden
- Motor Control Laboratory QA:27, Astrid Lindgren's Children's Hospital, Karolinska University Hospital, Karolinska Vägen 37A, 17176 Stockholm, Sweden
| | - Cecilia Lidbeck
- Division of Paediatric Neurology, Department of Women's and Children's Health, Karolinska Institutet, 17176 Stockholm, Sweden
- Motor Control Laboratory QA:27, Astrid Lindgren's Children's Hospital, Karolinska University Hospital, Karolinska Vägen 37A, 17176 Stockholm, Sweden
| |
Collapse
|
7
|
Faedda N, Piccardi L, Boccia M, Bartonek Å, Guariglia C. Editorial: Spatial Navigation and Neurodevelopmental Disorders. Front Psychiatry 2022; 13:875868. [PMID: 35401277 PMCID: PMC8987567 DOI: 10.3389/fpsyt.2022.875868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/25/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Noemi Faedda
- Department of Human Neuroscience, Section of Child and Adolescents Neuropsychiatry, Sapienza University of Rome, Rome, Italy
| | - Laura Piccardi
- Department of Psychology, University Sapienza of Rome, Rome, Italy.,Cognitive and Motor Rehabilitation and Neuroimaging Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Santa Lucia, Rome, Italy
| | - Maddalena Boccia
- Department of Psychology, University Sapienza of Rome, Rome, Italy.,Cognitive and Motor Rehabilitation and Neuroimaging Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Santa Lucia, Rome, Italy
| | - Åsa Bartonek
- Neuropaediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Guariglia
- Department of Psychology, University Sapienza of Rome, Rome, Italy.,Cognitive and Motor Rehabilitation and Neuroimaging Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Santa Lucia, Rome, Italy
| |
Collapse
|
8
|
Abstract
BACKGROUND Among children with cerebral palsy (CP) some choose to be mobile by crawling or walking on their knees despite some bipedal walking ability. This motor behaviour raises questions and we wanted to enhance understanding of the child's choice of mobility. AIM To explore gross motor abilities in positions with various postural demands focusing on floor mobility among children with CP. DESIGN A cross-sectional observational study was performed at the neuropediatric outpatient department at Karolinska University Hospital. POPULATION Thirty-six children with bilateral CP, median age 11.2 years, functioning at Gross Motor Function Classification System (GMFCS) level I-IV. METHODS Motor skills using the Gross Motor Function Measure (GMFM-88), and lower leg muscles strength in hip flexors, knee extensors, ankle dorsiflexors and plantarflexors with a hand-held dynamometer were assessed. A Kruskal-Wallis Test with post hoc Bonferroni corrections were used to compare GMFM percentage (%) scores and muscle strength between the GMFCS levels. RESULTS GMFM-88 (%) scores in Walking (E) and Standing (D) dimensions were significantly higher at GMFCS levels I and II, compared to levels III and IV. In Crawling & Kneeling (C) level I achieved higher score than levels III and IV, and in Sitting (B) than level IV. Muscle strength values in the plantarflexors were significantly higher at GMFCS level I compared to level II. CONCLUSIONS As expected the children at GMFCS III performed less than those at GMFCS II at high postural demands in GMFM dimensions including standing and walking. Identical GMFM-scores in dimension C confirm similar motor function in items including kneeling and knee walking. Since lower limb muscle strength was similar, the difference in postural behaviour between the groups at high level motor activities may be associated with sensorimotor disturbances along with the children's motor disorder. CLINICAL REHABILITATION IMPACT The GMFM-88, in particular dimension C, including kneeling and walking items can be used as an identification of preference of floor mobility in children with CP. Awareness and understanding of how postural positions affect movement is of importance for prognosis, and physiotherapy.
Collapse
Affiliation(s)
- Cecilia Lidbeck
- Neuropediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden -
| | - Åsa Bartonek
- Neuropediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
9
|
Eriksson M, Bartonek Å, Villard L, Kroksmark AK, Jylli L. Health-related quality of life and satisfaction with orthoses in an ambulatory group of children with arthrogryposis. Gait Posture 2021; 83:306. [PMID: 33518361 DOI: 10.1016/j.gaitpost.2016.07.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
| | | | - Li Villard
- Karolinska Institutet, Stockholm, Sweden
| | | | | |
Collapse
|
10
|
Bartonek Å, Guariglia C, Piccardi L. Locomotion and Topographical Working Memory in Children With Myelomeningocele and Arthrogryposis Multiplex Congenita. Front Psychiatry 2021; 12:729859. [PMID: 34867521 PMCID: PMC8632943 DOI: 10.3389/fpsyt.2021.729859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background: In children with myelomeningocele (MMC) and arthrogryposis multiplex congenital (AMC), adequate rehabilitation measures are accessible with the goal of attaining the utmost motor development. However, there is a lack of knowledge as to how children develop navigation utilizing their locomotion abilities. The aim of the present study was to explore topographic working memory in children with MMC and AMC. Methods: For this purpose, we assessed 41 children with MMC and AMC, assigned an ambulation group, and 120 typical developing (TD) children, with mean ages of 11.9, 10.6, and 9.9 years, respectively. All groups performed a topographic working memory test while moving in a walking space and a visuospatial working memory test in a reaching space. Children with MMC and AMC also performed a test to measure their ability to reason on visuospatial material, Raven's Coloured Progressive Matrices. Results: The topographic working memory span was shorter in the MMC group than in the TD group. In general, all ambulation groups had a shorter topographic working memory span than the TD group. The visuospatial working memory span was shorter in the non-ambulation group than in the TD group. Scores from the visuospatial reasoning test were lower in the non-ambulation group than in the community ambulation group. Conclusions: Even though a higher cognitive score was found in the community ambulation group than in the non-ambulation group, topographic working memory was affected similarly in both groups. Including children who develop community ambulation in therapy programs containing aspects of navigation may gain even children with low levels of MMC and AMC. These results evidenced the importance of motor development and navigational experience gained through direct exploration of the environment on topographic memory.
Collapse
Affiliation(s)
- Åsa Bartonek
- Neuropaediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Guariglia
- Department of Psychology, University Sapienza of Rome, Rome, Italy.,Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Laura Piccardi
- Department of Psychology, University Sapienza of Rome, Rome, Italy.,Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| |
Collapse
|
11
|
Bartonek Å, Guariglia C, Piccardi L. Topographical working memory in children and adolescents with motor disabilities. Cogent Psychology 2020. [DOI: 10.1080/23311908.2020.1757855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Åsa Bartonek
- Neuropediatric Unit, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Guariglia
- Department of Psychology, Sapienza Universityof Rome, Rome, Italy
- Cognitive and Motor Rehabilitation and Neuropsychology Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Laura Piccardi
- Department of Psychology, Sapienza Universityof Rome, Rome, Italy
- Cognitive and Motor Rehabilitation and Neuropsychology Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| |
Collapse
|
12
|
Abstract
Forty children with cerebral palsy (CP) and 120 typical developing children (TD) performed a topographic working memory (WalCT) test requiring to move their body in a walked vista-space and a visuo-spatial test (CBT) requiring just reaching movements. WalCT score was significantly higher in GMFCS II/III than in TD. CBT score was significantly lower in GMFCS I than in III/IV but lower than TD in all CP groups. Similar results in WalCT between GMFCS I and TD and GMFCS II and III/IV respectively indicate that mobility is associated with topographic working memory. Differently in CBT, the absence of bodily movement allows using different cognitive strategies. Children should be provided with opportunities and active participation to enhancing spatial awareness and navigational skills.
Collapse
Affiliation(s)
- Åsa Bartonek
- Neuropediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm Sweden
| | - Laura Piccardi
- Department of Psychology, Sapienza University of Rome, Italy and Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Fondazione Santa Lucia, Rome Italy
| | - Cecilia Guariglia
- Department of Psychology, Sapienza University of Rome, Italy and Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Fondazione Santa Lucia, Rome Italy
| |
Collapse
|
13
|
Abstract
BACKGROUND Joint contractures are the main characteristics for children with arthrogryposis multiplex congenita. Orthoses are often used to enable or facilitate walking. OBJECTIVES To describe health-related quality of life in children with arthrogryposis multiplex congenita and satisfaction with orthoses in those using orthoses. STUDY DESIGN Cross-sectional study. METHODS A total of 33 children with arthrogryposis multiplex congenita participated in the study. Questionnaires were used which measured health-related quality of life (Child Health Questionnaire-Parent Form and EQ-5D youth), mobility and self-care (Paediatric Evaluation of Disability Inventory) and satisfaction with orthoses (Quebec User Evaluation of Satisfaction with Assistive Technology 2.0). Children were divided into groups based on the use of orthoses: Ort-D were dependent on orthoses for walking, Ort-ND used orthoses but were not dependent on them for walking and Non-Ort did not use orthoses. RESULTS Children with arthrogryposis multiplex congenita had significantly lower Child Health Questionnaire scores in 9 of 12 subscales compared to healthy controls. The children's reported perceived health with EQ-5D youth did not show any difference between children using orthoses or children using only shoes. Paediatric Evaluation of Disability Inventory showed less mobility in Ort-D than in Non-Ort. In total, both orthosis groups were 'quite satisfied' with their orthoses. CONCLUSION Child Health Questionnaire-physical functioning was lowest in children who were dependent on orthoses (Ort-D) for walking. Both Ort-D and Ort-ND were similar satisfied with their orthoses. Clinical relevance This study contributes to knowledge about health-related quality of life in a group of ambulatory children with arthrogryposis multiplex congenita. For children using orthoses, it is relevant to capture their opinion about their orthoses but a questionnaire specifically for children should be developed.
Collapse
Affiliation(s)
| | | | - Li Villard
- 1 Karolinska Institutet, Stockholm, Sweden
| | | | | |
Collapse
|
14
|
Lidbeck C, Bartonek Å, Yadav P, Tedroff K, Åstrand P, Hellgren K, Gutierrez-Farewik EM. The role of visual stimuli on standing posture in children with bilateral cerebral palsy. BMC Neurol 2016; 16:151. [PMID: 27557808 PMCID: PMC4997695 DOI: 10.1186/s12883-016-0676-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 08/17/2016] [Indexed: 11/15/2022] Open
Abstract
Background In children with bilateral cerebral palsy (CP) maintaining a standing position can be difficult. The fundamental motor task of standing independently is achieved by an interaction between the visual, somatosensory, and vestibular systems. In CP, the motor disorders are commonly accompanied by sensory and perceptual disturbances. Our aims were to examine the influence of visual stimuli on standing posture in relation to standing ability. Methods Three dimensional motion analysis with surface electromyography was recorded to describe body position, body movement, and muscle activity during three standing tasks: in a self-selected position, while blindfolded, and during an attention-demanding task. Participants were twenty-seven typically-developing (TD) children and 36 children with bilateral CP, of which 17 required support for standing (CP-SwS) and 19 stood without support (CP-SwoS). Results All children with CP stood with a more flexed body position than the TD children, even more pronounced in the children in CP-SwS. While blindfolded, the CP-SwS group further flexed their hips and knees, and increased muscle activity in knee extensors. In contrast, the children in CP-SwoS maintained the same body position but increased calf muscle activity. During the attention-demanding task, the children in CP-SwoS stood with more still head and knee positions and with less muscle activity. Conclusions Visual input was important for children with CP to maintain a standing position. Without visual input the children who required support dropped into a further crouched position. The somatosensory and vestibular systems alone could not provide enough information about the body position in space without visual cues as a reference frame. In the children who stood without support, an intensified visual stimulus enhanced the ability to maintain a quiet standing position. It may be that impairments in the sensory systems are major contributors to the difficulties to stand erect in children with CP.
Collapse
Affiliation(s)
- Cecilia Lidbeck
- Department of Women's and Children's Health, Karolinska Institutet, SE-171 76, Stockholm, Sweden.
| | - Åsa Bartonek
- Department of Women's and Children's Health, Karolinska Institutet, SE-171 76, Stockholm, Sweden
| | - Priti Yadav
- Royal Institute of Technology, KTH Mechanics, Stockholm, Sweden.,Royal Institute of Technology, KTH BioMEx Center, Stockholm, Sweden
| | - Kristina Tedroff
- Department of Women's and Children's Health, Karolinska Institutet, SE-171 76, Stockholm, Sweden
| | - Per Åstrand
- Department of Women's and Children's Health, Karolinska Institutet, SE-171 76, Stockholm, Sweden
| | - Kerstin Hellgren
- Department of Clinical Neuroscience, Karolinska Institutet, SE-171 76, Stockholm, Sweden
| | - Elena M Gutierrez-Farewik
- Department of Women's and Children's Health, Karolinska Institutet, SE-171 76, Stockholm, Sweden.,Royal Institute of Technology, KTH Mechanics, Stockholm, Sweden.,Royal Institute of Technology, KTH BioMEx Center, Stockholm, Sweden
| |
Collapse
|
15
|
Affiliation(s)
- Martina Bendt
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Rehab Station Stockholm/Spinalis R&D Unit, Stockholm, Sweden
| | - Åsa Bartonek
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
16
|
Eriksson M, Bartonek Å, Pontén E, Gutierrez-Farewik EM. Gait dynamics in the wide spectrum of children with arthrogryposis: a descriptive study. BMC Musculoskelet Disord 2015; 16:384. [PMID: 26821804 PMCID: PMC4731970 DOI: 10.1186/s12891-015-0834-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 11/28/2015] [Indexed: 11/23/2022] Open
Abstract
Background Arthrogryposis Multiplex Congenita (AMC) is a heterogeneous condition characterized by multiple joint contractures at birth. Greater movements in the trunk and pelvis during walking have been observed in children with AMC using orthoses compared to those wearing only shoes. This study investigated gait dynamics in children with AMC and identified compensatory mechanisms that accommodate walking. Methods Twenty-six children with AMC who walked with orthoses or shoes and a control group consisting of 37 typically-developing children were evaluated in 3D gait analysis. Children with AMC were divided into subgroups based on which joints needed to be stabilized in the sagittal plane; AMC1 used knee-ankle-foot orthoses (KAFOs) with locked knee joints, AMC2 used KAFOs with open knee joints or ankle-foot orthoses, and AMC3 used shoes. Results The Gait Deviation Index was lower in AMC groups than in the control group, with the lowest in AMC1. Excessive trunk movements in frontal and transverse planes were observed in AMC2 and especially in AMC1. Lower hip flexion moment was found in AMC1, while AMC2 and AMC3 showed similar hip flexion moments as the control group. Knee extension moments were similar between the groups. In the frontal plane there were only small differences between the groups in hip abduction moment. A joint work analysis indicated greater contribution from the hip muscles to overall positive work in AMC groups, particularly in AMC1, than in the control group. Conclusion All AMC groups showed less hip extension than the control group, but hip flexion moment was significantly lower only in AMC1, which can be attributed to their gait strategy with bilateral locked KAFOs. AMC1, who had weak knee extensors, were helped by their locked KAFOs and therefore showed similar knee extension moment as the other groups. This finding, together with their gait patterns, demonstrates the children’s high reliance on hip muscles and presumably trunk muscles to provide propulsion. Our study shows that with adequate orthotic support, children with AMC and even with severe weakness and contractures can achieve walking.
Collapse
Affiliation(s)
- Marie Eriksson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Åsa Bartonek
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Eva Pontén
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Elena M Gutierrez-Farewik
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. .,KTH Mechanics, Royal Institute of Technology, KTH BioMEx Center, Royal Institute of Technology, Stockholm, Sweden.
| |
Collapse
|
17
|
Lidbeck C, Tedroff K, Bartonek Å. Muscle strength does not explain standing ability in children with bilateral spastic cerebral palsy: a cross sectional descriptive study. BMC Neurol 2015; 15:188. [PMID: 26449859 PMCID: PMC4599329 DOI: 10.1186/s12883-015-0441-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 09/25/2015] [Indexed: 11/15/2022] Open
Abstract
Background In bilateral cerebral palsy (CP) muscle strength is considered important for development of gross motor functions, but its influence on standing ability has not been explored. Our aims were to examine muscle strength with respect to the ability to stand with (SwS) or without (SwoS) hand support, asymmetrical weight bearing (WB), and whether the ability to produce strength was influenced by different seated conditions. Methods In this cross sectional descriptive study standing posture was recorded with 3D motion analysis, and muscle strength was measured with a hand-held dynamometer, in 25 children with bilateral CP, GMFCS levels II-III, SwS (n = 14, median age 11.4 years), or SwoS, (n = 11, median age 11.4 years). Strength measurements were taken in the hip flexors, knee extensors, dorsiflexors and plantarflexors, in two seated conditions; a chair with arm- and backrests, and a stool. Results Compared to SwoS, children SwS stood with a more flexed posture, but presented with equal strength in the hip flexors, dorsiflexors and plantarflexors, and with somewhat more strength in the knee extensors. Despite asymmetric WB during standing, both limbs were equally strong in the two groups. No differences in strength were measured between the two seated conditions. Conclusions Despite challenges measuring muscle strength in CP, the lower limb muscle strength cannot be considered an explanatory factor for variations in standing in this group of children with bilateral CP. The findings rather strengthen our hypothesis that deficits in the sensory systems could be as determinant for standing as muscle weakness in children with bilateral spastic CP.
Collapse
Affiliation(s)
- Cecilia Lidbeck
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Kristina Tedroff
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Åsa Bartonek
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| |
Collapse
|
18
|
Abstract
PURPOSE Excessive movements during walking have been observed by gait analysis in children with arthrogryposis (AMC) using orthoses compared to children using only shoes. The aim of this study was to evaluate energy expenditure and functional exercise capacity in children with AMC. METHODS Twenty-four children with AMC and 25 typically developing (TD) children underwent oxygen measurement and the 6-minute walk test (6MWT). Children were divided into AMC1 using knee-ankle-foot orthoses with locked knee joints (KAFO-LK); AMC2 KAFOs with open knee joints (KAFO-O) or ankle-foot orthoses (AFO); and AMC3 using shoes. RESULTS The net non-dimensional oxygen cost (NNcost) was lower in TD (0.308) than in AMC2 (0.455, n = 10) (p = 0.002). There were no differences in the net non-dimensional consumption (NNconsumption) or normalised walking velocity. The lowest NNconsumption (0.082), NNcost (0.385) and normalised walking velocity (0.214) were found in AMC1 (n = 3), but no statistical calculation was performed. In the 6MWT, both AMC2 (402.7, n = 11) and AMC3 (476.8, n = 10) walked shorter distances (m) than TD (565.1) (p < 0.001 and p = 0.043, respectively). AMC2 (0.435) had lower normalised walking velocity than TD (0.564) (p < 0.001). CONCLUSIONS Children with AMC using open KAFOs or AFOs (AMC2) had higher energy effort represented by significantly higher NNcost than TD, whereas AMC children requiring only shoes (AMC3) did not differ significantly from TD. To maintain the NNconsumption at an acceptable level, children using locked KAFOs (AMC1) slowed down their walking velocity. Compared to TD, the exercise capacity was lower in children with AMC using open KAFOs or AFOs and shoes, represented by lower walking velocity and shorter distance walked during the 6MWT.
Collapse
Affiliation(s)
- Marie Eriksson
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden ,Q2:07 MotorikLab, Astrid Lindgren Children’s Hospital, 171 76 Stockholm, Sweden
| | - Li Villard
- Department of Physiotherapy, Astrid Lindgren Children’s Hospital, Stockholm, Sweden
| | - Åsa Bartonek
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
19
|
Burström K, Bartonek Å, Broström EW, Sun S, Egmar AC. EQ-5D-Y as a health-related quality of life measure in children and adolescents with functional disability in Sweden: testing feasibility and validity. Acta Paediatr 2014; 103:426-35. [PMID: 24761459 DOI: 10.1111/apa.12557] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM The EQ-5D-Y is a newly developed generic instrument measuring health-related quality of life in children and adolescents. The aim of the study was to test the feasibility and validity of the EQ-5D-Y in a Swedish patient sample of children and adolescents with functional motor, orthopaedic and medical disabilities and to compare the results with a general population sample. METHODS Two samples of children and adolescents answered the EQ-5D-Y and a core set of internationally standardised instruments, variables and socio-demographic questions. Patients with functional disability (n = 71, aged seven to 17 years) and individuals from the general population (n = 407, aged eight to 16 years) were included in this study. RESULTS There was a low number of missing answers. Significantly more problems were reported in all dimensions in the patient sample, and the mean visual analogue scale (VAS) score was significantly lower. Any problems were reported by 83% of the patients and by 37% of the general population. In the patient sample, 21% reported problems at the most severe level, compared with 1.5% in the general population sample. By subgroup analyses by diagnoses, the frequency of reported problems in the different dimensions varied. CONCLUSION Even though feasibility and discriminative validity of the EQ-5D-Y were supported in our study, further studies are needed including more patients and patient groups.
Collapse
Affiliation(s)
- K Burström
- Department of Learning Informatics Management and Ethics; Medical Management Centre; Karolinska Institutet; Stockholm Sweden
- Department of Public Health Sciences; Equity and Health Policy Research Group; Karolinska Institutet; Stockholm Sweden
- Stockholm County Council; Health Care Services; Stockholm Sweden
| | - Å Bartonek
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
- Astrid Lindgren's Children's Hospital; Karolinska University Hospital; Stockholm Sweden
| | - EW Broström
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
- Astrid Lindgren's Children's Hospital; Karolinska University Hospital; Stockholm Sweden
| | - S Sun
- Department of Learning Informatics Management and Ethics; Medical Management Centre; Karolinska Institutet; Stockholm Sweden
- Department of Public Health Sciences; Equity and Health Policy Research Group; Karolinska Institutet; Stockholm Sweden
- Stockholm County Council; Health Care Services; Stockholm Sweden
| | - A-C Egmar
- Department of Learning Informatics Management and Ethics; Medical Management Centre; Karolinska Institutet; Stockholm Sweden
- The Red Cross University College; Stockholm Sweden
| |
Collapse
|
20
|
|
21
|
Hamrah Nedjad J, Jansson E, Bartonek Å. Physical activity in a Swedish youth and adult population with cerebral palsy. European Journal of Physiotherapy 2013. [DOI: 10.3109/21679169.2013.781220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
22
|
Engström P, Bartonek Å, Tedroff K, Orefelt C, Haglund-Åkerlind Y, Gutierrez-Farewik EM. Botulinum toxin A does not improve the results of cast treatment for idiopathic toe-walking: a randomized controlled trial. J Bone Joint Surg Am 2013; 95:400-7. [PMID: 23467862 DOI: 10.2106/jbjs.l.00889] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There are many treatments for idiopathic toe-walking, including casts with or without injection of botulinum toxin A. Combined treatment with casts and botulinum toxin A has become more common even though there have been few studies of its efficacy and safety problems. Our aims were to conduct a randomized controlled trial to test the hypotheses that combined treatment with casts and botulinum toxin A is more effective than casts alone in reducing toe-walking by patients five to fifteen years of age, and that the treatment effect correlates with the extent of coexisting neuropsychiatric problems. METHODS All patients who had been consecutively admitted to the pediatric orthopaedics department of our institution because of idiopathic toe-walking between November 2005 and April 2010 were considered for inclusion in the study. Forty-seven children constituted the study population. The children were randomized to undergo four weeks of treatment with below-the-knee casts either as the sole intervention or to undergo the cast treatment one to two weeks after receiving injections of botulinum toxin A into the calves. Before treatment and three and twelve months after cast removal, all children underwent three-dimensional (3-D) gait analysis. The severity of the idiopathic toe-walking was classified on the basis of the gait analysis, and the parents rated the time that their child spent on his/her toes during barefoot walking. Passive hip, knee, and ankle motion as well as ankle dorsiflexor strength were measured. Before treatment, all children were evaluated with a screening questionnaire for neuropsychiatric problems. RESULTS No differences were found in any outcome parameter between the groups before treatment or at three or twelve months after cast removal. Several gait-analysis parameters, passive ankle motion, and ankle dorsiflexor strength were improved at both three and twelve months in both groups, even though many children still demonstrated some degree of toe-walking. The treatment outcomes were not correlated with coexisting neuropsychiatric problems. CONCLUSION Adding botulinum toxin-A injections prior to cast treatment for idiopathic toe-walking does not improve the outcome of cast-only treatment.
Collapse
Affiliation(s)
- Pähr Engström
- Department of Women's and Children's Health. Karolinska University Hospital, 171 76 Stockholm, Sweden.
| | | | | | | | | | | |
Collapse
|
23
|
Engström P, Gutierrez-Farewik EM, Bartonek Å, Tedroff K, Orefelt C, Haglund-Åkerlind Y. Does botulinum toxin A improve the walking pattern in children with idiopathic toe-walking? J Child Orthop 2010; 4:301-8. [PMID: 21804891 PMCID: PMC2908341 DOI: 10.1007/s11832-010-0263-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 04/17/2010] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Numerous recommendations have been made for treating idiopathic toe-walking (ITW), but the treatment results have been questioned. The purpose of this study was to investigate whether botulinum toxin A (BTX) improves the walking pattern in ITW as examined with 3-D gait analysis. PARTICIPANTS AND METHODS A consecutive series of 15 children (aged 5-13 years) were enrolled in the study. The children underwent a 3-D gait analysis prior to treatment with a total of 6 units/kg bodyweight Botox(®) in the calf muscles and an exercise program. The gait analysis was repeated 3 weeks and 3, 6, and 12 months after treatment. A classification of toe-walking severity was made before treatment and after 12 months. The parents rated the perceived amount of toe-walking prior to treatment and 6 and 12 months after treatment. RESULTS Eleven children completed the 12-month follow-up. The gait analysis results displayed a significant improvement, indicating decreased plantarflexion angle at initial contact and during swing phase and increased dorsiflexion angle during midstance at all post-treatment testing instances. According to the parents' perception of toe-walking, 3/11 children followed for 12 months had ceased toe-walking completely, 4/11 decreased toe-walking, and 4/11 continued toe-walking. After 6-12 months, the toe-walking severity classification improved in 9 of the 14 children for whom data could be assessed. CONCLUSIONS A single injection of BTX in combination with an exercise program can improve the walking pattern in children with ITW seen at gait analysis, but the obvious goal of ceasing toe-walking is only occasionally reached.
Collapse
Affiliation(s)
- Pähr Engström
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden ,Department of Paediatric Orthopaedics, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Elena M. Gutierrez-Farewik
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden ,KTH Mechanics, Royal Institute of Technology, Stockholm, Sweden
| | - Åsa Bartonek
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Tedroff
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Christina Orefelt
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | | |
Collapse
|
24
|
Eriksson M, Gutierrez-Farewik EM, Broström E, Bartonek Å. Gait in children with arthrogryposis multiplex congenita. J Child Orthop 2010; 4:21-31. [PMID: 21286255 PMCID: PMC2811679 DOI: 10.1007/s11832-009-0234-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 12/21/2009] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Lower limb contractures and muscle weakness are common in children with arthrogryposis multiplex congenita (AMC). To enhance or facilitate ambulation, orthoses may be used. The aim of this study was to describe gait pattern among individuals wearing their habitual orthotic devices. METHODS Fifteen children with AMC, mean age 12.4 (4.3) years, with some lower limb involvement underwent 3-D gait analysis. Three groups were defined based on orthosis use; Group 1 used knee-ankle-foot orthoses with locked knee joints, Group 2 used ankle-foot orthoses or knee-ankle-foot orthoses with open knee joints and Group 3 used no orthoses. RESULTS The greatest trunk and pelvis movements in all planes and the greatest hip abduction were observed in Group 1, compared to Groups 2 and 3, as well as to the gait laboratory control group. Maximum hip extension was similar in Groups 1 and 2, but in Group 3, there was less hip extension and large deviations from the control data. Lower cadence and walking speed were observed in Group 1 than in Groups 2 and 3. The step length was similar in all groups and also with respect to the gait laboratory reference values. CONCLUSIONS Children with AMC were subdivided according to orthoses use. Kinematic data as recorded with 3-D gait analysis showed differences among the groups in trunk, pelvis and knee kinematics, and in cadence and walking speed. The step length was similar in all groups and to the gait laboratory reference values, which may be attributable to good hip extension strength in all participants.
Collapse
Affiliation(s)
- Marie Eriksson
- />Department of Women’s and Children’s Health, Karolinska Institutet, MotorikLab Q2:07, 171 76 Stockholm, Sweden
| | - Elena M. Gutierrez-Farewik
- />Department of Women’s and Children’s Health, Karolinska Institutet, MotorikLab Q2:07, 171 76 Stockholm, Sweden , />KTH Mechanics, Royal Institute of Technology, Stockholm, Sweden
| | - Eva Broström
- />Department of Women’s and Children’s Health, Karolinska Institutet, MotorikLab Q2:07, 171 76 Stockholm, Sweden
| | - Åsa Bartonek
- />Department of Women’s and Children’s Health, Karolinska Institutet, MotorikLab Q2:07, 171 76 Stockholm, Sweden
| |
Collapse
|
25
|
Danielsson AJ, Bartonek Å, Levey E, McHale K, Sponseller P, Saraste H. Associations between orthopaedic findings, ambulation and health-related quality of life in children with myelomeningocele. J Child Orthop 2008; 2:45-54. [PMID: 19308602 PMCID: PMC2656781 DOI: 10.1007/s11832-007-0069-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2007] [Accepted: 11/10/2007] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Modern principles for treatment of patients with myelomeningocele include early closure of the neural tube defect, neurosurgical treatment of hydrocephalus and treatment aimed at minimizing contractures and joint dislocations. The aim is to achieve a better survival rate and a better quality of life (QOL). Better ambulatory function is thought to improve the management of activities of daily living. This study focused on evaluating which factors might affect ambulation, function and health-related QOL in children with myelomeningocele. METHODS Thirty-eight patients with neurological deficit from myelomeningocele were examined in an unbiased follow-up. This included a physical examination using validated methods for ambulatory function and neuromuscular status, chart reviews and evaluation of radiographs in terms of hip dislocation and spine deformity. The Pediatric Evaluation of Disability Inventory (PEDI) was used to measure mobility, self-care and social function, and the Child Health Questionnaire (CHQ-PF50) was used to measure QOL. RESULTS Muscle function class, quadriceps strength, spasticity in hip and/or knee joint muscles and hip flexion contracture as well as the ambulatory level all affected functional mobility as well as self-care/PEDI. Patients with hip dislocation, spinal deformity or those who were mentally retarded also had significantly worse functional mobility. Besides being affected by the severity of the neurological lesion, self-care/PEDI was significantly impaired by hip flexion contracture and absence of functional ambulation. General health-related QOL was significantly lower in this patient group than for US norms. Nonambulatory and mentally retarded patients had a significantly lower physical function of their QOL (CHQ). CONCLUSIONS The severity of the disease, i.e. reduced muscle strength and occurrence of spasticity around hip/knee, affected ambulation, functional mobility and self-care. Acquired deformities (hip dislocation and spine deformity) affected functional ambulation only. Patients with reduced functional mobility and self-care experienced lower physical QOL. Children with myelomeningocele had significantly reduced QOL compared to healthy individuals.
Collapse
Affiliation(s)
- Aina J. Danielsson
- />Department of Orthopaedics, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden
| | - Åsa Bartonek
- />Department of Women and Child Health, Karolinska Institutet, Stockholm, Sweden
| | - Eric Levey
- />Kennedy Krieger Institute, Baltimore, MD USA
| | - Kathleen McHale
- />Department of Orthopaedics, Walter Reed Army Medical Center, Washington, DC USA
| | - Paul Sponseller
- />Department of Orthopaedics, Johns Hopkins Hospital, Baltimore, MD USA
| | - Helena Saraste
- />Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|