Gait & posture最新文献

{"title":"Acetabular orientation measured in the Lewinnek plane is not adequate for adult spinal deformity patients with high pelvic retroversion","authors":"Elena Jaber, Rami El Rachkidi, Elma Ayoub, Ali Rteil, Maria Saade, Celine Chaaya, Rami Rhayem, Ismat Ghanem, Abir Massaad, Ayman Assi","doi":"10.1016/j.gaitpost.2023.07.108","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.108","url":null,"abstract":"Patients with adult spinal deformity (ASD) are known to compensate by retroverting their pelvis and flexing their knees in order to maintain postural stability [1]. Increased pelvic retroversion in patients with ASD is associated with alteration of acetabular orientation both in standing and during walking, increasing the risk of hip osteoarthritis usually treated by total hip replacement [2,3]. A safe zone is targeted during cup positioning where acetabular orientation is calculated relatively to the invariant morphological Lewinnek plane, unruled by the patient’s position. Changes in hip positioning encountered in daily life activities were associated with higher rates of prosthesis instability in ASD patients. To evaluate the mismatch between Lewinnek and positional acetabular measurements in variable patient’s postures. 121 primary ASD and 32 controls (age and sex matched: 54 years, 73% F) underwent biplanar X-rays in both standing and sitting positions. 3D acetabular parameters (anteversion, abduction, anterior coverage, posterior coverage) were calculated in both the Lewinnek and radiological positional planes (frontal, sagittal and horizontal). The mismatch between Lewinnek and positional acetabular measurements (Δ=Lewinnek-Positional) was evaluated. Radiographic pelvic tilt (PT) adjusted to pelvic incidence (PI) was calculated (adj.PT=0.37*PI-7°). Patients having a high adjusted PT (>2 SD in controls) were grouped as ASD-HighPT, otherwise as ASD-NormPT. 42 ASD had a high PT and 79 a normal PT. Although all 3 groups had similar PI (average: 52°), ASD-HighPT had a decreased lumbar lordosis (L1S1=33°, PT=31°) and decompensated sagittal malalignment (SVA=76 mm). In standing position, ASD-HighPT showed an increased planes mismatch of their acetabular parameters (Δanteversion=-12 vs 2°, Δabduction=-8 vs 0°, ∆anterior coverage=13 vs 0°, Δposterior coverage=-8 vs -1°, all p<0.001), compared to other groups. In the sitting position, ASD-HighPT showed an increased planes mismatch of their acetabular parameters (Δanteversion=-16 vs -10°, Δabduction=-12 vs -8°, ∆anterior coverage=16 vs 11°, Δposterior coverage=-12 vs -8°, all p<0.001), but to a lesser extent than the standing position. PT was strongly correlated to Δanteversion (r=-0.74) and Δanterior coverage (r=0.67, Fig. 1) in the standing position, and moderately correlated in the sitting position (r=-0.40 & 0.28 resp., all p<0.001). This study showed that the Lewinnek plane is not representative of the positional acetabular orientation in the presence of sagittal malalignment. This emphasizes the importance to consider the variation of the acetabular orientation between different postures. It is then necessary to determine a patient-specific functional safe zone in the preoperative planning of total hip replacement to avoid cup instability. Fig. 1: Correlation between pelvic tilt and planes mismatch of acetabular orientation.Download : Download high-res image (91KB)Download : Download full-size ","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postural and kinematic changes in the transition from sit-to-stand position in adolescent idiopathic scoliosis","authors":"Nabil Nassim, Elio Mekhael, Rami El Rachkidi, Carlo El Khoury, Pascal El Braidy, Mohamad Karam, Abir Massaad, Bilal Ramadan, Ismat Ghanem, Ayman Assi","doi":"10.1016/j.gaitpost.2023.07.168","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.168","url":null,"abstract":"","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of knee joint reaction force for the back and front leg during the forward jump in soccer","authors":"Meroeh Mohammadi, Javad Kalantari, Ali Mohammadi, Reza Najarpour, Fatemeh Bagheri, Abolfazl Panahi, Mahdi Barnamehei, Setayesh Asadollahi, Sara Salehimojarad","doi":"10.1016/j.gaitpost.2023.07.160","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.160","url":null,"abstract":"Non-contact anterior cruciate ligament (ACL) injuries often happen during the forward jump-landings in soccer [1]. Two main parts of the forward head jump are jumping and landing. Usually, one leg locates front, and another leg locates back during jumping and landing phases [2-4]. The ground reaction force, which presents the impact loads, affects the knee joint reaction loads and can grow biomechanical stress on the anterior cruciate ligament [3,5–7]. Therefore, the aim of the current study was to compare knee joint reaction loads between the back and front leg during the soccer forward jump. What are the differences in knee joint reaction loads between the back and front leg during the soccer forward jump? Twenty elite soccer athletes (68.3±7.5 kg, 178±5.3 cm, 27.5±4.5 years) participated in the current study [8]. Ten Vicon motion captures (Vicon MX, Oxford, UK, 200 Hz) were used to measure the kinematics variables [6,9,10]. EMG activity in the rectus femoris, vastus lateral, vastus medial, tibialis anterior, gastrocnemius medial, gastrocnemius lateral, soleus, biceps femoris, and semitendinosus was recorded by the Myon wireless EMG system [11,12]. Raw EMG signals were full-wave rectified and linear enveloped using a dual-pass fourth-order low-pass Butterworth filter at 4 Hz [13]. A musculoskeletal model with a total of 10 bodies and 92 muscles was used to estimate joint reaction loads in OpenSim [4,14,15]. The inverse kinematics, static optimization, and joint reaction analysis were used to estimate angles, muscle loads, and joint loads, respectively [16,17]. Fig. 1 presents the mean of knee joint reaction forces in anterior-posterior, medial-lateral, and superior-inferior directions during the forward jumping and landing for the back and front leg. Significant differences of knee joint reaction were found between back and front leg.Download : Download high-res image (131KB)Download : Download full-size image Fig. 1: Mean of knee joint reaction forces in anterior-posterior, medial-lateral, and superior-inferior directions during the forward jumping and landing for back and front leg. This study compared the knee joint reaction loads during the soccer forward jump for the back and front leg by a previously described musculoskeletal model. In general, the forces experienced at the knee joint were not of similar magnitude.","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of cognitive impairment on gait in Parkinson's disease","authors":"Radim Krupicka, Christiane Malá, Slávka Neťuková, Tereza Duspivová, Anna Vážná, None Jan Novák, Evžen Růžička, Ondřej Bezdíček","doi":"10.1016/j.gaitpost.2023.07.132","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.132","url":null,"abstract":"Gait and cognitive deficits are common symptoms of Parkinson's disease (PD) [1]. Cognitive deficits can manifest themselves in gait impairment and are tested with the gait-cognitive dual task (DT) [2]. Although a study [3] showed that the cognitive deficit represented by Montreal Cognitive Assessment (MoCA) weakly correlated with DT gait parameters, the opposite question, if worse gait performance in DT correlates with cognition in patients with PD, has not been answered. Does the performance in gait-cognitive dual task correlate with the performance in MoCa test in patients with Parkinson's disease? We examined 99 de-novo, drug-naive patients with PD (59±13 years) and 58 healthy controls (CON) (60±9 years) [4]. All subjects completed an extended Timed Up & Go Test (TUG) and Montreal Cognitive Assessment (MoCA). The TUG was performed twice and captured on a 5.15 m long and 0.9 m wide pressure walkway (GAITRite®). Participants were instructed to walk in the two different conditions: (i) at a normal pace (ST) and (ii) at a normal pace while counting down from 100 by seven (DT). Gait velocity, cadence, and stride length were selected as representative gait parameters. Cognitive costs [(DT − ST)/ST × 100] were calculated for each parameter and the first PCA component was calculated for the threshold for gait cognitive impairment. The threshold was defined as the 10th percentile of CON and filtered patients without gate-cognitive deficit. The groupwise comparison was made using the two-sample t-test. The Pearson correlation between MoCA and gait parameters was calculated for filtered PD (31 patients, 61±13 years). The t-test revealed significant differences (p<0.05) between CON and PD in velocity cost and stride length cost. PD’s MoCA moderately correlated with the velocity cost (r=0.37) and strongly correlated with the stride length cost (r=0.52) (see Figure). Figure: Visualization of results A) Distribution and differences in gait parameters of healthy controls (CON) and patients with Parkinson's disease (PD) B) Pearson’s correlation of gait parameters and MoCA presented by r and significance (*p<0.05, **p<0.01). Download : Download high-res image (419KB)Download : Download full-size image The impairment of gait performance in PD is mainly characterized by a slower velocity with a shorter stride length and a compensatory increase in walking cadence [5]. Significant changes in velocity cost and stride length cost confirm that a cognitive task accents gait impairment. Although the studies [2,3] showed a weak correlation between MoCA and DT in patients with cognitive deficits in PD, our study showed a strong correlation in stride length for PD patients with worse DT performance. This may suggest that gait performance is dependent on cognitive performance and may be improved by cognitive training.","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconstructing bones: using statistical shape modelling to create 3D models of the femur from ultrasound images","authors":"Alex Mitton, Jonathan Noble, Adam Shortland","doi":"10.1016/j.gaitpost.2023.07.157","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.157","url":null,"abstract":"Many children with cerebral palsy (CP) develop bony deformities of the femur that require surgical intervention to correct1. Concerns regarding the radiation exposure from CT and the cost and scan time of MRI mean patient-specific 3D models of the femur are rarely used for surgical planning in this patient group, despite evidence supporting their role in improving surgical outcomes2,3,4. Ultrasound (US) imaging presents a cheap, low-risk, and readily available means of constructing such models. However, US is only able to capture partial views of the femur. The “missing” views may be reconstructed using statistical shape modelling; a mathematical technique used to quantitatively analyse complex shapes5,6. Can patient-specific 3D models of the femur be accurately reconstructed from partial surface data acquired with simulated 3D ultrasound using statistical shape modelling? 60 3D meshes of the femur were derived from MR images of 32 young adult subjects (13 with CP, 19 typically developing (TD)). The femur meshes from the left side were flipped horizontally to match those from the right. The meshes from both groups were then used to construct a statistical shape model (SSM) of the femur. An algorithm was written which used the SSM to reconstruct a complete femur mesh from partial information. To test the effectiveness of the algorithm, a dataset of partial surfaces replicating the views possible using US was created. Complete femurs were reconstructed from this dataset, and evaluated against the original 3D meshes using a leave-one-out cross validation procedure. An average point-to-point error of 1.16 ± 0.45 mm was found for reconstructions of the femurs from the TD group, compared to 2.55 ± 0.47 mm in the CP group. Fig. 1 – “a) Example partial surface from the simulated US dataset; b) Example TD reconstruction; c) Example CP reconstruction (reconstruction in purple, original mesh in white”)Download : Download high-res image (36KB)Download : Download full-size image The relatively low error for the reconstructions of the TD femurs demonstrates a promising proof of concept for the proposed technique of creating 3D femur models from partial surface data acquired with US. Future work may develop the algorithm further to improve its performance in the presence of increased femoral deformity, as found in the CP group. With development, this technique has the potential to bring the use of 3D models for preoperative planning into common practice for this patient group, which is likely to improve surgical outcomes. Although the focus of this study has been the creation of 3D models of the femur, the technique of reconstructing US images using statistical shape modelling could be applied to other anatomical structures. Owing to the reduced risk, cost and scan time compared with CT and MRI, the application of the proposed reconstruction technique has the potential to positively impact other surgical services.","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients with scoliosis have dysfunctional spinal muscles, preliminary study","authors":"Mikko Mattila, Andrey Zhdanov, Juha-Pekka Kulmala","doi":"10.1016/j.gaitpost.2023.07.150","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.150","url":null,"abstract":"Etiology of idiopathic scoliosis is still unknown. Many theories have been introduced throughout the history to clarify the etiology of the scoliosis. Especially vague is the idiopathic scoliosis that apparently does not have any reasonable explanation. Due to the cosmetic appearance of the scoliotic spine, scoliosis has been mostly studied on its treatment. Because children’s vertebral column is flexible, uneven spinal muscle activity and forces may potentially play a role in the development of scoliosis. Some electromyographic (EMG) studies have reported higher activity in the convex side while other found no differences. Mixed findings may be due to fact that previous studies have analyzed absolute rather than normalized EMG results, although latter is commonly recommended. Do spinal muscles show uneven activity in scoliotic patients when examined using normalized EMG. We report results of six scoliotic patients. Multifidus (Mul), Lumbar erector spinae (Les) and thoracic erector spinae (Tes) EMG was recorded during walking and normalized to values of maximal voluntary contraction (MVC). At groups level, we found relatively little differences in the normalized EMG magnitude between concave (left) and convex (right) side; however, individual results reveal large side-to-side differences especially in the Les and Tes (Fig. 1). The peak normalized EMG values were relatively high often exceeding the 50% level of the MVC. Picture: Scoliotic spine and EMG of the spinal muscles.Download : Download high-res image (125KB)Download : Download full-size image During walking spinal muscles of the young scoliosis patients were activated asymmetrically in a patient-specific manner. While some patients showed relatively low normalized EMG values, others demonstrated high activity levels, indicating that substantial uneven forces are directed to the flexible vertebral column of these patients. Presumably, this influences the stability of the vertebra. It is evident that scoliosis already develops earlier than when it is actually diagnosed, suggesting that a large-scale EMG screening could help to detect abnormal spinal muscle function before scoliosis is manifested.","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of accelerometer sensor position on freezing gait ratio parameters","authors":"Slavka Viteckova, Lucie Horakova, Tereza Duspivova, Evžen Růžička, Zoltan Szabo, Radim Krupicka","doi":"10.1016/j.gaitpost.2023.07.170","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.170","url":null,"abstract":"Freezing of gait (FoG) is an episodic gait pattern characterised by the inability to step that occurs on initiation or turning while walking for those with Parkinson’s disease (PD) [1]. This phenomenon is one of the most disabling yet poorly understood symptoms. It has been shown that tasks requiring bilateral limb coordination are the most likely to elicit FoG in the laboratory. Among the most promising tasks are stepping in place [2], walking and turning [3], and turning in place[4]. Previously, the Freezing Ratio parameter (FoG-ratio) has been developed to objectively measure freezing severity[5]. Usually, a lower limb acceleration signal in an antero-posterior direction measured by an inertial sensor has served as the source for its calculation[6,7]. Growing interest in single sensor utilisation in gait analysis brings up the question of whether any sensor other than the foot can measure freezing severity via FoG-ratio. Is FoG-ratio computed from a sensor located on the sternum or lower back comparable to the foot FoG-ratio during a walking turn? We included 34 Parkinson disease patients (21 males, 13 females), mean age 59.0 (SD 12.3) years in the study. All subjects performed an instrumented extended Timed Up&Go Test (TUG) wearing six synchronised inertial measurement units (Opals, APDM, USA) fitted via elastic straps. Sensors were located at the sternum, lower back, both wrists and feet. The turn subtask was automatically extracted from each TUG measurement. The FoG-ratio was calculated from antero-posterior acceleration acquired by a right foot sensor, left foot sensor, sternum (S) sensor, and lumbar (L) sensor. Depending on turn direction (left or right), each foot was denoted as the inner foot (IF) and outer foot (OF). Thus, four FoG-ratios (FoG_S-ratio, FoG_L-ratio, FoG_IF-ratio, FoG_OF-ratio) were obtained for each subject. The Kolmogorov-Smirnov test rejected the null hypothesis, i.e. data was not normally distributed. The Friedman test was employed for comparison of FoG-ratios. Posthoc pairwise comparisons were performed by Wilcoxon signed rank test (alpha level set to 0.05). Next, the Spearman correlation coefficient was calculated for all FoG-ratio pairs. The Friedman test revealed that the FoG-ratios from different sensor locations are statistically different (p<0.001). Pairwise tests showed statistically significant differences between the FoG_S-ratio and FoG_L-ratio (p<0.001), the FoG_S-ratio and FoG_IF-ratio (p=0.006), the FoG_L-ratio and FoG_IF-ratio (p=0.001), and the FoG_L-ratio and FoG_OF-ratio (p=0.001). The correlation analysis detected no significant relationship, Fig. 1.Download : Download high-res image (232KB)Download : Download full-size image Taking into account the results of location comparisons and their mutual relationships, no sensor seems to be a suitable alternative to foot sensors for freezing ratio calculation. However, additional analyses need to be performed before rejecting the possibility of employing o","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing the effects of multi-session cerebellar and prefrontal trans-cranial direct current stimulation on postural balance in patients with multiple sclerosis","authors":"Narges Jahantigh Akbari, Mohammad Yousefi, Nahid Tahan","doi":"10.1016/j.gaitpost.2023.07.111","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.111","url":null,"abstract":"Multiple sclerosis (MS) is a progressive autoimmune disease, characterized by a destructive inflammatory process in the myelin sheaths (1). Multiple disorders are associated with MS, which typically include muscle weakness, spasticity, cognitive disorder, sensory symptoms, movement disorders, fatigue, and gait disorders (2). Generally, gait and balance disorders are common in patients with MS (3). Approximately 80% of these patients, even in the early stages of disease, show deficits in postural control, which in turn affect their quality of life (3). Therefore, the aim this study was to comparing the effects of multi-session anodal trans-cranial direct current stimulation of cerebellar and dorsolateral prefrontal cortices on postural balance in patients with multiple sclerosis Which area of cerebellum tDCS or prefrontal tDCS will have a greater effect on postural balance in MS patients? In this double-blind randomized controlled trial, 20 patients with multiple sclerosis were randomly divided into two groups: dorsolateral prefrontal cortex (DLPFC) tDCS (n=11) and cerebellum tDCS (n=9). Treatment in both groups consisted of 20 minutes tDCS with 2 mA intensity and 10 minutes’ balance training, for 10 sessions, over four weeks. Dynamic balance was assessed with Berg Balance Scale (BBS), Timed Up and Go test (TUG) and static balance using force plate before and after treatment. In both groups, a significant increase in BBS and a significant decrease in TUG was observed (P <0.05). A significant decrease found in sways path in the anterior-posterior direction and total sway path in the cerebellum group (P <0.05). A significant improvement was found in BBS, sway speed in the anterior-posterior direction, and total sway speed in the cerebellum group compared to the DLPFC group (P <0.05). Findings suggest that tDCS can use in combination with physical therapy to treat balance disorders in MS patients.","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CrossFit® to improve gross motor function and gait in adolescents and young adults with unilateral cerebral palsy: a pilot study","authors":"Michèle Widmer, Alice Minghetti, Jacqueline Romkes, Morgan Sangeux, Cornelia Neuhaus, Bastian Widmer, Elke Viehweger","doi":"10.1016/j.gaitpost.2023.07.267","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.267","url":null,"abstract":"Cerebral palsy (CP) is a childhood disability which affects the development of movement and posture, impairs muscle function and muscle strength, and can furthermore negatively impact gait. Recent data shows that not only strength, but also bouts of anaerobic exercise in patients with CP might help to transfer muscle strength into functional capacity (1). This pilot study examined the feasibility and effects of a functional high-intensity exercise intervention (CrossFit®) performed in a group-setting with unilateral CP patients on indicators of daily functionality, including gait. 9 adolescents with unilateral CP (7 males, 2 females, mean age: 16.9 (SD 3.48); GMFCS Level: I-II) participated in the study. The intervention consisted of two weekly supervised training sessions over 12 weeks, which contained progressive resistance training performed with free weights as well as high-intensity aerobic and anaerobic workouts performed through functional movement patterns which were adapted to individual ability and capacity. A 3D-gait analysis, the six-minute walking-test (6MWT), a clinical exam and the Gross Motor Function Measure-66 (GMFM-66) (2) were performed before and after the intervention. Mean differences were calculated with paired t-tests and corresponding 95% confidence intervals. The exercise intervention was not accompanied by any adverse events except light muscle soreness. We measured a significant increase in the GMFM 66 (p = 0.031, mean difference = 2.19 (CI 0.71-3.67)). Furthermore, a non-significant increase in the distance of the 6 MWT (p = 0.09, mean difference = 29.8 m (CI -5.8-65.5)) and the propulsion ratio (p = 0.067, mean difference 5.4% (CI 0.5-11.4%)) of the affected leg was found. No statistically significant changes were found for Gait Profile Score (GPS) (3), spatiotemporal parameters or clinical exam (ankle range of motion, popliteal angle). This pilot study shows that a high-intensity functional training with free weights (CrossFit®) in adolescents with unilateral CP is a safe training method that might effectively improve gross motor function, endurance, and asymmetry in gait. Therefore, the intervention seems to show a transfer into non-task-specific movements of daily life. Based on this pilot study, studies with bigger patient samples and control groups may be performed to detail the effect of high-intensity functional training. Furthermore, this pilot study raises the question to explore the possibilities of more functional tests to measure daily life function by for example using wearable inertial measurement units (IMU).","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medial gastrocnemius morphology after orthopedic surgery in a child with spastic cerebral palsy","authors":"Babette Mooijekind, Lynn Bar-On, Marjolein M. van der Krogt, Wouter Schallig, Melinda M. Witbreuk, Annemieke I. Buizer","doi":"10.1016/j.gaitpost.2023.07.164","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.164","url":null,"abstract":"To improve gait in children with spastic cerebral palsy (CP), the calf muscle can be surgically elongated, for instance with an incision at the muscle-tendon junction [1,2]. Previous studies showed that this procedure results in a larger ankle range of motion [1,2]. However, it is unclear whether the elongation originates from lengthening of the tendon, the muscle belly, or a combination of both. What is the effect of surgical elongation on the morphology of the medial gastrocnemius (MG) in a child with CP and how does the MG morphology of the child with CP relate to MG morphology of typically developing children (TD) before and after the surgery? Muscle-tendon unit (MTU), muscle belly, tendon, and fascicle lengths, pennation angle of the fascicles as well as muscle volume were determined with 3D ultrasound for a boy with spastic CP (13 years, GMFCS I) one week before and 21 weeks after surgery (including a period of intensive physiotherapy), and compared to reference data of 20 TD children (10±3 years). Morphological variables were collected with the foot positioned at an angle corresponding to a moment of 0 Nm. Lengths were normalized to tibia length and volume to body weight. One-sample t-tests were conducted to compare the CP case with TD reference data. Before surgery, ankle angle at 0 Nm, MTU length, muscle belly length, and muscle volume were significantly lower and tendon length longer in the child with CP compared to TD references (Fig. 1). Fascicle length and pennation angle were similar to TD. After surgery, the ankle angle at 0 Nm increased with 18° achieved by an increase in MTU, muscle belly and tendon length with 11%, 1% and 18% respectively. Fascicle length decreased with 16% and muscle volume and pennation angle increased with 8% and 62% respectively. After surgery, only MTU length was similar in CP compared to TD. In this case, the surgical elongation resulted more ankle dorsiflexion mainly due to tendon elongation. Despite the better overall MTU length, there was overall more atypical MG morphology. The simultaneous increase in muscle volume and reduced fascicle length could be explained by the combined effect of fascicle hypertrophy and increase in pennation angle. The increased ankle dorsiflexion and longer MTU length may have improved the child’s function during daily life and physiotherapy, thereby facilitating fascicle hypertrophy shown by the increase in muscle volume. Our results should be verified in a larger sample size and related to his gait pattern and capacity. Additionally, more insight in the healing process can be obtained with recurring follow-up measurements planned 1 year post-surgery. Fig. 1. Adaptations following surgical elongation of the medial gastrocnemius.Download : Download high-res image (87KB)Download : Download full-size image","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135297870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}