Gait & posture最新文献

{"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":"161 1","pages":"0"},"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":"26 1","pages":"0"},"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":"256 1","pages":"0"},"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":"27 1","pages":"0"},"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}

{"title":"What are the effects of induced toe flexor weakness on foot kinematics? A study protocol and preliminary results","authors":"Halenur Evrendilek, İlknur Özkaradeniz, Kubra Onerge, Nazif Ekin Akalan, Derya Çelik","doi":"10.1016/j.gaitpost.2023.07.182","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.182","url":null,"abstract":"The foot core is supported by active subsystems like intrinsic foot muscles(1). Weakness of these muscles can lead to a decrease in the medial longitudinal arch(MLA), resulting in altered foot mechanics, function, and increasing the risk of injuries(1,2). Intrinsic muscle strength is compatible with toe flexor strength and has been found to be lower in flat feet (3,4). It is challenging to determine the isolated effects of intrinsic muscle weakness in foot kinematics while walking(4) which can provide valuable insights for clinical reasoning. What are the effects of induced toe flexor weakness on foot kinematics? 4 adults (3 female,1 male;24.75±2.98 y.o.) with typical foot posture (Foot-Posture-Index-6 score: <5) participated into the pilot study. Toe flexor muscle strength of the dominant foot was assessed with a dynamometer (Lafayette Instrument Company, USA) while sitting before and after the fatigue procedure (Figure-1:a1-a2) (5). A 3D-printed foot arc heightening device (AHD) with 4 kg resistance spring was used to generate fatigue in the toe flexor muscles (Figure-1:2). The participants were required to complete 75 reps. for each set by a metronome at 45 BPM under the discomfort level (6/10) until achieving 10% muscle force-drop(Figure-1:c1-c2). Heel-rising and extrinsic muscle activation were not allowed. The Oxford Foot Model was used to analyze three trials of walking kinetics and kinematics. Wilcoxon test was used for statistical non-parametric paired analysis (p<0.05).Download : Download high-res image (148KB)Download : Download full-size image To achieve >10% muscle weakness each participant completed varying numbers of sets (3-5 sets). The decrease of great toe and toe flexor muscle strength was 19.57%±7.01 and 19.01%±3.58 after the procedure respectively. Some of the effects of the procedure remained after analyses were completed (15.67%±13.34 and 12.3%±11.31). The mean velocity, temporospatial parameters, kinematic parameters of pelvis, hip and knee joints, ankle power and arch height were not different before and after the procedure (p>0.05). Peak hindfoot plantarflexion was lower and peak hindfoot inversion was higher significantly after the procedure. The sagittal and frontal plane range of the hindfoot relative to the tibia decreased (p<0.05, Graph-1: I,II,III) The pilot study protocol was effective enough to induce temporary toe flexor muscle weakness. Although the isometric muscle force reduced for intrinsic muscles after the procedure, controversially to the literature (2), increased hindfoot inversion was found which may be related to increased motor unit activation or proprioceptive alterations which should be studied in detail. The device was more efficient in great toe grasping compared to other toes, which might result in differential level muscle weakness among the toes. Comparison studies with a larger sample size are needed to conclude to describe the effects of fatigue procedure.","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135297871","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":"Effects of 8-weeks selective training on the peroneus longus and peroneus brevis morphologies","authors":"Yukio Urabe, Satoshi Arima, Oda Sakura, Tsubasa Tashiro, Rami Mizuta, Komiya Makoto, Noriaki Maeda","doi":"10.1016/j.gaitpost.2023.07.252","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.252","url":null,"abstract":"Resistance training for the peroneus muscles is important because this muscles undergo morphological changes and functional decline after a lateral ankle sprain. We reported at last year's ESMAC 2022 the possibility of selectively training each muscle by implementing immediate selective interventions for the peloneus long (PL) and peroneus brevis (PB) (Arima et al., 2022). However, it has not been examined whether long-term interventions can selectively train the PL and PB. Does an 8-weeks intervention allow selective training of the PL and PB? Eighteen healthy participants were divided into two task groups that performed two different 3 times a week for 8-weeks tasks: the PL task in which a Thera-Band was placed on the ball of the foot and pushed out from the contact point (n=9), and the PB task in which the Thera-Band was pulled out from the base of the fifth metatarsal (n=9). Muscle cross-sectional area (CSA) at 25% (showing PL) and 75% (showing PB) proximal to the line connecting the fibular head and lateral malleolus measured by an ultrasound system, and PL and PB strength measured using a handheld dynamometer were determined at the beginning of week 1 (baseline) and on the first day of the week following each weekly task. PL and PB strength measured muscle strength during exercise of the same as PL and PB tasks. Two-way ANOVA was used to check for differences in changes in values by the 8-weeks PL and PB tasks. There was significant interaction between groups and measurement weeks for the 25% and 75% CSA, PL and PB strength (p<0.05). Post hoc test showed that the 25% CSA was significantly higher in the PL task between weeks 3 and 8 compared to baseline (p<0.05). The 75% CSA was significantly higher in the PB task compared to baseline for all weeks between weeks 4 and 8 (p<0.05). PL strength was significantly higher in the PL task between weeks 2 and 8 compared to baseline (p<0.05). PB strength was significantly higher in the PB task compared to baseline for all weeks between weeks 3 and 8 (p<0.05). PL muscle activity is increased by the ball of the foot loading, and the PB contributes to ankle eversion compared to the PL. In this study, the 8-week intervention also increased 25% CSA and PL muscle strength in the PL task over time with each passing week, and 75% CSA and PB muscle strength in the PB task. This suggests that an 8-weeks PL and PB tasks probably be useful for long-term selective training of peroneus muscles.","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":"77 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135297888","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":"Musculoskeletal modelling informed muscle coordination re-training to reduce knee joint loads","authors":"Hans Kainz, Willi Koller, Elias Wallnöfer, Gabriel Mindler, Andreas Kranzl","doi":"10.1016/j.gaitpost.2023.08.023","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.08.023","url":null,"abstract":"","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298037","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":"Age group identification using machine learning and IMU: A comparison of sensor placements","authors":"Yong Kuk Kim, Noah Fehr, Fatemeh Fahimi, Michelle Gwerder, Angela Frautschi, William Taylor, Navrag Singh","doi":"10.1016/j.gaitpost.2023.07.122","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.122","url":null,"abstract":"","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298048","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":"Quantitative gait analysis of patients with unilateral juvenile osteochondritis dissecans of the knee: Comparison with the contralateral side and controls","authors":"Mathieu Lalumière, Thierry Pauyo, Jean-François Girouard, Reggie Charles Hamdy, Louis-Nicolas Veilleux","doi":"10.1016/j.gaitpost.2023.07.137","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.137","url":null,"abstract":"Juvenile osteochondritis dissecans (JOCD) of the knee is a common cause of pain and dysfunction among active children and adolescents [1,2]. JOCD is defined as a pathologic process for which the blood supply to a bone area is disrupted due to excessive loading forces on some parts of the joint, causing the necrosis of the subchondral bone and cartilage [3–5]. In youths with stable JOCD of the knee, conservative management focusing on biomechanical factors and unloading is the standard of care [6]. However, it is not clear how the biomechanical factors, such as the lower limbs kinematics and kinetics during walking, are associated with JOCD [6]. The aim of this project was to identify objective biomechanical outcomes associated with JOCD to better target conservative treatment options. Thirteen (n=13) patients with unilateral medial femoral condyle JOCD and nineteen (n=19) control subjects were evaluated at the SHC-Canada. Three distinct groups were created for comparison: 1) JOCD side, 2) Unaffected contralateral side, 3) Healthy controls. JOCD patients were evaluated before conservative treatment initiation. All participants performed barefoot overground walking at a self-selected speed. Retroreflective markers were placed on specific bony landmarks according to the Plug-In-Gait marker set [7]. A 10-camera motion capture system (VICON) with 4 forceplates (AMTI) were used to collect kinematic and kinetic data. Joint angles and moments at the hip and knee was processed using Nexus 2.12.1 and averaged for three complete gait cycles. For the main outcome measures, peak joint angle and moment in the coronal plane were outputted at the hip and knee. To identify statistical differences between groups (α=0.05), the main outcome measures were compared using paired t-test between JOCD and unaffected groups, and unpaired t-test between JOCD and control groups. Data showed altered knee joint movement patterns for the JOCD side group, with significantly higher peak knee varus angle (vs. unaffected=+2.66°, p=0.002; vs. controls=+2.39°, p=0.02) and varus-thrust angle (vs. unaffected=+1.48°, p=0.02) (Fig. 1B). Data also showed altered kinetics for the JOCD side group, with significantly lower peak hip adduction moment (vs. controls=-0.19 N∙m/kg, p=0.001) and peak knee adduction moment (vs. controls=-0.12 N∙m/kg; p=0.02) (Fig. 1C&D).Download : Download high-res image (116KB)Download : Download full-size image Higher knee motion in the coronal plane for youths with JOCD suggest the presence of medio-lateral knee instability. Also, reduced knee adduction moment in the presence of JOCD suggest compensations at the ipsilateral trunk and hip to reduce medial femoral condyle loading. Potential treatment focusing on knee medio-lateral stability, such as motor control exercises and knee unloading brace, have potential at improving neutral dynamic knee alignment during walking. The current set of data will serve as a method to develop a standardized conservative protocol","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":"371 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298050","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":"Pattern-specific effects of botulinum neurotoxin type A injections and selective dorsal rhizotomy on gait in children with spastic cerebral palsy","authors":"Eirini Papageorgiou, Els Ortibus, Guy Molenaers, Anja Van Campenhout, Kaat Desloovere","doi":"10.1016/j.gaitpost.2023.07.191","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.191","url":null,"abstract":"Botulinum neurotoxin type A (BoNT) injections and selective dorsal rhizotomy (SDR) are often applied tone reduction procedures in children with spastic cerebral palsy (CP).[1,2] BoNT is focal and temporary, whereas SDR is generalized and non-reversible. Previous studies have investigated the changes inflicted by these treatments in generic CP-groups.[3,4] It is not yet clear whether specific gait patterns would respond differently to each treatment. What are the short-term, gait pattern-specific changes inflicted by BoNT injections or SDR in children with CP? Retrospective samples that had been treated either BoNT injections (NBoNT=117; baseline ageBoNT= 6y4mo±2y4mo; GMFCS I/II/III: 70/31/16) or SDR (NSDR=89; baseline ageSDR=9y5mo±2y3mo; GMFCS I/II/III: 18/54/17) were selected. All patients underwent three-dimensional gait analysis (3DGA) sessions at baseline and post-treatment (on average 1 y post-SDR and 2mo post-BoNT). The baseline 3DGA was used to classify the gait patterns of the patients, using the gait pattern classification system for children with spastic CP (GaP-CP).[5] For children with bilateral CP, both lower limbs were considered in case of asymmetric patterns between the two lower limbs, Their most affected side was selected when they displayed symmetric gait patterns, similar to the affected lower limb for children with unilateral CP. Gait-related changes focused on sagittal plane kinematics, which were compared with statistical non-parametric mapping (vector of four components, paired Hotellings T2 test, α=0.05 and post-hoc component-level comparisons, paired t-tests, α=0.0125). The comparisons were conducted in the total cohorts, as well as in gait pattern-specific subgroups. Thereafter, statistical clusters were deemed clinically relevant if their duration exceeded 3% of the gait cycle and the respective standard errors of measurement (SEM).[6,7] Changes in neuromuscular impairments were evaluated using the composite spasticity, weakness and selectivity scores of the muscles acting in the sagittal plane,[8] based on the clinical examination. Apparent equinus and jump gait were the best BoNT-responders, followed by dropfoot, where improvements were only observed in the ankle joint. In these three gait patterns, spasticity was improved, but not at the expense of additional weakness or selectivity. For SDR, the best responders were children with jump gait, crouch gait and apparent equinus. Spasticity was improved, while weakness and selectivity either improved or remained stable, in all gait patterns and for the total cohort. Fig. 1 shows the pre- vs post-treatment kinematics and statistically identified clusters of the three best responders to each treatment. \"Fig. 1. Pre- vs post-treatment kinematics and statistically identified clusters of the three best responders to each treatment.\"Download : Download high-res image (251KB)Download : Download full-size image These results highlight the need to inspect the short-term effects o","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":"120 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298194","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}