Pub Date : 2023-09-01DOI: 10.1016/j.gaitpost.2023.07.269
Jente Willaert, Lena H. Ting, Anja Van Campenhout, Kaat Desloovere, Friedl De Groote
Children with cerebral palsy (CP) often have balance impairments, but little is known about the relation between joint hyper-resistance (i.e., the most common symptom in spastic CP) and balance impairments (1). Both during clinical tests of joint hyper-resistance and when standing balance is perturbed, muscles are stretched. In children with CP, the stretch reflex in response to passive joint rotations is often hyper-excitable and reduced reciprocal inhibition has been observed in the antagonistic muscle (2). Furthermore, children with CP often have increased muscle co-activation during standing balance perturbations (3). Recently, we demonstrated that this increased muscle co-activation is not a useful compensation strategy and might therefore be a consequence of reduced reciprocal inhibition (4). Here, we investigated whether a reduction in reciprocal inhibition between plantarflexors and dorsiflexors in response to a passive stretching of the plantarflexors was related to higher levels of co-activation in response to toe-up rotational perturbations of standing balance. Twenty children with spastic CP participated in the study. We performed an instrumented spasticity assessment of the plantarflexors (5) followed by a standing balance assessment (Fig. 1, row1-2). During the instrumented spasticity assessment, the ankle was rotated as fast as possible from a plantar flexed position until the end of range of motion towards dorsiflexion. At least 7 seconds of rest were provided between different trials, five in total. Reactive standing balance was tested on a moving platform. Participants were instructed to maintain balance without stepping and the platform was rotated such that ankle dorsiflexion was elicited. Perturbations were repeated 8 times. Electromyography (EMG) from gastrocnemius lateralis (LG) and medialis (MG), soleus (SOL) and tibialis anterior (TA) was collected during both assessments. EMG was filtered and normalized to the maximal value across assessments (Fig. 1, row 3). We calculated the co-contraction index (CCI) as the overlap between TA and respectively LG, MG, and SOL EMG (6). We tested the relation between the CCI during passive joint rotations and reactive standing balance. The CCI between the plantarflexors and tibialis anterior during spasticity assessment was moderately correlated with the CCI during reactive balance responses (LG-TA: r=0.55; p= 0.02; MG-TA: r= 0.57, p=0.01; SOL-TA: r=0.54, p=0.02; Fig. 1, row 4). Fig. 1: Correlation between co-contraction index during instrumented spasticity assessment and perturbations of standing balance.Download : Download high-res image (242KB)Download : Download full-size image Our results suggest that deficits in spinal pathways governing the stretch reflex, and more specifically reduced reciprocal inhibition, might hinder reactive balance control. Successful postural control might therefore rely on compensations in supraspinal pathways to generate net balance correcting ankle momen
{"title":"Reduced reciprocal inhibition during passive spasticity assessments is related with increased muscle co-activation during perturbations of standing balance","authors":"Jente Willaert, Lena H. Ting, Anja Van Campenhout, Kaat Desloovere, Friedl De Groote","doi":"10.1016/j.gaitpost.2023.07.269","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.269","url":null,"abstract":"Children with cerebral palsy (CP) often have balance impairments, but little is known about the relation between joint hyper-resistance (i.e., the most common symptom in spastic CP) and balance impairments (1). Both during clinical tests of joint hyper-resistance and when standing balance is perturbed, muscles are stretched. In children with CP, the stretch reflex in response to passive joint rotations is often hyper-excitable and reduced reciprocal inhibition has been observed in the antagonistic muscle (2). Furthermore, children with CP often have increased muscle co-activation during standing balance perturbations (3). Recently, we demonstrated that this increased muscle co-activation is not a useful compensation strategy and might therefore be a consequence of reduced reciprocal inhibition (4). Here, we investigated whether a reduction in reciprocal inhibition between plantarflexors and dorsiflexors in response to a passive stretching of the plantarflexors was related to higher levels of co-activation in response to toe-up rotational perturbations of standing balance. Twenty children with spastic CP participated in the study. We performed an instrumented spasticity assessment of the plantarflexors (5) followed by a standing balance assessment (Fig. 1, row1-2). During the instrumented spasticity assessment, the ankle was rotated as fast as possible from a plantar flexed position until the end of range of motion towards dorsiflexion. At least 7 seconds of rest were provided between different trials, five in total. Reactive standing balance was tested on a moving platform. Participants were instructed to maintain balance without stepping and the platform was rotated such that ankle dorsiflexion was elicited. Perturbations were repeated 8 times. Electromyography (EMG) from gastrocnemius lateralis (LG) and medialis (MG), soleus (SOL) and tibialis anterior (TA) was collected during both assessments. EMG was filtered and normalized to the maximal value across assessments (Fig. 1, row 3). We calculated the co-contraction index (CCI) as the overlap between TA and respectively LG, MG, and SOL EMG (6). We tested the relation between the CCI during passive joint rotations and reactive standing balance. The CCI between the plantarflexors and tibialis anterior during spasticity assessment was moderately correlated with the CCI during reactive balance responses (LG-TA: r=0.55; p= 0.02; MG-TA: r= 0.57, p=0.01; SOL-TA: r=0.54, p=0.02; Fig. 1, row 4). Fig. 1: Correlation between co-contraction index during instrumented spasticity assessment and perturbations of standing balance.Download : Download high-res image (242KB)Download : Download full-size image Our results suggest that deficits in spinal pathways governing the stretch reflex, and more specifically reduced reciprocal inhibition, might hinder reactive balance control. Successful postural control might therefore rely on compensations in supraspinal pathways to generate net balance correcting ankle momen","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":"135299044","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}
Pub Date : 2023-09-01DOI: 10.1016/j.gaitpost.2023.07.113
Patrycja Bobowik, Ida Wiszomirska, Jan Gajewski, Michalina Błażkiewicz, Katarzyna Kaczmarczyk
The WHO declared COVID-19 a global pandemic [1], but the long-term consequences and aftermath of the disease remain unclear. The SARS-CoV-2 virus infects the respiratory system and probably also affects many other systems, including the musculoskeletal system [2–4]. In clinical practice, it has been observed that after recovering from COVID-19, a large number of seniors report prolonged general weakness and muscle fatigue. Falls, for instance, are a well-known consequence of reduced muscle strength [5,6]. Is COVID-19 infection associated with long-term reductions in muscle strength and balance ability in older women? The Study Group included 25 women, aged 65+, who declared they had recovered from SARS-CoV-2 infection. The Control Group consisted of women (n=30) of similar age, tested prior to the SARS-CoV-2 pandemic. Muscle torques were measured for the knee flexors (KF), knee extensors (KE), trunk flexors (TF), trunk extensors (TE), and elbow flexors (EF) under isometric conditions using a JBA Staniak® isometric torquemeter, by the maximum voluntary contraction method. Balance was assessed using a Biodex Balance System SD (BBS) platform. A static Postural Stability Test (PST) was performed using the stability platform with eyes open and eyes closed. A dynamic Fall Risk Test (FRT) was performed with eyes open at various levels of platform instability, and on this basis a fall risk index (FRI 6-2) was determined for each subject. Differences between the groups were assessed using the Mann-Whitney U test. A significance level of α=0.05 was assumed. Muscle torque values were normalized to the body weight of each subject. Statistical analysis showed higher values of EF, TF and TE for the Control Group. No statistical differences were found in static stabilographic parameters between groups. The Post-COVID Group did show higher results of the dynamic stabilographic index (FRI6-2) compared to the Control Group, which is indicative of poorer balance abilities. Results are presented in Table 1. Table 1 The results of the muscle toques of various muscle groups and fall risk in Post-COVID Group and Control GroupDownload : Download high-res image (88KB)Download : Download full-size image EF– elbow flexors torque; KF– knee flexors torque; KE– knee extensor torque; TF– trunk flexors torque; TE– trunk extensors torque; FRI– fall risk index; *n=24 We found FRI6-2 to be correlated with TE (r= -0.38) and TF (r= -0.37) for all participants, but this correlation was larger in the Post-COVID Group (r= -0.68 for TE and r= -0.55 for TF). Results indicate that post-COVID women exhibit impaired strength of various muscle groups and body balance in dynamic conditions. Post-COVID physiotherapy should therefore take into account not only respiratory problems but also musculoskeletal and equilibrium disorders, e.g. by using resistance training to improve muscle strength.
{"title":"Muscle strength and equilibrium-maintaining ability in post-COVID women","authors":"Patrycja Bobowik, Ida Wiszomirska, Jan Gajewski, Michalina Błażkiewicz, Katarzyna Kaczmarczyk","doi":"10.1016/j.gaitpost.2023.07.113","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.113","url":null,"abstract":"The WHO declared COVID-19 a global pandemic [1], but the long-term consequences and aftermath of the disease remain unclear. The SARS-CoV-2 virus infects the respiratory system and probably also affects many other systems, including the musculoskeletal system [2–4]. In clinical practice, it has been observed that after recovering from COVID-19, a large number of seniors report prolonged general weakness and muscle fatigue. Falls, for instance, are a well-known consequence of reduced muscle strength [5,6]. Is COVID-19 infection associated with long-term reductions in muscle strength and balance ability in older women? The Study Group included 25 women, aged 65+, who declared they had recovered from SARS-CoV-2 infection. The Control Group consisted of women (n=30) of similar age, tested prior to the SARS-CoV-2 pandemic. Muscle torques were measured for the knee flexors (KF), knee extensors (KE), trunk flexors (TF), trunk extensors (TE), and elbow flexors (EF) under isometric conditions using a JBA Staniak® isometric torquemeter, by the maximum voluntary contraction method. Balance was assessed using a Biodex Balance System SD (BBS) platform. A static Postural Stability Test (PST) was performed using the stability platform with eyes open and eyes closed. A dynamic Fall Risk Test (FRT) was performed with eyes open at various levels of platform instability, and on this basis a fall risk index (FRI 6-2) was determined for each subject. Differences between the groups were assessed using the Mann-Whitney U test. A significance level of α=0.05 was assumed. Muscle torque values were normalized to the body weight of each subject. Statistical analysis showed higher values of EF, TF and TE for the Control Group. No statistical differences were found in static stabilographic parameters between groups. The Post-COVID Group did show higher results of the dynamic stabilographic index (FRI6-2) compared to the Control Group, which is indicative of poorer balance abilities. Results are presented in Table 1. Table 1 The results of the muscle toques of various muscle groups and fall risk in Post-COVID Group and Control GroupDownload : Download high-res image (88KB)Download : Download full-size image EF– elbow flexors torque; KF– knee flexors torque; KE– knee extensor torque; TF– trunk flexors torque; TE– trunk extensors torque; FRI– fall risk index; *n=24 We found FRI6-2 to be correlated with TE (r= -0.38) and TF (r= -0.37) for all participants, but this correlation was larger in the Post-COVID Group (r= -0.68 for TE and r= -0.55 for TF). Results indicate that post-COVID women exhibit impaired strength of various muscle groups and body balance in dynamic conditions. Post-COVID physiotherapy should therefore take into account not only respiratory problems but also musculoskeletal and equilibrium disorders, e.g. by using resistance training to improve muscle strength.","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":"135299053","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}
Pub Date : 2023-09-01DOI: 10.1016/j.gaitpost.2023.07.273
Shiyang Yan, Yihong Zhao, Longbin Zhang, Luming Yang
Excessive weight-bearing positively affects the overloaded foot, which can induce multiple foot deformities [1]. Previous studies normalized maximum force to eliminate the influence of body weight on the mechanical loading of the foot [2]. To explore body weight itself to the change of the plantar pressure distribution, this study adopts a strategy of body weight scale to compare loading patterns between normal-weighted and obese children. It can acquire the exceeded foot loading data accurately for obese children compared to normal-weighted children, which could lead to finding the pressure threshold in obese children. Is there a method to grade the pressure thresholds of plantar overload in obese children? A cross-sectional study with a large sample size of 1170 participants aged 7-11 years was used to divide normal-weighted (n = 812) and obese children (n = 358) into eight groups based on the same weight class strategy: group 1 (25.5-30.4 kg), group 2 (30.5-35.4 kg), group 3 (35.5-40.4 kg), group 4 (40.5-45.4 kg), group 5 (45.5-50.4 kg), group 6 (50.5-55.4 kg), group 7 (55.5-60.4 kg), group 8 (60.5-65.4 kg). Dynamic plantar pressure data were collected using a Footscan® plantar pressure system (RSscan International, Belgium). Maximum forces were extracted from the main plantar region using principal component analysis. The change of obese children with the same weight grade compared with normal-weighted children was divided into six grades, to define the pressure threshold of obese children's plantar pressure compared with normal-weighted children. The assessment criteria of the pressure threshold level are set at 10 N (trivial effect), 10-20 N (very weak effect), 20-30 N (weak effect), 30-40 N (moderate effect), 40-50 N (strong effect) and 50-60 N (very strong effect). Table 1 shows the levels of the pressure threshold in obese children compared to normal-weighted children with the same weight class.Download : Download high-res image (64KB)Download : Download full-size image The results showed that the maximum force of obese children with 25.5-35.4 kg did not cause significant damage to the main stress area of the plantar, and there was no need for clinical intervention or other related foot decompression strategies. When the weight of obese children is greater than 35.5 kg, it is necessary to pay attention to the influence of excessive foot load on the development and health of obese children's feet. This study can provide data support for foot decompression protocols such as shoes or insoles and weight loss training.
{"title":"An approach to establishing the thresholds of plantar loading in obese children","authors":"Shiyang Yan, Yihong Zhao, Longbin Zhang, Luming Yang","doi":"10.1016/j.gaitpost.2023.07.273","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.273","url":null,"abstract":"Excessive weight-bearing positively affects the overloaded foot, which can induce multiple foot deformities [1]. Previous studies normalized maximum force to eliminate the influence of body weight on the mechanical loading of the foot [2]. To explore body weight itself to the change of the plantar pressure distribution, this study adopts a strategy of body weight scale to compare loading patterns between normal-weighted and obese children. It can acquire the exceeded foot loading data accurately for obese children compared to normal-weighted children, which could lead to finding the pressure threshold in obese children. Is there a method to grade the pressure thresholds of plantar overload in obese children? A cross-sectional study with a large sample size of 1170 participants aged 7-11 years was used to divide normal-weighted (n = 812) and obese children (n = 358) into eight groups based on the same weight class strategy: group 1 (25.5-30.4 kg), group 2 (30.5-35.4 kg), group 3 (35.5-40.4 kg), group 4 (40.5-45.4 kg), group 5 (45.5-50.4 kg), group 6 (50.5-55.4 kg), group 7 (55.5-60.4 kg), group 8 (60.5-65.4 kg). Dynamic plantar pressure data were collected using a Footscan® plantar pressure system (RSscan International, Belgium). Maximum forces were extracted from the main plantar region using principal component analysis. The change of obese children with the same weight grade compared with normal-weighted children was divided into six grades, to define the pressure threshold of obese children's plantar pressure compared with normal-weighted children. The assessment criteria of the pressure threshold level are set at 10 N (trivial effect), 10-20 N (very weak effect), 20-30 N (weak effect), 30-40 N (moderate effect), 40-50 N (strong effect) and 50-60 N (very strong effect). Table 1 shows the levels of the pressure threshold in obese children compared to normal-weighted children with the same weight class.Download : Download high-res image (64KB)Download : Download full-size image The results showed that the maximum force of obese children with 25.5-35.4 kg did not cause significant damage to the main stress area of the plantar, and there was no need for clinical intervention or other related foot decompression strategies. When the weight of obese children is greater than 35.5 kg, it is necessary to pay attention to the influence of excessive foot load on the development and health of obese children's feet. This study can provide data support for foot decompression protocols such as shoes or insoles and weight loss 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":"135299057","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}
Pub Date : 2023-09-01DOI: 10.1016/j.gaitpost.2023.07.165
Babette Mooijekind, Louise S. van Muijlwijk, Annemieke I. Buizer, Marjolein M. van der Krogt, Lynn Bar-On
3D ultrasound (3DUS) can be used to visualize the gross morphology of the medial gastrocnemius (MG), including muscle belly, tendon and fascicle lengths, pennation angle and muscle volume [1]. Such information can be used to indicate, and evaluate the effects of treatments that target these structures, for example in children with cerebral palsy [2]. It is essential that 3DUS is sufficiently reliable to quantify changes due to treatment at the individual level. The test-retest reliability of MG 3DUS, particularly of the fascicles, is not well established. What is the test-retest reliability of 3DUS applied on the MG of healthy adults? The MG of 16 healthy adults (27.30±6 years, 10 women, 6 men) was visualized with 3DUS with the foot in an overhanging position (Fig. 1). Two scans were carried out and participants were asked to walk approximately 50 m between scans. Muscle belly, tendon and fascicle lengths, pennation angle and muscle volume were determined from 3D reconstructions using custom-made scripts [1]. Test-retest reliability was analyzed with Bland Altmann plots to visually determine systematic differences between scans and by calculating the intraclass correlation coefficient (ICC), the relative standard error of measurement ((SEM/mean)*100%) and the relative smallest detectable difference ((SDD/mean)*100%). An intraclass correlation coefficient <0.50 was interpreted as poor, 0.50–0.75 as moderate, 0.75–0.90 as good, and >0.90 as excellent reliability [3]. No systematic differences for the morphological variables were observed between scans based on the absence of clusters in the Bland Altmann plots. ICC values were excellent (0.91-1.00) for muscle belly, tendon, and fascicle lengths, and muscle volume and good for the pennation angle (0.82). The test re-test reliability of the tendon length was found to be most reliable (ICC 1.00) with a relative SEM and SDD of 0.99% and 2.75%, respectively. Muscle belly length (%SEM 2.45%, %SDD 6.78%) and volume (%SEM 3.83%, %SDD 10.62%) were found to have better reliability than fascicle length (%SEM 5.76%, %SDD 15.97%) and pennation angle (%SEM 7.61%, %SDD 21.08%). Based on previous literature [2], the SDD values of the current study may be small enough to detect the effects of MG surgical elongation on muscle belly length and volume in children with cerebral palsy using 3DUS. However, to further elucidate the sensitivity of 3DUS, reliability and sensitivity studies should be carried out on children with cerebral palsy. Further improvements could be made to increase the accuracy of fascicle length and pennation angle determination in 3D. Fig. 1. Schematic representation of measurement set-up and analysis.Download : Download high-res image (92KB)Download : Download full-size image
{"title":"Test-retest reliability of 3D ultrasound to visualize the gross structures of the medial gastrocnemius","authors":"Babette Mooijekind, Louise S. van Muijlwijk, Annemieke I. Buizer, Marjolein M. van der Krogt, Lynn Bar-On","doi":"10.1016/j.gaitpost.2023.07.165","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.165","url":null,"abstract":"3D ultrasound (3DUS) can be used to visualize the gross morphology of the medial gastrocnemius (MG), including muscle belly, tendon and fascicle lengths, pennation angle and muscle volume [1]. Such information can be used to indicate, and evaluate the effects of treatments that target these structures, for example in children with cerebral palsy [2]. It is essential that 3DUS is sufficiently reliable to quantify changes due to treatment at the individual level. The test-retest reliability of MG 3DUS, particularly of the fascicles, is not well established. What is the test-retest reliability of 3DUS applied on the MG of healthy adults? The MG of 16 healthy adults (27.30±6 years, 10 women, 6 men) was visualized with 3DUS with the foot in an overhanging position (Fig. 1). Two scans were carried out and participants were asked to walk approximately 50 m between scans. Muscle belly, tendon and fascicle lengths, pennation angle and muscle volume were determined from 3D reconstructions using custom-made scripts [1]. Test-retest reliability was analyzed with Bland Altmann plots to visually determine systematic differences between scans and by calculating the intraclass correlation coefficient (ICC), the relative standard error of measurement ((SEM/mean)*100%) and the relative smallest detectable difference ((SDD/mean)*100%). An intraclass correlation coefficient <0.50 was interpreted as poor, 0.50–0.75 as moderate, 0.75–0.90 as good, and >0.90 as excellent reliability [3]. No systematic differences for the morphological variables were observed between scans based on the absence of clusters in the Bland Altmann plots. ICC values were excellent (0.91-1.00) for muscle belly, tendon, and fascicle lengths, and muscle volume and good for the pennation angle (0.82). The test re-test reliability of the tendon length was found to be most reliable (ICC 1.00) with a relative SEM and SDD of 0.99% and 2.75%, respectively. Muscle belly length (%SEM 2.45%, %SDD 6.78%) and volume (%SEM 3.83%, %SDD 10.62%) were found to have better reliability than fascicle length (%SEM 5.76%, %SDD 15.97%) and pennation angle (%SEM 7.61%, %SDD 21.08%). Based on previous literature [2], the SDD values of the current study may be small enough to detect the effects of MG surgical elongation on muscle belly length and volume in children with cerebral palsy using 3DUS. However, to further elucidate the sensitivity of 3DUS, reliability and sensitivity studies should be carried out on children with cerebral palsy. Further improvements could be made to increase the accuracy of fascicle length and pennation angle determination in 3D. Fig. 1. Schematic representation of measurement set-up and analysis.Download : Download high-res image (92KB)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":"135299062","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}
The impact of Covid-19 has been significant worldwide and it is essential to clarify the long-term effects of Covid-19. However, even though that mobility and biomechanics of the thorax are essential components of fluent respiration, no study has yet examined the effects of Covid-19 on thorax biomechanics (1). How do different postural conditions affect the velocity of the sternum during deep breathing in individuals with mild to moderate Covid-19 history? Sedentary individuals with mild or moderate Covid-19 history that fully recovered (n=11) and sedentary individuals with no history of Covid-19 (n=11) were invited to the study. Inertial motion units (MTw, Xsens Technologies BV, Enschede, The Netherlands) were used to evaluate the movement of the sternum velocity. Individuals were instructed to breathe slowly and deeply for three consecutive respiratory cycles at sitting position and afterward repeat the same cycle at standing position. Data during deep breathing were calculated and compared as minimum values, maximum values, and maximum range (range) between the first and last point of movement. Movements in the anteroposterior direction were defined on the X-Axis and movements in the craniocaudal direction were defined on the Z-axis. Both Covid-19 and control groups showed similar minimum, maximum, and range values of velocity (p>0.05) at sitting position. However, when switched to the standing position, there were significantly greater minimum velocity (p=0.028), maximum velocity (p=0.028), and velocity range (p=0.010) values in the Z-axis in the Covid-19 group. There were also significantly greater maximum velocity (p=0.028) and velocity range (p=0.023) values in the X-axis for the Covid-19 group (Table 1).Download : Download high-res image (94KB)Download : Download full-size image These results showed that the individuals with a mild to moderate history of Covid-19 were able to perform deep breathing with similar sternum velocity in a sitting position but when switched to standing, a more demanding postural condition, the differences became prominent. These results indicate that individuals with a mild to moderate history of Covid-19 increased their respiratory rate to perform deep breathing.
{"title":"The effect of different postural conditions on velocity of the sternum during deep breathing in individuals with mild-to-moderate Covid-19 history","authors":"Halit Selçuk, İlke Kurt, Sezer Ulukaya, Gülnur Öztürk, Hilal Keklicek","doi":"10.1016/j.gaitpost.2023.07.225","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.225","url":null,"abstract":"The impact of Covid-19 has been significant worldwide and it is essential to clarify the long-term effects of Covid-19. However, even though that mobility and biomechanics of the thorax are essential components of fluent respiration, no study has yet examined the effects of Covid-19 on thorax biomechanics (1). How do different postural conditions affect the velocity of the sternum during deep breathing in individuals with mild to moderate Covid-19 history? Sedentary individuals with mild or moderate Covid-19 history that fully recovered (n=11) and sedentary individuals with no history of Covid-19 (n=11) were invited to the study. Inertial motion units (MTw, Xsens Technologies BV, Enschede, The Netherlands) were used to evaluate the movement of the sternum velocity. Individuals were instructed to breathe slowly and deeply for three consecutive respiratory cycles at sitting position and afterward repeat the same cycle at standing position. Data during deep breathing were calculated and compared as minimum values, maximum values, and maximum range (range) between the first and last point of movement. Movements in the anteroposterior direction were defined on the X-Axis and movements in the craniocaudal direction were defined on the Z-axis. Both Covid-19 and control groups showed similar minimum, maximum, and range values of velocity (p>0.05) at sitting position. However, when switched to the standing position, there were significantly greater minimum velocity (p=0.028), maximum velocity (p=0.028), and velocity range (p=0.010) values in the Z-axis in the Covid-19 group. There were also significantly greater maximum velocity (p=0.028) and velocity range (p=0.023) values in the X-axis for the Covid-19 group (Table 1).Download : Download high-res image (94KB)Download : Download full-size image These results showed that the individuals with a mild to moderate history of Covid-19 were able to perform deep breathing with similar sternum velocity in a sitting position but when switched to standing, a more demanding postural condition, the differences became prominent. These results indicate that individuals with a mild to moderate history of Covid-19 increased their respiratory rate to perform deep breathing.","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":"135297873","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}
Stiff knee gait (SKG) is a common gait abnormality in children with spastic cerebral palsy (SCP) (1). The rectus femoris (RF) muscle is the most targeted treatment of SKG with surgical and neurological interventions (2,3). There is no study in the literature, as we are aware of, investigating the temporary effects of RF muscle weakness on gait in children with SPC. How does artificially reduced rectus femoris primered knee extensor muscle force alters the gait biomechanics of children with SCP? 4 children with SCP (GMFCS Level I-II; 3 females; 2 bilateral, 2 unilateral CP; age:12.75 ± 4.65 y.o., weight: 37.50 ± 12.44 kg, height: 143.88 ± 16.15 cm) were included in the study. To reduce the RF maximal isometric voluntary muscle contraction force (MIVMCF) temporarily, a stretching protocol (135 sec×13 repetitions with 5 sec. resting) was performed (4,5,6). Stretching severity is set as 7/10 discomfort level according to the visual analog scale. 3D gait analysis system (VICON, 6xVantage 5 + 2xAMTI force plates) was utilized before (BS) and after (AS) stretching. MIVMCF of knee-extensor muscles were measured in BS and AS conditions with a hand-held dynamometer (Lafayette 01165 A, US) 3 times at 30-second resting intervals in a sitting position. Interested kinematic and kinetic gait alterations were statistically compared with the paired statistical parametric mapping (SPM{t}) using MATLAB (p<0.05). The MIVMCF of knee-extensor muscles decreased by 15.59% (from 133.91 ± 59.89 N to 113.04 ± 46.35 N) in the AS period. No significant difference was observed between walking speeds (p=0.353). According to the SPM{t} analysis of the sagittal plane parameters of the knee between AS and BS, a significant difference was observed in the initial contact, loading response, and swing sub-phases. All interested gait parameters were compared in Table-1. Download : Download high-res image (255KB)Download : Download full-size image The stretching methodology was effective enough to temporarily reduce the MIVMCF of the knee extensors in children with SPC. As the first in the literature, the gait alterations of rectus femoris primered knee extensor muscle weakness in three planes were determined for children with SCP. As expected, the peak knee flexion and range improved in AS, although the peak knee flexion delay-related parameters did not significantly change. Although 2 of the 4 stiff knee parameters were improved, anterior pelvic tilt was not significantly reduced which may be related to stretching methodology partially involving other knee extensors such as three vastii. Therefore, this study demonstrated that, although the stretching methodology may be improved by surface EMG, it is capable to generate MIVMCF reduction to predict treatment on the knee extensors such as the application of neural agents or orthopedic surgery for SCPs.
{"title":"How does artificially reduced rectus femoris primered knee extensor muscle force alters the gait biomechanics in children with cerebral palsy?","authors":"Kubra Onerge, Rukiye Sert, Nazif Ekin Akalan, Shavkat Nadir, Fuat Bilgili","doi":"10.1016/j.gaitpost.2023.07.181","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.181","url":null,"abstract":"Stiff knee gait (SKG) is a common gait abnormality in children with spastic cerebral palsy (SCP) (1). The rectus femoris (RF) muscle is the most targeted treatment of SKG with surgical and neurological interventions (2,3). There is no study in the literature, as we are aware of, investigating the temporary effects of RF muscle weakness on gait in children with SPC. How does artificially reduced rectus femoris primered knee extensor muscle force alters the gait biomechanics of children with SCP? 4 children with SCP (GMFCS Level I-II; 3 females; 2 bilateral, 2 unilateral CP; age:12.75 ± 4.65 y.o., weight: 37.50 ± 12.44 kg, height: 143.88 ± 16.15 cm) were included in the study. To reduce the RF maximal isometric voluntary muscle contraction force (MIVMCF) temporarily, a stretching protocol (135 sec×13 repetitions with 5 sec. resting) was performed (4,5,6). Stretching severity is set as 7/10 discomfort level according to the visual analog scale. 3D gait analysis system (VICON, 6xVantage 5 + 2xAMTI force plates) was utilized before (BS) and after (AS) stretching. MIVMCF of knee-extensor muscles were measured in BS and AS conditions with a hand-held dynamometer (Lafayette 01165 A, US) 3 times at 30-second resting intervals in a sitting position. Interested kinematic and kinetic gait alterations were statistically compared with the paired statistical parametric mapping (SPM{t}) using MATLAB (p<0.05). The MIVMCF of knee-extensor muscles decreased by 15.59% (from 133.91 ± 59.89 N to 113.04 ± 46.35 N) in the AS period. No significant difference was observed between walking speeds (p=0.353). According to the SPM{t} analysis of the sagittal plane parameters of the knee between AS and BS, a significant difference was observed in the initial contact, loading response, and swing sub-phases. All interested gait parameters were compared in Table-1. Download : Download high-res image (255KB)Download : Download full-size image The stretching methodology was effective enough to temporarily reduce the MIVMCF of the knee extensors in children with SPC. As the first in the literature, the gait alterations of rectus femoris primered knee extensor muscle weakness in three planes were determined for children with SCP. As expected, the peak knee flexion and range improved in AS, although the peak knee flexion delay-related parameters did not significantly change. Although 2 of the 4 stiff knee parameters were improved, anterior pelvic tilt was not significantly reduced which may be related to stretching methodology partially involving other knee extensors such as three vastii. Therefore, this study demonstrated that, although the stretching methodology may be improved by surface EMG, it is capable to generate MIVMCF reduction to predict treatment on the knee extensors such as the application of neural agents or orthopedic surgery for SCPs.","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":"135297889","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}
Pub Date : 2023-09-01DOI: 10.1016/j.gaitpost.2023.07.152
Erik Meilak, Ruud Wellenberg, Wouter Schallig, Andrew Roberts, Melinda Witbreuk, Annemieke Buizer, Mario Maas, Marjolein van der Krogt, Luca Modenese, Caroline Stewart
Children suffering cerebral palsy (CP) often develop foot deformities [1]. These manifest as pathological postures including equinovarus, planovalgus non-midfoot break (PNMFB) and midfoot break (MFB) [2]. Although the mechanism for the development of foot deformity is poorly understood, recent research has highlighted how sensitive muscle moment arms [3] and joint moments are to the orientation of the subtalar joint (STJ) axis. Both are contributors to foot deformity. Studies have demonstrated a large variability in STJ axis orientations in healthy populations [4] and it is hypothesised that the variability in deformed feet will be even higher and correlate with specific deformities. How do STJ axis orientations in CP children with equinovarus, PNMFB and MFB deformities compare with typically developing children? Weight bearing (WB) and non-weight bearing (NWB) cone beam CT images of 21 feet from 17 CP patients (8 equinovarus, 7 PNMFB, 6 MFB, aged 12-17) and 7 feet from 7 typically-developing controls (aged 7-16) were acquired using a Verity (Planmed Oy) and Multitom Rax (Siemens) CBCT systems. Foot bones were semi-automatically segmented using Mimics 24.0, Materialize or Disior Bonelogic and remeshed to 1.0 mm isotropic edge length (OpenFlipper 4.1). Using the STAPLE pipeline [5], spheres were fitted to the talar head and talocalcaneal articulating surfaces and a cylinder to the talocrural articulating surface. STJ axis was approximated by the line joining the two fitted spheres [6]. The talocrural joint axis was approximated by the cylinder fitted to the talocrural articulating surface. An anterior-posterior (AP) line was calculated as the cross product of the ground normal and the talocrural joint axis. For each participant, STJ axis medial deviation and inclination from the AP line was calculated. A 2-sample t-test was used to test for statistically significant differences between groups. Mean STJ axis orientation in healthy participants was 23.2±5.7° (inclination) and 22.0±4.3° (medial deviation, Fig. 1). Inclinations varied from 31.4±6.3° for equinovarus feet to 20.2±4.2 for PNMFB and 4.0±10.6° for MFB patients. Mean medial deviations were 32.7±10.5° (equinovarus), 25.4±6.5° (PNMFB), and 28.8±4.5° (MFB). Both MFB and equinovarus groups exhibited STJ axis medial deviation angles greater than healthy controls. However, where the equinovarus group demonstrated 8.2° (p<0.05) greater inclination angle than the healthy controls, the MFB feet exhibited inclination angles 19.2° lower (p<0.05).Download : Download high-res image (99KB)Download : Download full-size image Although the analysis shows clear groupings in STJ axis orientations, further analyses of a greater range of CP pathological feet are needed to confirm these differences between groups. The abnormal STJ axis orientations of the deformed feet imply that abnormal moments are present during gait, further contributing to deformity. In conclusion, there is a measurable difference between t
{"title":"Subtalar joint axis alignments in pathological feet of children with cerebral palsy","authors":"Erik Meilak, Ruud Wellenberg, Wouter Schallig, Andrew Roberts, Melinda Witbreuk, Annemieke Buizer, Mario Maas, Marjolein van der Krogt, Luca Modenese, Caroline Stewart","doi":"10.1016/j.gaitpost.2023.07.152","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.152","url":null,"abstract":"Children suffering cerebral palsy (CP) often develop foot deformities [1]. These manifest as pathological postures including equinovarus, planovalgus non-midfoot break (PNMFB) and midfoot break (MFB) [2]. Although the mechanism for the development of foot deformity is poorly understood, recent research has highlighted how sensitive muscle moment arms [3] and joint moments are to the orientation of the subtalar joint (STJ) axis. Both are contributors to foot deformity. Studies have demonstrated a large variability in STJ axis orientations in healthy populations [4] and it is hypothesised that the variability in deformed feet will be even higher and correlate with specific deformities. How do STJ axis orientations in CP children with equinovarus, PNMFB and MFB deformities compare with typically developing children? Weight bearing (WB) and non-weight bearing (NWB) cone beam CT images of 21 feet from 17 CP patients (8 equinovarus, 7 PNMFB, 6 MFB, aged 12-17) and 7 feet from 7 typically-developing controls (aged 7-16) were acquired using a Verity (Planmed Oy) and Multitom Rax (Siemens) CBCT systems. Foot bones were semi-automatically segmented using Mimics 24.0, Materialize or Disior Bonelogic and remeshed to 1.0 mm isotropic edge length (OpenFlipper 4.1). Using the STAPLE pipeline [5], spheres were fitted to the talar head and talocalcaneal articulating surfaces and a cylinder to the talocrural articulating surface. STJ axis was approximated by the line joining the two fitted spheres [6]. The talocrural joint axis was approximated by the cylinder fitted to the talocrural articulating surface. An anterior-posterior (AP) line was calculated as the cross product of the ground normal and the talocrural joint axis. For each participant, STJ axis medial deviation and inclination from the AP line was calculated. A 2-sample t-test was used to test for statistically significant differences between groups. Mean STJ axis orientation in healthy participants was 23.2±5.7° (inclination) and 22.0±4.3° (medial deviation, Fig. 1). Inclinations varied from 31.4±6.3° for equinovarus feet to 20.2±4.2 for PNMFB and 4.0±10.6° for MFB patients. Mean medial deviations were 32.7±10.5° (equinovarus), 25.4±6.5° (PNMFB), and 28.8±4.5° (MFB). Both MFB and equinovarus groups exhibited STJ axis medial deviation angles greater than healthy controls. However, where the equinovarus group demonstrated 8.2° (p<0.05) greater inclination angle than the healthy controls, the MFB feet exhibited inclination angles 19.2° lower (p<0.05).Download : Download high-res image (99KB)Download : Download full-size image Although the analysis shows clear groupings in STJ axis orientations, further analyses of a greater range of CP pathological feet are needed to confirm these differences between groups. The abnormal STJ axis orientations of the deformed feet imply that abnormal moments are present during gait, further contributing to deformity. In conclusion, there is a measurable difference between t","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":"135297890","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}
In children with spastic cerebral palsy (SCP), conservative interventions such as physiotherapy, intra-muscular Botulinum Neurotoxin-A (BoNT-A) and serial casting are applied to counteract neuromuscular impairments [1]. The accumulated effects of these treatments on alterations in macroscopic muscle morphology are difficult to evaluate [2]. In Suriname, the access to these treatments for SCP-children is limited. Studying a cohort of treatment-naïve children, in comparison to a group of children with treatment history, can gain insight in the natural course of altered muscle morphology. Are the medial gastrocnemius (MG) macroscopic muscle morphology alterations different between treatment-naïve SCP children and SCP children with treatment history? In this cross-country comparison study, 20 treatment-naïve children from Suriname were case-control matched by age, GMFCS level and topographical description with 20 SCP-children with treatment history from Belgium. In addition, the data from 20 age-matched typically developing (TD) children from Belgium and 20 age-matched TD children from Suriname were assessed for comparison. A child was treatment-naïve if there was no previous 1) lower limb surgery, 2) serial casting in the last 3 years, 3) lower limb Botulinum Neurotoxin type A (BoNT-A) injection, 4) orthoses and 5) more than 10 physiotherapy sessions a year. SCP children had treatment history if they received usual care including orthoses and regular physiotherapy, and had access to BoNT-A treatment if clinically needed. Children with treatment history were excluded if they had 1) soft-tissue surgery, 2) BoNT-A injection in the last 10 months, 3) lower limb bony surgery in the last 2 years, 4) neurosurgery or 5) baclofen pump. Muscle-tendon unit (MTU) length, muscle length, tendon length and muscle volume were acquired from the MG with 3D freehand ultrasound measurement, which has proven reliability and validity [3]. Similar equipment, acquisition and processing procedures were used in both countries. The morphological alterations of the SCP child were calculated as a percentage of the morphology of the locally matched TD child. The medians and interquartile ranges of the deviation in morphology were defined, and treatment-naïve SCP-children and children with treatment history were compared by a Mann-Whitney U test. Both, the treatment-naïve and treatment-history groups showed alterations in their MG-muscle morphology compared to TD with greatest deviations in muscle volume (-47(19)% versus -31(30)%, Table 1). However, there were no significant differences in alterations for muscle volume, muscle length, tendon length and MTU length between treatment-naïve children and children with treatment history.Download : Download high-res image (167KB)Download : Download full-size image The natural course of pathological muscle morphology in treatment-naïve SCP-children seems comparable to SCP-children with treatment history. This may imply that the effect of
对于痉挛性脑瘫(SCP)患儿，保守性干预如物理治疗、肌内肉毒杆菌神经毒素- a (BoNT-A)和连续铸型等可用于对抗神经肌肉损伤[1]。这些治疗对宏观肌肉形态改变的累积效应很难评估[2]。在苏里南，scp儿童获得这些治疗的机会有限。研究一组treatment-naïve儿童，与一组有治疗史的儿童进行比较，可以深入了解肌肉形态改变的自然过程。treatment-naïve SCP患儿和有治疗史的SCP患儿的内侧腓肠肌(MG)宏观肌肉形态改变是否不同?在这项跨国比较研究中，来自苏里南的20名treatment-naïve儿童与来自比利时的20名有治疗史的scp儿童进行年龄、GMFCS水平和地形描述匹配的病例对照研究。此外，对来自比利时的20名年龄匹配的典型发育(TD)儿童和来自苏里南的20名年龄匹配的TD儿童的数据进行了评估以进行比较。如果以前没有做过1)下肢手术，2)过去3年连续铸造，3)下肢A型肉毒杆菌神经毒素(BoNT-A)注射，4)矫形器和5)每年10次以上物理治疗，则儿童为treatment-naïve。如果接受常规护理，包括矫形器和常规物理治疗，SCP儿童有治疗史，如果临床需要，可以接受BoNT-A治疗。排除有治疗史的儿童:1)软组织手术，2)近10个月BoNT-A注射，3)近2年下肢骨手术，4)神经外科手术或5)巴氯芬泵。通过三维徒手超声测量MG的肌腱单位(MTU)长度、肌长、肌腱长度和肌肉体积，证明了该方法的可靠性和有效性[3]。这两个国家都使用了类似的设备、采购和加工程序。SCP患儿的形态学改变计算为局部匹配的TD患儿形态学的百分比。定义形态学偏差的中位数和四分位数范围，并将treatment-naïve患儿与有治疗史的患儿进行Mann-Whitney U检验比较。与TD相比，treatment-naïve组和治疗史组的mg -肌形态都发生了变化，肌肉体积偏差最大(-47(19)%对-31(30)%，表1)。然而，treatment-naïve组和有治疗史的儿童在肌肉体积、肌肉长度、肌腱长度和MTU长度的变化方面没有显著差异。下载:下载高分辨率图片(167KB)下载:下载全尺寸图片treatment-naïve scp -儿童病理肌肉形态的自然过程似乎与有治疗史的scp -儿童相似。这可能意味着干预的效果不会显著影响肌肉病理形态。然而，数据的异质性要求在解释时谨慎。进一步的分析可能会揭示这些治疗对神经肌肉损伤和步态病理的累积效应。
{"title":"Medial gastrocnemius muscle morphology in spastic cerebral palsy: A comparison between treatment naïve children and children with a treatment history","authors":"Fenna Walhain, Britta Hanssen, Rhea Spong-Cruden, Delaja Plein, Chelsi Bardan, Ruby Chin A Fat, Marlies Declerck, Lynn Bar-On, Anja Van Campenhout, Kaat Desloovere","doi":"10.1016/j.gaitpost.2023.07.261","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.261","url":null,"abstract":"In children with spastic cerebral palsy (SCP), conservative interventions such as physiotherapy, intra-muscular Botulinum Neurotoxin-A (BoNT-A) and serial casting are applied to counteract neuromuscular impairments [1]. The accumulated effects of these treatments on alterations in macroscopic muscle morphology are difficult to evaluate [2]. In Suriname, the access to these treatments for SCP-children is limited. Studying a cohort of treatment-naïve children, in comparison to a group of children with treatment history, can gain insight in the natural course of altered muscle morphology. Are the medial gastrocnemius (MG) macroscopic muscle morphology alterations different between treatment-naïve SCP children and SCP children with treatment history? In this cross-country comparison study, 20 treatment-naïve children from Suriname were case-control matched by age, GMFCS level and topographical description with 20 SCP-children with treatment history from Belgium. In addition, the data from 20 age-matched typically developing (TD) children from Belgium and 20 age-matched TD children from Suriname were assessed for comparison. A child was treatment-naïve if there was no previous 1) lower limb surgery, 2) serial casting in the last 3 years, 3) lower limb Botulinum Neurotoxin type A (BoNT-A) injection, 4) orthoses and 5) more than 10 physiotherapy sessions a year. SCP children had treatment history if they received usual care including orthoses and regular physiotherapy, and had access to BoNT-A treatment if clinically needed. Children with treatment history were excluded if they had 1) soft-tissue surgery, 2) BoNT-A injection in the last 10 months, 3) lower limb bony surgery in the last 2 years, 4) neurosurgery or 5) baclofen pump. Muscle-tendon unit (MTU) length, muscle length, tendon length and muscle volume were acquired from the MG with 3D freehand ultrasound measurement, which has proven reliability and validity [3]. Similar equipment, acquisition and processing procedures were used in both countries. The morphological alterations of the SCP child were calculated as a percentage of the morphology of the locally matched TD child. The medians and interquartile ranges of the deviation in morphology were defined, and treatment-naïve SCP-children and children with treatment history were compared by a Mann-Whitney U test. Both, the treatment-naïve and treatment-history groups showed alterations in their MG-muscle morphology compared to TD with greatest deviations in muscle volume (-47(19)% versus -31(30)%, Table 1). However, there were no significant differences in alterations for muscle volume, muscle length, tendon length and MTU length between treatment-naïve children and children with treatment history.Download : Download high-res image (167KB)Download : Download full-size image The natural course of pathological muscle morphology in treatment-naïve SCP-children seems comparable to SCP-children with treatment history. This may imply that the effect of","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":"135298026","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}
Selective voluntary motor control (SVMC) is a major contributor to motor function, balance, and gait performance in spastic cerebral palsy (SCP)(1). Single-leg standing (SLS) is a simple test to measure static balance which is highly correlated(2) and affected by impaired voluntary control in SCP(3). Therefore, a rapid and effective clinical evaluation of SVMC is of great importance. The aim of the study is to test whether SVMC assessment can be performed during SLS. May lower extremity SVMC be predicted during SLS in children with SCP? A total of 42 limbs of 11 children with SCP (6 females, 6 bilateral, 5 unilateral, 17 affected limbs; 11.33 ± 3.13 y.o, 39.14 ± 12.42 kg, 141.86 ± 14.46 cm) and 10 typically developed (TD) controls (4 females; 12.04 ± 3.16 y.o, 44.42 ± 16.12 kg, 151.88 ± 16.56 cm) were assessed in the study. The Selective Control Assessment of the Lower Extremity (SCALE) tool was used to measure SVMC(4). Hip, knee, and ankle movements were evaluated with a 3-point likert scale (2: normal, 1: impaired, 0: unable) at the monarthric level. In order to predict SVMC during SLS, the participants were videotaped while standing on a flat surface on one limb for as long as they could without any support by a smartphone (Xiaomi Redmi 10,50 MP) with a tripod placed at knee-level height (anterolaterally 45°). The longest SLS (max 10 sec.) of the three separate video recordings was evaluated. Similar to the SCALE, a 0-1-2 scoring system was developed to assess each joint’s SVMC during SLS: (2: the expected movements to maintain balance, 1: partial movements to maintain stability, 0: no compensated movement). 4 pediatric physical therapists with 7+ years of experience scored the videos 2 times in total, 1 week apart. The intra-rater and inter-rater reliability were statistically analyzed with intraclass correlation coefficients (ICC) and corresponding 95% confidence intervals (CI)(p<0.05)(5). Intra-rater reliability ICC correlation was excellent level at the subtalar-joint, good level at the ankle and toes, moderate level at the knee, and poor level at the hip were found between SVMC and SLS (Table-1). Also, significantly good to excellent inter-rater reliability (from 0.619 to 0.911) was found between SLS and SVMC (p<0.001). Download : Download high-res image (195KB)Download : Download full-size image The video-based SLS novel assessment methodology in this study succeeded to have a good to excellent correlation on SVMC on foot (ankle-subtalar-toe) joint level which was moderately correlated with appropriate ankle dorsiflexion at late swing(6). Movement assessment during SLS may give so much information about the quality of SVMC at the ankle-foot level which is the most related item with the gait abnormality. The research team is currently continuing to increase the sample size by including more participants and train more raters with a simple form and/or videos.
{"title":"Can we predict lower extremity motor control problems from single leg standing test for children with cerebral palsy?","authors":"Kubra Onerge, Mervenur Arslan, Nazif Ekin Akalan, Rukiye Sert, Halenur Evrendilek","doi":"10.1016/j.gaitpost.2023.07.179","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.179","url":null,"abstract":"Selective voluntary motor control (SVMC) is a major contributor to motor function, balance, and gait performance in spastic cerebral palsy (SCP)(1). Single-leg standing (SLS) is a simple test to measure static balance which is highly correlated(2) and affected by impaired voluntary control in SCP(3). Therefore, a rapid and effective clinical evaluation of SVMC is of great importance. The aim of the study is to test whether SVMC assessment can be performed during SLS. May lower extremity SVMC be predicted during SLS in children with SCP? A total of 42 limbs of 11 children with SCP (6 females, 6 bilateral, 5 unilateral, 17 affected limbs; 11.33 ± 3.13 y.o, 39.14 ± 12.42 kg, 141.86 ± 14.46 cm) and 10 typically developed (TD) controls (4 females; 12.04 ± 3.16 y.o, 44.42 ± 16.12 kg, 151.88 ± 16.56 cm) were assessed in the study. The Selective Control Assessment of the Lower Extremity (SCALE) tool was used to measure SVMC(4). Hip, knee, and ankle movements were evaluated with a 3-point likert scale (2: normal, 1: impaired, 0: unable) at the monarthric level. In order to predict SVMC during SLS, the participants were videotaped while standing on a flat surface on one limb for as long as they could without any support by a smartphone (Xiaomi Redmi 10,50 MP) with a tripod placed at knee-level height (anterolaterally 45°). The longest SLS (max 10 sec.) of the three separate video recordings was evaluated. Similar to the SCALE, a 0-1-2 scoring system was developed to assess each joint’s SVMC during SLS: (2: the expected movements to maintain balance, 1: partial movements to maintain stability, 0: no compensated movement). 4 pediatric physical therapists with 7+ years of experience scored the videos 2 times in total, 1 week apart. The intra-rater and inter-rater reliability were statistically analyzed with intraclass correlation coefficients (ICC) and corresponding 95% confidence intervals (CI)(p<0.05)(5). Intra-rater reliability ICC correlation was excellent level at the subtalar-joint, good level at the ankle and toes, moderate level at the knee, and poor level at the hip were found between SVMC and SLS (Table-1). Also, significantly good to excellent inter-rater reliability (from 0.619 to 0.911) was found between SLS and SVMC (p<0.001). Download : Download high-res image (195KB)Download : Download full-size image The video-based SLS novel assessment methodology in this study succeeded to have a good to excellent correlation on SVMC on foot (ankle-subtalar-toe) joint level which was moderately correlated with appropriate ankle dorsiflexion at late swing(6). Movement assessment during SLS may give so much information about the quality of SVMC at the ankle-foot level which is the most related item with the gait abnormality. The research team is currently continuing to increase the sample size by including more participants and train more raters with a simple form and/or videos.","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":"135298195","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}
The anterior talofibular ligament connects the talus to the lateral malleolus and is an essential component in understanding the pathophysiology of ankle sprains. In recent years, ultrasound is often used in its evaluation, however, most of it remains a static assessment (Rein S et al., 2020). Are there gender differences in the dynamics of the distance between the talus and the lateral malleolus during the stance phase of gait using ultrasound in healthy adults? The participants in this study were 10 healthy males and 9 healthy females. All participants did not report a history of previous ankle sprains. We used a motion capture system (Vicon Motion Systems, UK) synchronized with an ultrasound (Art Us EXT-1H, Telemed, Vilnius, Lithuania) to examine the distance between the talus and the lateral malleolus during the stance phase of gait. The US probe (5-11 MHz, 60-mm field of view; Echoblaster, Telemed, Vilnius, Lithuania) was positioned on the lateral side of the ankle joint and visualized the most lateral part of the talus and lateral malleolus on the ultrasound screen. Participants walked at a comfortable speed on a force plate (OR-6, 1000 Hz: AMTI, USA) and the interval from heel contact to toe-off was included in the analysis. Tracker 5.1.5 software (Open-Source Physics) was used to calculate the distance between the talus and lateral malleolus and the amount of change with respect to that distance at heel contact. Unpaired t-tests were used to compare the gender differences in that distance in the early, middle, and terminal stance phases. The changes in the distance between the talus and the lateral malleolus were -0.15±1.15 mm in the early stance phase, -0.98±1.99 mm in the middle stance phase, and -0.77±1.99 mm in the terminal stance phase in males and -0.84±0.92 mm, -2.24±1.40 mm, and -0.64±1.52 mm in women, respectively. The changes in the distance were significantly higher in females than in males in the early and middle stance phases. In females, the distance between the talus and the lateral malleolus during the stance phase of gait is highly variable, and this hypermobility may be a risk for ankle sprains and future ankle osteoarthritis. Prior study has reported that joint laxity is greater in women than in men after puberty, which may affect the incidence of injury (Quatman CE et al., 2008). This study using ultrasound could provide a basic data for examining ankle dynamics during gait in patients with ankle sprains.
距腓骨前韧带连接距骨和外踝，是了解踝关节扭伤病理生理学的重要组成部分。近年来，超声经常用于其评估，然而，大多数仍然是静态评估(Rein S et al.， 2020)。在健康成人步态站立阶段使用超声观察距骨和外踝之间的距离是否存在性别差异?本研究的参与者为10名健康男性和9名健康女性。所有参与者都没有踝关节扭伤史。我们使用动作捕捉系统(Vicon motion Systems, UK)与超声波(Art Us EXT-1H, Telemed, Vilnius，立陶宛)同步来检查步态站立阶段距骨和外踝之间的距离。美国探头(5-11 MHz, 60毫米视场;Echoblaster, Telemed, Vilnius，立陶宛)定位于踝关节外侧，在超声屏幕上显示距骨和外踝的最外侧部分。参与者在力板上以舒适的速度行走(OR-6, 1000 Hz: AMTI, USA)，从脚后跟接触到脚趾脱落的时间间隔也包括在分析中。使用Tracker 5.1.5软件(开源物理)计算距骨和外踝之间的距离以及脚跟接触时距离的变化量。使用非配对t检验比较在站立早期、中期和终末阶段的距离的性别差异。距骨与外踝之间的距离变化，男性站立前期-0.15±1.15 mm，站立中期-0.98±1.99 mm，站立末期-0.77±1.99 mm，女性分别为-0.84±0.92 mm， -2.24±1.40 mm， -0.64±1.52 mm。在站立前期和中期，女性的距离变化明显高于男性。在女性中，步态站立阶段距骨和外踝之间的距离是高度可变的，这种过度活动可能是踝关节扭伤和未来踝关节骨关节炎的风险。先前有研究报道，女性在青春期后的关节松弛程度大于男性，这可能会影响损伤的发生率(Quatman CE et al.， 2008)。本研究可为踝关节扭伤患者步态过程中踝关节动力学的研究提供基础数据。
{"title":"Gender differences in distance between the talus and lateral malleolus during gait using ultrasound in healthy adults","authors":"Tsubasa Tashiro, Noriaki Maeda, Satoshi Onoue, Miki Kawai, Ayano Ishida, Shogo Tsutsumi, Satoshi Arima, Makoto Komiya, Yukio Urabe","doi":"10.1016/j.gaitpost.2023.07.242","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.242","url":null,"abstract":"The anterior talofibular ligament connects the talus to the lateral malleolus and is an essential component in understanding the pathophysiology of ankle sprains. In recent years, ultrasound is often used in its evaluation, however, most of it remains a static assessment (Rein S et al., 2020). Are there gender differences in the dynamics of the distance between the talus and the lateral malleolus during the stance phase of gait using ultrasound in healthy adults? The participants in this study were 10 healthy males and 9 healthy females. All participants did not report a history of previous ankle sprains. We used a motion capture system (Vicon Motion Systems, UK) synchronized with an ultrasound (Art Us EXT-1H, Telemed, Vilnius, Lithuania) to examine the distance between the talus and the lateral malleolus during the stance phase of gait. The US probe (5-11 MHz, 60-mm field of view; Echoblaster, Telemed, Vilnius, Lithuania) was positioned on the lateral side of the ankle joint and visualized the most lateral part of the talus and lateral malleolus on the ultrasound screen. Participants walked at a comfortable speed on a force plate (OR-6, 1000 Hz: AMTI, USA) and the interval from heel contact to toe-off was included in the analysis. Tracker 5.1.5 software (Open-Source Physics) was used to calculate the distance between the talus and lateral malleolus and the amount of change with respect to that distance at heel contact. Unpaired t-tests were used to compare the gender differences in that distance in the early, middle, and terminal stance phases. The changes in the distance between the talus and the lateral malleolus were -0.15±1.15 mm in the early stance phase, -0.98±1.99 mm in the middle stance phase, and -0.77±1.99 mm in the terminal stance phase in males and -0.84±0.92 mm, -2.24±1.40 mm, and -0.64±1.52 mm in women, respectively. The changes in the distance were significantly higher in females than in males in the early and middle stance phases. In females, the distance between the talus and the lateral malleolus during the stance phase of gait is highly variable, and this hypermobility may be a risk for ankle sprains and future ankle osteoarthritis. Prior study has reported that joint laxity is greater in women than in men after puberty, which may affect the incidence of injury (Quatman CE et al., 2008). This study using ultrasound could provide a basic data for examining ankle dynamics during gait in patients with ankle sprains.","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":"135298530","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}
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