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":"44 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":"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":"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":"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":"57 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":"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":"39 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":"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":"96 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":"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}
Pub Date : 2023-09-01DOI: 10.1016/j.gaitpost.2023.07.265
Niels Waterval, Frans Nollet, Merel-Anne Brehm
{"title":"Ankle power support of spring-like ankle foot orthoses and their effect on compensatory joint work","authors":"Niels Waterval, Frans Nollet, Merel-Anne Brehm","doi":"10.1016/j.gaitpost.2023.07.265","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.265","url":null,"abstract":"","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":"3 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":"135298549","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}
Patellofemoral pain (PFP) is one of the leading causes of knee pain. Changes in movement patterns and a possible relationship between movement patterns and muscle activation are commonly found in women with PFP [1]. The Movement Deviation Profile (MDP) showed differences in the movement pattern in women with PFP [2], however, to the best of our knowledge, the MDP was not used to differentiate the electromyography of women with and without PFP. This study aimed to verify whether the combined analysis of kinematics and EMG data increases the ability to differentiate between women with and without PFP compared to the independent analysis of kinematics and electromyographic activity. Is there a difference in movement patterns and muscle activation between women with and without PFP? Could the combination of EMG with kinematics data increase the ability to differentiate women with and without PFP? Seventy-one women, 37 with PFP and 34 unimpaired were selected for kinematic and EMG evaluation during the Lateral Step Down (LSD) task. For the 3D kinematics, movements in the sagittal, frontal and transverse planes of the trunk, pelvis and hip were used; sagittal and frontal planes of the knee; ankle sagittal plane; and the transverse plane of the foot in relation to the laboratory. For the EMG, filtered, rectified and smoothed signals from the adductor longus, gluteus medius, vastus lateralis and medialis, rectus femoris, biceps femoris, medial gastrocnemius and tibialis anterior muscles were used, which were normalised in amplitude to the average of the peaks of each cycle of LSD and in time by resampling the EMG envelopes every 1% of the LSD cycle. The MDP, which is a single number measure of movement deviation derived from a multidimensional neural network analysis, was used to analyse kinematics, EMG and kinematics combined with EMG. The Z-score of the MDPmean was calculated to compare the standardised results between women with and without PFP. A multivariate analysis with Bonferroni post-hoc test compared the groups considering p < 0.05. Multivariate analysis showed group interaction (l=0.838; F=4.329; p=0.008). There was a significant difference between groups in the MDPmean Z-Score only for kinematics (0.97). There was no difference between groups for EMG (0.44) and kinematics with EMG (0.39).Download : Download high-res image (117KB)Download : Download full-size image This study corroborates with the literature demonstrating that women with PFP present changes in the movement pattern but not in the amplitude of the electromyography. EMG, even when evaluating with a self-organising neural network (MDP), considering several muscles relevant to PFP, failed to differentiate between women with and without PFP both on its own or combined with kinematics. We conclude that, when using MDP, kinematics is the variable capable of differentiating women with and without PFP during LSD.
{"title":"Movement patterns are different but muscle activations are unchanged in women with patellofemoral pain","authors":"Albuquerque Tadeu, Cintia Lopes Ferreira, Juliane Almeida, Barton Gabor, Paulo Lucareli","doi":"10.1016/j.gaitpost.2023.07.240","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.240","url":null,"abstract":"Patellofemoral pain (PFP) is one of the leading causes of knee pain. Changes in movement patterns and a possible relationship between movement patterns and muscle activation are commonly found in women with PFP [1]. The Movement Deviation Profile (MDP) showed differences in the movement pattern in women with PFP [2], however, to the best of our knowledge, the MDP was not used to differentiate the electromyography of women with and without PFP. This study aimed to verify whether the combined analysis of kinematics and EMG data increases the ability to differentiate between women with and without PFP compared to the independent analysis of kinematics and electromyographic activity. Is there a difference in movement patterns and muscle activation between women with and without PFP? Could the combination of EMG with kinematics data increase the ability to differentiate women with and without PFP? Seventy-one women, 37 with PFP and 34 unimpaired were selected for kinematic and EMG evaluation during the Lateral Step Down (LSD) task. For the 3D kinematics, movements in the sagittal, frontal and transverse planes of the trunk, pelvis and hip were used; sagittal and frontal planes of the knee; ankle sagittal plane; and the transverse plane of the foot in relation to the laboratory. For the EMG, filtered, rectified and smoothed signals from the adductor longus, gluteus medius, vastus lateralis and medialis, rectus femoris, biceps femoris, medial gastrocnemius and tibialis anterior muscles were used, which were normalised in amplitude to the average of the peaks of each cycle of LSD and in time by resampling the EMG envelopes every 1% of the LSD cycle. The MDP, which is a single number measure of movement deviation derived from a multidimensional neural network analysis, was used to analyse kinematics, EMG and kinematics combined with EMG. The Z-score of the MDPmean was calculated to compare the standardised results between women with and without PFP. A multivariate analysis with Bonferroni post-hoc test compared the groups considering p < 0.05. Multivariate analysis showed group interaction (l=0.838; F=4.329; p=0.008). There was a significant difference between groups in the MDPmean Z-Score only for kinematics (0.97). There was no difference between groups for EMG (0.44) and kinematics with EMG (0.39).Download : Download high-res image (117KB)Download : Download full-size image This study corroborates with the literature demonstrating that women with PFP present changes in the movement pattern but not in the amplitude of the electromyography. EMG, even when evaluating with a self-organising neural network (MDP), considering several muscles relevant to PFP, failed to differentiate between women with and without PFP both on its own or combined with kinematics. We conclude that, when using MDP, kinematics is the variable capable of differentiating women with and without PFP during LSD.","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":"15 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":"135298551","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.2023.08.026
Alexia Patinioti, Georgios Gkrimas
{"title":"Comparison of the degree of reliability in forensic gait analysis Methods","authors":"Alexia Patinioti, Georgios Gkrimas","doi":"10.1016/j.gaitpost.2023.08.026","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.08.026","url":null,"abstract":"","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":"1 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":"135298553","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.2023.07.203
Maria Rassam, Karim Hoyek, Rony El Hayeck, Georges Haddad, Emmanuelle Wakim, Elio Mekhael, Nabil Nassim, Ismat Ghanem, Rami El Rachkidi, Ayman Assi
Scoliosis is a 3D spinal deformity that is known to affect patient’s alignment on static radiographs [1] and their movement during walking or other daily life activities [2]. Crossing obstacles is a common activity that can challenge patients’ stability. However, kinematics of the obstacle-crossing movement is still unknown in adolescent idiopathic scoliosis (AIS). Are kinematics affected in patients with AIS during obstacle-crossing? 18 AIS patients with major right convexity thoracic scoliosis (Cobb: 38° [25-55°]) and 15 controls (age and sex matched: 16 years, 85% F) underwent biplanar X-rays in standing position with the calculation of 3D radiographic spinopelvic parameters. 3D movement analysis was performed during obstacle-crossing, obstacle being fixed at 30% of lower limb length, and executed once with each leg leading the movement. Kinematic parameters of the head, trunk, pelvis, lower limbs and spinal segments were calculated [3,4]. Parameters were compared between the 2 groups and the relationship between kinematic and radiographic variables was investigated. During obstacle-crossing, AIS patients showed an increased thorax extension compared to controls (-19 vs 6°, p<0.05), especially in the main thoracic segment (T3T6-T6T9= 9 vs 14°, p<0.05). Conversely, AIS patients showed a decreased lumbar lordosis when compared to controls (T12L3-L3L5=-14 vs -20°, p<0.05). Moreover, AIS patients showed an anterior rotation (-2 vs 2°) and elevation (6 vs 0°, both p<0.05) of the right shoulder. Patients also showed a decreased hip abduction of the leading leg when compared to controls (-5 vs -9°, p<0.05). The main thoracic extension was correlated to the Cobb angle (r=-0.50) and the shoulder axial rotation to the apical vertebral rotation (r=0.75, both p<0.05; Fig. 1). AIS patients are known to have back flattening with a loss of lumbar lordosis due to their spinal deformity. This spinal malalignment was shown to persist dynamically during obstacle-crossing, associated with a forward shift and elevation of the convexity-side shoulder. The backward movement of the trunk and the shoulder rotation attitude, along with the decreased hip abduction, might hinder stability during obstacle-crossing. These kinematic alterations were shown to increase with the spinal deformity (increased Cobb and apical vertebral rotation). Future studies will investigate kinematic changes in AIS patients following spinal fusion. Fig. 1 Correlations between kinematic limitations and scoliosis severity in adolescent idiopathic scoliosis during obstacle-crossing movement.Download : Download high-res image (100KB)Download : Download full-size image
{"title":"Kinematic limitations during obstacle-crossing in adolescent idiopathic scoliosis","authors":"Maria Rassam, Karim Hoyek, Rony El Hayeck, Georges Haddad, Emmanuelle Wakim, Elio Mekhael, Nabil Nassim, Ismat Ghanem, Rami El Rachkidi, Ayman Assi","doi":"10.1016/j.gaitpost.2023.07.203","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.203","url":null,"abstract":"Scoliosis is a 3D spinal deformity that is known to affect patient’s alignment on static radiographs [1] and their movement during walking or other daily life activities [2]. Crossing obstacles is a common activity that can challenge patients’ stability. However, kinematics of the obstacle-crossing movement is still unknown in adolescent idiopathic scoliosis (AIS). Are kinematics affected in patients with AIS during obstacle-crossing? 18 AIS patients with major right convexity thoracic scoliosis (Cobb: 38° [25-55°]) and 15 controls (age and sex matched: 16 years, 85% F) underwent biplanar X-rays in standing position with the calculation of 3D radiographic spinopelvic parameters. 3D movement analysis was performed during obstacle-crossing, obstacle being fixed at 30% of lower limb length, and executed once with each leg leading the movement. Kinematic parameters of the head, trunk, pelvis, lower limbs and spinal segments were calculated [3,4]. Parameters were compared between the 2 groups and the relationship between kinematic and radiographic variables was investigated. During obstacle-crossing, AIS patients showed an increased thorax extension compared to controls (-19 vs 6°, p<0.05), especially in the main thoracic segment (T3T6-T6T9= 9 vs 14°, p<0.05). Conversely, AIS patients showed a decreased lumbar lordosis when compared to controls (T12L3-L3L5=-14 vs -20°, p<0.05). Moreover, AIS patients showed an anterior rotation (-2 vs 2°) and elevation (6 vs 0°, both p<0.05) of the right shoulder. Patients also showed a decreased hip abduction of the leading leg when compared to controls (-5 vs -9°, p<0.05). The main thoracic extension was correlated to the Cobb angle (r=-0.50) and the shoulder axial rotation to the apical vertebral rotation (r=0.75, both p<0.05; Fig. 1). AIS patients are known to have back flattening with a loss of lumbar lordosis due to their spinal deformity. This spinal malalignment was shown to persist dynamically during obstacle-crossing, associated with a forward shift and elevation of the convexity-side shoulder. The backward movement of the trunk and the shoulder rotation attitude, along with the decreased hip abduction, might hinder stability during obstacle-crossing. These kinematic alterations were shown to increase with the spinal deformity (increased Cobb and apical vertebral rotation). Future studies will investigate kinematic changes in AIS patients following spinal fusion. Fig. 1 Correlations between kinematic limitations and scoliosis severity in adolescent idiopathic scoliosis during obstacle-crossing movement.Download : Download high-res image (100KB)Download : Download full-size image","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":"57 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":"135298703","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.2023.07.256
Gaia Van Den Heuvel, Wouter Schallig, Marjolein van der Krogt, Ruud Wellenberg, Mario Maas, Annemieke Buizer, Ajay Seth
Children with cerebral palsy (CP) commonly develop deformities of the foot [1], which lead to pain and gait problems. One of the causes of such deformities is likely an imbalance in muscle forces around the foot [2]. In turn, these deformities can also alter muscle function due to altered muscle moment arms. Moment arms can be estimated using musculoskeletal models, but models based on generic bone geometry are unlikely to represent the deformity accurately. Weight-bearing computed tomography (WBCT) enables assessment of abnormal bone alignment under loaded conditions [3]. What are the changes in moment arm lengths of the main invertors and evertors (i.e. the tibialis and peroneal muscles) around the subtalar joint in children with cavovarus and equinovarus foot deformity due to CP? Six children with a severe hindfoot varus deformity due to CP (one female, aged 13.8 ± 2.3 years) and four typically developed (TD) adults (one female, aged 35.8 ± 4.8 years) were included. Personalized musculoskeletal foot models were created in OpenSim Creator [4] using WBCT scans. This foot was attached to the full-body OpenSim gait2392 model, which was scaled using gait analysis data. Muscle moment arms were calculated using OpenSim [5,6] and normalized to tibia length. A non-parametric Mann-Whitney U test was used to compare between groups. Normalized inversion-eversion moment arm lengths are shown in Fig. 1. The tibialis anterior had an inversion moment arm in the deformed CP feet, in contrast to an eversion moment arm in the TD group. No differences were found for the tibialis posterior. Although there was no overall group effect, the eversion moment arm of the peroneal muscles was smaller in most CP children compared to the TD group. Fig. 1 - Moment arms around the subtalar joint, normalized to tibia length. Note the different scales on the vertical axes. * p <.01.Download : Download high-res image (93KB)Download : Download full-size image We present the first study to evaluate altered moment arms in feet of children with CP using personalized musculoskeletal foot models based on WBCT scans. Our results indicate that the tibialis anterior becomes a more effective invertor with a varus deformity of the foot. Despite the fact that the tibialis posterior is often seen as an important cause of the varus deformity, its function as expressed by the moment arm does not change. On the other hand, the eversion moment arms of the peroneal muscles tend to become smaller, meaning they would be less effective in counterbalancing the deformity. Together, these altered moment arms would lead to an even larger varus moment in the subtalar joint with similar muscle forces, thereby pulling the foot even more towards varus. Our results could explain the progression of the deformity once the deformity is present.
患有脑瘫(CP)的儿童通常会出现足部畸形，从而导致疼痛和步态问题。造成这种畸形的原因之一可能是足部周围肌肉力量的不平衡。反过来，由于肌肉力臂的改变，这些畸形也会改变肌肉功能。力矩臂可以使用肌肉骨骼模型来估计，但基于一般骨骼几何的模型不太可能准确地表示畸形。负重计算机断层扫描(WBCT)可以评估负载条件下异常的骨排列[b]。CP引起的足内翻和马内翻畸形患儿距下关节周围主要内翻肌和外翻肌(即胫骨肌和腓骨肌)的力臂长度有什么变化?本研究包括6例由CP引起的严重后足内翻畸形儿童(1例女性，年龄13.8±2.3岁)和4例典型发育(TD)成人(1例女性，年龄35.8±4.8岁)。使用WBCT扫描在OpenSim Creator[4]中创建个性化的肌肉骨骼足模型。将这只脚连接到全身OpenSim gait2392模型上，使用步态分析数据对模型进行缩放。使用OpenSim计算肌肉力臂[5,6]，并将其归一化为胫骨长度。采用非参数Mann-Whitney U检验进行组间比较。归一化倒转力矩臂长度如图1所示。与TD组的外翻力臂相比，畸形CP足的胫骨前肌有内翻力臂。胫骨后肌无明显差异。虽然没有整体的组效应，但与TD组相比，大多数CP儿童的腓骨肌外翻力矩臂较小。图1 -距下关节周围的力臂，与胫骨长度标准化。请注意垂直轴上的不同刻度。* p < 0.01。下载:下载:下载全尺寸图片我们首次使用基于WBCT扫描的个性化足部肌肉骨骼模型来评估CP儿童足部力臂的改变。我们的结果表明，胫骨前肌成为一个更有效的倒置与足内翻畸形。尽管胫骨后肌通常被认为是内翻畸形的重要原因，但它的功能通过力臂表达并没有改变。另一方面，腓肌的外翻力矩臂往往会变小，这意味着它们在平衡畸形方面的效果会降低。总之，这些改变的力臂会导致距下关节在类似的肌肉力量下产生更大的内翻力矩，从而将脚进一步拉向内翻。我们的结果可以解释一旦畸形出现，畸形的进展。
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