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":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"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":"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":"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":"87 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":"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}
Pub Date : 2023-09-01DOI: 10.1016/j.gaitpost.2023.07.191
Eirini Papageorgiou, Els Ortibus, Guy Molenaers, Anja Van Campenhout, Kaat Desloovere
Botulinum neurotoxin type A (BoNT) injections and selective dorsal rhizotomy (SDR) are often applied tone reduction procedures in children with spastic cerebral palsy (CP).[1,2] BoNT is focal and temporary, whereas SDR is generalized and non-reversible. Previous studies have investigated the changes inflicted by these treatments in generic CP-groups.[3,4] It is not yet clear whether specific gait patterns would respond differently to each treatment. What are the short-term, gait pattern-specific changes inflicted by BoNT injections or SDR in children with CP? Retrospective samples that had been treated either BoNT injections (NBoNT=117; baseline ageBoNT= 6y4mo±2y4mo; GMFCS I/II/III: 70/31/16) or SDR (NSDR=89; baseline ageSDR=9y5mo±2y3mo; GMFCS I/II/III: 18/54/17) were selected. All patients underwent three-dimensional gait analysis (3DGA) sessions at baseline and post-treatment (on average 1 y post-SDR and 2mo post-BoNT). The baseline 3DGA was used to classify the gait patterns of the patients, using the gait pattern classification system for children with spastic CP (GaP-CP).[5] For children with bilateral CP, both lower limbs were considered in case of asymmetric patterns between the two lower limbs, Their most affected side was selected when they displayed symmetric gait patterns, similar to the affected lower limb for children with unilateral CP. Gait-related changes focused on sagittal plane kinematics, which were compared with statistical non-parametric mapping (vector of four components, paired Hotellings T2 test, α=0.05 and post-hoc component-level comparisons, paired t-tests, α=0.0125). The comparisons were conducted in the total cohorts, as well as in gait pattern-specific subgroups. Thereafter, statistical clusters were deemed clinically relevant if their duration exceeded 3% of the gait cycle and the respective standard errors of measurement (SEM).[6,7] Changes in neuromuscular impairments were evaluated using the composite spasticity, weakness and selectivity scores of the muscles acting in the sagittal plane,[8] based on the clinical examination. Apparent equinus and jump gait were the best BoNT-responders, followed by dropfoot, where improvements were only observed in the ankle joint. In these three gait patterns, spasticity was improved, but not at the expense of additional weakness or selectivity. For SDR, the best responders were children with jump gait, crouch gait and apparent equinus. Spasticity was improved, while weakness and selectivity either improved or remained stable, in all gait patterns and for the total cohort. Fig. 1 shows the pre- vs post-treatment kinematics and statistically identified clusters of the three best responders to each treatment. "Fig. 1. Pre- vs post-treatment kinematics and statistically identified clusters of the three best responders to each treatment."Download : Download high-res image (251KB)Download : Download full-size image These results highlight the need to inspect the short-term effects o
{"title":"Pattern-specific effects of botulinum neurotoxin type A injections and selective dorsal rhizotomy on gait in children with spastic cerebral palsy","authors":"Eirini Papageorgiou, Els Ortibus, Guy Molenaers, Anja Van Campenhout, Kaat Desloovere","doi":"10.1016/j.gaitpost.2023.07.191","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.191","url":null,"abstract":"Botulinum neurotoxin type A (BoNT) injections and selective dorsal rhizotomy (SDR) are often applied tone reduction procedures in children with spastic cerebral palsy (CP).[1,2] BoNT is focal and temporary, whereas SDR is generalized and non-reversible. Previous studies have investigated the changes inflicted by these treatments in generic CP-groups.[3,4] It is not yet clear whether specific gait patterns would respond differently to each treatment. What are the short-term, gait pattern-specific changes inflicted by BoNT injections or SDR in children with CP? Retrospective samples that had been treated either BoNT injections (NBoNT=117; baseline ageBoNT= 6y4mo±2y4mo; GMFCS I/II/III: 70/31/16) or SDR (NSDR=89; baseline ageSDR=9y5mo±2y3mo; GMFCS I/II/III: 18/54/17) were selected. All patients underwent three-dimensional gait analysis (3DGA) sessions at baseline and post-treatment (on average 1 y post-SDR and 2mo post-BoNT). The baseline 3DGA was used to classify the gait patterns of the patients, using the gait pattern classification system for children with spastic CP (GaP-CP).[5] For children with bilateral CP, both lower limbs were considered in case of asymmetric patterns between the two lower limbs, Their most affected side was selected when they displayed symmetric gait patterns, similar to the affected lower limb for children with unilateral CP. Gait-related changes focused on sagittal plane kinematics, which were compared with statistical non-parametric mapping (vector of four components, paired Hotellings T2 test, α=0.05 and post-hoc component-level comparisons, paired t-tests, α=0.0125). The comparisons were conducted in the total cohorts, as well as in gait pattern-specific subgroups. Thereafter, statistical clusters were deemed clinically relevant if their duration exceeded 3% of the gait cycle and the respective standard errors of measurement (SEM).[6,7] Changes in neuromuscular impairments were evaluated using the composite spasticity, weakness and selectivity scores of the muscles acting in the sagittal plane,[8] based on the clinical examination. Apparent equinus and jump gait were the best BoNT-responders, followed by dropfoot, where improvements were only observed in the ankle joint. In these three gait patterns, spasticity was improved, but not at the expense of additional weakness or selectivity. For SDR, the best responders were children with jump gait, crouch gait and apparent equinus. Spasticity was improved, while weakness and selectivity either improved or remained stable, in all gait patterns and for the total cohort. Fig. 1 shows the pre- vs post-treatment kinematics and statistically identified clusters of the three best responders to each treatment. \"Fig. 1. Pre- vs post-treatment kinematics and statistically identified clusters of the three best responders to each treatment.\"Download : Download high-res image (251KB)Download : Download full-size image These results highlight the need to inspect the short-term effects o","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":"120 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.gaitpost.2023.07.262
Rebecca Louise Walker, Tom D O'Brien, Gabor J Barton, Bernie Carter, David M Wright, Richard J Foster
Children with cerebral palsy (CwCP) regularly fall (35% fall daily), yet reasons for their falls are not well understood [1]. Stability and changes in walking behaviour of CwCP when negotiating challenging walking environments (e.g. uneven surfaces) have been accurately measured in laboratory settings [2], however these have not captured the real-world fall-risk that CwCP face daily. Walk-along interviews are a useful approach to capture the meaningful lived experiences of children whilst they are walking outside in challenging environments [3,4]. Previously, we co-designed a novel walk-along interview protocol by engaging with CwCP[5]. Real-world insights gathered from these walk-along interviews could enable us to design bespoke research protocols that explore the mechanisms of daily falls in CwCP. How do lived experiences of CwCP inform the development of a bespoke lab-based protocol to investigate the mechanisms of falls? Twelve CwCP (GMFCS I to III, 6 diplegia, 6 hemiplegia, 12±3 years old) and their parents took part in tailored walk-along interviews in which they discussed everyday fall experiences based on environments encountered on an outdoor walk. Chest-mounted cameras (Kaiser Baas X450) and wireless microphones (RODE GO II) captured environments and conversations. Walk-along interviews were analysed in NVivo using interpretive description[6]. Key insights from interviews (e.g. previous fall experiences) were used to determine the types of environments to be included in a bespoke walking protocol for assessing mechanisms of falls. Four CwCP and their parents were consulted about the findings from walk-along interviews to support protocol design. Walk-along interviews revealed that falls most often result when environmental challenges (“bumpy” surfaces) and sensory challenges (being “distracted” or “not looking”) are present together. Discussing previous falls or trips (Fig. 1) with CwCP and their parents informed the design of a bespoke walkway to investigate mechanisms of falls in challenging environments. The walkway includes common environmental challenges that cause falls (grass potholes and uneven pavements). To emulate the sensory challenges reported during walk-along interviews, randomly selected trials over the bespoke walkway will include a virtual distraction imitating noises and images of a busy street. Consultations with CwCP suggested these virtual distractions should include dogs barking and cars driving on busy roads. Download : Download high-res image (87KB)Download : Download full-size image We have designed a bespoke protocol that replicates the challenging environmental features and distractions faced daily by CwCP. Our protocol is unique because it was informed by the lived experiences of CwCP and their parents during novel walk-along interviews. We will next investigate, using 3D motion capture, potential indicators of high fall-risk (e.g. foot placement, decreased margins of stability) in CwCP compared to typicall
脑瘫儿童(CwCP)经常跌倒(35%每天跌倒)，但其跌倒的原因尚不清楚[1]。在实验室环境中，研究人员已经精确测量了CwCP在艰难行走环境(如凹凸不平的表面)时行走行为的稳定性和变化[2]，然而，这些并没有捕捉到CwCP每天面临的真实跌倒风险。行走访谈是一种有用的方法，可以捕捉到孩子们在充满挑战的环境中行走时有意义的生活经历[3,4]。在此之前，我们通过与CwCP合作设计了一种新颖的随走访谈协议[5]。从这些访谈中收集到的真实世界的见解可以使我们设计定制的研究方案，探索CwCP中每日跌倒的机制。CwCP的生活经验如何为研究跌倒机制的定制实验室方案的开发提供信息?12名CwCP (GMFCS I至III, 6名双瘫患者，6名偏瘫患者，12±3岁)及其父母参加了量身定制的步行访谈，在访谈中，他们根据户外散步时遇到的环境讨论了日常跌倒经历。胸装摄像头(Kaiser Baas X450)和无线麦克风(RODE GO II)可以捕捉环境和对话。在NVivo中使用解释性描述分析行走访谈[6]。从访谈中获得的关键见解(例如，以前的跌倒经历)用于确定用于评估跌倒机制的定制步行协议中要包含的环境类型。我们咨询了四名CwCP及其父母，以了解通过访谈获得的支持方案设计的结果。行走访谈显示，当环境挑战(“颠簸”的表面)和感官挑战(“分心”或“不看”)同时出现时，最容易导致跌倒。与CwCP和他们的父母讨论了以前的跌倒或旅行(图1)，从而设计了一个定制的人行道，以研究在具有挑战性的环境中跌倒的机制。人行道包括常见的环境挑战，导致跌倒(草坑和不平坦的路面)。为了模拟在步行采访中报告的感官挑战，在定制人行道上随机选择的试验将包括模仿噪音和繁忙街道图像的虚拟分心。与CwCP的磋商表明，这些虚拟干扰应该包括狗叫和汽车在繁忙的道路上行驶。下载:下载高分辨率图片(87KB)下载:下载全尺寸图片我们设计了一个定制的协议，复制了CwCP每天面临的具有挑战性的环境特征和干扰。我们的方案是独特的，因为它是由CwCP和他们的父母在新颖的walk-along访谈中的生活经历所提供的。接下来，我们将使用3D动作捕捉技术，在有或没有干扰的情况下，与正常发育的儿童相比，在CwCP中，潜在的高跌倒风险指标(例如，脚部放置，稳定度下降)。通过我们的协议，我们希望在CwCP协商复制真实世界环境时识别跌倒风险行为，为未来的跌倒预防计划提供信息。
{"title":"Designing a novel protocol to investigate mechanisms of falls in children with cerebral palsy, informed by lived experiences","authors":"Rebecca Louise Walker, Tom D O'Brien, Gabor J Barton, Bernie Carter, David M Wright, Richard J Foster","doi":"10.1016/j.gaitpost.2023.07.262","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.262","url":null,"abstract":"Children with cerebral palsy (CwCP) regularly fall (35% fall daily), yet reasons for their falls are not well understood [1]. Stability and changes in walking behaviour of CwCP when negotiating challenging walking environments (e.g. uneven surfaces) have been accurately measured in laboratory settings [2], however these have not captured the real-world fall-risk that CwCP face daily. Walk-along interviews are a useful approach to capture the meaningful lived experiences of children whilst they are walking outside in challenging environments [3,4]. Previously, we co-designed a novel walk-along interview protocol by engaging with CwCP[5]. Real-world insights gathered from these walk-along interviews could enable us to design bespoke research protocols that explore the mechanisms of daily falls in CwCP. How do lived experiences of CwCP inform the development of a bespoke lab-based protocol to investigate the mechanisms of falls? Twelve CwCP (GMFCS I to III, 6 diplegia, 6 hemiplegia, 12±3 years old) and their parents took part in tailored walk-along interviews in which they discussed everyday fall experiences based on environments encountered on an outdoor walk. Chest-mounted cameras (Kaiser Baas X450) and wireless microphones (RODE GO II) captured environments and conversations. Walk-along interviews were analysed in NVivo using interpretive description[6]. Key insights from interviews (e.g. previous fall experiences) were used to determine the types of environments to be included in a bespoke walking protocol for assessing mechanisms of falls. Four CwCP and their parents were consulted about the findings from walk-along interviews to support protocol design. Walk-along interviews revealed that falls most often result when environmental challenges (“bumpy” surfaces) and sensory challenges (being “distracted” or “not looking”) are present together. Discussing previous falls or trips (Fig. 1) with CwCP and their parents informed the design of a bespoke walkway to investigate mechanisms of falls in challenging environments. The walkway includes common environmental challenges that cause falls (grass potholes and uneven pavements). To emulate the sensory challenges reported during walk-along interviews, randomly selected trials over the bespoke walkway will include a virtual distraction imitating noises and images of a busy street. Consultations with CwCP suggested these virtual distractions should include dogs barking and cars driving on busy roads. Download : Download high-res image (87KB)Download : Download full-size image We have designed a bespoke protocol that replicates the challenging environmental features and distractions faced daily by CwCP. Our protocol is unique because it was informed by the lived experiences of CwCP and their parents during novel walk-along interviews. We will next investigate, using 3D motion capture, potential indicators of high fall-risk (e.g. foot placement, decreased margins of stability) in CwCP compared to typicall","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":"135298552","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 foot core is supported by active subsystems like intrinsic foot muscles(1). Weakness of these muscles can lead to a decrease in the medial longitudinal arch(MLA), resulting in altered foot mechanics, function, and increasing the risk of injuries(1,2). Intrinsic muscle strength is compatible with toe flexor strength and has been found to be lower in flat feet (3,4). It is challenging to determine the isolated effects of intrinsic muscle weakness in foot kinematics while walking(4) which can provide valuable insights for clinical reasoning. What are the effects of induced toe flexor weakness on foot kinematics? 4 adults (3 female,1 male;24.75±2.98 y.o.) with typical foot posture (Foot-Posture-Index-6 score: <5) participated into the pilot study. Toe flexor muscle strength of the dominant foot was assessed with a dynamometer (Lafayette Instrument Company, USA) while sitting before and after the fatigue procedure (Figure-1:a1-a2) (5). A 3D-printed foot arc heightening device (AHD) with 4 kg resistance spring was used to generate fatigue in the toe flexor muscles (Figure-1:2). The participants were required to complete 75 reps. for each set by a metronome at 45 BPM under the discomfort level (6/10) until achieving 10% muscle force-drop(Figure-1:c1-c2). Heel-rising and extrinsic muscle activation were not allowed. The Oxford Foot Model was used to analyze three trials of walking kinetics and kinematics. Wilcoxon test was used for statistical non-parametric paired analysis (p<0.05).Download : Download high-res image (148KB)Download : Download full-size image To achieve >10% muscle weakness each participant completed varying numbers of sets (3-5 sets). The decrease of great toe and toe flexor muscle strength was 19.57%±7.01 and 19.01%±3.58 after the procedure respectively. Some of the effects of the procedure remained after analyses were completed (15.67%±13.34 and 12.3%±11.31). The mean velocity, temporospatial parameters, kinematic parameters of pelvis, hip and knee joints, ankle power and arch height were not different before and after the procedure (p>0.05). Peak hindfoot plantarflexion was lower and peak hindfoot inversion was higher significantly after the procedure. The sagittal and frontal plane range of the hindfoot relative to the tibia decreased (p<0.05, Graph-1: I,II,III) The pilot study protocol was effective enough to induce temporary toe flexor muscle weakness. Although the isometric muscle force reduced for intrinsic muscles after the procedure, controversially to the literature (2), increased hindfoot inversion was found which may be related to increased motor unit activation or proprioceptive alterations which should be studied in detail. The device was more efficient in great toe grasping compared to other toes, which might result in differential level muscle weakness among the toes. Comparison studies with a larger sample size are needed to conclude to describe the effects of fatigue procedure.
{"title":"What are the effects of induced toe flexor weakness on foot kinematics? A study protocol and preliminary results","authors":"Halenur Evrendilek, İlknur Özkaradeniz, Kubra Onerge, Nazif Ekin Akalan, Derya Çelik","doi":"10.1016/j.gaitpost.2023.07.182","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.182","url":null,"abstract":"The foot core is supported by active subsystems like intrinsic foot muscles(1). Weakness of these muscles can lead to a decrease in the medial longitudinal arch(MLA), resulting in altered foot mechanics, function, and increasing the risk of injuries(1,2). Intrinsic muscle strength is compatible with toe flexor strength and has been found to be lower in flat feet (3,4). It is challenging to determine the isolated effects of intrinsic muscle weakness in foot kinematics while walking(4) which can provide valuable insights for clinical reasoning. What are the effects of induced toe flexor weakness on foot kinematics? 4 adults (3 female,1 male;24.75±2.98 y.o.) with typical foot posture (Foot-Posture-Index-6 score: <5) participated into the pilot study. Toe flexor muscle strength of the dominant foot was assessed with a dynamometer (Lafayette Instrument Company, USA) while sitting before and after the fatigue procedure (Figure-1:a1-a2) (5). A 3D-printed foot arc heightening device (AHD) with 4 kg resistance spring was used to generate fatigue in the toe flexor muscles (Figure-1:2). The participants were required to complete 75 reps. for each set by a metronome at 45 BPM under the discomfort level (6/10) until achieving 10% muscle force-drop(Figure-1:c1-c2). Heel-rising and extrinsic muscle activation were not allowed. The Oxford Foot Model was used to analyze three trials of walking kinetics and kinematics. Wilcoxon test was used for statistical non-parametric paired analysis (p<0.05).Download : Download high-res image (148KB)Download : Download full-size image To achieve >10% muscle weakness each participant completed varying numbers of sets (3-5 sets). The decrease of great toe and toe flexor muscle strength was 19.57%±7.01 and 19.01%±3.58 after the procedure respectively. Some of the effects of the procedure remained after analyses were completed (15.67%±13.34 and 12.3%±11.31). The mean velocity, temporospatial parameters, kinematic parameters of pelvis, hip and knee joints, ankle power and arch height were not different before and after the procedure (p>0.05). Peak hindfoot plantarflexion was lower and peak hindfoot inversion was higher significantly after the procedure. The sagittal and frontal plane range of the hindfoot relative to the tibia decreased (p<0.05, Graph-1: I,II,III) The pilot study protocol was effective enough to induce temporary toe flexor muscle weakness. Although the isometric muscle force reduced for intrinsic muscles after the procedure, controversially to the literature (2), increased hindfoot inversion was found which may be related to increased motor unit activation or proprioceptive alterations which should be studied in detail. The device was more efficient in great toe grasping compared to other toes, which might result in differential level muscle weakness among the toes. Comparison studies with a larger sample size are needed to conclude to describe the effects of fatigue procedure.","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135297871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.gaitpost.2023.07.176
Juliana D.O.H. Mendes, Lorraine B. Cordeiro, Grazielly N. Santos, Fernanda B.D. Carvalho, Luanda A.C. Grecco, Pedro A.S. Ribeiro, Priscilla M. Moraes, Claudia Oliveira
Mental maturity is a state of preparation for physical, mental and social aspects of life.1 Individuals with autism spectrum disorder (ASD) have low mental maturity and deficits with regards to social interactions, language,1 motor skills and postural control.2 Postural control is achieved by the integration of three systems: visual, vestibular and somatosensorial.3 Postural perturbation increases the risk of falls and can exert a negative impact on the development of communication skills and social interactions.4 Children with autism are more susceptible due to deficits related to visual and somatosensorial feedback.5 Do deprivation of the visual system and somatosensorial perturbation alter postural control variables in a child with autism compared to a child with neurotypical development? This case report involved two male children aged seven years and four months – one with a diagnosis of ASD (22 kg, 132 cm) and another with neurotypical development (26.4 kg, 129 cm). The psychological evaluation (general reasoning capacity) was performed using the Columbia Mental Maturity Scale (CMMS-3). The motor assessment was performed using the SMART-D 140® system (BTS Engineering), which has two force plates (Kistler Platform, model 9286BA). Postural control was investigated under the following conditions: eyes open, eyes closed, without a mat and with a 5-cm foam rubber mat. Table 1 lists the results of the CMMS-3 and force plate variables. The child with ASD had average reasoning capacity. Both children exhibited oscillations in postural control, but the child with autism had poorer results in the occurrence of visual deprivation and somatosensorial perturbation. Table 1- Results of Columbia Mental Maturity Scale-3 and force plate variablesDownload : Download high-res image (94KB)Download : Download full-size image This study investigated whether mental maturity exerts an influence on postural control in a child with autism and whether the deprivation of the visual system and sensorial perturbation alter postural control variables. The results suggest that mental maturity (general reasoning capacity) exerts an influence on postural control, the understanding of the positioning on the force plate and the cognitive information process of maintaining a static position, especially with sensorial input caused by the foam rubber mat. Deprivation of the visual system and somatosensorial perturbation exert an influence on postural control in children with ASD,6,7 generating an increase in body sway and the area of displacement of the centre of plantar pressure.
{"title":"Assessment of postural control with deprivation of visual system and somatosensorial perturbation in child with autism: case report","authors":"Juliana D.O.H. Mendes, Lorraine B. Cordeiro, Grazielly N. Santos, Fernanda B.D. Carvalho, Luanda A.C. Grecco, Pedro A.S. Ribeiro, Priscilla M. Moraes, Claudia Oliveira","doi":"10.1016/j.gaitpost.2023.07.176","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.176","url":null,"abstract":"Mental maturity is a state of preparation for physical, mental and social aspects of life.1 Individuals with autism spectrum disorder (ASD) have low mental maturity and deficits with regards to social interactions, language,1 motor skills and postural control.2 Postural control is achieved by the integration of three systems: visual, vestibular and somatosensorial.3 Postural perturbation increases the risk of falls and can exert a negative impact on the development of communication skills and social interactions.4 Children with autism are more susceptible due to deficits related to visual and somatosensorial feedback.5 Do deprivation of the visual system and somatosensorial perturbation alter postural control variables in a child with autism compared to a child with neurotypical development? This case report involved two male children aged seven years and four months – one with a diagnosis of ASD (22 kg, 132 cm) and another with neurotypical development (26.4 kg, 129 cm). The psychological evaluation (general reasoning capacity) was performed using the Columbia Mental Maturity Scale (CMMS-3). The motor assessment was performed using the SMART-D 140® system (BTS Engineering), which has two force plates (Kistler Platform, model 9286BA). Postural control was investigated under the following conditions: eyes open, eyes closed, without a mat and with a 5-cm foam rubber mat. Table 1 lists the results of the CMMS-3 and force plate variables. The child with ASD had average reasoning capacity. Both children exhibited oscillations in postural control, but the child with autism had poorer results in the occurrence of visual deprivation and somatosensorial perturbation. Table 1- Results of Columbia Mental Maturity Scale-3 and force plate variablesDownload : Download high-res image (94KB)Download : Download full-size image This study investigated whether mental maturity exerts an influence on postural control in a child with autism and whether the deprivation of the visual system and sensorial perturbation alter postural control variables. The results suggest that mental maturity (general reasoning capacity) exerts an influence on postural control, the understanding of the positioning on the force plate and the cognitive information process of maintaining a static position, especially with sensorial input caused by the foam rubber mat. Deprivation of the visual system and somatosensorial perturbation exert an influence on postural control in children with ASD,6,7 generating an increase in body sway and the area of displacement of the centre of plantar pressure.","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":"135298695","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":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"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":"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}
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