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}
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}
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