Evaluation of the Catch in Spasticity Assessment in Children With Cerebral Palsy (original) (raw)
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PLOS ONE, 2015
Introduction Rigid Ankle-Foot Orthoses (AFOs) are commonly prescribed to counteract excessive knee flexion during the stance phase of gait in children with cerebral palsy (CP). While rigid AFOs may normalize knee kinematics and kinetics effectively, it has the disadvantage of impeding push-off power. A spring-like AFO may enhance push-off power, which may come at the cost of reducing the knee flexion less effectively. Optimizing this tradeoff between enhancing push-off power and normalizing knee flexion in stance is expected to maximize gait efficiency. This study investigated the effects of varying AFO stiffness on gait biomechanics and efficiency in children with CP who walk with excessive knee flexion in stance. Fifteen children with spastic CP (11 boys, 10±2 years) were prescribed with a ventral shell spring-hinged AFO (vAFO). The hinge was set into a rigid, or spring-like setting, using both a stiff and flexible performance. At baseline (i.e. shoes-only) and for each vAFO, a 3D-gait analysis and 6-minute walk test with breath-gas analysis were performed at comfortable speed. Lower limb joint kinematics and kinetics were calculated. From the 6-minute walk test, walking speed and the net energy cost were determined. A generalized estimation equation (p<0.05) was used to analyze the effects of different conditions. Compared to shoes-only, all vAFOs improved the knee angle and net moment similarly. Ankle power generation and work were preserved only by the spring-like vAFOs. All vAFOs decreased the net energy cost compared to shoes-only, but no differences were found between vAFOs, showing that the effects of spring-like vAFOs to promote push-off power did not lead to greater reductions in walking energy cost. These findings suggest that, in this specific group of children with spastic CP, the vAFO stiffness that maximizes gait efficiency is primarily determined by its effect on knee kinematics and kinetics rather than by its effect on push-off power.
Evaluation of clinical spasticity assessment in Cerebral palsy using inertial sensors
Gait & Posture, 2009
Osteoarthritis (OA) of the knee is associated with alterations in gait. As an alternative to force plates, an instrumented force shoe (IFS) can be used to measure ground reaction forces. This study evaluated the influence of the IFS on gait pattern in patients with knee OA. Twenty patients with knee OA walked in a gait laboratory on IFSs and control shoes (CSs). An optoelectronic marker system and force plate were used to perform 3D gait analyses. A comparison of temporal-spatial gait parameters, kinematics and kinetics was made between IFS and CS. Patients wearing IFS showed a decrease in walking velocity and cadence (8%), unchanged stride length, and an increase in stance time (13%), stride time (11%) and step width (14%). No differences were found in knee adduction moment or knee kinematics. Small differences were found in foot and ankle kinematics (2-5 o ), knee transverse moments (5%), ankle frontal (3%) and sagittal moments (1%) and ground reaction force (1-6%). In conclusion, the gait of patients with knee OA was only mildly influenced by the IFS, due to increased shoe height and mass and a change in sole stiffness. The changes were small compared to normal variation and clinically relevant differences. Importantly, in OA patients no effect was found on the knee adduction moment.
Journal of Electromyography and Kinesiology, 2014
Purpose: To determine the effects of decreased ankle-foot dorsiflexion (A-Fdf) range of motion (ROM) on gait kinematics in children with spastic cerebral palsy (SCP). Methods: All participants were children with spastic cerebral palsy (n = 10) who walked with knee flexion in midstance. Data were collected over 2-5 sessions, at 3-monthly intervals. A-Fdf ROM was quantified using a custom-designed hand-held ankle dynamometer that exerted 4 Nm at the ankle. Ankle-foot and knee angles during gait were quantified on sagittal video recordings. Linear regression (cross-sectional analysis) and General Estimation Equation analysis (longitudinal analysis) were performed to assess relationships between (change in) A-Fdf ROM and (change in) ankle-foot and knee angle during gait. Results: Cross-sectional analysis showed a positive relationship between A-Fdf ROM and both ankle-foot angle in midstance and terminal swing. Longitudinal analysis showed a positive relationship between individual decreases in A-Fdf ROM and increases of knee flexion during gait (lowest knee angle in terminal stance and angle in terminal swing). Conclusion: For this subgroup of SCP children, our results indicate that while changes in ankle angles during gait are unrelated to changes in A-Fdf ROM, changes in knee angles are related to changes in A-Fdf ROM.
Journal of Bodywork and Movement Therapies, 2018
Dynamic joint stiffness represents the resistance that a joint opposes to an applied moment. Stiffness arises in conditions of joint laxity, instability and increased cocontraction and is commonly utilized as a means to stabilize the joint. The knee joint seems to be crucial for determining the walking pattern. The aim of this study was to investigate the association between the gait pattern, globally quantified by the Gait Profile Score (GPS), which indicates the 'quality' of a particular walking strategy, and knee dynamic joint stiffness (Kk) in children with diplegia. Kk is expressed by plotting the values of the knee flexion-extension moment versus the knee flexion-extension angle during weight acceptance. In this interval, the linear regression was fitted. The angular coefficient of the linear regression corresponded to the joint stiffness index. Sixty-one children with diplegia and 18 healthy individuals took part in this study. From their gait analysis data, the GPS (with its Gait Variable Scores-GVSs) and the Kk were calculated. Data showed that GPS (p= 2.73 *10-21) and GVSs values for the patients with diplegia were higher in comparison to healthy controls. The Kk values for patients were not statistically different from those of controls. The correlation between Kk and GPS did not show the presence of any significant relationship (r=-0.04; p> 0.05). Thus, the functional limitation in diplegic children does not seems to be strictly related to Kk.
International Journal Of Community Medicine And Public Health, 2022
Background: In cerebral palsy, importance must be given on effective and efficient walking. 30 subjects; 16 males and 14 females (mean age 6.5 year) of spastic cerebral palsy with knee hyperextension and ankle equines were included in this study and were fitted with bilateral moldedhinged SKAFO with pair of shoes.Methods: Observational gait analysis by video recording was performed and gait parameters by 10 m walk test and knee angle at mid stance using goniometer in standing position were recorded in bracing and non-bracing conditions.Results: The orthosis controlled knee hyperextension by not restricting normal flexion and extension moment with smooth transition of ankle motion. There was significant improvement in step length; stride length as well as knee angle at midstance (with orthosis) but velocity and cadence were reduced as compared to bare foot walking.Conclusions: A stable, natural and controlled knee hyperextension gait pattern was found.
Gait & Posture, 2010
Three-dimensional instrumented gait analysis (3d-IGA) is considered to be the gold standard for the assessment of gait abnormalities in patients with movement disorders [1]. It provides an accurate description of gait kinetics, gait kinematics and muscle activation, and can help to plan and evaluate treatment in patients with gait disorders [2,3]. The use of 3d-IGA, however, has some disadvantages: it requires special equipment, is time consuming, is dependent on patient compliance, and it is not always available. Observational gait analysis (OGA) has been proposed as an alternative to 3d-IGA [4]. In OGA an observer visually assesses the gait pattern, mostly with the aid of video recordings. Various OGA scales have been developed and modified [4-6]. For the detection and quantification of gait abnormalities these OGA scales rely on subjective ordinal scales that describe the gait abnormalities in different joints and planes. The reproducibility of OGA differs considerably between studies and between the single items within one OGA scale [4-8]. Kappa values ranged from À0.04 to 0.91 for intrarater repeatability and from 0.13 to 0.94 for interrater repeatability [4-7]. With respect to the agreement between OGA and 3d-IGA, the kappa values ranged from À0.11 to 0.94 [6,7,9] and the agreement ranged from 43% to 83% [4]. OGA scales provide a good general impression on the severity of a patient's gait deviation [10], but do not provide specific information on the gait kinematics of a single joint. In the evaluation of gait abnormalities one often relies on more detailed kinematic measurements. Different software programs allowing a 2-dimensional joint angle measurement on video screen (i.e. video screen measurement: VSM) have been developed [11-14]. Two studies evaluated the validity of VSM during gait in disabled patients [6,14]. In both studies the measurements were restricted to the knee joint. Kiernan et al.
Journal of Children's Orthopaedics, 2007
Purpose To evaluate the efficacy of ankle foot orthoses (AFOs) prescribed in the community for children with cerebral palsy (CP). Methods Fifty-six children (32 boys and 24 girls, mean age 8.9 years, range 4–17) who were diagnosed as having CP were enrolled. They were grouped according to the type of CP, diplegic ( n = 38) and hemiplegic ( n = 18). Three-dimensional gait analyses while patient were barefoot and with AFOs were obtained and analyzed. Results The spatio-temporal findings were the most significantly changed as a result of AFO use. In the hemiplegic group, stride length was 11.7% ( p = 0.001) longer with AFOs in both affected (10.2%) and non-affected (12.4%) legs, and cadence was reduced by 9.7%; walking speed was not affected. In the diplegic group, stride length with AFOs was 17.4% longer compared to barefoot ( p < 0.001) and walking velocity improved by 17.8% ( p < 0.001); cadence was unchanged. AFOs also increased ankle dorsiflexion at initial contact in both g...
Common abnormal kinetic patterns of the knee in gait in cerebral palsy
Gait & Posture, 1997
We studied the kinetic characteristics of the knee in patients with spastic diplegia. Twenty three children with spastic diplegia were recruited and had their 46 limbs categorised into the following four groups: jump (n= 7), crouch (n= 8), recurvatum (n =14) and mild (n=17). In the crouch pattern, the patients usually had a larger and longer lasting internal knee extensor moments in stance suggesting that rectus femoris had a relatively high activation. In the recurvatum pattern, the internal knee flexor moment was large and long lasting in stance. The biceps femoris showed less activity on EMG although the knee flexor moment was large and we concluded that the soft tissue behind the knee joint provided this flexor moment. In the jump knee pattern there was abnormal power generation at the knee and ankle joints in initial stance, which did not contribute to normal progression but aided upward body motion. In the mild group the kinetic data was similar to that seen in normal children. Knowledge of kinetic patterns in these patients may help in their subsequent management.
Analysis of Running Gait in Children with Cerebral Palsy: Barefoot vs. a New Ankle Foot Orthosis
International Journal of Environmental Research and Public Health
Running is an essential activity for children with cerebral palsy (CP). This study aims to characterize the locomotor pattern of running in hemiplegic children with new generation ankle foot orthosis (AFOs) conceived to foster intense motor activities such as running. A group of 18 children with spastic hemiplegia was recruited. A biomechanical multivariable comparison was made between barefoot and with AFO running trials. The focus was devoted to bilateral sagittal plane hip, knee, ankle kinematics and kinetics, and three-dimensional ground reaction forces. Wearing the orthoses, the children were found to reduce cadence and the duration of the stance phase as well as increase the step and stride length. The new AFO resulted in significant changes in kinematics of affected ankle both at initial contact 0–3% GC (p < 0.017) and during the entire swing phase 31–100%GC (p < 0.001) being the ankle more dorsiflexed with AFO compared to barefoot condition. Ankle power was found to di...
This study compared the effects of solid and hinged ankle-foot orthoses (AFOs) on the gait of children with spastic diplegic cerebral palsy (CP) who ambulate with excessive ankle plantar flexion during stance. Twelve children with spastic diplegic CP wore no AFOs for an initial 2-week period, solid AFOs for 1 month, no AFOs for 2 weeks, and hinged AFOs for 1 month. Lower extremity muscle timing, knee and ankle joint motions, moments and powers, and temporal-distance characteristics were measured during ambulation for an initial barefoot baseline test, and with solid and hinged AFOs for the other two tests. Both orthoses increased stride length, reduced abnormal ankle plantar flexion during initial contact, midstance and terminal stance (TST), and increased ankle plantar flexor moments closer to normal during TST. Hinged AFOs increased ankle dorsiflexion at TST and increased ankle power generation during preswing (PSW) as compared to solid AFOs, and increased ankle dorsiflexion at loading compared to no AFOs. No other significant differences were found for the gait variables when comparing these orthoses. Either AFO could be used to reduce the excessive ankle plantar flexion without affecting the knee position during stance. The hinged AFO would be recommended to produce more normal dorsiflexion during TST and increased ankle power generation during PSW in children with spastic diplegic CP.