scholarly journals Restoration of Heel–Toe Gait Patterns for the Prevention of Asymmetrical Hip Internal Rotation in Patients with Unilateral Spastic Cerebral Palsy

Children ◽  
2021 ◽  
Vol 8 (9) ◽  
pp. 773
Author(s):  
Reinald Brunner ◽  
William R. Taylor ◽  
Rosa M. S. Visscher
Keyword(s):  
Cerebral Palsy ◽  
Standard Deviation ◽  
Internal Rotation ◽  
Plantar Flexion ◽  
Gait Pattern ◽  
Spastic Cerebral Palsy ◽  
Forward Modelling ◽  
Gait Patterns ◽  
Hip Internal Rotation ◽  
Toe Walking

Forward modelling has indicated hip internal rotation as a secondary physical effect to plantar flexion under load. It could therefore be of interest to focus the treatment for patients with unilateral spastic cerebral palsy on achieving a heel–toe gait pattern, to prevent development of asymmetrical hip internal rotation. The aim of this preliminary retrospective cohort investigation was to evaluate the effect of restoring heel–toe gait, through use of functional orthoses, on passive hip internal rotation. In this study, the affected foot was kept in an anatomically correct position, aligned to the leg and the gait direction. In case of gastrosoleus shortness, a heel raise was attached to compensate for the equinus and yet to provide heel–floor contact (mean equinus = −2.6 degrees of dorsiflexion). Differences in passive hip internal rotation between the two sides were clinically assessed while the hip was extended. Two groups were formed according to the achieved correction of their gait patterns through orthotic care: patients with a heel-toe gait (with anterograde rocking) who wore the orthosis typically for at least eight hours per day for at least a year, or patients with toe-walking (with retrograde rocking) in spite of wearing the orthosis who used the orthosis less in most cases. A Student’s t-test was used to compare the values of clinically assessed passive hip rotation (p < 0.05) between the groups and the effect size (Hedges’ g) was estimated. Of the 70 study participants, 56 (mean age 11.5 y, majority GMFCS 1, similar severity of pathology) achieved a heel-toe gait, while 14 remained as toe-walkers. While patients with heel–toe gait patterns showed an almost symmetrical passive hip internal rotation (difference +1.5 degrees, standard deviation 9.6 degrees), patients who kept toe-walking had an increased asymmetrical passive hip internal rotation (difference +10.4 degrees, standard deviation 7.5 degrees; p = 0.001, Hedges’s g = 0.931). Our clinical findings are in line with the indications from forward modelling that treating the biomechanical problem might prevent development of a secondary deformity. Further prospective studies are needed to verify the presented hypothesis.

scholarly journals An Unsupervised Data-Driven Model to Classify Gait Patterns in Children with Cerebral Palsy

2020 ◽  
Vol 9 (5) ◽  
pp. 1432
Author(s):  
Julie Choisne ◽  
Nicolas Fourrier ◽  
Geoffrey Handsfield ◽  
Nada Signal ◽  
Denise Taylor ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Gait Pattern ◽  
Data Driven ◽  
Self Organizing Map ◽  
Gait Patterns ◽  
Gait Biomechanics ◽  
Children With Cerebral Palsy ◽  
Profile Score ◽  
Data Driven Modeling ◽  
Gait Variable

Ankle and foot orthoses are commonly prescribed to children with cerebral palsy (CP). It is unclear whether 3D gait analysis (3DGA) provides sufficient and reliable information for clinicians to be consistent when prescribing orthoses. Data-driven modeling can probe such questions by revealing non-intuitive relationships between variables such as 3DGA parameters and gait outcomes of orthoses use. The purpose of this study was to (1) develop a data-driven model to classify children with CP according to their gait biomechanics and (2) identify relationships between orthotics types and gait patterns. 3DGA data were acquired from walking trials of 25 typically developed children and 98 children with CP with additional prescribed orthoses. An unsupervised self-organizing map followed by k-means clustering was developed to group different gait patterns based on children’s 3DGA. Model inputs were gait variable scores (GVSs) extracted from the gait profile score, measuring root mean square differences from TD children’s gait cycle. The model identified five pathological gait patterns with statistical differences in GVSs. Only 43% of children improved their gait pattern when wearing an orthosis. Orthotics prescriptions were variable even in children with similar gait patterns. This study suggests that quantitative data-driven approaches may provide more clarity and specificity to support orthotics prescription.

Acclimatization of the gait pattern to wearing an ankle–foot orthosis in children with spastic cerebral palsy

2015 ◽  
Vol 30 (6) ◽  
pp. 617-622 ◽  
Author(s):  
Yvette L. Kerkum ◽  
Merel-Anne Brehm ◽  
Kim van Hutten ◽  
Josien C. van den Noort ◽  
Jaap Harlaar ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Gait Pattern ◽  
Spastic Cerebral Palsy ◽  
Ankle Foot Orthosis ◽  
Foot Orthosis

Effect of floor reaction ankle–foot orthosis on crouch gait in patients with cerebral palsy: What can be expected?

2017 ◽  
Vol 42 (3) ◽  
pp. 245-253 ◽  
Author(s):  
Harald Böhm ◽  
Hösl Matthias ◽  
Frank Braatz ◽  
Leonhard Döderlein
Keyword(s):  
Cerebral Palsy ◽  
Standard Deviation ◽  
Knee Extension ◽  
Spastic Cerebral Palsy ◽  
Foot Orthoses ◽  
Cross Sectional ◽  
Positive Effects ◽  
Foot Progression Angle ◽  
Ankle Foot Orthoses ◽  
Crouch Gait

Background: Floor reaction ankle–foot orthoses are commonly prescribed to improve knee extension of children with cerebral palsy having crouch gait. Their effectiveness is debated. Therefore, the objective of this study is to optimize current prescription criteria for the improvement of crouch gait. Study design: Cross-sectional interventional study. Methods: A total of 22 patients with bilateral spastic cerebral palsy, between 6 and 17 years, Gross Motor Function Classification System II–IV participated in this study. Instrumented gait analysis was done under three conditions: barefoot, shoed, and with orthotics. Patients were divided into two groups: good and non-responders with more and less than 8.8° improvement of knee extension during walking, respectively. A multiple predictor analysis was done on parameters that were different between groups. Results: In total, 12 of 22 patients showed good response in knee extension with a mean change of 17° (standard deviation = 5°). Good responders showed a significantly smaller walking velocity, knee extension strength, ankle plantarflexion strength, and greater external foot progression angle compared to non-responders. Foot progression angle together with ankle plantarflexion strength explained 37% of the variance in improvement of knee extension. Conclusion: With appropriate patient selection, an improvement of crouch gait by ankle–foot orthoses of 17° (standard deviation = 5°) can be expected. Patients with slow velocity, weak plantarflexors, and external foot progression benefit most. Joint contractures were no contraindications. Clinical relevance This study showed that gait in patients with low functional level benefit most from ankle–foot orthoses. Unlike in patients with higher functional status, contractures of hip, knee, and ankle did not reduce the positive effects on gait. The suggested prescription criteria may help to better select appropriate patients for orthotics.

Changes in gait patterns after operations in children with spastic cerebral palsy

1986 ◽  
Vol 10 (3) ◽  
Author(s):  
L.E. Larsson ◽  
M. Miller ◽  
R. Norlin ◽  
H. Tkaczuk
Keyword(s):  
Cerebral Palsy ◽  
Spastic Cerebral Palsy ◽  
Gait Patterns

External Rotation Osteotomy of Femur in Patients with Spastic Cerebral Palsy

1998 ◽  
Vol 02 (01) ◽  
pp. 1-8
Author(s):  
Ken N. Kuo ◽  
David W. Hang ◽  
Peter A. Smith
Keyword(s):  
Cerebral Palsy ◽  
Internal Rotation ◽  
External Rotation ◽  
Spastic Cerebral Palsy ◽  
Femoral Torsion ◽  
Younger Patients ◽  
Foot Progression Angle ◽  
Kinematic Study ◽  
Rotation Osteotomy

Fifteen subjects with ambulatory spastic cerebral palsy underwent proximal femoral external rotation osteotomy between 1990 to 1992 for severe intoeing gait due to internal femoral torsion. Among them 13 patients returned for follow-up. Preoperatively, maximum internal rotation of the hip on physical examination corrected from 77° to 50° postoperatively. Foot progression angle changed from 10° intoeing gait preoperatively to 9° outtoeing gait postoperatively ( p < 0.05). The recurrence rate for internal femoral torsion after correction is 9.5 degrees/year for the group of 10-year-olds and younger, and 2.1 degrees/year for the group older than 10-year-olds. In the kinematic study, foot progression angle changed from internal rotation of 9.2° to external rotation of 16.5° ( p < 0.05). Our study showed that external rotation osteotomy of the femur is a safe and effective procedure. The rate of recurrence for femoral internal torsion was greater for younger patients (≤10-year-old) when the surgery was performed.

scholarly journals The Contribution of Decreased Muscle Size to Muscle Weakness in Children With Spastic Cerebral Palsy

2021 ◽  
Vol 12 ◽  
Author(s):  
Britta Hanssen ◽  
Nicky Peeters ◽  
Ines Vandekerckhove ◽  
Nathalie De Beukelaer ◽  
Lynn Bar-On ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Muscle Weakness ◽  
Plantar Flexion ◽  
Joint Torque ◽  
Muscle Size ◽  
Spastic Cerebral Palsy ◽  
Regression Equations ◽  
Plantar Flexors ◽  
Cross Sectional ◽  
Large Variability

Muscle weakness is a common clinical symptom in children with spastic cerebral palsy (SCP). It is caused by impaired neural ability and altered intrinsic capacity of the muscles. To define the contribution of decreased muscle size to muscle weakness, two cohorts were recruited in this cross-sectional investigation: 53 children with SCP [median age, 8.2 (IQR, 4.1) years, 19/34 uni/bilateral] and 31 children with a typical development (TD) [median age, 9.7 (IQR, 2.9) years]. Muscle volume (MV) and muscle belly length for m. rectus femoris, semitendinosus, gastrocnemius medialis, and tibialis anterior were defined from three-dimensional freehand ultrasound acquisitions. A fixed dynamometer was used to assess maximal voluntary isometric contractions for knee extension, knee flexion, plantar flexion, and dorsiflexion from which maximal joint torque (MJT) was calculated. Selective motor control (SMC) was assessed on a 5-point scale for the children with SCP. First, the anthropometrics, strength, and muscle size parameters were compared between the cohorts. Significant differences for all muscle size and strength parameters were found (p ≤ 0.003), except for joint torque per MV for the plantar flexors. Secondly, the associations of anthropometrics, muscle size, gross motor function classification system (GMFCS) level, and SMC with MJT were investigated using univariate and stepwise multiple linear regressions. The associations of MJT with growth-related parameters like age, weight, and height appeared strongest in the TD cohort, whereas for the SCP cohort, these associations were accompanied by associations with SMC and GMFCS. The stepwise regression models resulted in ranges of explained variance in MJT from 29.3 to 66.3% in the TD cohort and from 16.8 to 60.1% in the SCP cohort. Finally, the MJT deficit observed in the SCP cohort was further investigated using the TD regression equations to estimate norm MJT based on height and potential MJT based on MV. From the total MJT deficit, 22.6–57.3% could be explained by deficits in MV. This investigation confirmed the disproportional decrease in muscle size and muscle strength around the knee and ankle joint in children with SCP, but also highlighted the large variability in the contribution of muscle size to muscle weakness.

scholarly journals The Immediate Effects of a Dynamic Orthosis on Gait Patterns in Children With Unilateral Spastic Cerebral Palsy: A Kinematic Analysis

2019 ◽  
Vol 7 ◽  
Author(s):  
Elisabete Martins ◽  
Rita Cordovil ◽  
Raul Oliveira ◽  
Joana Pinho ◽  
Ana Diniz ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Kinematic Analysis ◽  
Spastic Cerebral Palsy ◽  
Gait Patterns
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