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Knee cerebral palsy

Alexander Marcström, Gunnar Hägglund, Ann I Alriksson-Schmidt
BACKGROUND: Hip pain is prevalent in children with cerebral palsy (CP). Hip displacement is a known risk factor for hip pain. However, many children do not have displaced hips but still have hip pain and the aetiologies are poorly understood. The aims of this study were to investigate: 1. the prevalence of hip pain related to age, gender, gross motor function, degree of hip displacement and 2. the associations between hip pain and age, gender, gross motor function, degree of hip displacement, ranges of hip and knee motion (ROM) and degree of spasticity in the muscles around the hip...
February 8, 2019: BMC Musculoskeletal Disorders
Camila R Simão, Isabelly Cristina R Regalado, Ana Paula Spaniol, Débora O S Fonseca, Tatiana de Souza Ribeiro, Ana R Lindquist
BACKGROUND: Children with hemiparetic cerebral palsy are often characterized by reduced speed progression, shorter step length, and increased support base. These kinematic alterations result in inefficient gait. OBJECTIVE: To assess the immediate effects of treadmill training with additional lower limb loading on kinematic gait parameters in children with Cerebral Palsy (CP). METHODS: This cross-sectional, observational study, involved 20 children with hemiparetic CP that underwent single treadmill session with ankle loading...
January 29, 2019: NeuroRehabilitation
Deema Totah, Meghna Menon, Carlie Jones-Hershinow, Kira Barton, Deanna H Gates
BACKGROUND: Ankle-foot orthoses (AFOs) are commonly prescribed to provide ankle support during walking. Current prescription standards provide general guidelines for choosing between AFO types, but are limited in terms of guiding specific design parameter choices. These design parameters affect the ankle stiffness of the AFO. RESEARCH QUESTION: The aim of this review was to investigate the impact of AFO stiffness on walking mechanics. METHODS: A literature search was conducted using three databases: Pubmed, Engineering Village, and Web of Science...
January 15, 2019: Gait & Posture
Oussama Abousamra, Justin Connor, Chris Church, Daveda Taylor, Nancy Lennon, Maria Del Pilar Duque Orozco, John Henley, Julieanne Sees, Freeman Miller
This study evaluated knee hyperextension course in children with cerebral palsy over a 5-year follow-up. Knee hyperextension was identified in 308 knees, of which 97 had follow-up greater than 5 years. Between the tests, 40% of limbs had plantar flexor lengthening (PFL). Overall, knee flexion and ankle dorsiflexion in stance increased (P<0.0001). Similar changes were noted between limbs that had PFL and those that did not. PFL is indicated in cases associated with equinus. However, the role of multilevel surgery in the treatment of knee hyperextension needs to be further determined...
January 14, 2019: Journal of Pediatric Orthopedics. Part B
Maheshi P C Wijesekera, Nichola C Wilson, Daniele Trinca, Gillian Holmes, Alfie Bass, David M Wright, Roger Walton
BACKGROUND: Flexion deformity of the knee is a common presentation in children with cerebral palsy with hamstring surgery as an option for addressing this. However, concerns with regard to increased pelvic tilt have been raised. The purpose of this study was to compare preoperative and postoperative pelvic tilt after isolated hamstring lengthening versus combined hamstring lengthening and the influence of Gross Motor Function Classification System (GMFCS) levels on pelvic tilt. METHODS: This retrospective study included 46 ambulatory children with cerebral palsy who had had open medial hamstring lengthening (mean age at surgery, 11 y 11 mo; SD, 2 y 11 mo; GMFCS I, 16; GMFCS II 20; GMFCS III 10)...
January 14, 2019: Journal of Pediatric Orthopedics
M Schwarze, J Block, T Kunz, M Alimusaj, D W W Heitzmann, C Putz, T Dreher, S I Wolf
BACKGROUND: Treatment of cerebral palsy includes an interdisciplinary concept and in more severe cases the well-established multi-level surgery (MLS). Different kinds of orthoses are typically part of postoperative treatment but there is a lack of knowledge about their additional benefit. RESEARCH QUESTION: Do ankle foot orthoses lead to an additional, measurable improvement of gait after MLS? METHODS: 20 children with bilateral spastic cerebral palsy (9 retrospective, 11 in a postoperative clinical routine) were included...
January 6, 2019: Gait & Posture
Yosra Cherni, Geneviève Girardin-Vignola, Laurent Ballaz, Mickael Begon
BACKGROUND: The Lokomat (by L-Force tool) allows the measurement of the maximum voluntary isometric torque (MVIT) at the knee and hip joints in a standing position, as close as possible to the posture adopted during walking. However, the reliability of this measurement in children with cerebral palsy (CP) remains unknown. The main goal of this study was to evaluate inter and intra-tester reliability of a novel tool (L-Force) in CP population. PROCEDURE: L-Force reliability was determined in 17 children with CP by two experienced therapists...
December 23, 2018: Neurophysiologie Clinique, Clinical Neurophysiology
Melisa Osborne, Nicole M Mueske, Susan A Rethlefsen, Robert M Kay, Tishya A L Wren
BACKGROUND: Hamstring lengthening surgery (HSL) is often performed to correct crouch gait in patients with cerebral palsy (CP). However, crouch can recur over time, and repeat HSL may be ineffective. One possible reason is that the hamstrings in repeat HSL patients are neither short nor lengthening slowly and would therefore not benefit from HSL. RESEARCH QUESTION: This study aimed to determine whether the hamstrings are short and/or slow preoperatively only in patients with primary, and not repeat, HSL...
November 28, 2018: Gait & Posture
Jon R Davids, Nina Q Cung, Kelly Sattler, Jennette L Boakes, Anita M Bagley
BACKGROUND: Classic teaching for surgical lengthening of muscle contractures in children with cerebral palsy (CP) has emphasized complete correction of the deformity acutely, with immobilization of the targeted muscles in the fully corrected position. Clinical experience has led to the impression that the muscles are invariably weakened by this approach. We have developed an alternative technique for correction of contractures called slow surgical lengthening (SSL). The goal of the study was to determine the physical examination, kinematic, and muscle strength outcomes following SSL of the medial hamstring muscles in children with CP...
December 18, 2018: Journal of Pediatric Orthopedics
Hans Kainz, Marije Goudriaan, Antoine Falisse, Catherine Huenaerts, Kaat Desloovere, Friedl De Groote, Ilse Jonkers
BACKGROUND: Musculoskeletal models do not include patient-specific muscle forces but rely on a scaled generic model, with muscle forces left unscaled in most cases. However, to use musculoskeletal simulations to inform clinical decision-making in children with cerebral palsy (CP), inclusion of subject-specific muscle forces is of utmost importance in order to represent each child's compensation mechanisms introduced through muscle weakness. RESEARCH AIM: The aims of this study were to (i) evaluate if maximum isometric muscle forces (MIMF) in musculoskeletal models of children with CP can be scaled based on strength measurements obtained with a hand-held-dynamometer (HHD), (ii) evaluate the impact of the HHD based scaling approach and previously published MIMF scaling methods on computed muscle forces during gait, and (iii) compare maximum muscle forces during gait between CP and typically developing (TD) children...
September 2018: Gait & Posture
Matthias Hösl, Harald Böhm, Justine Eck, Leonhard Döderlein, Adamantios Arampatzis
BACKGROUND: Patients with spastic Cerebral Palsy are prone to equinus deformities, likely affected by short and inextensible plantarflexor muscles. Manual stretching is a popular treatment but its effectiveness concerning joint mobility, muscle-tendon morphometrics and walking function is debated. Eccentric exercise by backward-downhill treadmill training could be a therapeutic alternative for ambulatory patients improving gait and muscle function. RESEARCH QUESTION: What are the effects of eccentric training by backward-downhill treadmill training and plantarflexor stretching concerning gait and muscle function in patients with spastic Cerebral Palsy? METHODS: 10 independent ambulators with spastic Cerebral Palsy (12 [SD 4] years old, 2 uni- and 8 bilaterally affected) participated in a randomized crossover-study...
September 2018: Gait & Posture
Evelina Pantzar-Castilla, Andrea Cereatti, Giulio Figari, Nicolò Valeri, Gabriele Paolini, Ugo Della Croce, Anders Magnuson, Jacques Riad
Background and purpose - Gait analysis is indicated in children with cerebral palsy (CP) to identify and quantify gait deviations. One particularly difficult-to-treat deviation, crouch gait, can progress in adolescence and ultimately limit the ability to ambulate. An objective quantitative assessment is essential to early identify progressive gait impairments in children with CP. 3-dimensional gait analysis (3D GA) is considered the gold standard, although it is expensive, seldom available, and unnecessarily detailed for screening and follow-up...
December 2018: Acta Orthopaedica
Faustyna Manikowska, Brian Po-Jung Chen, Marek Jóźwiak, Maria K Lebiedowska
The aims were to determine during the popliteal angle (PA) tests whether particular knee muscles are activated and whether the position of pelvis affects the level of muscles activation. Twenty-two patients with cerebral palsy were recruited (age: 14±4.94 years). Knee muscle activities and range of motion were measured during PA. Knee flexors were active during tests, with fivefold increase of activation of ipsilateral hamstring. Higher and more frequent activation of muscles only in the contralateral limb was seen...
December 13, 2018: Journal of Pediatric Orthopedics. Part B
Mauro C de Morais Filho, Marcelo H Fujino, Cátia M Kawamura, Carlos A Dos Santos, José A F Lopes, Francesco C Blumetti, Rames Mattar
The aim of this study was to compare semitendinosus transfer to distal femur (STTX) to semitendinosus surgical lengthening (STL) regarding the increase of anterior pelvic tilt after flexed knee gait treatment. Thirty-nine patients were evaluated, and they were divided according surgical procedures at knees: STL group (22 patients/44 knees), which included patients who received medial hamstrings surgical lengthening as part of multilevel approach, and STTX group (17 patients/34 knees), which was represented by patients who underwent orthopedic surgery including a STTX instead of STL...
November 29, 2018: Journal of Pediatric Orthopedics. Part B
Firooz Salami, Julia Brosa, Stefan Van Drongelen, Matthias C M Klotz, Thomas Dreher, Sebastian I Wolf, Mirjam Thielen
AIM: To evaluate short-term (1y postoperatively; E1) and long-term (at least 4y postoperatively; E2) changes in hamstring muscle-tendon length (MTL) and lengthening velocity after hamstring lengthening in children with bilateral cerebral palsy (CP). METHOD: Three-dimensional gait analysis was performed in 19 children (16 males, 3 females; 36 limbs; mean age at surgery 9y [SD 3y]; range 6-10y) with flexed knee gait, preoperative ankle dorsiflexion lower than 20 degrees, and CP before bilateral hamstring lengthening (E0), at E1 and E2...
November 25, 2018: Developmental Medicine and Child Neurology
Adam T C Booth, Annemieke I Buizer, Jaap Harlaar, Frans Steenbrink, Marjolein M van der Krogt
OBJECTIVE: To investigate the immediate response to avatar-based biofeedback on three clinically important gait parameters; step length, knee extension and ankle power, in children with cerebral palsy (CP). DESIGN: Repeated measures design. SETTING: Rehabilitation clinic. PARTICIPANTS: Twenty-two children with spastic paresis (10y4m±3y1m), able to walk without assistive devices. INTERVENTION: Children walked on a treadmill with virtual reality environment...
November 14, 2018: Archives of Physical Medicine and Rehabilitation
Veronica Cimolin, Claudia Condoluci, Pier Francesco Costici, Manuela Galli
A new summary index for kinetic gait data is proposed (Gait Kinetic Index - GKI), BASED on six kinetic selected variables: hip, knee and ankle moments and powers on the sagittal plane. This method was applied on a control group (CG) of 18 subjects and on 57 patients with diplegic Cerebral Palsy (CP). CP showed statistical different GKI value in comparison with CG. The same is for the sub GKI with the exclusion of GKI Knee Power. The GKI seems to be a promising tool useful to measure extensively the gait pathology taking into consideration kinetic aspects of gait pattern...
November 16, 2018: Computer Methods in Biomechanics and Biomedical Engineering
Qi L Xiong, Xiao Y Wu, Jun Yao, Theresa M Sukal, Nong Xiao, Lin Chen, Xiao L Zheng, Yuan Liu, Wen S Hou
The aim of this study was to quantify and compare the inter-limb muscle coordination during crawling between typically developing infants and infants with developmental delay. Typically developing (TD, $\text{N}=$20) infants and infants with at risk of developmental delay (ARDD, $\textbf{N}=$33) or confirmed developmental delayCDD, N=14) participated in this study. Surface electromyography of eight muscles from arms and legs and the corresponding joint kinematic data were collected while they were crawling on hands and knees at their self-selected velocity...
July 2018: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Thomas C Bulea, Zachary F Lerner, Diane L Damiano
Effective solutions for gait rehabilitation in children with cerebral palsy (CP) remain elusive. Wearable robotic exoskeletons offer the potential to greatly increase the dosage and intensity of gait training in this population, which may improve outcomes. We recently reported that a robotic exoskeleton significantly improved knee extension in children with crouch gait from CP. Longitudinal studies are necessary to fully understand long term biomechanical effects of exoskeleton gait training. Given that children's gait can change both as they develop and throughout their therapy, advanced control strategies which can adapt assistance over time may be beneficial...
July 2018: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Adriana Neves Dos Santos, Nelci Adriana Cicuto Ferreira Rocha
BACKGROUND: Kinesiotaping (KT) has been commonly used in clinical setting. However, beneficial KT effects have not been proved yet. OBJECTIVE: We aimed to verify the effects of KT in knee extensor torque in children with CP. METHODS: We evaluated three children diagnosed as spastic CP, classified as level I, II and III, according with GMFCS. Knee extensor peak torque was analyzed by isokinetic evaluation (Biodex Multi Joint System). The test was performed at 60°/s in the concentric passive mode and the children performed maximal contractions...
2018: NeuroRehabilitation
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