Comparing the Lower-Limb Muscle Activation Patterns of Simulated Walking Using an End-Effector-Type Robot with Real Level and Stair Walking in Children with Spastic Bilateral Cerebral Palsy.

Cerebral palsy is a neurologic disorder caused by lesions on an immature brain, often resulting in spasticity and gait abnormality. This study aimed to compare the muscle activation patterns of real level and stair walking with those of simulated walking using an end-effector-type robot in children with spastic cerebral palsy. The electromyographic activities of the vastus lateralis, biceps femoris, tibialis anterior and medial gastrocnemius of nine children with spastic bilateral cerebral palsy were measured during gait using a wireless surface EMG device. Morning walk was used for the simulated gait. Differences in the muscle activation patterns between the real and simulated gait conditions were analyzed. In the loading response, all four muscles showed reduced activity during two simulated conditions. In mid-stance, mGCM showed reduced activity during simulated conditions, whereas BFem showed greater activity during simulated level walking. In the swing phase, BFem and TAnt activity was reduced during the simulated conditions. The onset-offset of the VLat, BFem and TAnt activity was significantly delayed during simulated versus real level walking. No differences in activity onset-offset were observed between the simulated level and stair conditions. In conclusion, the robot-simulated gait showed differences in its muscle activation patterns compared with the real gait conditions, which must be considered for gait training using an end-effector-type robot.

Virtual reality rehabilitation in children with brain injury: a randomized controlled trial.

AIM: To investigate the efficacy of a virtual reality rehabilitation system of wearable multi-inertial sensors to improve upper-limb function in children with brain injury. METHOD: Eighty children (39 males, 41 females) with brain injury including cerebral palsy aged 3 to 16 years (mean age 5y 8mo, SD 2y 10mo) were assessed as part of a multicentre, single-blind, randomized controlled trial. The intervention group received a 30-minute virtual reality intervention and a 30-minute session of conventional occupational therapy while the control group received 60 minutes of conventional occupational therapy per session, with 20 sessions over 4 weeks. The virtual reality rehabilitation system consisted of games promoting wrist and forearm articular movements using wearable inertial sensors. The Melbourne Assessment of Unilateral Upper Limb Function-2 (MA-2), Upper Limb Physician's Rating Scale, Pediatric Evaluation of Disability Inventory Computer Adaptive Test, and computerized three-dimensional motion analysis were performed. RESULTS: Both groups (virtual reality, n=40; control, n=38) significantly improved after treatment compared to baseline; however, the virtual reality group showed more significant improvements in upper-limb dexterity functions (MA-2, virtual reality group: Δ=10.09±10.50; control: Δ=3.65±6.92), performance of activities of daily living, and forearm supination by kinematic analysis (p<0.05). In the virtual reality group, children with more severe motor impairment showed significant improvements compared to those with less severe impairment. INTERPRETATION: The virtual reality rehabilitation system used in this study, which consists of wearable inertial sensors and offers intensive, interactive, and repetitive motor training, is effective in children with brain injury. WHAT THIS PAPER ADDS: Both virtual reality rehabilitation and conventional occupational therapy were effective for upper-limb training. Virtual reality training was superior in improving dexterity, performance of activities of daily living, and active forearm supination motion. The effect of virtual reality training was significant in children with more severe motor impairments.

Relationship between the more-affected upper limb function and daily activity performance in children with cerebral palsy: a cross-sectional study.

BACKGROUND: There are differences in roles between the more-affected and less-affected upper limb of children with cerebral palsy (CP). However, there is a lack of studies of the relationship between the more-affected limb function and activities of daily living (ADL) in children with CP. Thus, the aim of this prospective cross-sectional study was to investigate the relationship between more-affected upper limb function and ADL in children with CP. METHODS: Children with spastic CP (unilateral CP n = 28, bilateral CP n = 31; 34 males, 25 females; mean age ± SD, 6.8 ± 3.1y [range, 3-14y]) participated in this study. Function of the more-affected upper limb was measured using the Melbourne Assessment of Unilateral Upper limb Function, version 2 (MA2) and the Upper Limb Physician's Rating Scale (ULPRS). Performance of daily living activities was measured using the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT). RESULTS: The range, accuracy and fluency dimension of MA2 and ULPRS total scores were moderately correlated with the daily activity domain (r = 0.47, 0.47, 0.56 for MA2 and r = 0.50 for ULPRS, respectively; P < 0.001) rather than the mobility, social/cognitive, and responsibility domains of the PEDI-CAT. ULPRS scores for elbow extension, supination in extension, supination in flexion, and two-handed function were moderately correlated with the PEDI-CAT daily activity domain (r = 0.44, 0.43, 0.41, and 0.49, respectively; P < 0.01). Finger opening and thumb-in-palm deformity of the ULPRS did not correlate with any PEDI-CAT domain. CONCLUSIONS: The MA2 range, accuracy, and fluency domains (rather than dexterity) had the strongest correlations with the PEDI-CAT daily activity domain. Elbow extension, forearm supination, and two-handed function (rather than wrist and finger movements) of the ULPRS had the strongest correlations with the PEDI-CAT daily activity domain.

Neuromuscular structure of the tibialis anterior muscle for functional electrical stimulation.

PURPOSE: This study describes the nerve entry points and intramuscular nerve branching of the tibialis anterior, providing essential information for therapeutic functional electrical stimulation and botulinum toxin injection. METHODS: One hundred and ten legs from Korean and Thai cadavers were dissected. Ten specimens were harvested and subjected to modified Sihler's staining. RESULTS: The average total length from the lateral malleolus to the fibular head was 32.0 cm (SD 1.9). The nerve entry points were densely distributed between 86.5 and 90.6 % of the reference length, where the first and second nerve entry points were observable. A densely arborizing area of the intramuscular nerve branches was observed at 70-80 % of the reference length. CONCLUSIONS: Based on the results of this study, clinicians can increase the effectiveness of therapeutic functional electrical stimulation and identify the ideal sites for botulinum toxin injection to the tibialis anterior muscle.

Intramuscular nerve distribution pattern of ankle invertor muscles in human cadaver using sihler stain.

INTRODUCTION: We sought to the ideal sites for botulinum toxin injection by examining the intramuscular nerve patterns of the ankle invertors. METHODS: A modified Sihler method was performed on the flexor hallucis longus, tibialis posterior, and flexor digitorum longus muscles (10 specimens each). The muscle origins, nerve entry points, and intramuscular arborization areas were measured as a percentage of the total distance from the most prominent point of the lateral malleolus (0%) to the fibular head (100%). RESULTS: Intramuscular arborization patterns were observed at 20-50% for the flexor hallucis longus, 70-80% for the tibialis posterior, and 30-40% for the flexor digitorum longus. CONCLUSIONS: These findings suggest that treatment of muscle spasticity of the ankle invertors involves botulinum toxin injections in specific areas. These areas, corresponding to the areas of maximum arborization, are recommended as the most effective and safest points for injection.

Intramuscular nerve distribution of the hamstring muscles: Application to treating spasticity.

The aim of this article is to elucidate the ideal sites for botulinum toxin injection by examining the intramuscular nerve distributions in the hamstring muscles. The hamstring muscles, biceps femoris, semitendinosus, and semimembranosus (10 specimens each) were stained by the modified Sihler method. The locations of the muscle origins, nerve entry points, and intramuscular arborized areas were recorded as percentages of the total distance from the line crossing the medial and lateral tibial condyles (0%) to the ischial tuberosity (100%). Intramuscular arborization patterns were observed at 15-30% and 50-60% for the biceps femoris, 25-40% and 60-80% for the semitendinosus, and 20-40% for the semimembranosus. This study suggests that botulinum toxin injection for spasticity of the hamstring muscles should be targeted to specific areas. These areas, where the arborization of intramuscular nerve branches is maximal, are recommended as the most effective and safest points for injection. Clin. Anat. 29:746-751, 2016. © 2016 Wiley Periodicals, Inc.

Biomechanical and clinical correlates of swing-phase knee flexion in individuals with spastic cerebral palsy who walk with flexed-knee gait.

OBJECTIVE: To identify clinical and biomechanical parameters that influence swing-phase knee flexion and contribute to stiff-knee gait in individuals with spastic cerebral palsy (CP) and flexed-knee gait. DESIGN: Retrospective analysis of clinical data and gait kinematics collected from 2010 to 2013. SETTING: Motion and gait analysis laboratory at a children's hospital. PARTICIPANTS: Individuals with spastic CP (N=34; 20 boys, 14 girls; mean age ± SD, 10.1±4.1y [range, 5-20y]; Gross Motor Function Classification System I-III) who walked with flexed-knee gait ≥20° at initial contact and had no prior surgery were included; the more-involved limb was analyzed. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: The magnitude and timing of peak knee flexion (PKF) during swing were analyzed with respect to clinical data, including passive range of motion and Selective Control Assessment of the Lower Extremity, and biomechanical data, including joint kinematics and hamstring, rectus femoris, and gastrocnemius muscle-tendon length during gait. RESULTS: Data from participants demonstrated that achieving a higher magnitude of PKF during swing correlated with a higher maximum knee flexion velocity in swing (ρ=.582, P<0.001) and a longer maximum length of the rectus femoris (ρ=.491, P=.003). In contrast, attaining earlier timing of PKF during swing correlated with a higher knee flexion velocity at toe-off (ρ=-.576, P<.001), a longer maximum length of the gastrocnemius (ρ=-.355, P=.039), and a greater peak knee extension during single-limb support phase (ρ=-.354, P=.040). CONCLUSIONS: Results indicate that the magnitude and timing of PKF during swing were independent, and their biomechanical correlates differed, suggesting important treatment implications for both stiff-knee and flexed-knee gait.

Comparison of the therapeutic effects of ultrasound-guided platelet-rich plasma injection and dry needling in rotator cuff disease: a randomized controlled trial.

OBJECTIVE: To compare the effects of platelet-rich plasma injection with those of dry needling on shoulder pain and function in patients with rotator cuff disease. DESIGN: A single-centre, prospective, randomized, double-blinded, controlled study. SETTING: University rehabilitation hospital. PARTICIPANTS: Thirty-nine patients with a supraspinatus tendon lesion (tendinosis or a partial tear less than 1.0 cm, but not a complete tear) who met the inclusion criteria recruited between June 2010 and February 2011. INTERVENTION: Two dry needling procedures in the control group and two platelet-rich plasma injections in the experimental group were applied to the affected shoulder at four-week intervals using ultrasound guidance. MEASUREMENTS: The Shoulder Pain and Disability Index, passive range of motion of the shoulder, a physician global rating scale at the six-month follow-up, adverse effects monitoring and an ultrasound measurement were used as outcome measures. RESULTS: The clinical effect of the platelet-rich plasma injection was superior to the dry needling from six weeks to six months after initial injection (P < 0.05). At six months the mean Shoulder Pain and Disability Index was 17.7 ± 3.7 in the platelet-rich plasma group versus 29.5 ± 3.8 in the dry needling group (P < 0.05). No severe adverse effects were observed in either group. CONCLUSIONS: Autologous platelet-rich plasma injections lead to a progressive reduction in the pain and disability when compared to dry needling. This benefit is certainly still present at six months after treatment. These findings suggest that treatment with platelet-rich plasma injections is safe and useful for rotator cuff disease.

The Long-Term Outcome and Rehabilitative Approach of Intraventricular Hemorrhage at Preterm Birth.

Technological advances in neonatology led to the improvement of the survival rate in preterm babies with very low birth weights. However, intraventricular hemorrhage (IVH) has been one of the major complications of prematurity. IVH is relevant to neurodevelopmental disorders, such as cerebral palsy, language and cognitive impairments, and neurosensory and psychiatric problems, especially when combined with brain parenchymal injuries. Additionally, severe IVH requiring shunt insertion is associated with a higher risk of adverse neurodevelopmental outcomes. Multidisciplinary and longitudinal rehabilitation should be provided for these children based on the patients' life cycles. During the infantile period, it is essential to detect high-risk infants based on neuromotor examinations and provide early intervention as soon as possible. As babies grow up, close monitoring of language and cognitive development is needed. Moreover, providing continuous rehabilitation with task-specific and intensive repetitive training could improve functional outcomes in children with mild-to-moderate disabilities. After school age, maintaining the level of physical activity and managing complications are also needed.

Kinematic analysis of movement patterns during a reach-and-grasp task in stroke patients.

Background: This study aimed to evaluate the kinematic movement patterns during a reach-and-grasp task in post-stroke patients according to the upper extremity impairment severity. Methods: Subacute stroke patients (n = 46) and healthy controls (n = 20) were enrolled in this study. Spatiotemporal and kinematic data were obtained through 3D motion analysis during the reach-and-grasp task. Stroke patients were grouped using the Fugl-Meyer Assessment (FMA) scale, and a comparison of the groups was performed. Results: The severe group showed a significantly longer movement time, lower peak velocity, and higher number of movement units than the mild group during the reach-and-grasp task (p < 0.05). Characteristic compensatory movement patterns, such as shoulder abduction, thoracic posterior tilting, and upward and external rotation were significantly greater during the forward transporting phase in the severe group than in the mild group (p < 0.05). The FMA score was significantly associated with the movement time during the forward transporting phase, number of movement units during the reaching phase, range of shoulder abduction-adduction and wrist flexion-extension movements during the reaching phase, and range of thoracic internal-external rotation during the backward transporting phase (p < 0.05). Conclusion: Post-stroke patients have unique spatiotemporal and kinematic movement patterns during a reach-and grasp-task according to the impairment severity.

Home-based virtual reality-enhanced upper limb training system in children with brain injury: a randomized controlled trial.

Background: Rehabilitation of upper limb function can be challenging in children with brain lesion. Recent virtual reality (VR) rehabilitation may be an additional treatment option in pediatric rehabilitation. Objectives: To assess the feasibility and effectiveness of a home-based VR-enhanced rehabilitation program with wearable multi-inertial measurement unit (IMU) sensors on upper limb functions in children with brain injury. Methods: This multicenter single blind randomized controlled trial included 40 children with cerebral palsy (CP) or static brain injury. Subjects were randomized 1:1 to experimental and control group. Both the groups maintained the same therapeutic content and dose of occupational therapy during the intervention period. The experimental group performed additional training at home using the VR-enhanced program for at least 30 min/day, 5 days/week, for 6 weeks. VR training consisted of daily activities or games promoting wrist and forearm articular movements using wearable IMU sensors. The Melbourne Assessment of Unilateral Upper Limb Function-version 2 (MA2), Upper Limb Physician's Rating Scale (ULPRS), Pediatric Evaluation of Disability Inventory-computer adaptive test (PEDI-CAT), computerized 3D motion analysis, and user satisfaction survey were performed. Mann-Whitney U test was used to compare treatment effects between groups, and Friedman and Wilcoxon signed-rank tests were used to compare pre and post intervention. Results: Overall 35 children (15 in VR group and 20 in control group) completed the protocol. In the experimental group, an average VR training time was 855 min. The accuracy of motion measured by MA2, segmental movements by ULPRS, daily living capability and social cognitive function by PEDI-CAT, movement time and shoulder movement pattern by motion analysis showed significant improvements. However, there were no significant differences in any of the functional outcome measures compared to the control group. All the children and parents reported positive experiences. Conclusions: Home-based VR training though it had limited impact on improving upper limb function, it could help improve social cognitive function, movement pattern, and efficiency in children with brain injury and could be an effective means of extending clinical therapy to the home. Clinical Trial Registration: CRIS.nih.go.kr: identifier KCT0003172.

Intramuscular nerve distribution pattern of the adductor longus and gracilis muscles demonstrated with Sihler staining: guidance for botulinum toxin injection.

INTRODUCTION: The aims of this study were to clarify the intramuscular branching patterns and arborizing area of hip adductor muscles with reference to surface landmarks on the thigh and to thus suggest effective and safe injection points for botulinum neurotoxin (BoNT). METHODS: Ten gracilis and 10 adductor longus specimens were subjected to Sihler staining to reveal intramuscular nerve arborization patterns, and findings were matched with and referred to surface landmarks. Using these results, we determined the optimal location for BoNT injection in hip adductors in relation to the long axis of the femur. RESULTS: The corrected, most dense areas of innervation in adductor longus and gracilis were typically 30-50% and 40-50% from the anterior superior iliac spine (ASIS) along the vertical line of the femur, respectively. CONCLUSIONS: The most effective and safest point for BoNT injection into adductor muscles appears to be between 35% and 50% from ASIS, where neuromuscular junctions are most densely distributed.

Motor pathway injury in patients with periventricular leucomalacia and spastic diplegia.

Periventricular leucomalacia has long been investigated as a leading cause of motor and cognitive dysfunction in patients with spastic diplegic cerebral palsy. However, patients with periventricular leucomalacia on conventional magnetic resonance imaging do not always have motor dysfunction and preterm children without neurological abnormalities may have periventricular leucomalacia. In addition, it is uncertain whether descending motor tract or overlying cortical injury is related to motor impairment. To investigate the relationship between motor pathway injury and motor impairment, we conducted voxelwise correlation analysis using tract-based spatial statistics of white matter diffusion anisotropy and voxel-based-morphometry of grey matter injury in patients with periventricular leucomalacia and spastic diplegia (n = 43, mean 12.86 ± 4.79 years, median 12 years). We also evaluated motor cortical and thalamocortical connectivity at resting state in 11 patients using functional magnetic resonance imaging. The functional connectivity results of patients with spastic diplegic cerebral palsy were compared with those of age-matched normal controls. Since γ-aminobutyric acid(A) receptors play an important role in the remodelling process, we measured neuronal γ-aminobutyric acid(A) receptor binding potential with dynamic positron emission tomography scans (n = 27) and compared the binding potential map of the patient group with controls (n = 20). In the current study, white matter volume reduction did not show significant correlation with motor dysfunction. Although fractional anisotropy within most of the major white matter tracts were significantly lower than that of age-matched healthy controls (P < 0.05, family wise error corrected), fractional anisotropy mainly within the bilateral corticospinal tracts and posterior body and isthmus of the corpus callosum showed more significant correlation with motor dysfunction (P < 0.03) than thalamocortical pathways (P < 0.05, family-wise error corrected). Cortical volume of the pre- and post-central gyri and the paracentral lobule tended to be negatively correlated with motor function. The motor cortical connectivity was diminished mainly within the bilateral somatosensory cortex, paracentral lobule, cingulate motor area and visual cortex in the patient group. Thalamovisual connectivity was not diminished despite severe optic radiation injury. γ-Aminobutyric acid(A) receptor binding potential was focally increased within the lower extremity homunculus, cingulate cortex, visual cortex and cerebellum in the patient group (P < 0.05, false discovery rate corrected). In conclusion, descending motor tract injury along with overlying cortical volume reduction and reduced functional connectivity appears to be a leading pathophysiological mechanism of motor dysfunction in patients with periventricular leucomalacia. Increased regional γ-aminobutyric acid(A) receptor binding potential appears to result from a compensatory plasticity response after prenatal brain injury.

Comparing quantitative tractography metrics of motor and sensory pathways in children with periventricular leukomalacia and different levels of gross motor function.

INTRODUCTION: The neural tracts responsible for gross motor dysfunction in children with spastic cerebral palsy (CP) caused by periventricular leukomalacia remain unknown. This study investigated both sensory and motor tracts using diffusion tensor tractography (DTT). METHODS: Brain MRIs with diffusion tensor imaging (DTI) performed on 19 children (ten boys and nine girls) with bilateral spastic CP were analyzed. DTT was reconstructed from DTI. Participants were classified according to gross motor function measured with Gross Motor Function Classification System (GMFCS). Those with GMFCS levels I-III comprised the high-functioning group (n = 11), and those with GMFCS levels IV-V comprised the low-functioning group (n = 8). We compared DTT-based metrics, such as fractional anisotropy, apparent diffusion coefficient, and fiber number and volume, between the groups. RESULTS: In the corticospinal tract, the volume and number of fibers were significantly higher in the high-functioning group (p < 0.001), whereas the fractional anisotropy and apparent diffusion coefficient of the corticospinal tract did not differ significantly between the groups. In the somotosensory tract and posterior thalamic radiation, none of the DTT parameters differed significantly between the groups. CONCLUSIONS: Children with bilateral spastic CP with differing levels of gross motor function have corresponding differences detectable on DTT in their corticospinal tracts but not in their somatosensory tracts and posterior thalamic radiations. In addition, the number and volume of fibers, but not fractional anisotropy values or apparent diffusion coefficients, are lower in the corticospinal tracts in children with low gross motor function than in those with high gross motor function.

Ultrasound-guided lateral approach for needle insertion into the subscapularis for treatment of spasticity.

OBJECTIVE: To evaluate the safety and accuracy of ultrasound (US)-guided needle insertion into the subscapularis using fresh cadavers. DESIGN: A needle was inserted into the subscapularis of adult human cadavers under US guidance using a lateral approach from the posterior axillary fold. An anatomist dissected the cadavers to evaluate the effectiveness of this injection method. SETTING: University dissecting room. PARTICIPANTS: Fresh cadavers (N=5). INTERVENTIONS: US-guided dye injections targeting the motor points of the subscapularis. MAIN OUTCOME MEASURE: Accuracy of the injections and prevalence of complications. The presence of dye within 1.0cm of the motor points was defined as reaching the target. The injection procedure was considered a success if two-thirds of the injected dye reached the target. RESULTS: We did not identify any neurovascular structures at risk of injury in the injection route. All subscapularis muscles were injected successfully using the US-guided lateral approach. CONCLUSIONS: US-guided needle insertion into the subscapularis using this lateral approach was accurate and had the minimal risk of neurovascular or lung injuries.

Reliability of the Modified Ashworth and Modified Tardieu Scales with Standardized Movement Speeds in Children with Spastic Cerebral Palsy.

The Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS) are widely used to quantify spasticity. However, the reliability of their use for ankle plantar flexors has been questioned. In this study, we aimed to examine whether their reliabilities could be increased to acceptable levels for ankle plantar flexors using standardized movement speed in children with spastic cerebral palsy. The MAS and MTS scores for 92 limbs were assessed by two raters on two occasions, 1 week apart. A metronome was used to maintain the stretching velocity at 120 beats per minute. The intraclass correlation coefficients (ICCs) of the intra-rater reliabilities of the MAS and MTS and inter-rater reliability of the MAS were over 0.7. However, the ICCs for the inter-rater reliability of the MTS were <0.7 and >0.75 for the gastrocnemius and soleus muscles, respectively. The ICCs for the inter- and intra-rater reliabilities of the R1 angles ranged from 0.68 to 0.84, while those of the R2 angles ranged from 0.74 to 0.93. The reliabilities of the R2-R1 angles were not satisfactory. In conclusion, with a standardized movement speed, the reliability of the MAS for the ankle plantar flexors and the MTS for the soleus were satisfactory; however, that of the MTS for the gastrocnemius was not.

The Effects of Wearing Facemasks during Vigorous Exercise in the Aspect of Cardiopulmonary Response, In-Mask Environment, and Subject Discomfort.

Non-pharmaceutical intervention such as wearing a mask during the pandemic of SARS-CoV-2 is one of the most important ways to prevent the spread of the virus. However, despite high effectiveness and easy to access, the biggest problem is 'discomfort'. The purpose of this study was to measure the changes of cardiopulmonary response and related factors affecting breathing discomfort when wearing a mask during vigorous exercise. Fifteen healthy male adults participated in this study. The experimental protocol consisted of three conditions: no mask; KF-94 mask; and sports mask. Each condition consisted of three stages: stage I, 2 m/s on even level; stage II, 2 m/s with 5° inclination; and stage III, 3 m/s on even level. Oxygen saturation (SaO2) and heart rate (HR), partial pressure of carbon dioxide (pCO2), energy expenditure index (EEI), in-mask temperature, humidity, and a five-point scale questionnaire to evaluate subjective discomfort were measured. The results show that there was a significantly higher discomfort score in mask conditions compared with no mask (p < 0.05) and only pCO2 change significantly related to subjective discomfort during exercise (p < 0.05). Moreover, the pCO2 washout was significantly disturbed when wearing a sports mask in stages 2 and 3, which was related to wearer subjective discomfort.

Analysis of foot kinematics during toe walking in able-bodied individuals using the Oxford Foot Model.

Various neurological and musculoskeletal disorders can induce pathologic toe walking and lead to changes in foot kinematics. In this study, we analyzed the differences in foot kinematics between toe walking and heel-toe walking (HW) in able-bodied individuals. Twenty young healthy adults performed three gaits: HW, comfortable-height toe walking (CTW), and maximum-height toe walking (MTW). Oxford Foot Model was used for gait analysis. Toe walking showed increase of forefoot plantarflexion and hindfoot internal rotation compared to HW. Thus, our results may help distinguish the pathologic mechanism of the equinus gait in various disorders from the kinematic change of toe walking itself.

Spatiotemporal parameters from instrumented motion analysis represent clinical measurement of upper limb function in children with cerebral palsy.

BACKGROUND: There are various tools that measure upper limb function in children with cerebral palsy(CP) clinically, but these measurement methods are examiner-dependent and scale values are not proportional to the upper limb function which makes it difficult to quantify the function. RESEARCH QUESTION: The purpose of this study was to investigate whether the new parameters derived from 3D motion analysis reflect the upper limb function which measured by Melbourne Assessment 2 (MA2) in children with cerebral palsy (CP) compared to the clinical measurements. METHODS: Forty children with CP (24 boys, 16 girls; mean [SD] age, 6 years 11 months [3 years 5 months]) were recruited. Motion capture was conducted during phases T1-T4 of Reach and Grasp Cycles. New parameters (movement time, number of movement units, index of curvature) were derived from wrist marker data. Range of motion (ROM), accuracy, dexterity, and fluency of unilateral upper limb function were assessed using MA2. Spearman rank coefficients were determined to evaluate correlations between MA2 and the new parameters. RESULTS AND SIGNIFICANCE: Index of curvature correlated negatively with MA2 accuracy scores during T1 (rs -0.347, p < 0.05), T2 (rs -0.471, p < 0.01), and T3 (rs -0.660, p < 0.01). Number of movement units correlated negatively with MA2 ROM, accuracy, and fluency scores during T1 (ROM rs -0.334; accuracy rs -0.331; fluency rs -0.375; p < 0.05) and T3 (ROM rs -0.499; accuracy rs -0.531; fluency rs -0.515; p < 0.01). Index of curvature and number of movement units are objective, simple parameters showing fair to good correlation with MA2 accuracy and fluency of upper limb function.

Gait Adaptation Is Different between the Affected and Unaffected Legs in Children with Spastic Hemiplegic Cerebral Palsy While Walking on a Changing Slope.

Walking on sloped surfaces requires additional effort; how individuals with spastic hemiplegic cerebral palsy (CP) manage their gait on slopes remains unknown. Herein, we analyzed the difference in gait adaptation between the affected and unaffected legs according to changes in the incline by measuring spatiotemporal and kinematic data in children with spastic hemiplegic CP. Seventeen children underwent instrumented three-dimensional gait analysis on a dynamic pitch treadmill at an incline of +10° to -10° (intervals of 5°). While the step length of the affected legs increased during uphill gait and decreased during downhill gait, the unaffected legs showed no significance. During uphill gait, the hip, knee, and ankle joints of the affected and unaffected legs showed increased flexion, while the unaffected leg showed increased knee flexion throughout most of the stance phase compared with the affected leg. During downhill gait, hip and knee flexion increased in the affected leg, and knee flexion increased in the unaffected leg during the early swing phase. However, the ankle plantar flexion increased during the stance phase only in the unaffected leg. Although alterations in temporospatial variables and joint kinematics occurred in both legs as the slope angle changed, they showed different adaptation mechanisms.