Changes of kinematics parameters of pelvis during walking under the influence of means facilitates treatment of cerebral palsied children.

BACKGROUND: Physiological human gait is characterized by changes of foot and knee angle that make the gait efficient and not require excessive energy expenditure. In cerebral palsied children, the foot-knee relationship is disturbed by pathological synergies. Therefore, ways to improve this situation are sought. The aim of the study was to verify whether and how well the use of botulinum toxin or inhibitive casts alters the behaviour of the foot-knee complex in cerebral palsy gait. MATERIAL AND METHODS: The study involved 34 hemiparetic children with cerebral palsy aged 7-14 years who were able to walk unassisted. Neurodevelopmental treatment according to the NDT-Bobath method was given to all the children. Two groups were formed. In the first group of 16 children, inhibitive castings were used. The second group of 18 children received Btx-A injections. Gait analysis was performed at baseline and one month after administering these additional treatments. The CMS-HS ultrasonic system (Zebris) was used for three dimensional gait analysis. RESULTS: Apart from the pattern asymmetry characteristic of a hemiplegic gait, various pronounced abnormalities of the foot-knee complex were observed. Following treatment, gait symmetry improved in both groups as did the position of the hemiparetic foot in the mid-support phase. In the inhibitive casting groups, similar improvements were also observed in the initial contact phase. In the knee, greater improvement in knee was noted in the Btx-A group. CONCLUSIONS: Btx-A injections or inhibitive casts improve gait parameters in cerebral palsied children. This improvement is individual and seen in different stages of the support phase, but of similar magnitude following the use of either treatment. Achieving simultaneous improvement in the knee and foot is difficult.

Foot and Knee Behaviour During Gait in Response to the Use of Additional Means of Treatment in Cerebral Palsied Children

BACKGROUND: Physiological human gait is characterized by tree-dimensional pelvis movements, which make that gait is smooth and does not require excessive energy expenditure. In children with cerebral palsy determinants of the pelvis may be affected, mainly due to pathological afferent synergisms. Therefore many specialists is looking for ways to improve this situation. The aim of this study was to verify whether the use of botulinium toxin or inhibitive casts affects the kinematic parameters of the pelvis during the gait of children with hemiparetic form of cerebral palsy. MATERIAL AND METHODS: The study involved 34 hemiparetic children with cerebral palsy aged 7-14 years who reached the capacity of walking. All were improving by neurodevelop-mental treatment according to NDT-Bobath method. Two groups were created. In the first group inhibiting casting was used in 16 children. In the second group botulinium toxin was injected in 18 children. Gait analysis was performed before and after using those type of treatment. Ultrasonic CMS-HS system (Zebris) was used for three dimensional gait analysis. RESULTS: Despite of the characteristic for hemiplegic gait pattern asymmetry, various ab-normalities of pelvis kinematic parameters were observed. Gait symmetry was improved aafter the treatment. Using inhibiting casts also improved kinematic parameters of the pelvis, especially in those children who are found deficit of decreasing and rotation of the pelvis. CONCLUSIONS: 1) The use of Btx-A or inhibitive casts results in improving temporal- spatial parameters of gait of cerebral palsied children with hemiparesis. 2) The improvement of kinematic pelvis parameters are obtained through the use of inhibitive casts, while the use of Btx-A does not have a significant impact on them.

Professional experience and ergonomic aspects of midwives' work.

OBJECTIVES: The most frequent manner of attending childbirth imposes on midwives assuming poor body position affecting the musculoskeletal system. Long professional experience does not mitigate the negative effects. The adopted movement habit, as well as the type, number and frequency of actions influence the body posture. The aim of the study was to identify ergonomic threats of basic occupational midwives activities and how particular spinal segments arrangements while attending childbirth using the same technique in senior midwives differ from those of junior ones. It was also checked whether pain influences the working position assumed by midwives. MATERIALS AND METHODS: Examinations were conducted in 95 midwives aged 21-50 (X = 29.25 ± 9.34): 51 graduates of BSc midwifery who worked 680 h in delivery rooms during obligatory practical classes and apprenticeship and 44 senior midwives with professional experience of 7-27 years (X = 14.84 ± 5.98). The study was threefold. The spinal alignment while performing work activities associated with attending childbirth was assessed using the OWAS system and the SonoSens Monitor, the center of gravity projection on basal plane--using the AccuGait AMTI stabilometric platform. The measurements were taken during a simulation of attending childbirth (on examination model). A survey was conducted aimed at identifying spinal pain. RESULTS: Midwives' working postures require unnatural body alignments. Postural instability in the working position and no maximal usage of basal plane were observed. The work overload may afflict the musculoskeletal system, which was confirmed by different pain discomforts in 67.3% of the examinees. CONCLUSIONS: Spinal alignment while attending childbirth is individually differentiated and in every case non-ergonomic. Identifying explicitly spinal overloads is difficult, but the most prevalent ones affect lumbar and cervical regions altogether. Spinal pain is frequently noted, both in junior and senior midwives, and is characteristic for midwives working in maximal movement ranges.

Health status of adults treated for 1st degree scoliosis at school age.

BACKGROUND: Abnormal body alignment may lead to the development of spinal overload syndromes, nerve root irritation, pain, impaired ventilation, and compromise of exercise capacity. OBJECTIVE: The aim of the study was to find out whether low degree scoliosis impairs breathing, reduces exercise capacity and produces back pain over time. MATERIAL AND METHODS: Respiratory function, exercise capacity (PWC170) and pain intensity (Jackson and Moskowitz regimen) were assessed in 39 adults aged 19 to 38 years diagnosed with low degree scoliosis (10-280) several years ago. A group of 43 controls with no scoliosis in adolescence was also examined. RESULTS: There was no progression of the curvature after the treatment in the scoliosis group. Spirometric parameters in this group were slightly lower than in the controls, although there was no evidence of the restrictive type of respiratory disorder, which was found in only 5.1% patients. PWC170 test results were significantly lower (by about 20%) than in controls, and 84.6% of the subjects reported intermittent, occasional, or frequent pain, mostly lumbar and associated with the work performed. In 12.8% of cases, the pain interfered with breathing. In about half of the group, pain occurred after exertion and caused limitation of activity, while in the remaining subjects it did not affect daily activities. CONCLUSIONS: 1) low degree scoliosis generally did not cause restrictive impairment of ventilation; 2) adults with established low degree scoliosis demonstrated impaired exercise capacity, in the form of reduced PWC170 scores; 3) the presence of low degree scoliosis at school age was associated with back pain in adulthood.

Various attitudes to the use of corrective exercises in conservative treatment of scoliosis.

In acquired scoliosis, the degree of the curve is initially low and its type becomes apparent only after it has progressed. The characteristics of scoliosis include an abnormal spatial arrangement of individual body segments, which the central nervous system (CNS) interprets as a defect and automatically launches compensatory mechanisms. Neglecting low-degree scoliosis poses a two-fold danger. It usually leads to the development of structural changes, while the child gets used to the abnormal body arrangement, thus reinforcing the poor postural habits. The basic aim of early rehabilitation is to manage the compensatory mechanisms and prevent the development of adverse secondary changes, rehabilitation in scoliosis being no exception.Some cases of scoliosis require surgery. The point is to minimise the changes resulting from the progression of scoliosis. The role of corrective exercises seems to be significant here. However, views on the usefulness of such exercises are sometimes extremely varied, even though both favourable and sceptical opinions are not fully supported by the literature. However, a number of reports indicate that corrective exercises are useful.
The selection and of corrective exercises and how they should be performed are another question. A number of methods of conservative treatment of scoliosis have been devised. Currently, none of them is considered a comprehensive regimen since each patient requires an individual approach. The most difficult aspect is to ensure that local correction translates to the automatic maintenance of the corrected body posture in a standing position. This is facilitated by corrective exercises supported with biofeedback.
The aim of this paper is to elucidate this complex issue that often leads to divergent and improper attitudes to the conservative treatment of scoliosis.

"The inhibiting casts" used in cerebral palsed children.

Inhibiting casts, introduced to rehabilitation practice by NDT-Bobath therapists, are being used with increasing frequency in the physiotherapy of children with cerebral palsy (CP). In the literature these plaster casts are known as tone-reducing plasters, spasticity-reducing plasters, or short leg plaster casts. The casts are installed on the lower leg and foot in the form of plaster shoes to immobilize the foot and ankle joints in the proper position. This creates conditions for constant manipulation of the limb using key points located on the lower leg and foot. According to the NDT-Bobath concept, this enables positive changes in postural and locomotor patterns, as well as the distribution of postural tone. The construction and application of these inhibitive casts are not the same as in the standard plaster casts used to correct foot deformations. The casts are placed on both feet regardless of the type of paresis, for a period from one to three weeks, depending on the child's age. New casts can be applied repeatedly during the child's rehabilitation. Experience shows that inhibitive casts are a very important aid in the treatment of CP children. The decision to use plaster casting requires experience and detailed functional assessment for each individual child, in terms of muscle tone distribution, the necessary compensatory patterns, and disturbances in the coordination of motor patterns.