Randomized controlled trial assessing participation and quality of life in a supported speed treadmill training exercise program vs. a strengthening program for children with cerebral palsy.

OBJECTIVE: A multi-site Randomized-Controlled Trial compared a home-based Supported Speed Treadmill Training Exercise Program (SSTTEP) with a strengthening exercise program in children with cerebral palsy (CP) on the following categories; Participation, quality of life (QOL), self-concept, goal attainment, and satisfaction. DESIGN: Twenty-six children with spastic cerebral palsy were assigned by site-based block randomization to the SSTTEP (n=14) or strengthening exercise (n=12) group. Both groups participated in a two week clinic-based induction period and continued the intervention at home for ten weeks. Data were collected at baseline, post-intervention (12 weeks), and follow-up (16 weeks). Assessments included the Canadian Occupational Performance Measure, Children's Assessment of Participation and Enjoyment Scale, Pediatric Quality of Life Cerebral Palsy Module, and Piers-Harris Children's Self-Concept Scale. Evaluators were blinded to group assignment at two sites. RESULTS: Satisfaction and performance on individual goals, participation, and parent-reported QOL improved in both groups with improvement maintained for four weeks post intervention. CONCLUSION: The hypothesis that the SSTTEP group would have better outcomes than the exercise group was not supported. However, both groups showed that children with CP can make gains in participation, individual goals, and satisfaction following a 12-week intensive exercise intervention, and these findings persisted for four weeks post intervention.

Development of a method for analyzing three-dimensional scapula kinematics.

BACKGROUND: Scapula mobility complicates upper extremity kinematics assessment. Existing methods are diverse, providing inconsistent results. The current gold standard (bone pins) is prohibitively invasive. The purposes of the current study are to describe a virtual projection alternative to surface markers for video motion capture (VMC) of the scapula and to compare the results of the projection and surface marker methods to the results of similar existing methods. METHODS: Ten participants were evaluated using VMC. Surface markers were applied to the trunk and arm in accordance with existing guidelines. Three markers were affixed to plastic base on the skin over the acromion process. Other scapular landmarks were digitized in a neutral position. These landmarks' locations were defined in reference to the acromion cluster and used to generate the projection. Humerothoracic, glenohumeral, and scapulothoracic kinematics were evaluated during shoulder abduction, flexion, and scaption. Joint angles produced by the surface markers and the projection were compared by Bonferroni-adjusted t tests. The results were compared to prior findings in the literature. RESULTS: The projection resulted in greater scapulothoracic upward rotation, internal rotation, and anterior-posterior tilt and less glenohumeral elevation (p < .0055) than did surface markers. The virtual scapula produced greater estimates of scapular mobility than did surface markers, corresponding to pre-existing results from similar methodologies. CONCLUSIONS: The result is a noninvasive measurement tool that produces different and superior results than do scapula surface markers. Measuring scapula kinematics via VMC without bone pins will facilitate future investigations into interactions between upper extremity injury, kinematics, and activity performance.

Spinal cord and brain injury protection: testing concept for a protective device.

STUDY DESIGN: Test development for a device that could prevent both brain and spinal cord injuries during motorcycling and horseback riding. OBJECTIVE: The objective of this study was to develop a method and test a concept device that could protect against both spinal cord (SCI) and brain injuries (BI). SETTING: St Louis, Missouri, USA. METHODS: A Hybrid III dummy (that is, head, neck and torso) was used as a pendulum bob during three test conditions: (1) no protection, (2) standard motorcycle helmet and (3) SCI and BI test structure (SCIBITS). Triaxial accelerometers, a C1 force transducer and a video system were used to collect data as the dummy axially impacted a rigid barrier at speeds ranging from 10 to 605 cm s(-1). SCIBITS consisted of a fused fiberglass thoracic jacket/head shield unit. Separation between the dummy head and the head shield permitted freedom of head movement within safe limits as impact forces to the head shield were transferred from the head and neck to the upper thorax. The BI threshold was 200-300 g, and the SCI threshold was 3010 N. RESULTS: The SCIBITS protected against spinal cord injury, whereas the motorcycle helmet did not. The helmet protected against BI and the SCIBITS provided partial protection. CONCLUSIONS: The experiments describe the efficacy of an impact testing system utilizing an instrumented dummy suspended as a pendulum bob. The equipment will facilitate the design and construction of a functional device for protection against both SCI and BI in relation to both motorcycling and horseback riding.

Tendon Achilles lengthening for the treatment of neuropathic ulcers causes a temporary reduction in forefoot pressure associated with changes in plantar flexor power rather than ankle motion during gait.

The purposes of this study were to determine the effects of tendon Achilles lengthening (TAL) on ambulatory plantar pressures and ankle range of motion, moment, and power, and to determine whether changes in forefoot pressure after treatment of a neuropathic ulcer are related to changes in ankle dorsiflexion range of motion (DFROM) or plantar flexor (PF) power during gait. Pressure and gait tests were performed before treatment, and at 3 weeks and 8 months after treatment in two randomly assigned groups of subjects with diabetes, equinus deformity, and a neuropathic forefoot ulcer treated with TAL and total contact casting (TAL group, n=14), or total contact casting alone (TCC group, n=14). The TAL group had an initial decrease in forefoot peak pressure (PP) (27%), forefoot pressure-time integral (PTI) (42%), PF moment (53%), and PF power (65%), along with an initial increase in rear foot PP (34%), rear foot PTI (48%), and DFROM (74%). Post-surgical changes in rear foot pressure and DFROM were maintained up to 8 months after treatment with TAL, whereas forefoot pressure and PF moment and power increased significantly. Changes in forefoot pressure after treatment in either group were correlated with changes in PF power (r=0.45-0.60), but not with changes in DFROM during gait (r=-0.02-0.08). Results suggest TAL causes a temporary reduction in forefoot pressure primarily by reducing PF power during gait. The initial decrease in forefoot pressure, followed by progressive reloading of forefoot tissues as PF muscles regain strength after TAL, may help reduce the risk of ulcer recurrence in patients with diabetes.

Spasticity, strength, and gait changes after surgery for cervical spondylotic myelopathy: a case report.

STUDY DESIGN: A case report with repeated measures is presented. OBJECTIVE: To describe an objective method for evaluating changes in upper- and lower-extremity spasticity and strength, as well as temporal and kinematic gait variables, after surgical intervention for cervical spondylotic myelopathy. SUMMARY OF BACKGROUND DATA: Degenerative cervical spinal disease is a common disorder, with some form of spondylosis demonstrated radiographically in more than 80% of those older than 55 years. Normative pre- and postoperative objective data quantifying spasticity, strength, and gait do not exist. METHODS: A 65-year-old woman underwent C2-C3 anterior cervical discectomy and fusion for progressive myelopathy secondary to a spondylosis and disc herniation. The measure for spasticity and strength at the ankles and elbows and a gait analysis were collected before surgery and at 11 days, 3 and 6 months after surgery. Spasticity and strength were assessed using a dynamometer, and a six-camera video system was used to record the gait. RESULTS: Preoperative left elbow flexor spasticity was more than 10 times greater than the values for the able bodies. It was reduced to normal levels after surgery. Substantial presurgery weakness was present in the elbow flexors and extensors bilaterally. Elbow extensor strength was at able-body levels after surgery. Gait speed was 57% of the able-body level before surgery and 78% of the able-body level 6 months after surgery. CONCLUSIONS: This case study demonstrated the role of biomechanics in characterizing impairments associated with cervical spondylosis and its surgical intervention. Measures for spasticity, strength, and gait taken before and after surgery indicated a favorable outcome. This report provides a foundation for the continued use of biomechanical methods to measure changes in function and impairments associated with surgical intervention of cervical spine disorders.

Assessment of fatigue, monitor placement, and surgical experience during simulated laparoscopic surgery.

BACKGROUND: Laparoscopic surgery requires the surgeon to assume atypical postures for extended periods of time, potentially leading to fatigue and chronic injury. This study assessed the level of muscle activity and compared the effects of fatigue, monitor placement, and surgical experience during simulated laparoscopic surgery. METHODS: Four attending and four resident surgeons repeated a series of four tasks with a View site and a standard operating room monitor. Electromyography (EMG) activity and muscular discomfort scores were obtained before and after a "fatigue session." Two variables, the EMG amplitudes and discomfort scores, were analyzed. RESULTS: The EMG amplitudes generally exceed the recommended threshold limits of acceptable muscular load. EMG data and discomfort scores demonstrated a fatigue response in several muscle groups. Minimal differences between the two monitor positions were seen. Overall, the EMG data and discomfort scores showed less muscle activity and discomfort in the attending surgeons. CONCLUSION: Laparoscopic surgery required a relatively high muscular load, putting surgeons at risk for fatigue and injury. Altering the monitor placement did not reduce the surgeon's risk of fatigue. Experience slightly reduced the level of fatigue, but not enough to reduce the surgeon's risk category.

Preoperative gait comparisons between adults undergoing long spinal deformity fusion surgery (thoracic to L4, L5, or sacrum) and controls.

STUDY DESIGN: This investigation compared the gait of revision and primary spinal deformity patients about to undergo surgical reconstruction with that of a group of able-bodied controls. OBJECTIVES: The hypothesis of the study was that both patient groups would have significantly compromised gait, spine motion, and gait endurance compared with the able-bodied group. SUMMARY OF BACKGROUND DATA: There is a population of adults with degenerative changes superimposed on idiopathic scoliosis who present for reconstructive spinal surgery (primary patients). There is another group of adults who have already had spinal deformity surgery and present for revision surgery (revision patients). METHODS: Twenty-seven women were recruited (8 primary, 13 revision, 6 able-bodied controls). A typical gait analysis was performed. Walking endurance was estimated from a submaximal graded treadmill exercise test. Three motion variables describing the orientation of the shoulders with respect to the pelvis in the three principal planes of the body were determined. Also, gait speed, stride length, cadence, and step width were calculated. The variable for the endurance test was the length of time walked on the treadmill. RESULTS: Results for the revision group indicated a slower walking speed, greater sagittal plane trunk flexion, reduced range of motion in the coronal and transverse planes, and poorer endurance relative to age-matched controls. The primary group demonstrated a slower walking speed relative to age-matched controls. The revision group had poorer endurance scores relative to the primary group. CONCLUSION: This investigation is an objective report describing the compromised gait and walking endurance of adult patients with spinal deformity before spinal fusion surgery. Results supported subjective observations regarding the preoperative gait of these patients and presented results difficult to observe in a clinical setting. The techniques appear useful in providing objective information regarding the gait abilities of these patients.

Prospective dynamic functional evaluation of gait and spinal balance following spinal fusion in adolescent idiopathic scoliosis.

STUDY DESIGN: Prospective evaluation of gait and spinal-pelvic balance parameters in patients with adolescent idiopathic scoliosis undergoing a spinal fusion. OBJECTIVE: To evaluate changes in gait and three-dimensional alignment and balance of the spine relative to the pelvis as a consequence of spinal fusion. SUMMARY OF BACKGROUND DATA: Preoperative and postoperative spinal radiographs have been the major forms of outcome analysis of adolescent idiopathic scoliosis fusions. The use of optoelectronic analysis for posture and gait has gained acceptance recently. However, there is a paucity of data quantifying, comparing, and correlating structural and functional changes in patients undergoing scoliosis fusion surgery including upright posture and gait. METHODS: Thirty patients with adolescent idiopathic scoliosis undergoing an instrumented spinal fusion were prospectively evaluated. Coronal and sagittal vertical alignment was evaluated on radiographs (CVA-R, SVA-R), during upright posture (CVA-P and SVA-P), and during gait (CVA-G, SVA-G). Transverse plane alignment was evaluated by the acromion-pelvis angle during gait. RESULTS: Gait speed was significantly decreased (P < 0.05) between preoperative (129 +/- 16 cm/sec) and 2-year postoperative (119 +/- 16 cm/sec) testing sessions. Decreasing gait speed was the result of significantly reduced cadence and decreased stride length. There were no significant differences for lower extremity kinematics over the entire gait cycle. Spinal-pelvic balance parameters showed significant improvement in mean CVA-R, CVA-G (P < 0.05), then unchanged CVA-P at 2 years postoperation. CVA-P was relatively unchanged while the mean CVA-G also showed significant improvement from preoperation (2.2 +/- 2.4 cm) to 2 years postoperation (1.3 +/- 1.3 cm)(P < 0.05). The mean SVA-R, SVA-P, and SVA-G were unchanged at 2 years postoperation (P > 0.05). The acromion-pelvis angle during gait at maximum shoulder rotation was statistically improved at 1 year (P = 0.002) and 2 years (P = 0.001) after surgery. Importantly, CVA-P correlated with CVA-G, and SVA-P correlated with SVA-G to the P < 0.05 level. CONCLUSIONS: Patients with adolescent idiopathic scoliosis undergoing spinal fusion show slightly decreased gait speed at 2 years postoperation without any change in lower extremity kinematics. Spinal-pelvic balance parameters are improved in the coronal plane and unchanged in the sagittal plane radiographically and during standing posture and gait. Transverse plane parameters also are improved at maximum shoulder rotation during gait.

Quadriceps and hamstring strength changes as a function of selective dorsal rhizotomy surgery and rehabilitation.

PURPOSE: Objective measures of strength in children with cerebral palsy (CP) are needed to determine the effect that selective dorsal rhizotomy surgery (SDR) and subsequent rehabilitation have on muscle strength. This investigation quantified quadriceps and hamstring strength in children with CP pre-SDR and eight months post-SDR. METHOD: Nineteen children with CP and 20 children without disabilities (WD group) were tested with an isokinetic dynamometer. The children performed a maximum concentric contraction of the quadriceps muscles as the dynamometer moved the knee from a flexed position to an extended position at 10 degrees per second. A maximum concentric contraction of the hamstring muscles was then performed as the knee was moved from extension to flexion. Four variables were recorded from the torque-angle data; peak extension and flexion torque and extension and flexion work. RESULTS: Children with CP, both pre- and post-SDR were significantly weaker in all strength measures compared with the WD group. Children with CP post-SDR and rehabilitation had significantly greater peak torque and work values compared with their pre-SDR values. The results agreed with previous studies indicating that children with CP are weaker than their peers without disabilities. Previous studies on strength changes after SDR remain controversial. CONCLUSIONS: The results of this study showed a significant increase in strength at the knee after rhizotomy and rehabilitation.

Changes in synergistic movement patterns after selective dorsal rhizotomy.

The purpose of this investigation was to quantitatively compare synergistic movement patterns between seven children (four male, three female; aged 3 to 17 years; mean 6.7, SD 5.3) without cerebral palsy (CP) (controls) and 27 children (15 male, 12 female; aged 2 to 16 years; mean 5.7, SD 3.7) with spastic diplegic CP before and after selective dorsal rhizotomy (SDR). The study design was also descriptive, comparing results of before and after SDR to control children. A two dimensional video system and retroreflective markers were used to obtain sagittal plane angles for the hip, knee, and ankle during maximum active knee flexion and extension. Correlations were calculated between the knee and hip and between the knee and ankle joint pairs. Control children demonstrated non-synergistic movement patterns (-0.75 and -0.61). These results were significantly different from children with CP (0.40 and 0.43, p<0.05). Eight months after SDR, synergistic patterns did not significantly change from preoperative results (0.23 and 0.36, p>0.05) and remained significantly different from control children (p<0.05). We conclude that it may not be possible to significantly alter synergistic patterns after SDR.

Effects of a tendo-Achilles lengthening procedure on muscle function and gait characteristics in a patient with diabetes mellitus.

STUDY DESIGN: Case report with repeated measures. OBJECTIVES: To describe the effects of a tendo-Achilles lengthening (TAL) and total contact casting (TCC) on wound healing, motion, plantar pressure, and function in a patient with diabetes mellitus, peripheral neuropathy, neuropathic ulcer, and limited dorsiflexion range of motion (DFROM). BACKGROUND: Limited DFROM has been associated with increased forefoot pressures and skin breakdown. A TAL was expected to increase DFROM and reduce forefoot pressures during walking, but the influence on muscle performance and function was unknown. METHODS AND MEASURES: The patient was a 42-year-old man with a 20-year history of type 1 diabetes (NIDDM) and a recurrent neuropathic plantar ulcer. Outcome measures were DFROM, isokinetic plantar flexor muscle peak torque, in-shoe and barefoot peak plantar pressure, physical performance test (PPT) score, and peak ankle and hip moments during walking obtained from an automated gait analysis. All tests were completed pre-TAL, 8 weeks post-TAL (after immobilization in a TCC), and 7 months post-TAL. RESULTS: The wound healed in 40 days. The TAL resulted in a sustained increase in DFROM (0 to 18 degrees). Plantar flexor peak torque was reduced by 21% 8 weeks after the TAL compared with the torque before surgery but recovered fully at 7 months. Seven months following TAL, in-shoe forefoot peak plantar pressure was reduced by 55%, barefoot pressure decreased by 14%, PPT score increased by 24%, peak ankle plantar flexor moment remained decreased by 30%, and the peak hip flexor moment increased by 41% during walking. CONCLUSION: For this patient, a TAL resulted in short-term deficits in peak plantar flexor torque, but a 7-month follow-up showed improvements in ankle DFROM, walking ability, and a decrease in forefoot in-shoe peak plantar pressure.

Ankle spasticity and strength in children with spastic diplegic cerebral palsy.

Ankle spasticity and strength in 27 children with spastic diplegic cerebral palsy (CP) (mean age 9 years, range 3 to 18 years) and a group of 12 children without CP (comparison group) (mean age 9 years, range 5 to 18 years) were observed. To measure spasticity, a KinCom dynamometer dorsiflexed the passive ankle at five different speeds and recorded the resistive plantarflexion torques. Work values for the torque-angle data were calculated at each speed. Using this data, linear regression was used to measure spasticity. To measure strength, the dynamometer rotated the ankle from maximum dorsiflexion to maximum plantarflexion at a speed of 10 degrees/s while the child performed a maximum plantarflexion concentric contraction. The movement was reversed to record maximum dorsiflexion. Maximum torques and work by the plantarflexors and dorsiflexors were calculated. The group with CP had significantly more spasticity in the plantarflexors and significantly less strength in the plantarflexors and dorsiflexors than the group without CP. Results provide objective information quantifying ankle spasticity and strength in children with CP.

Changes in ankle spasticity and strength following selective dorsal rhizotomy and physical therapy for spastic cerebral palsy.

OBJECT: In this investigation the authors quantified changes in ankle plantarflexor spasticity and strength following selective dorsal rhizotomy (SDR) and intensive physical therapy in patients with cerebral palsy (CP). METHODS: Twenty-five patients with cerebral palsy (CP group) and 12 able-bodied volunteers (AB controls) were tested with a dynamometer. For the spasticity measure, the dynamometer was used to measure the resistive torque of the plantarflexors during passive ankle dorsiflexion at five different speeds. Data were processed to yield a single value that simultaneously encompassed the three key elements associated with spasticity: velocity, resistance, and stretch. For the strength test, the dynamometer rotated the ankle from full dorsiflexion to full plantarflexion while a maximum concentric contraction of the plantarflexors was performed. Torque angle data were processed to include the work done by the patient or volunteer on the machine. Plantarflexor spasticity values for the CP group were significantly greater than similar values for the AB control group prior to surgery but not significantly different after surgery. Plantarflexor strength values of the CP group were significantly less than those of the AB control group pre- and postsurgery. Postsurgery strength values did not change relative to presurgery values. CONCLUSIONS: The spasticity results of the present investigation agreed with those of previous studies indicating a reduction in spasticity for the CP group. The strength results did not agree with the findings of most previous related literature, which indicated that a decrease in strength should have occurred. The strength results agreed with a previous investigation in which knee flexor strength was objectively examined, indicating that strength did not decrease as a consequence of an SDR. The methods of this investigation could be used to improve SDR patient selection.

Fate of the psoas muscle after open reduction for developmental dislocation of the hip (DDH).

We evaluated the anatomic and functional consequences of psoas lengthening during operative intervention for developmental dislocation of the hip (DDH). Possible anatomic changes were assessed by magnetic resonance imaging (MRI), and functional assessment included strength determination by an isokinetic dynamometer and gait analysis. Six girls and one boy, ranging in age from 15 to 20 months, had operative reduction of a unilateral DDH. One closed and six open reductions (three anteromedial and three anterolateral approaches) were performed. Follow-up ranged from 4 years 0 months to 9 years 2 months. The cross-sectional area determined by MRI of the lengthened psoas muscles was markedly reduced for all of the six open-reduction patients (three moderate and three severe). Atrophy of the iliacus muscle also was apparent by MRI in five of the six open-reduction patients. Maximum flexion torque, as determined by the isokinetic dynamometer, was diminished on the DDH side for the three patients whose hips were reduced open through the anteromedial approach. Average hip-flexion torque over the entire range of motion was decreased for both anteromedial and anterolateral groups on the operated-on side. Lengthening of the psoas tendon during open reduction of a DDH is associated with considerable atrophy of the psoas muscle.

Spasticity and strength changes as a function of selective dorsal rhizotomy.

OBJECT: The goal of this investigation was to quantify changes in hamstring muscle spasticity and strength in children with cerebral palsy (CP) as a function of their having undergone a selective dorsal rhizotomy. METHODS: Nineteen children with CP (CP group) and six children with able bodies (AB group) underwent testing with a dynamometer. For the spasticity measure, the dynamometer measured the resistive torque of the hamstring muscles during passive knee extension at four different speeds. Torque-angle data were processed to calculate the work done by the machine to extend the knee for each speed. Linear regression was used to calculate the slope of the line of best fit for the work-velocity data. The slope simultaneously encompassed three key elements associated with spasticity (velocity, resistance, and stretch) and was considered the measure of spasticity. For the strength test, the dynamometer moved the leg from full knee extension to flexion while a maximum concentric contraction of the hamstring muscles was performed. Torque-angle data were processed to calculate the work done on the machine by the child. Hamstring spasticity values for the CP group were significantly greater than similar values for the AB group prior to surgery; however, they were not significantly different after surgery. Hamstring strength values for the CP group remained significantly less than those for the AB group after surgery, but were significantly increased relative to their presurgery values. CONCLUSIONS: The results of spasticity testing in the present investigation agreed with those of previous studies, indicating a reduction in spasticity for the CP group. The results of strength testing did not agree with those in the previous literature; a significant increase in strength was observed for the CP group.

Spasticity and strength changes as a function of selective dorsal rhizotomy.

This investigation quantified pre- and postsurgery (8 months) hamstring muscle spasticity and strength in children with cerebral palsy (CP) undergoing a selective dorsal rhizotomy. Nineteen children with CP (CP group) and six children with able bodies (AB group) underwent testing with a dynamometer. For the spasticity measure, the dynamometer measured the resistive torque of the hamstring muscles during passive knee extension at four different speeds. Torque angle data were processed to calculate the work done by the machine to extend the knee for each speed. Linear regression was used to calculate the slope of the line of best fit for the work velocity data. The slope simultaneously encompassed three key elements associated with spasticity (velocity, resistance, and stretch) and was considered the measure of spasticity. For the strength test, the dynamometer moved the leg from full knee extension to flexion while a maximum concentric contraction of the hamstring muscles was performed. Torque angle data were processed to calculate the work done on the machine by the child. Hamstring spasticity values for the CP group were significantly greater than similar values for AB group prior to surgery; however they were not significantly different after surgery. Hamstring strength values for the CP group remained significantly less than those for the AB group after surgery, but were significantly increased relative to their presurgery values. The results of spasticity testing in the present investigation agreed with previous studies indicating a reduction in spasticity for the CP group. The results of strength testing did not agree with those in the previous literature; a significant increase in strength was observed for the CP group.

Quantitative clinical measure of spasticity in children with cerebral palsy.

OBJECTIVE: This investigation developed an objective measure to quantify the degree of spasticity. DESIGN: Specifications included a single variable that integrated key elements characterizing spasticity: velocity, range of motion, and resistance to passive motion. A dynamometer at a children's hospital quantified the passive resistance of the hamstrings to knee extension for a range of motion at 4 different speeds for the prospective descriptive investigation. PATIENTS: A convenience sample of six children with able bodies and 17 children with spastic diplegic cerebral palsy volunteered. DATA PROCESSING: Torque-angle data were processed to calculate the work done by the machine on the children for each speed and then determine the slope of the work-velocity curves. This slope was considered to be the measure of spasticity and it was hypothesized that children with cerebral palsy would have a greater slope than children with able bodies. An independent test determined whether a significant difference existed between groups (p < .05). RESULTS: Torque-angle data for children with able bodies indicated little change in passive resistance as a function of speed. Similar data for children with cerebral palsy indicated larger resistive torques with increasing speed. Slope from the work-velocity data was close to zero for children with able bodies [.003 J/(degrees/sec)], while the corresponding slope for children with cerebral palsy was approximately 10 times greater [.031 J/(degrees/sec)] and significantly different (p < .05). CONCLUSION: The slope of the work-velocity data integrates three major components characterizing spasticity, it is a single number that can easily be evaluated and interpreted in a clinical setting, and it utilizes a machine that is available at many centers.

A new method for quantifying pronation in overpronating and normal runners.

Previous studies investigating motion of the ankle joint complex (AJC) and its relationship to chronic long-distance running injuries have quantified motion relative to a neutral position. No investigators have examined pronation during running relative to a total range of motion of the AJC. This investigation developed a method to quantify pronation during running from a total range of motion of the AJC. A six degree of freedom fixture quantified an active range of motion of the AJC. Common methods were used to obtain kinematic data of the AJC from running as a function of time. A method was developed to directly relate the range of motion data to the kinematic data. Fourteen overpronating and 10 normal runners were tested. Angular variables describing ranges of motion and maximum values were determined for each group, and an unpaired t-test was used to test for significant differences (P < 0.05). Results indicated overpronators had maximum eversion and abduction values during running that were significantly different from the normal runners. When measured from a neutral position no clear testable hypothesis was evident to identify runners predisposed to injury. When measured relative to the end ranges of motion a clear testable hypothesis was apparent. This method could be used to prospectively test the hypothesis.

Relation among indices of effort and oxygen uptake in below-knee amputee and able-bodied children.

The purpose of this investigation was to determine the relationships among simple methods for measuring effort in below-knee amputee (BKA) and able-bodied (AB) children. Ten BKA children and 13 AB children walked on a treadmill and selected a freely chosen walking speed (CWS). Children then walked for 2 minutes at each of three speeds: CWS, 20% above CWS, and 20% below CWS. Oxygen uptake, heart rate, physiological cost index, percent maximum heart rate, and vertical displacement of a surface marker on the sacrum were determined for each subject and speed. Linear regression with repeated measures was used to determine correlations between oxygen uptake and the four variables (p < 0.05). To evaluate the effectiveness of the regression equations, two male children not part of the AB group were tested. The proportion of explained variance arising from the significant correlations between oxygen uptake and the four measured variables were all between 0.91 and 0.92. It was concluded that the vertical displacement of a marker on the sacrum is a simple and convenient measure for a biomechanics gait laboratory to estimate effort because only standard biomechanics laboratory equipment is required. Further, in a clinical setting and/or where the necessary equipment is available heart rate, physiological cost index, and percent maximum heart rate are also adequate.

A pilot study to test the influence of specific prosthetic features in preventing trans-tibial amputees from walking like able-bodied subjects.

The purpose of this pilot investigation was to develop a method to test the influence of specific prosthetic features in preventing trans-tibial amputees from walking like able-bodied subjects. An able-bodied subject was fitted with a patellar-tendon-bearing orthosis incorporating several features of an amputee's prosthesis. Kinetic, kinematic and metabolic data were collected as features were systematically removed from the orthosis. While wearing the orthosis the gait of the able-bodied subject closely simulated trans-tibial amputee gait kinematically, kinetically and metabolically. Although it was obvious that the various prosthetic features influenced the kinetics and kinematics of gait, they were difficult to quantify with only a single subject. However, the two features which appeared to have the largest influence in preventing trans-tibial amputees from walking like able-bodied subjects were patellar tendon loading and a solid ankle.