Identification of gait patterns in individuals with cerebral palsy using multiple correspondence analysis.

Great importance has been placed on the development of gait classification in cerebral palsy (CP) to assist clinicians. Nevertheless, gait classification is challenging within this group because the data is characterized by a high-dimensionality and a high-variability. Thus, the aim of this study was to analyze without a priori, a database of clinical gait analysis (CGA) of CP patients, using multiple correspondence analysis (MCA). A retrospective search, including biomechanical and clinical parameters was done between 2006 and 2012. One hundred and twenty two CP patients were included in this study (51 females and 71 males, mean age ± SD: 14.2 ± 7.5 years). Sixteen biomechanical spatio-temporal and kinematic parameters were included in the analysis. This data was transformed by a fuzzy window coding based on the distribution of each parameter in three modalities: low, average and high. Afterward, a MCA was used to associate parameters and to define classes. From this, seven most explicative gait parameters used to characterize gait of CP patients were identified: maximal hip extension, hip range, knee range, maximal knee flexion at initial contact, time of peak knee flexion, and maximal ankle dorsiflexion in stance phase and in swing phase. Moreover, four main profiles of CP patients have been defined from the multivariate approach: an apparent equinus gait group (the most similar of the control group with diplegic and hemiplegic patients with a GMFCS 1), a true equinus gait group (the youngest group with diplegic and some hemiplegic patients with a GMFCS 1), a crouch gait group (the oldest group with a majority of diplegic and rare hemiplegic patients with a GMFCS 2) and a jump knee gait group (the greatest level of global spasticity of the lower limbs with a majority of diplegic and rare hemiplegic patients with a GMFCS 2). Thus, this study showed the feasibility of the MCA in order to characterize and classify a large database of CP patients.

Operative correction of arch collapse with forefoot deformity: a retrospective analysis of outcomes.

BACKGROUND: There are many forefoot deformities, including hallux valgus, forefoot overload, and hammertoe that are treated as unrelated problems with multiple different techniques. Currently, there has been renewed interest in the role of a gastrocnemius contracture on foot deformities. Our objective was to review a specific surgical treatment plan for forefoot deformities classified by us as Type 2 arch collapse and evaluate the outcomes. MATERIALS AND METHODS: We retrospectively reviewed the charts of 374 patients who underwent foot procedures to treat deformity classified as a Type 2 arch collapse. Data was collected regarding complications and need for secondary surgery. A phone survey was performed to assess patient satisfaction, pain level, and Foot Function Index (FFI) scores. RESULTS: Of the 374 patients (412 feet), there was a 96% (357 of 371 feet) union rate at the first tarsometatarsal joint and 98% (227 of 232 feet) union rate at metatarsal shortening osteotomy sites. Recurrence of hallux valgus was 2.7% (7 of 256 feet), while hallux varus occurred in 1.6% (4 of 256 feet). There were 292 patients (78%) available for phone interview. Of those patients, 88% were satisfied with the results of the procedure. The subset of procedures relating to the highest mean FFI was hammertoe correction (22.2) and the highest mean pain score was related to metatarsal shortening osteotomy (2.6). CONCLUSION: Utilizing the arch collapse model, operative treatment of forefoot deformities with a combination of procedures including gastrocnemius recession, first TMT fusion, modified McBride, hammertoe correction, and metatarsal shortening osteotomy can produce good satisfaction rates with low complication rates.

Equinus foot classification in cerebral palsy: an agreement study between clinical and gait analysis assessment.

BACKGROUND: Excessive ankle plantar flexion (equinus foot) is a common problem in cerebral palsy (CP) and several treatment options can be considered depending on the equinus type. Few attempts have been made to classify different forms of equinus foot for specific treatment. AIM: This study is aimed at defining equinus foot types in CP patients according to the Ferrari classification, integrating clinical and instrumental assessments. The hypothesis is that clinical differentiation of equinus foot can be evidenced by recurrent anomalies identifiable through gait analysis (GA), which can make the assessment, usually based only on clinician semeiotics, more objective. DESIGN: Clinical and instrumental assessments were performed separately by a senior CP physiatrist and a senior GA physiatrist, the latter was blind to the clinical diagnosis of equinus type. SETTING: Outpatients POPULATION: Twenty patients, 16 diplegics and 4 hemiplegics (mean age 11 years, SD 4 years 11 months). METHODS: Clinical assessment by means of Modified Ashworth Scale, Gross Motor Function Measure (GMFM), Observational Gait Analysis (OGA), and measurement of lower limb muscle strength by dynamometer were used to classify the equinus type. Gait analysis assessed the kinematics and EMG of affected lower limbs. RESULTS: Ten different equinus types were identified. Since various forms of equinus can be present in the same patient, we were able to classify a total of 61 types of equinus in 36 feet. Substantial agreement was found between Clinical and Gait Analysis equinus assignment matched in 50 out of 61 types (Index of agreement with Fleiss' Kappa 79.3 % ). In some case only Gait Analysis was able to identify the equinus type, while in others it did not confirm clinical assignment. CONCLUSION: Gait analysis is able to distinguish different equinus types according to Ferrari classification, making the clinical decision less arbitrary. CLINICAL REHABILITATION IMPACT: Correct objective diagnosis of equinus foot in CP patients is of paramount importance when choosing suitable rehabilitative interventions.

Classification of equinus in ambulatory children with cerebral palsy-discrimination between dynamic tightness and fixed contracture.

In this study a generalised dynamic neural network (GDNN) was designed to process gait analysis parameters to evaluate equinus deformity in ambulatory children with cerebral palsy. The aim was to differentiate dynamic calf muscle tightness from fixed muscle contracture. Patients underwent clinical examination and had instrumented gait analysis before evaluating their equinus under anaesthesia and muscle relaxation at the time of surgery to improve gait. The performance of the clinical examination, the subjective interpretation of gait analysis results, and the application of the neural network to assess ankle function were compared to the examination under anaesthesia. Evaluation of equinus by a Neural Network showed high sensitivity and specificity values with a likelihood ratio of +14.63. The results indicate that dynamic calf muscle tightness can be differentiated from fixed calf muscle contracture with considerable precision that might facilitate clinical decision-making.

Resultados y evolución del tratamiento quirúrgico del pie equino varo congénito, en el Hospital Escuela Oscar Danilo Rosales Argüello del 01 de enero de 1997 al 15 de febrero de 1999 / Results and evaluation of the treatment of surgical congenital equinovarus foot (Clubfoot) in the Hospital Escuela Oscar Danilo Rosales foom january 1 of 1997 - to 15 th of february of 1999

Se realizó un estudio descriptivo de serie de casos a pacientes atendidos en el departamento de Ortopedía y Traumatología del Hospital Escuela Oscar Danilo Rosales Argüello, durante el período del primero de enero de 1997 al 15 de febrero de 1999. El universo de estudio serán los pacientes afectados por la enfermedades pie equino varo congenito, ingresados en el departamentode Ortopedía. Según el estudio el sexo masculino fué el más afectado, las intervenciones quirúrgicas se realizán un poco más tarde, ya que la mayoría de pacientes, se operan después del primer año. El tipo de tratamiento utilizado es el tratamiento conservador a base de yeso se prolonga por mucho tiempo

A method of assessment of the clubfoot deformity.

The literature on clubfeet is inadequate because a common method language for assessing the deformity is lacking. Different severities of clubfoot deformity will give different results for a standard procedure: a less severe deformity can be corrected by limited releases, whereas a severe deformity requires radical procedures. This paper presents a language of assessment that has been used for a number of years. The importance of developing a language of assessment to be able to identify the various types of clubfoot deformity is important if the treatment of this condition is to develop within the field of pediatric orthopedics.

Tratamiento del pie equino varo congenito (chapin) / Treatment of congenital equinovarus foot (clubfoot)

Motivados por la dificil problematica que conlleva el tratamiento exitosos del pie equino varo, por la alta frecuencia de casos y por la disparidad de criterios en la orientacion y tratamiento, el auto ha aplicado las orientaciones del Duke University Medical Center y presenta un analisis del problema y el enfoque quirurgico respectivo. De acuerdo a la intensidad de la contractura que presenten, los pies se clasifican en 3 grandes grupos: Mediano, Moderado y Severo. Dentro de estos grupos se incluyen 8 subgrupos, distribuidos en 2 para el primero y el segundo grupo y 4 para el tercero. Partiendo del primer grupo o mediano, los pies presentan contractura de triceps sural con insercion medializada de su tendon distal en el calcaneo, desplazamiento medial del grueso artejo y los metatarsianos, y minima contractura del ligamento tibio-escafoideo. Estas contracturas mediales responden a tratamiento convencionales de yesos y manipulacion. Se debe practicar alargamiento quirurgico del tendon de Aquiles para lograr maxima correccion y disminuir el tiempo de tratamiento. En el segundo grupo moderado las contracturas del pie son mas intensas. El escafoides esta desplazado medialmente. El abductor retrae el grueso artejo y la rotacion medial del astragalo impide la dorsiflexion del pie. Requiere liberacion quirurgica. El tercer grupo o severo, comprende los pacientes afectos de atrogriposis, con incongruencia cartilaginosa avanzada que impide una reposicion anatomica. Estos pies deben ser operados lo mas pornto posible, para que puedan soportar el peso corporal mas adelante.