Excessive Flexion Research Articles

Gait Pattern of Adults with Cerebral Palsy and Spastic Diplegia More Than 15 Years after Being Treated with an Interval Surgery Approach: Implications for Low-Resource Settings.

Background:Single-event multilevel surgery (SEMLS) approach is regarded as the golden standard in developed countries to improve gait and functional mobility in children with cerebral palsy (CP). However, this approach is not always feasible in developing countries. Therefore, orthopedic surgery based on an interval surgery approach (ISA) is still commonly used in developing countries, although little is known about the long term outcomes of an ISA. Therefore, the aim of this study was to describe the gait patterns of adults with CP, who have been treated with ISA, which started more than 15 years ago.Materials and Methods:Thirty adults with CP and spastic diplegia, who received ISA treatment 21.6–33.7 years ago, were recruited for this study and participated in three-dimensional gait analysis. Twenty kinematic and nondimensional temporal-distance parameters were captured, while the overall gait deviation index (GDI) was also calculated. Data of the adults with CP were compared to normative data of typically developing (TD) adults.Results:Although all adults with CP were still ambulant, their gait parameters significantly differed from TD adults, with a lower GDI in the adults with CP. The CP gait patterns were characterized by excessive hip flexion and hip internal rotation as well as a stiff-knee gait.Conclusion:Although different to TD adults, the gait patterns observed in the adult with CP treated with ISA is in line with other studies. Gait patterns suggest that derotation osteotomies potentially could have improved the long term gait patterns. Although SEMLS might be the preferred treatment method, potentially resulting in better outcomes, ISA can also be used to treat children with CP in developing countries as India and South Africa, where a SEMLS approach is not always feasible.

Biomechanical modeling of deep squatting: Effects of the interface contact between posterior thigh and shank

Epidemiological studies indicate that occupational activities that require extended deep knee flexion or kneeling are associated with a higher prevalence of knee osteoarthritis. In many sport activities, such as a catcher in a baseball or a softball game, athletes have to make repetitive deep squatting motions, which have been associated with the development of osteochondritis dissecans. Excessive deep knee flexion postures may cause excessive loading in the knee joint. In deep knee flexion postures, the posterior aspect of the shank will contact the posterior thigh, resulting in a compressive force within the soft tissues. The current study was aimed at analyzing the effects of the posterior thigh/shank contact on the joint loading during deep knee flexion in a natural knee. An existing, whole body model with detailed anatomical components of the knee (AnyBody) has been adopted and modified for this study. The effects of the posterior thigh/shank contact were evaluated by comparing the results of the inverse dynamic analysis for two scenarios: with and without the posterior thigh/shank contact force. Our results showed that, in a deep squatting posture (knee flexion 120+ degrees), the posterior thigh/shank contact helps reduce the patellofemoral (PF) and tibiofemoral (TF) normal contact forces by 42% and 57%, respectively.

Effect of altered sagittal-plane knee kinematics on loading during the early stance phase of gait

BackgroundIndividuals with knee osteoarthritis (OA) show various dynamic sagittal-plane changes during the early stance phase of gait. However, the effect of these kinematic alterations on knee load during the early stance remains poorly understood. Research question: The purpose of this study was to examine the effect of altered sagittal- plane knee kinematics on knee load during the early stance. MethodsA total of 13 healthy adult men underwent gait analysis trials using four conditions (baseline and three altered conditions). The three altered conditions were defined as follows:1) Less flexion (LF): a gait that decreased knee flexion excursion (KFE) owing to a reduced peak knee flexion angle compared to baseline.2) Initial flexion (IF): a gait with decreased KFE owing to an increased knee flexion angle at initial contact, during which the peak knee flexion angle did not differ from baseline.3) Flexion gait (FG): a gait that increased the knee flexion angle at initial contact but did not reduce KFE compared with the baseline.Data analyzed included peak external knee flexion moment (KFM), KFM impulse (impulse was an integral value from initial contact to peak value), peak vertical ground reaction force (VGRF), and maximum loading rate. ResultsBoth LF and IF conditions significantly decreased peak VGRF (p < 0.05) compared with the baseline. Peak KFM decreased in the LF condition and increased in the FG condition versus baseline (p < 0.05). A significantly increased KFM impulse was found in both IF and FG conditions when compared with baseline (p < 0.05). SignificanceAn increase in knee flexion angle during early stance increased knee loading. Interventions are likely required for improving excessive knee flexion during early stance phase of gait in individuals with knee OA.

Impact of intraoperative adjustment method for increased flexion gap on knee kinematics after posterior cruciate ligament-sacrificing total knee arthroplasty

BackgroundIn general, the flexion gap is larger than the extension gap with posterior cruciate ligament-sacrificing total knee arthroplasty. Several methods compensate for an excessive flexion gap, but their effects are unknown. The purpose of this study was to compare three methods to compensate for an increased flexion gap. MethodsIn this study, squatting in knees with excessive (4 mm) and moderate (2 mm) flexion gaps was simulated in a computer model. Differences in knee kinematics and kinetics with joint line elevation, setting the femoral component in flexion, and using a larger femoral component as compensatory methods were investigated. FindingsThe rotational kinematics during flexion with setting the femoral component in flexion were opposite to those in the other models. Using a larger femoral component resulted in the most physiological motion. The peak anterior translation was 10 mm in the joint line elevation model compared with approximately 6 mm in the other models. In the joint line elevation model, patellofemoral contact stress was excessively increased at 90° of knee flexion. In contrast, tibiofemoral contact stress was higher during knee extension with setting the femoral component in flexion due to anterior impingement. There were few differences in the effect of the three compensatory methods with a moderate flexion gap. InterpretationA larger femoral component should be used to compensate for an excessive flexion gap because it has less negative impact on posterior cruciate ligament-sacrificing total knee arthroplasty, whereas any compensation method might be acceptable for a moderate flexion gap.

A New Stance Control Knee Orthosis Using a Self-Locking Mechanism Based on a Planetary Gear Train

The objective of this work was to design and build a fully mechanical knee orthosis. A knee orthosis should both allow control of the angle of flexion of the knee during the stance phase of the gait cycle and leave the joint free during the swing phase. Knee orthoses are normally used to assist the walking of people suffering from muscle weaknesses or gait pathologies in order to avoid excessive knee flexion during the stance phase. The design of the orthosis proposed in the present work is characterized by allowing the knee to be locked at any angle of flexion during the stance phase, and because the orthosis can be unlocked to allow the joint to be released in the swing phase without the action of any external agent, i.e., without requiring external electrical or electronic systems for the control and performance of the orthosis. These characteristics mean that the design can be adapted to the gait of any user. The proposed design consists of a set of three rods, one attached to the user's thigh, another to the calf, and the other to the foot, connected to each other by a self-locking planetary gear train (PGT).

Computer-assisted anteverting eccentric rotational acetabular osteotomy for recurrent posterior dislocation associated with acetabular retroversion: a case report

BackgroundAcetabular retroversion is a rotatory abnormality of the entire hemipelvis that includes anterior over-coverage and posterior deficiency of the acetabulum, and is associated with pincer-type femoroacetabular impingement and posterior hip instability. Acetabular retroversion is thought to cause posterior dislocation of the hip in athletes due to both the pincer-type femoroacetabular impingement and posterior hip instability.Case presentationA 26-year-old Japanese man had acetabular retroversion that induced recurrent posterior dislocation of his hip due to excessive hip flexion while wakeboarding. We performed anteverting eccentric rotational acetabular osteotomy using preoperative three-dimensional planning and an intraoperative computerized navigation system. Our patient was able to return to sports activities 1 year postoperatively.ConclusionsBoth preoperative three-dimensional surgical planning software and an intraoperative navigation system can provide a highly accurate map for this complicated surgery that simultaneously improves the pincer-type femoroacetabular impingement and posterior deficiency of the acetabulum.

The gait deviations of ankylosing spondylitis with hip involvement.

The aim of the study was to investigate the gait deviations of ankylosing spondylitis (AS) patients with hip involvement. Thirty-six subjects, including 18 AS patients with hip involvement (AS group) and 18 healthy people (control subjects, CS group), were enrolled in the study. Three-dimensional gait analysis of the AS group and CS group was performed. Kinematic parameters, kinetic parameters and surface electromyography (sEMG) during the gait cycle were measured. The AS patients with hip involvement had a lower gait velocity, shorter step length and shorter stride length. In the hip angles, there was significantly decreased flexion, excessive abduction and excessive external rotation; there was excessive flexion in the knee and reduction in plantar flexion of the ankle. AS patients had increased forward trunk flexion, excessive obliquity and restricted rotation of the trunk during the gait cycle. The hip moments of the AS group showed a significant reduction in flexion, abduction and external rotation during the gait cycle. The root mean square amplitude of the sEMG for the rectus femoris in the AS group was higher than that in the CS group. The gait deviations in AS patients with hip involvement were described in this study. The gait analysis results demonstrated statistically significant alterations regarding the kinematic and kinetic gait parameters for the patients included in the sample. Coordination and balance were impaired by the disease. An efficient physical exercise plan can be formulated according to the results of gait analysis.

Implementation of Mass-Independent Impedance Control for RFSEA Using a Linkage Arm

When using the powered lower-limb prosthesis, it is important to obtain varying amputee's weight to prevent an excessive knee flexion in the early stance phase of finite state impedance control. This paper proposes a method for implementing an impedance controller that can operate independently of the varying load mass for reaction force sensing elastic actuator (RFSEA) with a linkage arm. The proposed controller estimates the load mass using recursive least square. We apply a Kalman filter and a disturbance observer to improve the accuracy of the measurement and the tracking performance of the force controller, respectively. The results of an experiment applying a lab-developed RFSEA system with a linkage arm validate the feasibility of this approach. It is also expected that the proposed system reduces the size and development costs of the prosthesis due to the advantages of using the RFSEA.

Effects of dorsiflexor functional electrical stimulation compared to an ankle/foot orthosis on stroke-related genu recurvatum gait.

[Purpose] We evaluated the effects of functional electrical stimulation (FES) and an ankle/foot orthosis (AFO) in hemiplegic patients exhibiting excessive plantar flexion during the stance phase, associated with genu recurvatum. [Participants and Methods] In total, 12 stroke patients were recruited. We measured changes in knee and ankle joint angles, gait speed, and step and stride length during the gait cycle during barefoot walking, walking while wearing an AFO, and walking after FES application; we used a three dimensional gait analysis system. [Results] In terms of kinematic variables, FES walking was associated with significant increases in peak ankle dorsiflexion during swing, dorsiflexion angle at initial contact, peak ankle dorsiflexion during stance, knee angle at initial contact, and peak knee flexion in the loading response compared to AFO and barefoot walking. AFO walking was associated with a significant difference in peak ankle dorsiflexion during swing compared to barefoot walking. [Conclusion] FES afforded kinematic advantages to the ankle and knee joints compared to AFO in hemiplegic patients with a genu recurvatum gait.

Commonly Used Assistive Devices in Neurological Conditions

Background: Assistive devices used externally which made for adaptation with appropriate assisted an impaired person to perform their daily functions. It may be simple, low cost types and also controlled by specialized computer software. Various types of positional devices, mobility devices, daily living devices & also prosthetics, orthotics were used for support. Some evidence suggested that assistive devices helped for ambulation & ambulatory function assessment should be depending on the requirements of assistive device uses in neurological conditions especially on stroke and SCI. Study focused that applicationof stretch splint on experimental thumb where reduced the space. But resultshowed that intensive stretch which applied regularly for three months did not reduce thumb web-space contractures. On the other hand, other study suggested everyday used of assistive devices with environmental modification improves GMFS levels in CP children. Another RCT discussed that h-AFO may reduce toe walking on the hemi paretic side into a heel–toe gait pattern & it also controlled excessive ankle plantar flexion in swing phase. This study also focused that h AFO was more effective than dynamic AFO in gait rehabilitation for hemiplegic CP. Objective: To focus on the uses of assistive devices in neurology. Methodology: Study was done by narrative review. Conclusion: Assistive device helped a physiotherapist to achieve maximum goal during rehabilitation in neurological conditions. Some assistive devices were used for treatment purpose as well as ADL modification & it improved, maintain their quality of life. But it was very much important to know the proper use of devices with their rational and important concerning issue about the overuses and inappropriate uses of assistive devices which may lead to more dependency of neurological patients and also negatively impact on their rehabilitation process. If more RCT will be done about the use and effect of assistive devices may help us to clear conception about the uses of assistive devices and its importance on rehabilitation of neurological conditions.

Evaluasi Knee Ankle Foot Ortosis Dengan Parameter Spatiotemporal Dan Keseimbangan Pada Pengguna dengan Polio

The knee-ankle-foot orthosis (KAFO) tool is commonly described for patients with a history of poliomyelitis and serves to improve gait and prevent degeneration of the knee joint. However, at present the effect of using knee ankle foot orthosis in monoplegia polio patients when walking has never been evaluated. The purpose of this study was to analyze biomechanical adaptation especially in spatiotemporal parameters and stability when the subjects walked with and without KAFO aids. Methods: Fifteen monoplegia subjects with poliomyelitis were tested with two gait analyzes (i.e. with and without KAFO aids). Spatiotemporal parameters were tested using the 10 Meter Walk Test (10MWT) instrument, while stability when running was tested with the Timed up and Go (TUG) test instrument. Data from the spatiotemporal parameters obtained were analyzed using paired T tests, and the McNemar test was used to analyze the stability variables while walking. Both analyzes will analyze differences in parameters tested when subjects are in line with and without KAFO tools. Significant level used is p &lt;0.05. Results: The results showed that there were significant differences in spatiotemporal parameters and stability when subjects walked with and without KAFO aids. This tool increases spatiotemporal parameters and stability when the subject runs using KAFO compared to when they did not use orthosis at all. When the stance phase in the leg is paralysis, hyperextension in the knee and excessive flexion of the knee is reduced, while flexion in the hip joint increases. Walking stability increased in 60% of subjects when they used KAFO when walking. This study found that gait compensation was also reduced when subjects walked using KAFO, and through direct feedback the subject stated that walking using KAFO made them not easily tired and could go further.

Flexor muscle disconnection combined with myocutaneous flap for pressure ulcer in patients of ankylosing posture

Objective To investigate the efficacy of flexor muscle disconnection combined with myocutaneous flap in the treatment of pressure ulcer in patients of ankylosing posture. Methods A retrospective case series study was conducted to analyze 15 patients with pressure ulcer at different body parts due to ankylosing posture after paraplegia admitted to the First Affiliated Hospital of Jinan University from January 2012 to July 2017. There were 10 males and five females, aged 40-78 years, with an average age of 68 years. The pressure ulcer ranged from 3 cm×3 cm to 15 cm×11 cm. The pressure ulcers were distributed at sacrococcygeal region in eight patients, macro-rotator in four, and ischial nodules in three. According to the size and position of pressure ulcer, different musculocutaneous flaps were selected, and high selective decompression of hip flexion and knee flexion was performed to ensure the tension free suture of the wound. After the operation, the negative pressure closed drainage (VSD) was given to maintain a proper posture for wound healing. The stitches were removed after the wound healed. The wound healing, pressure ulcer recurrence, flap texture, flap color, and donor site were observed, and patient satisfaction were also surveyed. Results All patients were followed up for 12-36 months, average 24 months. The pressure ulcer was healed in 12 patients after the first repair operation. In two nonunion cases, the unrelieved knee flexion and knee muscles led to high muscular tension and stiff joint, causing strong resistance during limb movement and strong flexor reflex. Two patients were healed after twice operation. In one patient, the incision was torn by the excessive flexion tension due to improper body position caused by the passive movement of the limb after operation, and the wound was healed after twice operation. All muscle flaps covered the wound and survived well, and the wounds were completely closed and healed with good shape, texture as well as elastic recovery. After the suture was removed 18 days after surgery, the patients were discharged satisfactorily. The patients received conventional pressure ulcer care, and no new pressure ulcer was reported during the follow-up. The flap donor site was healed well after autologous skin repair. Conclusion For pressure ulcer in patients of ankylosing posture, flexor muscle disconnection combined with myocutaneous flap has notable effects in reducing tension and can accelerate wound healing and improve healing rate. Key words: Pressure ulcer; Surgical flaps; Reconstructive surgical procedures; Closed negative pressure drainage

Outcomes of Splinting in Pediatric MalletFinger.

Excessive flexion at the distal interphalangeal (DIP) joint disrupts the extensor mechanism, leading to mallet finger injuries. The goal of management is to restore active DIP joint extension. We sought to learn which variables (treatment technique, injury type, time to presentation, adherence to treatment) affect clinical outcomes of pediatric mallet finger injuries. A retrospective review was performed of patients who presented with mallet finger injuries during 2013 to 2017 at a large pediatric hospital. Patient characteristics, treatments, outcomes, and radiographic data were collected. Types of nonsurgical treatment, acute versus delayed (> 28 days) presentation, and compliant versus noncompliant patients were compared. Differences in extension lag and incidence of complications were evaluated. There were 94 patients with 99 mallet fingers, with a mean age of 13.7 years, 66 of whom were boys (70%) and 28 girls (30%). Most injuries occurred during recreation (78%). Ninety-nine percent of patients were treated nonsurgically with extension orthoses. The majority of injuries were bony mallets (80%). The outcomes resulted in a mean extension lag of 1°. Of patients presenting acutely, residual extension lag and complications occurred in 12% and 9%, respectively; the lag and complication rate for patients presenting after a delay was 25% and 19%, respectively. Treatment adherence was associated with better clinical outcomes, with nonadherent patients more likely to experience a residual extensor lag (11% vs 67%) and potentially clinically relevant complications (8% vs 50%). The majority of pediatric mallet finger injuries can achieve good outcomes with nonsurgical treatment. Absolute indications for surgery in this population remain unclear. Therapeutic IV.

Role of Posterior Ligamentous Reinforcement in Proximal Junctional Kyphosis: A Cadaveric Biomechanical Study.

Study DesignCadaveric biomechanical study.PurposeThe purpose of this study was to biomechanically evaluate the effect of preserving or augmenting the interspinous ligament (ISL) and supraspinous ligament (SSL; ISL/SSL) complex between the upper instrumented vertebra (UIV) and UIV+1 using a cadaveric model.Overview of LiteratureAdult spinal deformity is becoming an increasingly prevalent disorder, and proximal junctional kyphosis (PJK) is a well-known postoperative complication following long spinal fusion.MethodsPure moments of 4 and 8 Nm were applied to the native and instrumented spine, respectively (n=8). The test conditions included the following: native spine (T7–L2), fused spine (T10–L2), fused spine with a hand-tied suture loop through the spinous processes at T9–T10, and fused spine with severed T9–T10 ISL/SSL complex.ResultsThe flexion range of motion (ROM) at T9–T10 of the fused spine loaded at 8 Nm increased by 62% compared to that of the native spine loaded at 4 Nm. The average flexion ROM at T9–T10 for the suture loop and severed ISL/SSL spines were 141% (p=0.13) and 177% (p=0.66) of the native spine at 4 Nm, respectively (p-values vs. fused).ConclusionsTransection of the ISL/SSL complex did not significantly change flexion ROM at the proximal junctional segment following instrumented spinal fusion. Furthermore, augmentation of the posterior ligamentous tension band with a polyester fiber suture loop did not mitigate excessive flexion loads on the proximal junctional segment. We postulate that the role of the posterior ligamentous tension band in mitigating PJK is secondary to the anterior column support provided by the vertebral body and intervertebral disc.

Impact of gait analysis on pathology identification and surgical recommendations in children with spina bifida

BackgroundGait analysis provides quantitative data that can be used to supplement standard clinical evaluation in identifying and understanding gait problems. It has been established that gait analysis changes treatment decision making for children with cerebral palsy, but this has not yet been studied in other diagnoses such as spina bifida. Research questionTo determine the effects of gait analysis data on pathology identification and surgical recommendations in children with spina bifida. MethodsTwo pediatric orthopaedic surgeons and two therapists with >10 years of experience in gait analysis reviewed clinical, video, and gait analysis data from 43 ambulatory children with spina bifida (25 male; mean age 11.7 years, SD 3.8; 25 sacral, 18 lumbar). Primary gait pathologies were identified by each assessor both before and after consideration of the gait analysis data. Surgical recommendations were also recorded by the surgeons before and after consideration of the gait analysis data. Frequencies of pathology and surgery identification with and without gait analysis were compared using Fisher’s exact test, and percent change in pathology and surgery identification was calculated. ResultsPathology identification often changed for common gait problems including crouch (28% of cases), tibial rotation (35%), pes valgus (18%), excessive hip flexion (70%), and abnormal femur rotation (75%). Recognition of excessive hip flexion and abnormal femur rotation increased significantly after consideration of gait analysis data (p < 0.05). Surgical recommendations also frequently changed for the most common surgeries including tibial derotation osteotomy (30%), antero-lateral release (22%), plantar fascia release (33%), knee capsulotomy (25%), 1st metatarsal osteotomy (60%), and femoral derotation osteotomy (89%). At the patient level, consideration of gait analysis data altered surgical recommendations for 44% of patients. SignificanceSince gait analysis data often changes pathology identification and surgical recommendations, treatment decision making may be improved by including gait analysis in the patient care process.

Prediction of mild anatomical leg length discrepancy based on gait kinematics and linear regression model

BackgoundLeg length discrepancy (LLD) can be related to different pathologies, due to an inadequate distribution of mechanical loads, as well as gait kinematics asymmetries resulted from LLD. Research questionTo validate a model to predict anatomical LLD (ALLD) based on gait kinematics. MethodsGait of 39 participants with different lower limb pathologies and mild discrepancy were collected. Pelvic, hip, knee and ankle kinematics were measured with a 3D motion analysis system and ALLD, femur discrepancy (FD) and tibia discrepancy (TD) were measured by a computerized digital radiograph. Three multiple linear regression models were used to identify the ability of kinematic variables to predict ALLD (model 1), FD (model 2) and TD (model 3). ResultsDifference between peak knee and hip flexion of the long and short lower limb was selected by models 1 (p < 0.001) and 2 (p < 0.001). Hip adduction was selected as a predictor only by model 1 (p = 0.05). Peak pelvic obliquity and ankle dorsiflexion were not selected by any model and model 3 did not retain any dependent variable (p > 0.05). Regression models predicted mild ALLD with moderate accuracy based on hip and knee kinematics during gait, but not ankle strategies. Excessive hip flexion of the longer limb possibly occurs to reduce the limb to equalize the LLD, and discrepancies of the femur and tibia affects gait cycle in a different way. SignificanceThis study showed that kinematic variables during gait could be used as a screening tool to identify patients with ALLD, reducing unnecessary x-ray exposure and assisting rehabilitation programs.

Trunk Kinematic Analysis during Gait in Cerebral Palsy Children with Crouch Gait Pattern.

Deficits in upper body movement have received little attention during gait in cerebral palsy (CP) children with crouch gait pattern (CGP). Purpose of this research is to describe the correlation of trunk movement with the excessive knee flexion and ankle kinematic in CP children with CGP. Gait analysis data from 57 limbs of diplegic CP children with CGP and 26 limbs of normal children was gathered. Kinematic parameters of trunk in relation to the pelvis were extracted in the sagittal, transverse and coronal planes. CP limbs were clustered using K-means cluster analysis according to the knee flexion angle at initial contact and the mean position of ankle joint during the stance phase of gait cycle, to three clusters. Pearson correlation coefficient between knee, ankle and trunk kinematic variables was assessed. Differences between clusters were analyzed with Kruskal-Wallis and post hoc tests. The results revealed: 1) crouch clusters had more trunk obliquity and rotation mean position than normal; 2) the range of motions of the trunk obliquity and rotation exhibited significant differences between crouch and normal clusters; 3) the level of excessive knee flexion had positive correlation with the trunk mean position in all planes; 4) the ankle kinematic at stance phase was associated with the trunk mean position in all planes. The results revealed the trunk mean position is correlated with the excessive knee flexion severity and ankle joint kinematic in CP children with CGP.

Effect of Kinesio Taping on Grasp and Release in Children with Spastic Hemiparetic Cerebral Palsy: A Pilot Study

AbstractBackground: Cerebral Palsy (CP) children have motor dysfunction due to non-progressive brain damage. Hemiplegic cerebral palsy children usually have marked hand involvement with limited active wrist extension and excessive thumb adduction and flexion which appears from infancy. Various techniques are generally used in the course of CP management. A recent method such as taping is frequently used in pediatrics rehabilitation clinics. It is easy to apply and inexpensive and can be easily removed or changed according to therapy objects. In CP it corrects postural misalignment enhance joint stability, activate weak muscle and manage spasticity.Aim of Study: To determine the short term effect of kinesio taping on hand functions especially grasp and release in the children with spastic hemiparetic cerebral palsy.Participants and Methods: Eleven spastic hemiparetic cerebral palsied children (2-7 years old) of both sexes with mild hand and/or wrist spasticity (grade 1 to 1+) according to the Modified Ashowrth Scale, and had impaired hand functions level II, III and IV according to Manual Ability Classification System (MACS) participated in this study. Participants received kinesio tape for wrist and thumb in addition to the standard conventional physical therapy program (2-3 hours per week). Participants were evaluated before and after four weeks using the Grasping subtests of the Quality of Upper Extremity Skills Test (QUEST) and Peabody Devel-opmental Motor Scale (PDMS).Results: After Four weeks of intervention results showed that no significant changes post treatment application when compared with corresponding pretreatment for the PDMS (p-value=0.096) and QUEST (p-value=0.052) scores.Conclusion: These results suggested that four weeks Kinesio taping was not effective in improving the hand functions of spastic hemiparetic cerebral palsy children.

Optimal Condition to Create Femoral Tunnel Considering Combined Influence of Knee Flexion and Transverse Drill Angle in Anatomical Single-Bundle ACL Reconstruction Using Medial Portal Technique: 3D Simulation Study.

There has been no previous study using three-dimensional (3D) measurement on femoral tunnel characteristics according to the combined influence of various flexion angles of knee and transverse drill angles in single-bundle ACL reconstruction with transportal technique. The purpose of this study was to determine optimal condition of knee flexion angle and transverse drill angle to create secure femoral tunnel in single-bundle ACL reconstruction with transportal technique considering tunnel length, tunnel wall breakage, and graft bending angle. This study was conducted using simulation of 3D computed tomography of thirty subjects. Three variables of femoral tunnel changed according to combined influence of four flexion angles of knee and three transverse drill angles were measured: tunnel length, wall breakage, and graft bending angle. There was no case of short femoral tunnel less than 25 mm at 120° and 130° of flexion. There was no case of breakage of femoral tunnel at 120° of flexion with maximum transverse drill angle (MTA) and MTA-10° and at 130° of flexion. Considering effect on graft bending angle, decrease of flexion angle and transverse drill angle could be appropriate in creating femoral tunnel. Increased flexion angle and transverse drill angle secured femoral tunnel having sufficiently long length without wall breakage. However, avoiding excessive flexion angle and maximum transverse drill angle could be recommended because they tended to cause more acute graft bending angle.

Evolution of gait in adolescents and young adults with spastic diplegia after selective dorsal rhizotomy in childhood: A 10 year follow-up study

BackgroundShort-term benefit on gait of selective dorsal rhizotomy (SDR) surgery, which relieves spasticity of the lower extremities has been demonstrated in children with cerebral palsy (CP). However very little is known of the evolution of gait when patients become adolescents and young adults. Research questionHow does the gait pattern evolve in adolescents and young adults who underwent SDR during childhood? MethodsA longitudinal study was performed including 19 ambulant patients with spastic diplegia due to CP or other causes (mean age at SDR: 6.6 ± 1.6 years) who were assessed four times: pre-SDR, 2 years post- SDR, 5 years post-SDR and at least 10 years post-SDR. From 2D video recordings, Edinburgh Visual Gait Score and lower limb joint kinematic parameters were calculated. ResultsOur data show that the improvement in the gait pattern obtained short-term after SDR continues during into adolescence and adulthood. Ten years after SDR all patients improved compared to baseline. Considering the lower limb joint kinematics, most notable improvements were found at knee and ankle joints. Compared to the evaluation before SDR, the range of motion of the knee increased: the knee was more extended at initial contact and knee flexion in midswing improved. Excessive ankle plantar flexion was reduced during the entire gait cycle. Only minor changes were found at hip and pelvis. Eight patients underwent additional orthopaedic surgery in the years after SDR, and the present findings should be considered as a combination of SDR, development and additional treatment. SignificanceWe demonstrate lasting improvement of gait quality in ambulant patients with spastic diplegia who underwent SDR during childhood when they become adolescents and young adults.