Gait Patterns In Children Research Articles

Cluster analysis to identify the most prominent gait patterns in children with torsional deformities

Cluster analysis to identify the most prominent gait patterns in children with torsional deformities

Residual gait deviations in children treated by medial open reduction for developmental dysplasia of the hip at long-term follow-up: a comparison with healthy controls.

This study aimed to analyze and compare gait patterns and deviations at long-term follow-up in children who received medial open reduction (MOR) before 18months for unilateral or bilateral hip developmental dysplasia (DDH). A retrospective chart review was conducted on children who underwent MOR. The study population was divided into two groups: the unilateral group, including unilateral (five children with unilateral) and bilateral (five children with bilateral DDH). Ten healthy children were recruited for the control group. Spatiotemporal, kinematic, stiff-knee gait (SKG), and kinetic gait characteristics were analyzed. Stance time was significantly shorter in both the unilateral (median [IQR]; 590ms, [560.0-612.5] and bilateral (575ms, [550-637.5]) groups than in the control group (650, [602.5-677.5]) (p < 0.001), whereas swing time did not differ substantially (p = 0.065) There was no considerable difference in the mean knee flexion at swing between the unilateral (31.6°, [30-36]) and control (30.11°, [27.8-33.6] groups (p > 0.05), but the bilateral group (28.5°, [24.9-32.1]) showed the lower values than the other groups (p < 0.001 for bilateral vs unilateral group; p = 0.008 bilateral vs unilateral group). All the SKG parameters significantly differed among the groups in multi-group comparisons (p < 0.001 for each parameter). Three children had borderline SKG, and two had not-stiff limbs in the unilateral group. In the bilateral group, four children had stiff limbs, and one had borderline SKG. Most kinetic gait parameters were not statistically different between groups (p > 0.05). This study has revealed notable deviations in gait patterns of children with DDH treated by MOR at long-term follow-up compared to healthy children's gait. MOR could negatively affect pelvic motion during gait due to impaired functions of the iliopsoas and adductor muscles, and SKG can be encountered secondary to iliopsoas weakness.

The applicability of markerless motion capture for clinical gait analysis in children with cerebral palsy

The aim of this comparative, cross-sectional study was to determine whether markerless motion capture can track deviating gait patterns in children with cerebral palsy (CP) to a similar extent as marker-based motion capturing. Clinical gait analysis (CGA) was performed for 30 children with spastic CP and 15 typically developing (TD) children. Marker data were processed with the Human Body Model and video files with Theia3D markerless software, to calculate joint angles for both systems. Statistical parametric mapping paired t-tests were used to compare the trunk, pelvis, hip, knee and ankle joint angles, for both TD and CP, as well as for the deviation from the norm in the CP group. Individual differences were quantified using mean absolute differences. Markerless motion capture was able to track frontal plane angles and sagittal plane knee and ankle angles well, but individual deviations in pelvic tilt and transverse hip rotation as present in CP were not captured by the system. Markerless motion capture is a promising new method for CGA in children with CP, but requires improvement to better capture several clinically relevant deviations especially in pelvic tilt and transverse hip rotation.

Altered gait patterns during arch important development period in children with persistent obesity: An experimental longitudinal study

BackgroundObesity can cause structural changes and functional adjustments in growing children’s feet. However, there is a lack of continuous observation of changes in feet in children with persistent obesity during important developmental periods. This makes it challenging to provide precise preventive measures. ObjectiveThis study aimed to investigate the effects of persistent obesity on gait patterns in children at an important stage in the formation of a robust foot arch. MethodsThe Footscan® plantar pressure system was used for 3 checks over two years. A total of 372 children aged 7–8 years participated in the study, and gait data from 33 children who maintained normal weight and 26 children with persistent obesity were finally selected. Repeated measures ANOVA or Friedman’s test were used for longitudinal comparisons. Independent-Sample t-tests or the Mann-Whitney-Wilcoxon tests were used for cross-sectional comparisons. ResultsDuring the important period of development, children with persistent obesity did not exhibit a significant decrease in the arch index and had significantly higher values than the normal group in the third check. The persistently obese children showed increased load accumulation in the lateral rearfoot, first metatarsophalangeal joints, and the great toe regions. Children with persistent obesity had significantly greater medial-lateral displacements in the initial contact phase and forefoot contact phase than normal children in the first check. These differences diminished between the second and third checks. SignificancePersistent obesity during an important period of foot development leads to slow or abnormal development of arch structure and affects foot loading patterns with heel inverted and forefoot everted. Additionally, the development of gait stability is not limited by persistent obesity.

Population longitudinal analysis of Gait Profile Score and North Star Ambulatory Assessment in children with Duchenne muscular dystrophy.

Duchenne muscular dystrophy (DMD) is a rare X-linked recessive disorder characterized by loss-of-function mutations in the gene encoding dystrophin. These mutations lead to progressive functional deterioration including muscle weakness, respiratory insufficiency, and musculoskeletal deformities. Three-dimensional gait analysis (3DGA) has been used as a tool to analyze gait pathology through the quantification of altered joint kinematics, kinetics, and muscle activity patterns. Among 3DGA indices, the Gait Profile Score (GPS), has been used as a sensitive overall measure to detect clinically relevant changes in gait patterns in children with DMD. To enhance our understanding of the clinical translation of 3DGA, we report here the development of a population nonlinear mixed-effect model that jointly describes the disease progression of the 3DGA index, GPS, and the functional endpoint, North Star Ambulatory Assessment (NSAA). The final model consists of a quadratic structure for GPS progression and a linear structure for GPS-NSAA correlation. Our model was able to capture the improvement in function in GPS and NSAA in younger subjects, as well as the decline of function in older subjects. Furthermore, the model predicted NSAA (CFB) at 1 year reasonably well for DMD subjects ≤7 years old at baseline. The model tended to slightly underpredict the decline in NSAA after 1 year for those >7 years old at baseline, but the prediction summary statistics were well maintained within the standard deviation of observed data. Quantitative models such as this may help answer clinically relevant questions to facilitate the development of novel therapies in DMD.

Combined Effect of Quad Springboard Walkway with Platform Swing on Gait Pattern of Children with Spastic Diplegia

Combined Effect of Quad Springboard Walkway with Platform Swing on Gait Pattern of Children with Spastic Diplegia

Gait Characterization in Duchenne Muscular Dystrophy (DMD) Using a Single-Sensor Accelerometer: Classical Machine Learning and Deep Learning Approaches.

Differences in gait patterns of children with Duchenne muscular dystrophy (DMD) and typically developing (TD) peers are visible to the eye, but quantifications of those differences outside of the gait laboratory have been elusive. In this work, we measured vertical, mediolateral, and anteroposterior acceleration using a waist-worn iPhone accelerometer during ambulation across a typical range of velocities. Fifteen TD and fifteen DMD children from 3 to 16 years of age underwent eight walking/running activities, including five 25 m walk/run speed-calibration tests at a slow walk to running speeds (SC-L1 to SC-L5), a 6-min walk test (6MWT), a 100 m fast walk/jog/run (100MRW), and a free walk (FW). For clinical anchoring purposes, participants completed a Northstar Ambulatory Assessment (NSAA). We extracted temporospatial gait clinical features (CFs) and applied multiple machine learning (ML) approaches to differentiate between DMD and TD children using extracted temporospatial gait CFs and raw data. Extracted temporospatial gait CFs showed reduced step length and a greater mediolateral component of total power (TP) consistent with shorter strides and Trendelenberg-like gait commonly observed in DMD. ML approaches using temporospatial gait CFs and raw data varied in effectiveness at differentiating between DMD and TD controls at different speeds, with an accuracy of up to 100%. We demonstrate that by using ML with accelerometer data from a consumer-grade smartphone, we can capture DMD-associated gait characteristics in toddlers to teens.

Hypermobility in patients with epidermolysis bullosa—A retrospective observational study from a national referral center

AbstractBackgroundEpidermolysis bullosa (EB) is an inherited genodermatosis of variable severity characterised by skin and mucosal fragility commonly associated with altered gait patterns and hypermobility.ObjectivesTo define the altered gait pattern and identify possible causes in patients with EB.MethodsRetrospective review of the EB database to identify children with EB with at least one physiotherapy assessment between 2009 and 2022.ResultsForty‐eight children out of 59 referrals to physiotherapy with an altered gait pattern were identified (81.3%); 23 (48%) had recessive dystrophic EB (RDEB), 17 (36%) EB simplex, five (10%) Junctional EB (JEB) and three (6%) dominant dystrophic EB (DDEB). The patho‐mechanical altered gait patterns were characterised by altered load‐bearing surface in contact with the floor (63%), short shuffling pattern with high cadence and decreased single support (42%) and equinovarus (toe walking) (6%). Hypermobility (as defined by the Beighton score) was present in 67% of patients: 43% in RDEB, 88% in EBS, 100% in JEB and 67% in DDEB.ConclusionsIn this study, we provide the first accurate data for the causes of altered gait patterns in children with EB. Healthcare professionals should be aware of joint hypermobility and its effect on gait in this patient cohort.

Clubfoot Twin Study with Wearable GaitUp Sensors and Footscan V9

Purpose: To control the therapeutic results in manual-dynamic physiotherapy for clubfeet we analyzed the gait pattern in children with clubfeet and their healthy twin siblings, aged between 3 and 13 years for GaitUp and 4 to 14 years for the footplate V9. Methods: With the inertial GaitUp sensors and the footscan V9 pedobarographic plate the 11 twin-pairs were tested and statistically assessed. For the GaitUp sensors 22 parameters were considered and 10 parameters for the footplate V9. We analyzed the gait pattern for each child separately for both feet and in a second evaluation compared the affected feet with the ipsilateral feet of the healthy twins. The statistical comparisons were made with nonparametric methods. An additional twin girl treated with various therapies and her sister are included as a contrast. Results: Especially in younger children, the gait pattern is not stabilized yet. Therefore, sometimes the healthy twins have inferior values in gait patterns than the affected siblings. Over the whole study there are only minor statistical differences between the affected group and the healthy group suggesting that with the manual-dynamic therapy the clubfeet children show a gait pattern statistically similar to the healthy group. Noteworthy are the less convincing results of the contrast twins. Conclusion: Manual-dynamic physiotherapy can lead to a gait pattern equal to the one of unaffected children the same age. Our results do not support the statement that in one-sided clubfoot the other foot cannot be considered normal.

The gait pattern and not the femoral morphology is the main contributor to asymmetric hip joint loading.

Gait asymmetry and skeletal deformities are common in many children with cerebral palsy (CP). Changes of the hip joint loading, i.e. hip joint contact force (HJCF), can lead to pathological femoral growth. A child's gait pattern and femoral morphology affect HJCFs. The twofold aim of this study was to (1) evaluate if the asymmetry in HJCFs is higher in children with CP compared to typically developing (TD) children and (2) identify if the bony morphology or the subject-specific gait pattern is the main contributor to asymmetric HJCFs. Magnetic resonance images (MRI) and three-dimensional gait analysis data of twelve children with CP and fifteen TD children were used to create subject-specific musculoskeletal models and calculate HJCF using OpenSim. Root-mean-square-differences between left and right HJCF magnitude and orientation were computed and compared between participant groups (CP versus TD). Additionally, the influence on HJCF asymmetries solely due to the femoral morphology and solely due to the gait pattern was quantified. Our findings demonstrate that the gait pattern is the main contributor to asymmetric HJCFs in CP and TD children. Children with CP have higher HJCF asymmetries which is probably the result of larger asymmetries in their gait pattern compared to TD children. The gained insights from our study highlight that clinical interventions should focus on normalizing the gait pattern and therefore the hip joint loading to avoid the development of femoral deformities.

The Immediate Effects of Spiral Kinesio Taping on In-toeing Gait Pattern in Children with Spastic Diplegic Cerebral Palsy

The Immediate Effects of Spiral Kinesio Taping on In-toeing Gait Pattern in Children with Spastic Diplegic Cerebral Palsy

Design and Implementation of a Portable Knee Actuator for the Improvement of Crouch Gait in Children with Cerebral Palsy.

Common manifestation of spastic Cerebral Palsy (CP) are abnormal gait pathologies. These conditions require greater energy expenditure to successfully ambulate and are linked with significant deterioration in joint health and childhood musculoskeletal development. Crouch gait presents with knee hyperflexion throughout stance due to extensor muscle weakness and spasticity in flexor muscles stemming from neurological damage. The goal of this study was to develop a wearable cable-driven robotic system that applies controlled perturbation to the knee joint during overground walking in children with CP. Two children with spastic CP were recruited in this pilot study. They were tested in two conditions, i.e., applying knee resistance vs. knee assistance during overground walking. Kinematic and EMG data were recorded during overground walking. Data indicated that it was feasible to apply controlled knee perturbation torque during overground walking in children with crouch and preliminary results showed an improvement in crouch gait pattern in children with CP after one session of walking with the robotic system.Clinical Relevance- This study might have a potential clinical significance modifying neuromuscular control of CP patients with Crouch Gait.

Causal modelling demonstrates metabolic power is largely affected by gait kinematics and motor control in children with cerebral palsy.

Metabolic power (net energy consumed while walking per unit time) is, on average, two-to-three times greater in children with cerebral palsy (CP) than their typically developing peers, contributing to greater physical fatigue, lower levels of physical activity and greater risk of cardiovascular disease. The goal of this study was to identify the causal effects of clinical factors that may contribute to high metabolic power demand in children with CP. We included children who 1) visited Gillette Children's Specialty Healthcare for a quantitative gait assessment after the year 2000, 2) were formally diagnosed with CP, 3) were classified as level I-III under the Gross Motor Function Classification System and 4) were 18 years old or younger. We created a structural causal model that specified the assumed relationships of a child's gait pattern (i.e., gait deviation index, GDI) and common impairments (i.e., dynamic and selective motor control, strength, and spasticity) with metabolic power. We estimated causal effects using Bayesian additive regression trees, adjusting for factors identified by the causal model. There were 2157 children who met our criteria. We found that a child's gait pattern, as summarized by the GDI, affected metabolic power approximately twice as much as the next largest contributor. Selective motor control, dynamic motor control, and spasticity had the next largest effects. Among the factors we considered, strength had the smallest effect on metabolic power. Our results suggest that children with CP may benefit more from treatments that improve their gait pattern and motor control than treatments that improve spasticity or strength.

Comparative Analysis of the Components of a Child's Gait Pattern with Flat Foot Disorder

Flat foot is a condition that generally occurs in children. Flat-foot is a condition where the entire foot is on the ground. The condition of a flat foot often does not show symptoms because in pre-school children, this condition remains a physiological condition. However, this condition will become pathological if it continues with age. The gait pattern is a structured movement carried out by a person to move and have a step distance, speed, and footprints. This study aimed to determine the gait pattern of normal-foot children and flat-foot children between the ages of 4-6 years at PAUD Sahabat Ananda Dau. The method used is a case-control two-group test on 23 children who have met the inclusion and exclusion criteria at PAUD Sahabat Ananda Dau in March 2022. Measurements of the wet footprint test, Clarke‘s angle, and gait parameters were out after obtaining approval from the respondents. \ It was found that respondents with flat-foot were 57%. Based on the T2 Sample Independent Test, the results obtained on stride was p=0.263, step right was p=0.235, step left was p=0.69, cadence p=0.7, and speed p=0.311(p&lt;0,05). It was discovered that there is no difference in gait pattern in normal foot and flat foot children aged 4-6 years at PAUD Sahabat Ananda Dau.&#x0D; Keywords: normal arch, flat foot, Gait pattern, Gait parameter, preschool children

Effects of ankle-foot orthoses on different gait patterns in children with spastic cerebral palsy: A statistical parametric mapping study.

Ankle-foot orthoses (AFOs) are a common treatment to correct gait deviations in children with spastic cerebral palsy (SCP). Studies on the outcome of AFOs on gait often do not account for different gait patterns. The aim of this study was to investigate the effects of AFOs on specific gait patterns in children with cerebral palsy. Retrospective, unblinded, controlled, cross-over study. Twenty-seven children with SCP were assessed in the conditions walking barefoot or with shoes and AFO. AFOs were prescribed based on usual clinical practice. Gait patterns for each leg were classified as excess ankle plantarflexion in stance (equinus), excess knee extension in stance (hyperextension), or excess knee flexion in stance (crouch). Differences in spatial-temporal variables and sagittal kinematics and kinetics of the hip, knee, and ankle between the 2 conditions were determined using paired t-tests and statistical parametric mapping, respectively. The effect of AFO-footwear neutral angle on knee flexion was tested using statistical parametric mapping regression. AFO use improved spatial-temporal variables and reduced ankle power generation in preswing. For "equinus" and "hyperextension" gait patterns, AFOs decreased ankle plantarflexion in preswing and initial swing and decreased ankle power in preswing. Ankle dorsiflexion moment increased in all gait pattern groups. Knee and hip variables did not change in any of the 3 groups. AFO-footwear neutral angle had no effect on changes in sagittal knee angle. Although improvements in spatial-temporal variables were seen, gait deviations could only partially be corrected. Therefore, AFO prescriptions and design should individually address specific gait deviations and their effectiveness in children with SCP should be controlled.

Changes of the gait induced by two different conservative methods applied to correct flexible flat feet in children 5 to 9 years old: foot orthoses vs foot orthoses supplemented with Zukunft-Huber manual therapy

Abstract Study aim: A flexible flat foot (FFF), one of the most common postural deformities among children, should not be perceived as an isolated problem of static alignment of foot and ankle, but as a part of dynamic biomechanical chain of a lower extremity, pelvis, and lower back. The aim of the study was to compare the impact of two methods, used for treating FFF, on the gait pattern in children after 12 months treatment. Material and methods: 49 study participants with FFF were randomly assigned to one of the two intervention methods. One group was treated with foot orthoses (FOs), the other group with manual therapy, corrective bandaging and FOs. Results: After one year of therapy, no significant differences were observed within either group before and after treatment regarding dimensional, spatio-temporal parameters, and ground reaction forces. However, noteworthy changes emerged in hip flexion moment, ankle plantar flexion moment, and ankle power in the group treated with the combined method. In the FOs-treated group, significant changes were found in ankle plantar flexion moment and ankle power. Conclusion: The observed changes in joints’ peak moments and powers in both groups were positive changes, but the combine method seems to be more effective than wearing FOs only.

Влияние отводящего ортеза на кинематические показатели тазобедренного сустава при ходьбе у детей со спастическими формами ДЦП

Introduction Adduction or flexion-adduction contracture of the hip joint often causes static and dynamic impairments in children with spastic cerebral palsy that can be corrected with hip abduction orthosis. No reports confirming or rejecting the effectiveness of the method in the gait correction have not found. The objective was to explore the effect of the hip abduction orthosis on gait kinematics in children with spastic cerebral palsy. Material and methods Twelve biomechanical tests were performed for 6 patients of GMFCS level 3 (6 tests with hip abduction orthosis and 6 tests with no hip abduction orthosis). Gait analysis was produced using the Qualisys Miqus M5 motion capture system (Sweden). Clinical gait analysis was performed with PAF 2.0 of QTM software, Visual3D, Statistica 10 and Excel. Results A comparative analysis of the mean values showed differences in the gait parameters depending on test conditions. Improvements in the spatial-temporal parameters ranged between 0.4 % and 23.6 % with use of orthosis. The kinematic analysis of large joints demonstrated a slight positive effect on the hip joint function. There were no significant differences in the function of other joints. The use of orthosis improved the overall gait index score for the left and right lower limbs by 12.5 % and 5.7 %, respectively. A detailed analysis of the gait index for large joints of the lower limbs demonstrated the discrete improvement. Conclusion Hip abduction orthosis showed a positive effect on the gait pattern of children with spastic cerebral palsy.

Effects of orthotic insole on gait patterns in children with mild leg length discrepancy

BackgroundLeg length discrepancy (LLD) is commonly associated with compensatory gait strategies leading to musculoskeletal disorders of the lower extremity and lumbar spine. Orthotic insole (OI) is considered as a conservative treatment for patients with mild LLD, especially for children. However, the restoration of normal gait when wearing OI with foot lift are still poorly understood. Research questionWhat are the immediate effects of OI on the gait patterns in children with mild LLD? MethodsGait data and plantar pressure data were collected for 12 children with mild anatomical LLD in barefoot and OI conditions. Paired t-test was performed to determine the changes in gait between these two conditions, and also the symmetry between limbs in the same condition for spatiotemporal, kinematic, and kinetic variables. ResultsChildren with mild LLD showed an immediate gait improvement confirmed by increased step length and velocity, decreased peak plantar pressure in both limbs with OI. Additionally, the significant between-limb differences disappeared for peak ankle dorsiflexion, hip adduction, pelvis upward obliquity and also second peak plantar pressure with OI, which improved gait symmetry. SignificanceThis study provides a better understanding of the immediate effect of OI with foot lift on biomechanical changes in gait, which identify that OI with foot lift could be a potential therapeutic option for children with mild structural LLD to improve gait metrics.

Effect of antigravity moon shoes on gait cycle in children with diplegic cerebral palsy

IntroductionThe study aimed to evaluate the effect of antigravity moon shoes on the values of stance and swing phases of the gait cycle in children with diplegia.MethodsThe study involved 30 children with spastic diplegia, aged 6–8 years, of both genders. They were randomly divided into 2 groups: A and B. All children were evaluated before and after 4 successive months of a rehabilitation program with 2-dimension gait analysis for measuring step lengths and values of stance and swing phases for both lower limbs. Both groups received a designed program which included stretching exercises for tight flexors of the lower limbs, progressive resisted exercises for extensors, and standing and weight shifting exercises. In addition, classical gait training was applied in group A and gait training with antigravity moon shoes in group B. Mann-Whitney U test served to assess differences in means of step length between the groups. Wilcoxon signed rank test was used to evaluate differences in means of step length and values of stance and swing phases during gait cycles.ResultsPost-treatment results revealed a decrease in step lengths and stance phase values, as well as increased values of swing phase for both groups. The changes were more significant in group B.ConclusionsAntigravity moon shoes are a new idea to improve gait pattern in children with diplegia by decreasing stance time and increasing swing time in the gait cycle.

P014 Use of prosthetic surgery in Juvenile Idiopathic Arthritis

Abstract Background Juvenile Idiopathic Arthritis (JIA) is the most common inflammatory rheumatism in childhood characterized by destructive potential. The involvement of weight-bearing joints constitutes an evolutionary turning point in the course of the disease, which may be responsible for a major functional handicap. In this context, arthroplasty constitutes a therapeutic alternative. Through this study, we aimed to determine the prevalence of the prosthetic surgery and its benefits in children with JIA. Methods This is a retrospective study of JIA patients. The diagnosis of JIA was selected according to ILAR criteria. All the patients included were followed for a minimum of 1 year. The parameters collected were: pain VAS, HAQ, Lequesnealgofunctional index (AFI), disease activity scores and mobility of the operated joint before and 6 months after surgery. Results Forty -four JIA patients were followed over an average period of 14 years (minimum of 1 year). The mean age of disease onset was 9 years [1.5–16 years]. Fifteen cases of coxitis (34%) and 4 cases of destruction of the knees (9%) were noted after an average course of the disease of 8 years [6 months–19 years]. Radiologically, coxofemoral ankylosis is reported in 6 cases, acetabular protrusion in 2 others and total destruction of the knee with misalignment in 2 cases. Eight patients required hip replacement surgery and 2 knee cases. In all cases, the hip prostheses were bilateral. Only one knee prosthesis was placed. The JIA subtype was rheumatoid factor seronegative polyarthritis in 5 cases and enthesitis related arthritis in 3 cases. Six months after surgery, the average AFI dropped from 15.4–4.5; the pain VAS from 73 mm to 50 mm and the HAQ from 2.5–1.06. In the polyarticular JIA, the DAS28 composite score decreased from 4.02–3.8 and in ERA patients the BASDAI decreased from 6.5–4.25 while BASFI remained stable. Recovery of joint mobility was partial in only one case. No immediate or late postoperative complications were noted. Conclusion Prosthetic surgery provided improvement in disease activity and recovery of gait pattern in children with severe JIA. However, the decision of an arthroplasty remains delicate in children, especially since this intervention can compromise the stature growth.