Gait Patterns In Children Research Articles

Effect of Individualized High-Velocity (Power) Resistance Training on Gait Biomechanics of Children with Cerebral Palsy

High-velocity resistance (HVRT) training can increase gait speed and reduce power asymmetries in adults; but this intervention is seldom provided to younger persons, particularly those with chronic disease states such as cerebral palsy (CP). PURPOSE: To determine if HVRT targeting the specific needs of each patient could improve gait patterns in children with CP. METHODS: Five subjects (1 male, 4 females, age 12.8 ± 4.3 yrs., height 1.4 ± .01 m, weight 37.9 ± 15.8 kg) participated in a 12-week HVRT program. During session 1, each subject’s gait pattern was recorded via a three-dimensional wireless inertial gait analysis system (YEI Technology, USA). Also their one repetition maximums were determined for the leg press, hip abduction, chest press, and seated row on pneumatic resistance machines (Keiser Corp, Fresno, CA). During session 2, children’s optimal loads for power were determined to establish their training loads. Based on their results tailored unilateral and bilateral programs were provided for each child. Loads were then adjusted using power plateaus throughout the training period. RESULTS: Subject 1 increased knee flexion in the pre-swing phase for her right knee and improved maximum knee flexion for the left knee during the swing phase. While right hip extension was limited by an undersized assistive devise; her left hip ROM improved substantially. Subject 2 increased propulsion and knee flexion ROM during the swing phase and increased left and right knee ROM during the stance phase. Hip ROM did not improve perhaps due to tight hip flexors resulting from a constantly flexed position when using an assistive device. Subject 3 showed improvement in the right knee but not the left. Improvements in the hip were seen as reduced hyperextension and increased extension for the right and left sides, respectively. Subject 4 showed an increase in right knee flexion in the swing phase with no change for the left knee and improved ROM for both hips, though only the right attained a neutral position in the transition phase. Subject 5 showed improved ROM in both knees and the left and right hips showed increased hip extension in the stance phase. CONCLUSIONS: These results show the potential for targeted HVRT to improve gait in CP children as evidenced by curves that more closely follow the typical patterns seen in children without CP.

Combined robotic-aided gait training and physical therapy improve functional abilities and hip kinematics during gait in children and adolescents with acquired brain injury

Purpose: To evaluate the combined effect of robotic-aided gait training (RAGT) and physical therapy (PT) on functional abilities and gait pattern in children and adolescents exiting acquired brain injury (ABI), through functional clinical scales and 3D-Gait Analysis (GA).Methods: A group of 23 patients with ABI underwent 20 sessions of RAGT in addition to traditional manual PT. All the patients were evaluated before and after the training by using the Gross Motor Function Measures (GMFM) and the Functional Assessment Questionnaire. Ambulant children were also evaluated through the 6 Minutes Walk Test (6MinWT) and GA. Finally, results were compared with those obtained from a control group of ABI children who underwent PT only.Results: After the training, the GMFM showed significant improvement in both dimensions ‘D’ (standing) and ‘E’ (walking). In ambulant patients the 6MinWT showed significant improvement after training and GA highlighted a significant increase in cadence, velocity and stride length. Moreover, hip kinematics on the sagittal plane revealed a statistically significant increase in range of motion (ROM) during the whole gait cycle, increased hip extension during terminal stance and increased ROM during the swing phase.Conclusions: The data suggest that the combined programme RAGT + PT induces improvements in functional activities and gait pattern in children and adolescents with ABI and demonstrated it to be an elective tool for the maintenance of the patients’ full compliance throughout the rehabilitative programme.

Gait patterns in children with limb length discrepancy.

Very few articles describe the compensations in gait caused by limb-length discrepancy (LLD). Song and colleagues explored kinematic and kinetic variables utilizing work equalization as a marker of successful compensation for LLD. They found no difference in strategies based on the location of pathology. The purpose of this study was to define the various gait patterns in patients with LLD and the impact of these compensations on gait kinetics. Forty-three children (mean age 12.9±3.7 y) with LLD >2 cm were evaluated in the motion lab using a VICON motion system with 2 AMTI force plates. Etiologies included Legg-Calve-Perthes, developmental hip dysplasia, growth plate damage due to infection or trauma, congenital shortening of the femur or tibia, and syndromes creating shortening of the limb. Evaluation included physical examination and 3-dimensional motion data generated using the model described by Vicon Clinical Manager (VCM). For data analysis, 3 representative trials were processed with the Plug-in Gait lower-body model using the "VCM spline" filter. Walking strategies were identified by visual review. A kinematic threshold of 2 SD away from normal values was used for inclusion in each group. Strategies included: (1) pelvic obliquity with the short side lower (<-1.5 degrees); (2) flexion of the knee of the longer leg in stance (>5.2 degrees); (3) plantar flexion of the ankle on the shorter leg through the gait cycle (<0 degrees); and (4) early plantarflexion crossover of the shorter limb (plantarflexion crossover occurred before 35% of the gait cycle). Variables were extracted into Excel using PECS (Vicon Motion Systems). The mean of the 3 trials was used for analysis. Scanograms were used to establish lengths of the femur and the lower leg including the foot. The percentage difference for the subject (%LLD) was calculated as the leg length between the 2 sides divided by the length of the long side. The total mechanical work over the stride was the sum of the positive work and the absolute value of the negative work in all planes. Paired t tests were used to analyze the work differences between the short limb versus the long limb. Unpaired t tests were used to compare between the different groups (short tibias, short femurs, and controls). Distribution of single strategies for the group included: pelvis (11), equinis (5), vaulting (7), knee flexion (3); 17 subjects used multiple strategies. If the discrepancy was in the femur, patients chose a more distal compensation strategy, utilizing ankle movements, which resulted in more work at the ankle joint on the short limb compared with normal (P<0.0001). All subjects with tibia shortening showed pelvic obliquity (3 combined with knee flexion), which caused more work at the hip joint on the short limb compared with normal (P<0.01). Total mechanical work on the uninvolved limb was above normal for all groups (P<0.0001). Our study contradicts previous literature that found no difference in strategy on the basis of location of the shortening and also a higher number of children with pelvic obliquity than previously described. It appears that different compensation schemes are used by patients with LLD. The increase in work may have long-term implications for management. Future studies will include changes in kinematics and work, after intervention. Better understanding of postoperative changes from different surgical methods may provide more insight for preoperative planning and may lead to a more satisfactory outcome for specific patients. Level II.

The Underwater Treadmill as a Physical Therapy Intervention for Children with Cerebral Palsy

Cerebral Palsy is a congenital and physical disability that leads into abnormal muscle tone, dyskinesia, and muscle spasticity, which can negatively impact functional gait patterns. Using the principles of activity based programs and repetitive task specific exercises involving a treadmill in physical therapy can replicate normal gait patterns, which can improve the quality of life. There is a scarcity of research that explores the effectiveness of underwater treadmill training as a form of physical therapy intervention. As such, the purpose of the study is to examine available research that studied the benefits of aquatic therapy, land based treadmill training, and underwater treadmill training on the gait patterns in children with cerebral palsy. The researchers conducted a review of literature that focuses on beneficial effects of physical therapy interventions such as aquatic exercise, resistance training, land‐based treadmill training, as well as underwater treadmill training; then ranked them using the Oxford Level of Evidence‐based Medicine. Based on the evidence gathered, we can conclude that the physiological benefits associated with aquatic therapy in combination with the repetitive task specific exercise used with treadmill training can improve mobility and functional gait patterns of children with cerebral palsy.

Effect of extracorporeal shock wave therapy on gait pattern in hemiplegic cerebral palsy: a randomized controlled trial.

The aim of this study was to investigate the effects of shock wave therapy on gait pattern in children with hemiplegic cerebral palsy. Fifteen children were assigned to the study group, whose members received shock wave therapy (1500 shots/muscle, frequency of 5Hz, energy of 0.030 mJ/mm, one session/wk). Another 15 were assigned to the control group, whose members participated in a conventional physical therapy exercise program for 3 successive months. Baseline and posttreatment assessments were performed using the Modified Ashworth Scale to evaluate spasticity degrees and using a three-dimensional gait analysis to evaluate gait parameters. Children in the study group showed a significant improvement when compared with those in the control group (P < 0.005). The Modified Ashworth scores after treatment were 1.86 (0.22) and 1.63 (0.23) for the control and study groups, respectively. The gait parameters (stride length, cadence, speed, cycle time, and stance phase percentage) after treatment were 0.5 m, 125 steps/min, 0.6 m/sec, 0.48 sec, and 50.4% and 0.74 m, 119 steps/min, 0.75 m/sec, 0.65 sec, and 55.9% for the control group and the study group, respectively. Shock wave therapy may be a useful tool for improving spasticity and gait pattern in children with hemiplegic cerebral palsy.

Gait characteristics of children with cerebral palsy as they walk with body weight unloading on a treadmill and over the ground.

Body weight support (BWS) has become a typical strategy for gait training, in special with children with cerebral palsy (CP). Although several findings have been reported in the literature, it remains uncertain how different types of surfaces and gradual amount of BWS can facilitate the mobility of children with CP. The aim of this study was to investigate gait kinematic parameters of children with CP by manipulating BWS and two different types of ground surfaces. Ten children (7.7 ± 2.1 years old) diagnosed with spastic CP and GMFCS classification between levels II and IV were asked to walk on a treadmill and over the ground. In both conditions, BWS was manipulated to minimize gravitational effects and spatial-temporal gait parameters and lower limb joints were analyzed. The results revealed that the type of ground surface causes greater impact on the gait pattern of children with CP as compared to body weight unloading. This finding may provide new insights into the behavioral heterogeneity of children with CP, and offers critical information to be considered on interventional programs specifically designed to improve mobility on this population.

Transcranial direct current stimulation during treadmill training in children with cerebral palsy: a randomized controlled double-blind clinical trial.

Impaired gait constitutes an important functional limitation in children with cerebral palsy (CP). Treadmill training has achieved encouraging results regarding improvements in the gait pattern of this population. Moreover, transcranial direct current stimulation (tDCS) is believed to potentiate the results achieved during the motor rehabilitation process. The aim of the present study was to determine the effect of the administration of tDCS during treadmill training on the gait pattern of children with spastic diparetic CP. A double-blind randomized controlled trial was carried out involving 24 children with CP allocated to either an experimental group (active anodal tDCS [1mA] over the primary motor cortex of the dominant hemisphere) or control group (placebo tDCS) during ten 20-min sessions of treadmill training. The experimental group exhibited improvements in temporal functional mobility, gait variables (spatiotemporal and kinematics variables). The results were maintained one month after the end of the intervention. There was a significant change in corticospinal excitability as compared to control group. In the present study, the administration of tDCS during treadmill training potentiated the effects of motor training in children with spastic diparetic CP.

Gait pattern differences between children with mild scoliosis and children with unilateral cerebral palsy.

This study was conducted to investigate the effects of asymmetrical body posture alone, i.e., the effects seen in children with mild scoliosis, vs. the effects of body posture control impairment, i.e., those seen in children with unilateral cerebral palsy on gait patterns. Three-dimensional instrumented gait analysis (3DGA) was conducted in 45 children with hemiplegia and 51 children with mild scoliosis. All the children were able to walk without assistance devices. A set of 35 selected spatiotemporal gait and kinematics parameters were evaluated when subjects walked on a treadmill. A cluster analysis revealed 3 different gait patterns: a scoliotic gait pattern and 2 different hemiplegic gait patterns. The results showed that the discrepancy in gait patterns was not simply a lower limb kinematic deviation in the sagittal plane, as expected. Additional altered kinematics, such as pelvic misorientation in the coronal plane in both the stance and swing phases and inadequate stance phase hip ad/abduction, which resulted from postural pattern features, were distinguished between the 3 gait patterns. Our study provides evidence for a strong correlation between postural and gait patterns in children with unilateral cerebral palsy. Information on differences in gait patterns may be used to improve the guidelines for early therapy for children with hemiplegia before abnormal gait patterns are fully established. The gait pathology characteristic of scoliotic children is a potential new direction for treating scoliosis that complements the standard posture and walking control therapy exercises with the use of biofeedback.

An innovative approach toward gait feature detection in children with CP

INTRODUCTION and AIM Classifying gait patterns in children with cerebral palsy (CP) and reducing the vast amount of data from gait analysis into a set of clinically relevant gait features remains a challenge [1]. A priori selection of gait features, often based on clinical expert knowledge, can result in either incomplete or redundant data [2]. The goal is to quantify differences in lower limb kinematics between CP children and typically developing controls using principal component analysis (PCA). Secondly, for features that differ between CP and controls, a discriminant analysis (DA) will be applied to determine which features discriminate best between both groups.

Effects of gastrocnemius fascia lengthening on gait pattern in children with cerebral palsy using the Gait Profile Score

The aim of the present study was to investigate the efficacy of the GPS regarding the quantification of changes in gait following the gastrocnemius fascia lengthening in children with CP. Nineteen children with CP were selected and evaluated in the preoperative period (PRE session) and approximately one year postoperatively (POST session; mean 13.1 ± 5.1 months) using 3D gait analysis and computing the GPS and GVSs. As the GPS represents the difference between the patient's data and the average from the reference dataset, the higher the value of GPS is, more compromised gait of the subject. A statistically significant improvement in mean GPS was found in the POST session (PRE: 13.38 ± 5°; POST: 10.26 ± 2.41°; p<0.05), with an improvement close to 23%. Moreover, the GVSs demonstrated statistically significant improvements in ankle dorsi-plantarflexion (PRE: 22.20 ± 16.36°; POST: 11.50 ± 6.57°; p<0.05) and pelvic rotation (PRE: 9.53 ± 3.87°; POST: 6.47 ± 2.98°; p<0.05). A strong correlation (r=0.75; p<0.05) was found between the preoperative GPS and the percentage of GPS improvement. The results demonstrated that the gastrocnemius fascia lengthening produced a global gait pattern improvement, as showed by the GPS value, which decreased after surgery. Besides this, the GVS permitted to better evidence the joints more compromised by the pathology and their improvement due to the surgery, in this case not only the GVS of the ankle joint but also of the pelvis were characterized by higher GVS values.

Effect of the Modulation of Optic Flow Speed on Gait Parameters in Children with Hemiplegic Cerebral Palsy

[Purpose] We investigated the effects of modulation of the optic flow speed on gait parameters in children with hemiplegic cerebral palsy. [Methods] We examined 10 children with hemiplegic cerebral palsy. The children underwent gait analysis under 3 different conditions of optic flow speed: slow, normal, and fast optic flow speed. The children walked across the walkway of a GAITRite system, while watching a virtual reality screen, and walking velocity, cadence, stride length, step length, single support time, and double support time were recorded. [Results] Compared with the other applied flow speed conditions, the fast optic flow speed (2 times the normal speed) significantly increased walking velocity, cadence, normalized step length, base of support, and single support cycle of both the paretic and non-paretic lower limbs. Moreover, compared with the other applied flow speed conditions, the slow optic flow speed (0.25 times the normal speed) yielded a significantly decreased walking velocity, cadence, normalized step length, base of support, and single support cycle for both the paretic and non-paretic lower limbs. [Conclusion] The gait parameters of children with hemiplegic cerebral palsy are altered by modulation of the optic flow speed. Thus, we believe that gait training involving modulation of the optic flow speed is feasible and suitable for resolving abnormal gait patterns in children with hemiplegic cerebral palsy.

Spastic diplegia in children with HIV encephalopathy: first description of gait and physical status

The aim of this study was to explore the physical status and gait patterns of children with spastic diplegia secondary to human immunodeficiency virus encephalopathy (HIVE). A cross-sectional study was conducted on children diagnosed with HIVE and spastic diplegia. Sociodemographic and clinical background information was obtained, followed by three-dimensional gait analysis (3DGA) and a physical examination including assessments of muscle tone, strength, motor control, contractures, and bony deformities of the lower extremities. Fourteen children (eight males, six females; mean age 5 y 8 mo [SD 9 mo], range 4 y 4 mo-6 y 10 mo) were studied. The cohort was divided into two groups based on distinctive gait patterns. Nine participants in group I showed only limited abnormalities. Group II displayed a more pathological gait pattern including stiff knee and equinus ankle abnormalities. Results of 3DGA, as with the physical examination outcomes, showed increased impairments from proximal to distal (except for hip extension). This study provides a first description of distinctive gait patterns and related physical characteristics of children with HIVE and spastic diplegia. Further research is necessary.

Robotic assisted gait training and gait pattern in children affected with cerebral palsy

every foot joint during gait. For this reason a FE model was created and a validated using a dummy model. Patients/materials and methods: Gait analysis in one patient was done with a Vicon MX System and 6 cameras, one AMTI Force plate and one EMED SF pressure measurement platform. The “GaitLowerExtremity” model from the ANYBODY Repository AMMRV1.4.1 and ANYBODY Version 5.1 was used to determine the muscle forces of the lower leg during gait. The muscle forces from the ANYBODY model, the regional reaction forces from the EMED SF platform and the 3D kinematics were used to build up the FE-model. A “standard foot model” was created from a CT scan of one healthy foot. This model was imported in ANSYS Workbench V.14.0 and scaled according to the patient’s standard X-rays. The bony segments were linked by revolute joints. This model was validated by measuring the intra-articular forces at the ankle joint in a dummy model constructed by aluminium and computing the FE Model using data for both analysis from the same patient at 50% stance phase (Figs. 1 and 2). Results: Validation of the FE model shows a good correlation of the measured data in the dummy model and the computed data at the ankle joint in the FE model. Only the moments in z direction (vertical to the floor) showed a difference of 19%. All other differences were in a range between 2 and 8%. Discussion and conclusions: For the dynamic validation of the FEmodel the load during one representative step inmid stancewas applied on the dummymodel. The results of the dummymodel and the FE calculation correlated well. Only the moments in z direction at the ankle joint differed between FE Model and dummy model. The reason is not understood yet and is further analyzed.

Children with cerebral palsy have greater stochastic features present in the variability of their gait kinematics

Children with CP have a more variable gait pattern. However, it is currently unknown if these variations arise from deterministic variations that are a result of a change in the motor command or stochastic features that are present in the nervous system. The aim of this investigation was to use a Langevin equation methodology to evaluate the deterministic and stochastic features that are present in the variability of the gait kinematics of children with cerebral palsy (CP). Ten children with spastic diplegic CP and nine typically developing (TD) children participated in this investigation. All of the children walked on a treadmill for 2 min while a three-dimensional motion capture system recorded the step kinematics. Our major findings for this investigation were: (1) children with CP had greater variability in their gait patterns than TD children, (2) the variability of the children with CP and TD children had similar deterministic features, (3) the variability had greater stochastic features for the children with CP, and (4) the increase in the amount of variability was strongly correlated with the increase in stochastic features. These results indicate that the variability seen in the gait patterns of children with CP may be due to the inability to suppress the noise that is present in the neuromuscular system.

Categorization of gait patterns in adults with cerebral palsy: A clustering approach

Gait patterns in adults with cerebral palsy have, to our knowledge, never been assessed. This contrasts with the large number of studies which have attempted to categorize gait patterns in children with cerebral palsy. Several methodological approaches have been developed to objectively classify gait patterns in patients with central nervous system lesions. These methods enable the identification of groups of patients with common underlying clinical problems. One method is cluster analysis, a multivariate statistical method which is used to classify an entire data set into homogeneous groups or “clusters”. The aim of this study was to determine, using cluster analysis, the principal gait patterns which can be found in adults with cerebral palsy. Data from 3D motion analyses of 44 adults with cerebral palsy were included. A hierarchical cluster analysis was used to subgroup the different gait patterns based on spatiotemporal and kinematic parameters in the sagittal and frontal planes. Five clusters were identified (C1–C5) among which, 3 subgroups were determined, based on spontaneous gait speed (C1/C2: slow, C3/C4: moderate and C5: almost normal). The different clusters were related to specific kinematic parameters that can be assessed in routine clinical practice. These 5 classifications can be used to follow changes in gait patterns throughout growth and aging as well to assess the effects of different treatments (physiotherapy, surgery, botulinum toxin, etc.) on gait patterns in adults with cerebral palsy.

The relationship between clinical measurements and gait analysis data in children with cerebral palsy

Spasticity is a common impairment that interferes with motor function (particularly gait pattern) in children with cerebral palsy (CP). Gait analysis and clinical measurements are equally important in evaluating and treating gait disorders in children with CP. This study aimed to explore the relationship between the spasticity of lower extremity muscles and deviations from the normal gait pattern in children with CP. Thirty-six children with spastic CP (18 with spastic hemiplegia [HS] and 18 with spastic diplegia [DS]), ranging in age from 7 to 12 years, participated in the study. The children were classified as level I (n=24) or level II (n=12) according to the Gross Motor Function Classification System. Spasticity levels were evaluated with the Dynamic Evaluation of Range of Motion (DAROM) using the accelerometer-based system, and gait patterns were evaluated with a three dimensional gait analysis using the Zebris system (Isny, Germany). The Gillette Gait Index (GGI) was calculated from the gait data. The results show that gait pathology in children with CP does not depend on the static and dynamic contractures of hip and knee flexors. Although significant correlations were observed for a few clinical measures with the gait data (GGI), the correlation coefficients were low. Only the spasticity of rectus femoris showed a fair to moderate correlation with GGI. In conclusion, the results indicate the independence of the clinical evaluation and gait pattern and support the view that both factors provide important information about the functional problems of children with CP.

A comprehensive evaluation of the variation in ankle function during gait in children and youth with Charcot–Marie–Tooth disease

A better understanding of gait dysfunction for children and youth with Charcot–Marie–Tooth (CMT) will assist in developing appropriate treatments and understanding prognosis for ambulation. The purpose of this retrospective study was to document the typical gait patterns in children and youth (12±4 years) with CMT using motion analysis and relate these findings back to the clinical assessment at the ankle. All patients underwent a motion analysis as a component of treatment decision-making.Lower extremity kinematics and kinetics were evaluated in comparison to a typically developing age-matched reference control group collected in the same gait laboratory. Three patient subgroups were defined based on peak ankle dorsiflexion in terminal stance: greater than typical (n=23), within typical range (n=30) and less than typical (n=13). The three subgroups showed statistically significant differences (p<0.004) in degree of impairment for ankle plantar flexor and dorsiflexor weakness and ankle plantar flexor contracture. Patients with excessive dorsiflexion in terminal stance had the greatest ankle plantar flexor weakness (median 2) and the greatest dorsiflexor weakness (median 4). Patients with less than typical dorsiflexion in terminal stance were the only patients with a plantar flexor contracture (−2±9°). Delayed peak dorsiflexion in stance was the most common kinematic finding and consistent with ankle plantar flexor weakness. All patients showed significantly less (p<0.001) peak ankle moments and power generation in terminal stance than the typically developing controls. We concluded that children and youth with CMT present differently in terms of impairment and associated gait issues which therefore require patient specific treatment strategies.

Can Rhythmical Auditory Stimulation Alter Gait Pattern in Children with Asperger Syndrome?

The aims of this study were to evaluate the gait abnormalities in children with Asperger syndrome (AS) and to investigate the effectiveness of rhythmical auditory stimulation (RAS) on gait training in children with this condition. Five children with AS (mean age: 8.5 ± 2.0 years) and 6 children with normal development (mean age: 9.5 ± 2.0 years) participated in this study. The participants were asked to walk on a treadmill under each of the following conditions conducted in sequence: (1) walk at a comfortable speed with no RAS (baseline), (2) walk at a comfortable speed accompanied by RAS (sound-on condition), and (3) walk again at a comfortable speed with no RAS (sound-off condition). The temporal and kinematic gait parameters of the walking in each condition were recorded with a VICON 370 system. No significant differences were found among the baseline, sound-on, and sound-off gait parameters in either group. The children with AS rotated their pelvis more during walking than the control group did at baseline (p=0.018) and during the sound-on (p=0.011) condition. Moreover, the control group spent less time in the doubleleg supporting position in the sound-on and subsequent sound-off condition than the AS group did. No statistically significant differences were found between the two groups in all other gait parameters (i.e., step length, step width, step height, hip and knee joint angles at mid-stance phase of gait) in the three testing conditions. The children with AS demonstrated excessive pelvic rotation during walking when compared to children with normal development. A short period of gait training with RAS might not be able to improve the walking pattern in children with AS.

Changes of gait pattern in children with Charcot-Marie-Tooth disease type 1A: a 18 months follow-up study

BackgroundIn a previous study we identified 3 different gait patterns in a group of children with CMT1A disease: Normal-like (NL), Foot-drop (FD), Foot-drop and Push-off Deficit (FD&POD). Goal of the present study was to perform a follow-up evaluation of the same group of patients to analyze possible changes of gait features in relation to disease progression or specific therapy.MethodsNineteen children with CMT1A were evaluated clinically (CMT-Examination Score and Overall Neuropathy Limitation Scale) and through gait analysis 18.2±1.5 months after a baseline evaluation. Meanwhile, 3 of them had foot surgery.ResultsFifteen out of the 16 non-operated patients significantly changed at least one of the two parameters associated to primary signs (FD and/or POD). Eleven participants worsened at least one parameter and 9 improved one parameter. CMTES significantly worsened for the group of non-operated patients. However, there was no change in CMTES score in 4 patients and in ONLS score in 11. At subgroup level, participants originally belonging to NL group showed a trend towards a foot-drop deficit (−15%, ns); FD and FD&POD subgroups did not change their primary signs, although significant changes were identified individually. All 3 patients operated have improved push-off and proximal joint patterns during walking. Clinical scores did not change within any sub-group.ConclusionsSubtle changes occurring in 1.5 year in gait features of CMT1A children can be instrumentally identified. Such changes show a large inter-subject variability, with some patients even improving their walking pattern. There is anecdotal evidence that foot surgery may improve the push-off phase of gait.

Effect of fine wire electrode insertion on gait patterns in children with hemiplegic cerebral palsy

BackgroundFine wire electromyography (EMG) is commonly used for surgical decision making in equinovarus foot deformity. However, this invasive technique may have the unwanted effect of altering the gait of children with cerebral palsy (CP). The purpose of this study was to determine if fine wire insertion into the posterior tibialis muscle affects temporal-spatial parameters and hindfoot kinematics during gait in children with equinovarus secondary to hemiplegic CP. Methods12 children with hemiplegic CP who presented with an equinovarus foot (mean age 12.5 yrs, four right-sided, eight left-sided) were recruited. Temporal-spatial parameters and 3-D segmental foot and ankle kinematic gait data were collected utilizing standard gait analysis and the Milwaukee Foot Model (MFM). Three representative trials with and without fine wire electrode insertion were compared to determine the effect of electrode placement in the posterior tibialis on temporal spatial-parameters and hindfoot sagittal, coronal and transverse plane kinematic peaks, timing of kinematic peaks, and excursions. ResultsNo significant differences in any temporal-spatial or kinematic parameters were observed between “with wire” and “without wire” conditions. Strong correlations were observed among the gait parameters, with the exception of cadence, for the two conditions. DiscussionFine wire insertion into the posterior tibialis had no measurable effect on the gait of individuals with equinovarus secondary to hemiplegic CP. This suggests that the simultaneous collection of segmental foot and ankle kinematics and fine wire EMG data of the posterior tibialis is acceptable for surgical decision making in this patient population.