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1.
目的:探讨脑性瘫痪(脑瘫)患儿的头颅MRI表现及其与脑瘫类型的关系。方法:回顾性分析81例脑瘫患儿的临床资料与MRI表现。结果:81例脑瘫患儿MRI异常率为85.2%,痉挛型双瘫、四肢瘫、偏瘫、不随意运动型脑瘫、共济失调型脑瘫、肌张力低下型脑瘫和混合型脑瘫MRI异常率分别为92.9%、100%、100%、60%、87.5%、50%和81.8%。各类型脑瘫的MRI异常表现不同,痉挛型双瘫以脑室周围白质软化(PRL)为主,偏瘫型突出表现为单侧脑损伤,四肢瘫表现为广泛、弥漫、双侧脑损伤,不随意运动型表现为基底节病变或PVL,共济失调型绝大部分存在先天性小脑发育不全。结论:MRI有助于评价各型脑瘫的病理特点,对脑瘫病因的推测有帮助。 相似文献
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New stationary cycles can decrease motion in the frontal and transverse planes with a shank guide. However, there are no studies comparing cycling with and without this guide. The purpose of this study was to compare cycling with and without a shank guide for adolescents with cerebral palsy (CP). Three males and seven females (15.6 ± 1.8 years) with CP, classified as levels III and IV with the Gross Motor Functional Classification System, underwent biomechanical analysis of stationary recumbent cycling with and without a shank guide at 30 and 60 rpm if able. Data collected included three-dimensional lower extremity joint kinematics using motion analysis, surface electromyography of eight lower extremity muscles, cocontraction of six agonist/antagonist pairings, efficiency (power output divided by oxygen consumption), and perceived exertion (OMNI Scale of Perceived Exertion). Non-circular data were analyzed via ANOVAs, and circular data were analyzed using circular t-tests. The shank guide altered joint kinematics in all three planes (p < 0.008), had a minor impact on muscle activity (p < 0.006), and had no impact on cocontraction (p > 0.008), efficiency (p = 0.920), or perceived exertion (p = 0.318). The results suggest that a shank guide during cycling may be beneficial for individuals with CP to decrease the amount of hip and knee frontal and transverse plane motion. Knee movement in these planes has been associated with pain in healthy adults; therefore the guide may help to prevent long-term complications from cycling for adolescents with CP. 相似文献
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《Gait & posture》2016
The aim of this study was to evaluate the outcome of combined tibialis anterior tendon shortening (TATS) and calf muscle-tendon lengthening (CMTL) in spastic equinus.Prospectively collected data was analysed in 26 patients with hemiplegic (n = 13) and diplegic (n = 13) cerebral palsy (CP) (GMFCS level I or II, 14 males, 12 females, age range 10–35 years; mean 16.8 years). All patients had pre-operative 3D gait analysis and a further analysis at a mean of 17.1 months (±5.6 months) after surgery. None was lost to follow-up. Twenty-eight combined TATS and CMTL were undertaken and 19 patients had additional synchronous multilevel surgery. At follow-up 79% of patients had improved foot positioning at initial contact, whilst 68% reported improved fitting or reduced requirement of orthotic support. Statistically significant improvements were seen in the Movement Analysis Profile for ankle dorsi-/plantarflexion (4.15°, p = 0.032), maximum ankle dorsiflexion during swing phase (11.68°, p < 0.001), and Edinburgh Visual Gait Score (EVGS) (4.85, p = 0.014). Diplegic patients had a greater improvement in the EVGS than hemiplegics (6.27 -vs- 2.21, p = 0.024).The originators of combined TATS and CMTL showed that it improved foot positioning during gait. The present study has independently confirmed favourable outcomes in a similar patient population and added additional outcome measures, the EVGS, foot positioning at initial contact, and maximum ankle dorsiflexion during swing phase. Study limitations include short term follow-up in a heterogeneous population and that 19 patients had additional surgery. TATS combined with CMTL is a recommended option for spastic equinus in ambulatory patients with CP. 相似文献
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This study evaluated within- and between-session reliability and validity of temporal–spatial gait parameters derived from the intelligent device for energy expenditure and activity (IDEEA) activity monitor (Minisun, Fresno, CA) in subjects with cerebral palsy, using three-dimensional gait analysis (3-DGA) as the criterion standard. Twenty-five subjects with cerebral palsy (mean age 14.1 years, range 8–23) and 30 control subjects (mean age 14.2 years, range 7–24) completed two 3-DGA, 1 week apart with simultaneous IDEEA data collection. The IDEEA had lower within-session reliability than the 3-DGA for both groups, indicated by greater measurement errors and wider repeatability values for all temporal–spatial parameters. Between-session reliability of 3-DGA was high for both groups with intra-class correlation coefficients (ICC) >0.80. The IDEEA monitor showed high between-session reliability for control subjects (ICC 0.71–0.89), but lower reliability in subjects with cerebral palsy, particularly for walking velocity and stride length (ICC 0.53 and 0.62, respectively). Validity comparison between IDEEA and 3-DGA measures using Bland Altman 95% limits of agreement showed a measurement bias, with the IDEEA over-estimating step and stride length and underestimating cadence in both subject groups compared to 3-DGA. The 95% limits of agreement were smaller in controls (step ±0.20 m; stride ±0.27 m; walking velocity ±0.28 m/s) than in subjects with cerebral palsy (step ±0.36 m; stride ±0.37 m; velocity ±0.58 m/s). Modifications may be necessary to improve the reliability and validity of the IDEEA in children, particularly for use in neurological conditions. 相似文献
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《Gait & posture》2020
Background: Out-toeing is common in children with cerebral palsy (CP), contributing to lever arm dysfunction and functional limitations. It is important to determine the cause(s) of out-toeing prior to treatment, whether surgical or non-surgical.Research Questions: What are the contributors to out-toeing in children with CP and do they differ between children with bilateral and unilateral involvement?Methods: The causes of out-toeing gait were determined retrospectively, with the use of computerized gait analysis, in 261 children with cerebral palsy (344 sides). The prevalence of various causes was calculated separately for children with bilateral and unilateral involvement, and compared statistically between groups using Fisher’s Exact analysis.Results: The most common cause of out-toeing was pes valgus in bilaterally involved subjects (71%) and pelvic external rotation (64%) in unilaterally involved subjects. Over half of the cases of out-toeing were due to multiple causes: 62% of the unilateral group and 53% of the bilateral group. In limbs with multiple causes of out-toeing in the bilateral group, pes valgus was one of the causes in 91% of limbs (146/161), and was most commonly combined with hip external rotation (27%), pelvic external rotation (22%), or external tibial torsion (20%). For the unilateral group with multiple causes of out-toeing, pelvic external rotation was one of the causes in 83% of limbs (20/24) and hip external rotation in 63% (15/24). Both were present (with or without additional causes) in 46% (11/24) of such limbs.Significance: The causes of out-toeing are multifactorial in over half of affected limbs of children with cerebral palsy. They also differ for children with bilateral and unilateral involvement. These findings should be carefully considered prior to non-surgical or surgical treatment of out-toeing gait in these patients, to allow all sites of pathology to be addressed, and to optimize outcomes. 相似文献
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《Gait & posture》2016
Excessive trunk motion has been shown to be characteristic of cerebral palsy (CP) gait. However, the associated demands on the lower spine are unknown. This study investigated 3-dimensional reactive forces and moments at the low back in CP children compared to healthy controls. In addition, the impact of functional level of impairment was investigated (GMFCS levels). Fifty-two children with CP (26 GMFCS I and 26 GMFCS II) and 26 controls were recruited to the study. Three-dimensional thorax kinematics and reactive forces and moments at the low back (L5/S1 spine) were examined. Discrete kinematic and kinetic parameters were assessed between groups. Thorax movement demonstrated increased range for CP children in all 3 planes while L5/S1 reactive forces and moments increased with increasing level of functional impairment. Peak reactive force data were increased by up to 57% for GMFCS I and 63% for GMFCS II children compared to controls. Peak moment data were increased by up to 21% for GMFCS II children compared to GMFCS I and up to 90% for GMFCS II compared to control. In addition, a strong correlation was demonstrated between thorax side flexion and L5/S1 lateral bend moment (r = 0.519, p < 0.01) and medial/lateral force (r = 0.352, p < 0.01). Children with CP demonstrated increased lower spinal loading compared to TD. Furthermore, GMFCS II children demonstrated significantly more involvement. Intervention should be aimed at reducing excessive thorax movement, especially in the coronal plane, in order to reduce abnormal loading on the spine in this population. 相似文献
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The Edinburgh Visual Gait Score (EVGS) for cerebral palsy has been validated for observer reliability and validity for observers experienced in gait analysis. This study investigated the reliability and validity of the EVGS for observers inexperienced in gait analysis. Six medical students used the score to analyse videotapes from the original study by Read et al. [Read HS, Hazlewood ME, Hillman SJ, Prescott RJ, Robb JE. Edinburgh visual gait score for use in cerebral palsy. J Pediatr Orthop 2003;23:296-301]. These were viewed on two separate occasions to provide inter- and intra-observer reliability, and the results of the numerical items were compared to those from three-dimensional (3D) gait analyses for validity. Observer agreement was tested using Coefficient of Repeatability (CoR), percentage of complete agreement and the kappa statistic. The CoR for inter-observer agreement for inexperienced observers was 5.99/5.07 (Session 1/Session 2) compared to 4.60/3.95 (Session 1/Session 2) for experienced observers. The CoR for intra-observer agreement for inexperienced observers was 5.15 compared to 4.21 for experienced observers. There was complete agreement for 52% of the 10 numerical items with 3D-gait analysis data for inexperienced observers compared to 64% for experienced observers. Ranking of reliability of individual items was similar between the two groups and was generally best for events occurring at the foot and ankle. Observations of gait events by the inexperienced observers using the EVGS were reasonably reliable but not very accurate when compared to experienced observers and 3D-gait analysis. 相似文献
8.
《Gait & posture》2019
BackgroundCrouch gait is a common pattern in children with CP. Little investigation has been performed as to the role of the trunk during crouch gait. A compensatory movement of the trunk may alter the position of the ground reaction force with the effect of reducing the moment arm about the knee or hip. While this may benefit these joints in the context of reduced loading, there may be implications further up the kinematic chain at the level of the lumbar spine.Research QuestionAre compensatory movements of the trunk present during crouch gait in children with CP and are levels of loading at the lower lumbar spine affected?MethodsA full barefoot lower limb and trunk 3-dimensional kinematic and kinetic analysis, with kinetics estimated at the spinal position of L5/S1, was performed on 3 groups of children, namely CP Crouch, CP No-Crouch and TD. Differences in trunk position and L5/S1 loading were compared between groups.ResultsMean trunk position in relation to the pelvis and laboratory was not statistically significant between groups. At the level of the spine, no differences were present in mean position between groups for L5/S1 sagittal moment or anterior/posterior force.SignificanceCrouch gait does not elicit a compensatory response of the trunk in children with CP and, consequently, reactive forces and moments at the lower lumbar spine remain within normal limits. With this in mind, it is unlikely that a crouch gait pattern will affect the health of the spine over time in these children. 相似文献
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《Gait & posture》2021
BackgroundThis prospective study used instrumented gait analysis, patient-reported outcomes, and portable accelerometers to examine walking activity in adults with cerebral palsy (CP).Research questionThis study aimed to provide objective data and evaluate factors associated with walking activity in adults with CP.MethodsParticipants with CP (ages 25–45 years) completed instrumented gait analysis and patient-reported outcomes, including the Patient Reported Outcome Measurement Information System (PROMIS) and Satisfaction with Life Score (SWLS), and wore a StepWatch for 8 days. Average strides per day, stratified by Gross Motor Function Classification System (GMFCS), were compared with nondisabled adults ages 30–39 years utilizing Welch’s t-tests with Bonferroni corrections. Correlation coefficients and stepwise multiple linear regression analyses examined relationships between walking activity and GMFCS, gait deviation index (GDI), gait velocity, PROMIS physical function, SWLS, body mass index (BMI), and employment.ResultsParticipants included 109 adults with CP, ages 29 ± 4 years, classified at GMFCS levels I/II (73 %) and III/IV (27 %). Compared with nondisabled adults, daily stride count was significantly lower in both groups of adults with CP (p < 0.00025), with a progressive decline according to GMFCS level. Walking activity correlated with PROMIS physical function (r = .42), GDI (r = .48), and gait velocity (r = .58). Association for employment was lower (r = 0.27) but significant, while age, SWLS, and BMI were not individually correlated with walking activity. Stepwise, multiple linear regression modeled with Akaike information criterion explained 40.9 % of the observed variability in walking activity in this cohort of adults with CP.SignificancePhysical function, as classified by GMFCS or measured by PROMIS and self-selected walking velocity, has the strongest association with and is the most significant predictor of walking activity in adults with CP. After accounting for physical function, a small amount of the variation in walking activity can be explained by GDI, employment, and age. 相似文献
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《Gait & posture》2021
BackgroundThe longitudinal stability of sagittal gait patterns in diplegic cerebral palsy (CP), stratified using the Rodda classification, is currently unknown.Research questionWhat is the trajectory of sagittal plane gait deformities as defined by the Rodda classification in a large cohort treated with orthopedic surgery guided by gait analysis?MethodsA retrospective study utilized gait analysis to evaluate sagittal gait parameters before age 8 and after age 15 years. Individual limbs were categorized at each time point according to the Rodda classification based on mean sagittal plane knee and ankle angle during stance. Welch’s t-tests compared gait variables from early childhood with maturity and examined changes associated with plantarflexor lengthening surgery.Results100 youth with CP were evaluated twice: at a mean age of 5.49 ± 1.18 and 19.09 ± 4.32 years, respectively. Gross Motor Function Classification System distribution at maturity was I (10.5 %), II (55.2 %), III (28.6 %), and IV (5.7 %). At the initial visit, most limbs were in either true equinus (30 %) or jump-knee gait (26.5 %). At maturity, crouch gait (52.5 %) was the most common classification, of which 47.6 % were mild (1–3 standard deviations from age-matched norm; 21°–30°) and 52.4 % moderate or severe. For the entire cohort, at initial and final visits, respectively, mean knee flexion in stance was 26.8°±14.8° and 25.9°±11.4° (p = 0.320), ankle dorsiflexion in stance increased from −0.3°±11.5° to 9.0°±6.0° (p < 0.001), and passive knee flexion contracture was −2.3°±7.0° and -3.9°±8.0° (p = 0.043). In children who started in true equinus, apparent equinus, and crouch, there was no difference in stance phase knee flexion at maturity between those who underwent plantarflexor lengthenings versus those who did not (p > 0.18).SignificanceThe trend in this cohort was toward crouch with increased stance phase ankle dorsiflexion from early childhood to maturity. Plantarflexor lengthenings were not a significant factor in the progression of stance phase knee flexion. 相似文献
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《Gait & posture》2019
BackgroundThe most prominent characteristics of hemiparetic cerebral palsy (hCP) children are structural and functional asymmetries. These children have low walking speeds, endurance and poor balance. The robotic walking devices repeat and experience symmetrical stepping at the corresponding speed and angles of the lower extremities.Research Question 1Are robotic walking devices effective in the development of walking in hCP children who can walk?Research Question 2How does the aerobic exercise experience with assisted and symmetrical movement affect the walking and local muscle, peripheral oxygenation of children with hCP?MethodsThis prospective, controlled study included 24 children with hCP. All children attended to a standard physiotherapy rehabilitation (PTR) program (three days a week for 12 weeks); those in the study group (n=12) also attended to an Robotic Gait Training (RGT) program three times a week. Evaluations performed before treatment, after treatment, and at the 3rd month after treatment included assessment of balance, functionality walking and measurements for oxygenation of vastus lateralis muscle and peripheral oxygenation.Results: The evaluations were similar for both groups before treatment. After treatment, walking speed, endurance and peripheral O2 saturation were increased and balance abilities and functional performances improved in the RGT group as compared with the pre-treatment evaluations; these improvements in balance and functional performance were generally preserved after 3 months of treatment. An increase in 6-min walking distance and a partial increase in gross motor functions and functional muscle strength were observed in the control group; however, these abilities were not preserved after the treatment.SignificanceRGT can provide a faster and higher effect on the development of functional muscle strength, balance, walking speed and endurance than the standard PTR program. It improves functional walking performance. RGT can be used for aerobic exercise training in children with walking hCP. 相似文献
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《Gait & posture》2021
BackgroundPrevious studies have looked at the short-term effectiveness of conservative and surgical treatment of children with cerebral palsy (CP), but few have explored the long-term outcomes into adulthood using gait analysis and patient-reported outcome measures.Research questionHow do gait, mobility, and patient-reported outcomes in adults with CP who received specialized pediatric orthopedic care change from adolescence?MethodsWe identified 645 adults with 1) CP, 2) age 25–45 years, and 3) an adolescent instrumented gait analysis (IGA) at our center. Measurement outcomes included physical examination, IGA, and select domains of the Patient-Reported Outcomes Measurement Information System (PROMIS).ResultsParticipants included 136 adults with CP; Gross Motor Function Classification System levels I (21 %), II (51 %), III (22 %), and IV (7%); 57 % males; and average age 16 ± 3/29 ± 3 years (adolescent/adult visits). There was no significant difference in gait deviation index, stride length, or gross motor function between adolescent and adult visits. There were statistically significant but not clinically meaningful declines in gait velocity. At adulthood, PROMIS results revealed limitations in physical function compared with a normative sample but no differences in depression, participation, or pain interference.SignificanceIn this relatively homogeneous group of adults with CP who received orthopedic care from one center, gait and gross motor function showed no clinically meaningful change from adolescence, which differs from recent reports of declining mobility in adulthood. Expert orthopedic care, guided by IGA, may prevent losses in functional mobility for adults with CP. 相似文献
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目的比较脑瘫患儿术前口服氯胺酮、咪唑安定混合液与单纯肌注氯胺酮的优缺点.方法选择脑瘫患儿60例,随机分为观察组30例和对照组30例.观察组术前口服氯胺酮(6.0 mg/kg)和咪唑安定(0.3mg/kg)混合液,对照组肌肉注射氯胺酮(5.0 mg/kg).观察用药前和用药后5、10、15 min时患儿的心率、呼吸、脉搏、血氧饱和度,以及术后精神状态和有无并发症.结果观察组94%的患儿给药时合作,对照组仅有10%,两组间差异非常显著(P＜0.01).而对照组患儿的呼吸频率和心率较观察组明显增快,两组间差异显著(P＜0.05).两组患儿麻醉诱导前脉搏、血氧饱和度正常,也无恶心、呕吐等并发症;术后清醒时间及其他与麻醉有关的并发症,两组间无显著差异.术后随访有恐惧和抵触情绪的患儿观察组为9%,对照组为83%,两组间差异非常显著(P＜0.01).结论患儿术前口服氯胺酮和咪唑安定混合液,镇痛和镇静效果良好.术中血流动力学稳定,围手术期并发症无增加,术后患儿心理和精神状态稳定.口服氯胺酮和咪唑安定混合液作为脑瘫患儿术前用药是安全和可靠的. 相似文献
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《Gait & posture》2021
AimTo examine the regional spinal curvatures and movements in the sagittal and frontal planes during sitting position, and the ability to act independently in patients with CP and to compare the differences between children and adolescents with minimal-to-moderate functional limitations.MethodTwenty-one participants diagnosed with CP aged 5–16 years were included. The participants’ Gross Motor Function Classification System (GMFCS) levels were determined and those at levels I (minimal functional limitation group: minFLG) or II-III (moderate functional limitation group: modFLG) were included. Spinal curvatures, mobilities, and inclinations in the sagittal and frontal planes were evaluated in the sitting position using a hand-held, computer-assisted non-invasive electromechanical device. Participants’ functional independence levels were assessed with the Functional Independence Measure (WeeFIM).ResultsIn the sagittal plane, there were no differences in terms of spinal curvatures between the minFLG and modFLG (p > 0.05). Spinal mobility degrees for flexion (thoracic and lumbar regions and total spine), extension (sacral region), and total spine mobility scores were significantly greater in the minFLG (p < 0.05). In the frontal plane, lumbar spinal curvature significantly increased, and total spine mobility in the right/left lateral motions and functional independence decreased in the modFLG (p < 0.05).InterpretationThe children/adolescents with minimal functional limitations had greater spinal mobility during flexion, extension, and lateral flexions. Spinal curvatures were similar between groups in the sagittal plane. The lumbar region posture scores in the frontal plane observed as lordoscoliosis were higher, and functional independence was lower in the modFLG. 相似文献
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《Radiography》2020,26(4):e246-e250
IntroductionIn the surveillance of children with cerebral palsy, the measurement of migration percentage is used to identify children at risk of hip dislocation. Early identification of children at risk facilitates early intervention with less invasive surgical procedures to prevent further deterioration.The aim of this study is to evaluate the safety of the measurements of migration percentage for surveillance in cerebral palsy by extended-role radiographers by evaluating the reliability and validity of measurements performed by these professionals.MethodsA sample of thirty pelvic x-rays were selected from the local cerebral palsy database. A range of hip displacement was selected including some challenging borderline x-rays. All ten extended-role radiographers completed measurements using TraumaCAD which were repeated at a minimum of 4 weeks.Inter-rater and intra-rater reliability was calculated using intraclass correlation coefficients. The accuracy and safety of the system was evaluated by converting measurements into referral categories (red, amber or green) and cohen's kappa was calculated when categories were compared to measurements to orthopaedic surgeonResultsThe inter-rater reliability between radiographers was 0.938 (95% CI 0.914–0.991). The intra-rater reliability was 0.941 (95% CI 0.931–0.949).The percentage agreement was 94.8% for green, 93.8% for amber and 98.2% for red hips. The weighted kappa value was 0.923 (95% CI 0.889–0.957).ConclusionThe reliability and accuracy of radiographer measurement of migration percentage is excellent. It is safe for radiographers to calculate the migration percentage using semi-automated software for the surveillance of children with cerebral palsy.Implications for practiceWe recommend the measurement of migration percentage may be performed by extended-role radiographers to deliver accurate and reliable measurements for use in cerebral palsy surveillance. 相似文献
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Morphology of cerebral lesions in children with congenital hemiplegia 总被引：13，自引：0，他引：13
Summary This study has analysed the results of CT scans of the brains in children with congenital hemiplegia. The material consists of 111 out of a total of 151 children with this cerebral palsy syndrome in a population-based series. We have classified the morphological findings in five groups. The groups are designed to reflect the phase of maturation of the brain when the insult happened. The groups are: 1. Maldevelopment, 2. Periventricular atrophy, 3. Cortical-/subcortical atrophy, 4. Miscellaneous, 5. Normal. In contrast to previous reports we found a high proportion (17%) with maldevelopment. However the dominating morphological pattern was periventricular atrophy, consistent with a hypoxic-ischemic insult to the immature brain, seen in 42%. Cortical and/or subcortical atrophy was found in 12%. Three children (3%) presented with morphological patterns not possible to classify. The group with no pathology according to CT was 26%. 相似文献
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《Gait & posture》2020
BackgroundPathologic gait is common in patients with cerebral palsy (CP). Single-event multilevel surgery (SEMLS) is a combination of surgical procedures to improve pathologic gait in patients with CP. However, the effect of each procedure is difficult to predict. The gait deviation index (GDI) is useful in comparing pre- and postoperative improvement.Research questionIn this study, we evaluated the degree of GDI improvement in patients with CP and analyzed factors related to surgical outcomes.MethodsWe screened patients seen between May 2003 and December 2019 via a clinical data warehouse to identify those with CP who had been followed up for >1 year and who had undergone SEMLS. The inclusion criteria were (1) CP patients with GMFCS levels I, II and III, (2) patients who underwent SEMLS, (3) and patients who underwent 3D gait analyses preoperatively and at least 1 year postoperatively. A linear mixed model was used to model GDI improvement, assess effects of covariates, and examine factors that contributed to improvement.ResultsOverall, 544 patients were included. The average improvement in overall GDI was 8.9 ± 12.3, 9.6 ± 12.0, and 6.4 ± 8.6 in Gross Motor Function Classification System (GMFCS) levels I, II, and III, respectively. In GMFCS level II patients, GDI improvement decreased by 0.26 points with a 1-year delay in surgery (p = 0.0022). Within each group of GMFCS levels, femoral derotation osteotomy (FDO) was a significant factor in GDI improvement in GMFCS levels I and II. Rectus femoris transfer (RFT) and supracondylar extension osteotomy (SCO) were significant factors in GMFCS level II. No single procedure was shown to affect improvement in GMFCS level III.SignificancePostoperative GDI improved in all levels of GMFCS. Particular procedures especially affected postoperative improvement in GDI in levels I and II. Our data do not mean to set an indication for particular procedures; however, in GMFCS levels I, II patients, particular procedures, such as FDO, yielded a greater GDI improvement in our data set. 相似文献
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《Gait & posture》2021
BackgroundDynamic ankle stiffness has been quantified as the slope of the ankle joint moment-angle curve over the gait interval of the second rocker, defined explicitly as the period of the gait cycle from the first relative maximum plantar flexion in early stance to maximum dorsiflexion in midstance. However, gastrocnemius spasticity may interfere with the second ankle rocker in patients with spasticity. This gait disruption results in stiffness calculations which are misleading. Current dynamic stiffness metrics need to be modified.Research QuestionThe main goal of this study was to develop and test a new method to better evaluate dynamic ankle stiffness in individuals with pathologic gait who lack a second rocker interval.MethodsTwenty unimpaired ambulators (10/20 female, 26.7 ± 5.0 years, BMI: 23.2 ± 2.2) and 9 individuals with cerebral palsy (5/9 female, 5.7 ± 1.7 years, BMI: 14.6 ± 2.1, GMFCS Levels: I – 2, II – 5, III - 2) participated in this study. Dynamic ankle stiffness was evaluated using the previous kinematic method, defined by the interval of maximum plantar flexion to maximum dorsiflexion angle in midstance, and the proposed kinetic method, defined by the interval from the maximum dorsiflexion moment to first peak plantar flexion moment. Stiffness was quantified as the linear slope between the sagittal plane ankle angle and moment. Method differences were explored using an equivalence test (α = 0.05).Results and SignificanceThere was equivalence between the methods for unimpaired ambulators (p = 0.000) and a lack of equivalence for patients with spasticity (p = 0.958). The new method was successfully applied to all 9 pediatric ambulators with CP and demonstrated increased stiffness in patients with spasticity as compared to the previous method. The ability to objectively calculate ankle stiffness in pathologic gait is critical for determining change associated with clinical intervention. 相似文献