Quantitative Evaluation of the Effects of Ankle Foot Orthosis on Gait in Children with Cerebral Palsy Using the Gait Profile Score and Gait Variable Scores

Ankle foot orthoses (AFOs) are often used in children with Cerebral Palsy (CP) to facilitate and optimise their impaired gait pattern. The aim of this study was to assess quantitatively the effects of AFOs on gait in CP using a summary measure obtained by Gait Analysis (GA): the Gait Profile Score (GPS) with its Gait Variable Scores (GVSs).A total of 21 children with CP (hemiplegic group: 11 children; diplegic group: 10 children) were evaluated barefoot and wearing AFOs using GA; GPS with its GVSs were calculated from GA data. The results evidenced that in diplegic children significant improvements when wearing AFOs were observed at pelvic tilt and ankle dorsi-plantarflexion GVS values; no changes were found as for GPS. The plegic side of hemiplegic children improved significantly globally with AFO, as displayed by the reduction of GPS value; in addition, some reductions were observed in terms of pelvic rotation and obliquity, knee flex-extension and ankle dorsi-plantarflexion GVSs. Significant changes appeared at some GVS values of the non-plegic side, too.Our results showed that, compared with barefoot gait, AFOs enhanced gait strategy in diplegic and hemiplegic children with CP. While GPS, together with GVSs, seems to be a useful method for evaluating immediate effects of AFOs in hemiplegia, in diplegia the improvements are evident only in some GVSs (pelvic tilt and ankle dorsi-plantarflexion) but not in GPS.     

Direct effect of percutaneous electric stimulation during gait in children with hemiplegic cerebral palsy: a report of 2 cases

The feasibility of using percutaneous intramuscular functional electric stimulation (FES) in children with cerebral palsy (CP) as a method to improve ankle kinematics and kinetics during gait was investigated. Two children with right hemiplegic CP had percutaneous intramuscular electrodes implanted into the gastrocnemius and tibialis anterior muscles of the involved limb. FES was provided during the gait cycle using force-sensing foot switches to detect gait phase transitions. The children ambulated using FES under 3 conditions (gastrocnemius on, tibialis anterior on, gastrocnemius and tibialis anterior on). For each condition, two 45-minute walking sessions were conducted per day for 1 week. Immediately after each week of practice, a gait analysis was performed at the subject's self-selected walking speed for that stimulation condition and without stimulation. Both children demonstrated improvements in ankle dorsiflexion angle at initial contact, peak dorsiflexion during swing, mean dorsiflexion during swing, and ankle work during early stance with tibialis anterior stimulation alone and combined gastrocnemius and tibialis anterior stimulation. Improvements in ankle work were found during late stance for both children with all stimulation conditions. These results suggest that percutaneous intramuscular FES was effective in improving aspects of ankle kinematics and kinetics of 2 children with hemiplegic CP.     

脑卒中后肩关节半脱位对偏瘫侧上肢周围神经电生理特征的影响

目的:探讨脑卒中后肩关节半脱位对偏瘫侧上肢周围神经电生理参数的影响。方法:纳入20例脑卒中伴肩关节半脱位的患者,分别对患者双上肢肩胛上神经、腋神经、肌皮神经、桡神经、正中神经、尺神经的运动神经传导及桡神经、正中神经、尺神经的感觉神经传导进行评估,并对偏瘫上肢冈上肌、三角肌、肱二头肌、伸指总肌、拇短展肌和小指展肌进行静息...     

Physique,range of motion,and gross muscle strength in hemiplegic para swimmers: a cross-sectional case series

[Purpose] The physical functions related to swimming should be evaluated to enhance competitive performance and prevent sports injuries. This study aimed to determine the physique, range of motion, and gross muscle strength of the limbs among hemiplegic para swimmers. [Participants and Methods] Three male para swimmers with hemiplegia and five male para swimmers with impaired vision were included in the study. The limb circumference, range of motion, quadriceps flexibility, and gross muscle strength were evaluated. The hemiplegic swimmers and swimmers with impaired vision were compared using an unpaired t-test. [Results] The maximum values of the upper and forearm circumferences; the range of motion for shoulder flexion, external rotation, ankle dorsiflexion on the paretic side; and the single-leg sit-to-stand test of the dominant limb were significantly lower in hemiplegic swimmers than in swimmers with impaired vision. [Conclusion] Hemiplegic swimmers had decreased upper limb circumferences on the paretic limb; the range of motion for shoulder flexion, external rotation, and ankle dorsiflexion on the paretic limb; and muscle strength on the dominant lower limb.     

Hemiplegic gait of stroke patients: the effect of using a cane.

OBJECTIVE: To assess the effects of cane use on the hemiplegic gait of stroke patients, focusing on the temporal, spatial, and kinematic variables. DESIGN: Case-control study comparing the effect of walking with and without a cane using a six-camera computerized motion analysis system. SETTING: Stroke clinic of a tertiary care hospital. PARTICIPANTS: Fifteen ambulatory stroke patients were analyzed, including 10 men and 5 women (mean age, 56.9 years; mean time since stroke, 9.8 weeks). Nine age-matched healthy elderly subjects were recruited as a control group. RESULTS: Stroke patients walking with a cane showed significantly increased stride period, stride length, and affected side step length, as well as decreased cadence and step width (p < .05) in comparison with those who walked without a cane. There were no significant differences in the gait phases and the five gait events of hemiplegic gait walking with or without a cane. Cane use thus may have more effect on spatial variables than on temporal variables. The affected-side kinematics of hemiplegic gait with a cane showed increased pelvic obliquity, hip abduction, and ankle eversion during terminal stance phase; increased hip extension, knee extension, and ankle plantar-flexion during preswing phase; and increased hip adduction, knee flexion, and ankle dorsiflexion during swing phase as compared with hemiplegic gait without a cane. A cane thus improved the hemiplegic gait by assisting the affected limb to smoothly shift the center of body mass toward the sound limb and to enhance push off during preswing phase. It also improved circumduction gait during swing phase. CONCLUSION: Stroke patients walking with a cane demonstrated more normal spatial variables and joint motion than did those without a cane.     

Kinetic Relationships between the Hip and Ankle Joints during Gait in Children with Cerebral Palsy: A Pilot Study

[Purpose] The purpose of this study was to evaluate kinetic relationships between the ankle and hip joints during gait, in the late stance, in children with spastic cerebral palsy (CP). [Subjects] The subjects were 3 ambulant children with spastic hemiplegic CP (aged 10, 13, and 14: CP group) and 3 typically developing children with the same ages (control). [Methods] A three-dimensional gait analysis including force data was performed to compare the peak moment, power, and ankle/hip power ratio between the hemiplegic (uninvolved and hemiplegic) and the control groups. In the statistical analysis, mean values from 5 gait cycles for each of 3 conditions (uninvolved, hemiplegic and control) were used. The three conditions were compared by performing a Kruskal-Wallis test and Steel-Dwass multiple comparisons. [Results] The peak moments of ankle plantar flexors in the 10-year-old case, were significantly lower on the uninvolved and hemiplegic sides compared with the control group, respectively. The peak flexion moments of the hip on the hemiplegic side were significantly higher compared with the control in the 14- and 13-year-old cases. The peak of ankle power generation (A2) in the 13- and 10-year-old cases were significantly lower on the uninvolved and hemiplegic sides, respectively, compared with the control. The peaks of hip flexor power generation (H3) in the 14- and 13-year-old cases were significantly higher on the uninvolved and hemiplegic sides, respectively. The A2/H3 ratios were significantly lower on the uninvolved and hemiplegic sides compared with the control, and the ratio for the hemiplegic side was lower than that for the uninvolved side. [Conclusion] This study shows that propulsion of walking is generated by hip, rather than the ankle, on both the hemiplegic and involved sides.Key words: Children with cerebral palsy, Gait, Ankle     

Standardization of upper limb exercises to improve radiation therapy for breast cancer,a conceptual literature review

IntroductionMany patients with breast cancer are left with upper arm mobility dysfunction following surgery. Despite the beneficial effects of upper limb exercises on shoulder dysfunction, radiation therapists still do not widely encourage patients to participate in arm exercises after surgery. This conceptual literature review synthesizes evidence on how patients with breast cancer that participate in upper limb exercises after surgery have improved arm mobility which could result in a more consistent arm position during radiation therapy.MethodsA literature search was performed in the PubMed, Athabasca University Library, and Google Scholar databases to identify articles that evaluated the effect of upper limb exercises on patients’ arm mobility and range of motion after breast cancer surgery, and the impact of arm position on anatomy during radiation therapy. Sixteen studies were included in the conceptual review synthesis.ResultsThe studies were heterogeneous in terms of the utilized exercise methods and the upper limb related outcomes measured. Twelve studies demonstrated that upper arm exercises are an effective intervention in restoring arm mobility and decreasing pain in women with breast cancer. Additionally, four studies showed that differences in arm rotation affect the breast region's anatomy, which could result in set-up errors during radiation therapy.ConclusionThe effectiveness of radiation therapy for breast cancer treatment relies on women to reproduce their shoulder position each day. Any inability to replicate the arm position due to mobility issues can affect the accuracy of the dose delivered and, ultimately, the treatment outcome. Therefore, upper limb exercises should be recommended by radiation therapists to their patients before or during radiation therapy to improve patient comfort and the accuracy of treatment. Additionally, upper limb exercise standards need to be developed for patients with breast cancer and implemented by radiation therapists.     

上肢位及椅子高度对脑卒中偏瘫患者坐-站转移时下肢负重及稳定性的影响

目的：探讨上肢位及椅子高度对脑卒中偏瘫患者坐-站转移下肢负重及稳定性的影响。方法：脑卒中偏瘫患者30例,分别在双手叉握（GA）及双手交叉胸前（CA）两种上肢位及两种不同高度的椅子（高椅及标准椅）上完成坐-站转移测试,采用AL-080型步态与平衡功能训练评估系统对受试者完成坐-站转移的时间、双下肢负重、双下肢负重不对称性（IOA）及人体重心点（COG）在冠状面上的摆动幅度（COGX）进行测量,探讨其不同差异。结果：姿势GA时,除坐-站转移所需的时间外,健足平均负重、患足平均负重、IOA及COGX与姿势CA相比较,差异均有统计学意义（P〈0.05）。在高椅子上完成坐-站转移时,与标准椅子相比较,健足平均负重、患足平均负重及IOA无明显差异,而坐-站转移所需时间以及COGX均差异有统计学意义（P〈0.05）。左侧脑卒中偏瘫与右侧偏瘫相比较,坐-站转移所需时间、患侧下肢负重、健侧下肢负重、IOA及COGX均无差异（P〈0.05）。结论：不同上肢位影响脑卒中偏瘫患者坐-站转移的下肢负重及稳定性;椅子高度影响脑卒中偏瘫患者坐-站转移的稳定性。     

艾盐包热熨手三阳经对脑卒中偏瘫患者上肢运动功能的影响

目的 观察艾盐包热熨手三阳经对脑卒中偏瘫患者上肢运动功能、上肢关节活动度和偏瘫手功能分级的影响。方法选取2021年3—9月收住福建中医药大学附属康复医院神经康复科的脑卒中后偏瘫患者86例,随机分为试验组和对照组,每组各43例。对照组进行常规内科治疗、护理与康复训练,试验组在对照组的基础上进行艾盐包手三阳经热熨,1次/d,30 min/次,5次/周,连续干预4周。于干预前、干预2周后及干预4周后评估患者上肢运动功能、上肢关节活动度、偏瘫手功能分级。结果 最终81例完成试验,试验组40例,对照组41例。结果显示,干预2周后试验组的上肢运动功能与对照组比较,差异无统计学意义（P>0.05）;干预4周后试验组的上肢运动功能优于对照组（P<0.05）。上肢关节活动度方面,干预2周后试验组肩前屈、肩后伸、肩外展、肩内旋和肘屈的活动度均优于对照组（P<0.05）,干预4周后试验组肩前屈、肩后伸、肩外展、肩内旋、肩外旋、肘屈、腕掌屈和腕背伸的关节活动度均优于对照组（P<0.05）;干预2周、干预4周后,2组偏瘫手功能分级比较,差异无统计学意义（P>0.05）。结论艾盐包热...     

Effects of auditory feedback during gait training on hemiplegic patients’ weight bearing and dynamic balance ability

[Purpose] This study examined the effects of auditory feedback during gait on the weight bearing of patients with hemiplegia resulting from a stroke. [Subjects] Thirty hemiplegic patients participated in this experiment and they were randomly allocated to an experimental group and a control group. [Methods] Both groups received neuro-developmental treatment for four weeks and the experimental group additionally received auditory feedback during gait training. In order to examine auditory feedback effects on weight bearing during gait, a motion analysis system GAITRite was used to measure the duration of the stance phase and single limb stance phase of the subjects. [Results] The experimental group showed statistically significant improvements in the duration of the stance phase and single limb stance phase of the paretic side and the results of the Timed Up and Go Test after the training. [Conclusion] Auditory feedback during gait training significantly improved the duration of the stance phase and single limb stance phase of hemiplegic stroke patients.Key words: Auditory feedback, Gait, Hemiplegic patients     

步态诱发功能性电刺激对痉挛型脑瘫足下垂患儿的疗效

目的:观察应用功能性电刺激(FES)治疗痉挛型脑瘫偏瘫患儿足下垂的疗效.方法:痉挛型脑瘫偏瘫患儿24例分为观察组和对照组各12例,2组均进行运动训练、物理因子等治疗.观察组在此基础上应用FES对偏瘫侧腓总神经进行神经肌肉电刺激治疗(NMES),同时进行步行训练.治疗前后分别用改良的Ashworth量表测定患儿腓肠肌肌张力的变化、关节量角器法测量下肢踝关节主动背屈角度和粗大运动功能量表(GMFM-88)之D区(站立)、E区(走跑跳)分值.结果:治疗12周后,2组患儿患侧腓肠肌肌张力评分均较治疗前显著降低(P＜0.01),且观察组更低于对照组(P＜0.05);2组GMFM-88之D、E区评分及踝关节主动背屈角度均高于治疗前(P＜0.01),且观察组更高于对照组(P＜0.05).结论:FES配合康复功能训练能改善痉挛型脑瘫偏瘫患儿的踝关节活动范围,提高下肢运动功能.     

Effects of different baggage carrying methods on walking while wearing an arm sling in simulated hemiplegic stroke patients

[Purpose] We aimed to clarify the effects of different baggage carrying methods on the movement of the trunk and pelvis while walking with an arm sling in simulated hemiplegic stroke patients. [Participants and Methods] The participants were 14 healthy young adults. Measurements were obtained using a three-dimensional motion analysis device in the following order: normal walking, walking with an arm sling on the upper left limb, walking with baggage on the right side, vertical walking, and diagonal walking. The range of motion of the trunk and pelvis during one walking cycle was analyzed. [Results] The range of motion of the lateral tilt of the pelvis significantly differed between normal and vertical walking, as well as between normal walking and diagonal walking. A significant difference was observed in the range of movement in pelvic rotation during the three walking cycles—walking with baggage, vertical walking, and diagonal walking. The range of movement in pelvic rotation was seemingly smaller under other conditions compared to that in normal walking. [Conclusion] It was shown that walking with restrictions on the upper limbs, such as wearing an arm sling or carrying baggage, may impose slight restrictions on the lateral tilt as well as on the rotation of the pelvis.     

Upper body movements in children with hemiplegic cerebral palsy walking with and without an ankle–foot orthosis

Background

It has previously been discussed that treatment of the hemiplegic arm in patients with cerebral palsy can improve gait parameters in the lower body. Our question was whether improving the ankle rocker with an orthosis has an effect on the upper body during walking. The main aim was to investigate, which trunk and arm kinematics of toe walking children with hemiplegic cerebral palsy are changed by wearing a hinged ankle–foot orthosis, restoring an initial heel contact.

Methods

Specific parameters of the pelvis, thorax, and arm kinematics were investigated. Differences in the hemiplegic side between the barefoot and the orthotic condition were calculated by Students t-tests. Additionally, the 95% confidence intervals were used to explore clinically relevant differences between the controls and the patients and asymmetries within the patients' affected and unaffected sides.

Findings

Pelvic tilt range of motion (barefoot: 7.5° (6.1–9.0°), orthosis: 6.6° (5.1–8.1) P = 0.040) and mean shoulder abduction (barefoot: 14.3° (10.2–18.4°), orthosis: 12.1° (8.4–15.8) P = 0.027) were the only two parameters with statistically significant differences, although not clinically relevant, between the barefoot and orthotic conditions. Abnormalities in all three planes were explored between the patients and controls. The entire trunk was more externally rotated, the pelvis stood lower, and the elbow was more flexed on the hemiplegic side compared to the unaffected side.

Interpretation

A hinged ankle–foot orthosis, restoring the first ankle rocker, had no clinically relevant effects on trunk kinematics. None of the observed upper body gait deviations seemed to be secondary to or caused by toe walking.     

Isometric Contraction of an Upper Extremity and Its Effects on the Contralateral Lower Extremity

[Purpose] The aim of this study was to examine effects of the isometric contraction of an upper limb in a supine position on the muscle activity of a healthy adult in the contralateral lower limb. [Subjects] The subjects were 40 healthy adults (35 males and 5 females). [Methods] The muscle activity of the rectus femoris (RF), biceps femoris, anterior tibialis, and medial gastrocnemius (MG) of the contralateral lower limb was measured using electromyography while the subjects flexed, extended, abducted, and adducted the shoulder joint of an upper limb. [Results] The muscle activity of the RF of the contralateral lower limb was significantly high when the subject flexed the shoulder joint of an upper limb, and the muscle activity of the MG of the contralateral lower limb was significantly high when the subject adducted the shoulder joint of an upper limb. [Conclusion] The isometric contraction that results from flexion and adduction of the shoulder joint of an upper limb in a supine position is considered to selectively affect the RF and MG activity of the contralateral lower limb.Key words: Muscle activity, Isometric contraction, Contralateral lower extremity     

Effects of a knee–ankle–foot orthosis on gait biomechanical characteristics of paretic and non-paretic limbs in hemiplegic patients with genu recurvatum

Background

A knee–ankle–foot orthosis may be prescribed for the prevention of genu recurvatum during the stance phase of gait. It allows also to limit abnormal plantarflexion during swing phase. The aim is to improve gait in hemiplegic patients and to prevent articular degeneration of the knee. However, the effects of knee–ankle–foot orthosis on both the paretic and non-paretic limbs during gait have not been evaluated. The aim of this study was to quantify biomechanical adaptations induced by wearing a knee–ankle–foot orthosis, on the paretic and non-paretic limbs of hemiplegic patients during gait.

Methods

Eleven hemiplegic patients with genu recurvatum performed two gait analyses (without and with the knee–ankle–foot orthosis). Spatio-temporal, kinematic and kinetic gait parameters of both lower limbs were quantified using an instrumented gait analysis system during the stance and swing phases of the gait cycle.

Findings

The knee–ankle–foot orthosis improved spatio-temporal gait parameters. During stance phase on the paretic side, knee hyperextension was reduced and ankle plantarflexion and hip flexion were increased. During swing phase, ankle dorsiflexion increased in the paretic limb and knee extension increased in the non-paretic limb. The paretic limb knee flexion moment also decreased.

Interpretation

Wearing a knee–ankle–foot orthosis improved gait parameters in hemiplegic patients with genu recurvatum. It increased gait velocity, by improving cadence, stride length and non-paretic step length. These spatiotemporal adaptations seem mainly due to the decrease in knee hyperextension during stance phase and to the increase in paretic limb ankle dorsiflexion during both phases of the gait cycle.     

The development and validity of the Salford Gait Tool: an observation-based clinical gait assessment tool

OBJECTIVES: To develop the construct, content, and criterion validity of the Salford Gait Tool (SF-GT) and to evaluate agreement between gait observations using the SF-GT and kinematic gait data. DESIGN: Tool development and comparative evaluation. SETTING: University in the United Kingdom. PARTICIPANTS: For designing construct and content validity, convenience samples of 10 children with hemiplegic, diplegic, and quadriplegic cerebral palsy (CP) and 152 physical therapy students and 4 physical therapists were recruited. For developing criterion validity, kinematic gait data of 13 gait clusters containing 56 children with hemiplegic, diplegic, and quadriplegic CP and 11 neurologically intact children was used. For clinical evaluation, a convenience sample of 23 pediatric physical therapists participated. INTERVENTIONS: We developed a sagittal plane observational gait assessment tool through a series of design, test, and redesign iterations. The tool's grading system was calibrated using kinematic gait data of 13 gait clusters and was evaluated by comparing the agreement of gait observations using the SF-GT with kinematic gait data. MAIN OUTCOME MEASURES: Criterion standard kinematic gait data. RESULTS: There was 58% mean agreement based on grading categories and 80% mean agreement based on degree estimations evaluated with the least significant difference method. CONCLUSIONS: The new SF-GT has good concurrent criterion validity.     

A型肉毒毒素注射配合康复功能训练对痉挛型偏瘫脑瘫患儿上肢运动功能疗效观察

目的观察A型肉毒毒素(BTX-A)注射治疗配合康复功能训练对痉挛型偏瘫脑瘫患儿上肢功能障碍的疗效。方法60例痉挛型偏瘫型脑瘫患儿均接受BTX-A注射治疗,治疗后进行强制性诱导运动训练、物理疗法、肌电生物反馈治疗、作业治疗及家庭训练。在治疗前与治疗3 个月后,分别用改良Ashworth 痉挛量表(MAS)评定患侧上肢肌张力、关节量角器法测量患侧腕关节主动背伸角度、Peabody 运动发育量表(PDMS-II)进行患侧手精细运动商(FMQ)的评估、日常生活活动能力(ADL)量表评估ADL 能力以比较观察疗效。结果治疗后患儿上述指标均较治疗前显著改善(P<0.001)。结论BTX-A注射治疗配合康复功能训练能明显降低痉挛型偏瘫型脑瘫患儿的上肢肌张力,改善关节活动范围,明显提高上肢运动功能。     

Thoracic position effect on shoulder range of motion, strength, and three-dimensional scapular kinematics.

OBJECTIVES: To determine the effect of thoracic posture on scapular movement patterns, active range of motion (ROM) in scapular plane abduction, and isometric scapular plane abduction muscle force. STUDY DESIGN AND METHOD: Repeated measures design. There were 34 healthy subjects (mean age, 30.2 yrs). Each subject was positioned and stabilized while sitting in both erect and slouched trunk postures. In each sitting posture a three-dimensional electromechanical digitizer was used to measure thoracic flexion and scapular position and orientation in three planes. Measurements were taken with the arm (1) at the side, (2) abducted to horizontal in the scapular plane, and (3) at maximum scapular plane abduction. In each posture, isometric abduction muscle force was measured with the arm at the side and abducted to horizontal in the scapular plane. RESULTS: In the slouched posture, the scapula was significantly more elevated in the interval between 0 to 90 degrees abduction. In the interval between 90 degrees and maximum abduction, the slouched posture resulted in significantly less scapular posterior tilting. There was significantly less active shoulder abduction ROM in the slouched posture (mean difference = 23.6 degrees +/- 10.7 degrees). Muscle force was not different between slouched and erect postures with the arm at the side, but with the arm horizontal muscle force was decreased 16.2% in the slouched position. CONCLUSION: Thoracic spine position significantly affects scapular kinematics during scapular plane abduction, and the slouched posture is associated with decreased muscle force.     

Plantarflexor training affects propulsive force generation during gait in children with spastic hemiplegic cerebral palsy: a pilot study

[Purpose] The purpose of this preliminary study was to assess the trade-off relationship between the hip and ankle joints after plantarflexor training in children with spastic hemiplegic cerebral palsy (CP). [Subjects and Methods] Three boys aged 9, 10, and 13 years with spastic hemiplegic CP participated in the study. Gait analysis was performed using a three-dimensional motion analysis device and a floor reaction force detection device before and after plantarflexor training. Data on gait speed and stride length for both sides were collected. Peak hip and ankle powers in the sagittal plane and ankle-to-hip power ratio (A2/H3 ratio) were calculated. Plantarflexor training comprised heel raises and exercise band resistance at the participant’s home (3 times/week for 12 weeks). [Results] The A2/H3 ratio increased significantly on both sides in two of three subjects after training. Peak A2 power increased significantly on both sides in subject 3 and on the affected side of subject 2. Peak H3 power decreased significantly on the non-affected side of subjects 1 and 2. [Conclusion] This study confirmed that two of three subjects demonstrated a trade-off relationship between the hip and ankle joints during gait after plantarflexor training.