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Oudenhoven LM, van der Krogt MM, Romei M, van Schie PE, van de Pol LA, van Ouwerkerk WJ, Harlaar J, Buizer AI. Factors Associated With Long-Term Improvement of Gait After Selective Dorsal Rhizotomy. Arch Phys Med Rehabil 2019; 100:474-480. [DOI: 10.1016/j.apmr.2018.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 05/03/2018] [Accepted: 06/13/2018] [Indexed: 12/19/2022]
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Buizer AI, Martens BHM, Grandbois van Ravenhorst C, Schoonmade LJ, Becher JG, Vermeulen RJ. Effect of continuous intrathecal baclofen therapy in children: a systematic review. Dev Med Child Neurol 2019; 61:128-134. [PMID: 30187921 PMCID: PMC7379262 DOI: 10.1111/dmcn.14005] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2018] [Indexed: 01/09/2023]
Abstract
AIM To investigate the effects of continuous intrathecal baclofen (ITB) therapy in children with cerebral palsy (CP) and other neurological conditions. METHOD This systematic review was conducted using standardized methodology, searching four electronic databases (PubMed, Embase, CINAHL, Cochrane Library) for relevant literature published between inception and September 2017. Included studies involved continuous ITB as an intervention and outcome measures relating to all International Classification of Functioning, Disability and Health: Children and Youth (ICF-CY) components. RESULTS Thirty-three studies were identified, of which one, including 17 children with spastic CP, produced level II evidence, and the others, mainly non-controlled cohort studies, level IV and V. Outcomes at body function level were most frequently reported. Results suggest continuous ITB may be effective in reducing spasticity and dystonia in CP, as well as other neurological conditions, and may improve the ease of care and quality of life of children with CP, but the level of evidence is low. INTERPRETATION Despite three decades of applying ITB in children and a relatively large number of studies investigating the treatment effects, a direct link has not yet been demonstrated because of the low scientific quality of the primary studies. Further investigation into the effects of continuous ITB at all levels of the ICF-CY is warranted. Although large, controlled trials may be difficult to realize, national and international collaborations may provide opportunities. Also, multicentre prospective cohort studies with a long-term follow-up, employing harmonized outcome measures, can offer prospects to expand our knowledge of the effects of continuous ITB therapy in children. WHAT THIS PAPER ADDS There is low-level evidence for continuous intrathecal baclofen (ITB) in children with cerebral palsy. Continuous ITB is effective in reducing spasticity and dystonia in non-controlled cohort studies. Evaluation of individual goals and systematic assessment of long-term effects in large cohort studies are required.
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Affiliation(s)
- Annemieke I Buizer
- Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, the Netherlands
| | - Brian H M Martens
- Department of Neurology, Section of Pediatric Neurology, Maastricht UMC+, Maastricht, the Netherlands
| | - Casey Grandbois van Ravenhorst
- Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, the Netherlands
| | | | - Jules G Becher
- Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, the Netherlands
| | - R Jeroen Vermeulen
- Department of Neurology, Section of Pediatric Neurology, Maastricht UMC+, Maastricht, the Netherlands
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van der Veldt N, van Rappard DF, van de Pol LA, van der Knaap MS, van Ouwerkerk WJR, Becher JG, Wolf NI, Buizer AI. Intrathecal baclofen in metachromatic leukodystrophy. Dev Med Child Neurol 2019; 61:232-235. [PMID: 29806077 PMCID: PMC7379712 DOI: 10.1111/dmcn.13919] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2018] [Indexed: 01/30/2023]
Abstract
Metachromatic leukodystrophy (MLD) is a rare progressive neurological disorder, often accompanied by motor impairments that are challenging to treat. In this case series, we report the course of treatment with intrathecal baclofen (ITB), aimed at improving daily care and comfort in children and young adults with MLD. All patients with MLD in our centre on ITB treatment for a minimum of 6 months were included (n=10; 4 males, 6 females; mean age 10y 8mo [range 6-24y]). Eight patients had MLD with a predominant spastic movement disorder (sMLD) and two were mainly dyskinetic. Patients with sMLD were compared with matched patients with spastic cerebral palsy (CP). Complication rates related to ITB treatment were similar in both groups. ITB treatment course in the first 6 months after pump implantation appears to show more dose increase in most patients MLD, compared to patients with spastic CP. This may be due to the progressive disease in MLD. ITB is a feasible therapy to improve daily care and comfort in patients with MLD and should therefore be considered early. WHAT THIS PAPER ADDS: Intrathecal baclofen (ITB) is a feasible therapy to improve comfort and daily care in children and young people with metachromatic leukodystrophy (MLD). In the first 6 months of ITB treatment, MLD seems to show more dose increase compared to spastic cerebral palsy.
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Affiliation(s)
- Nikki van der Veldt
- Department of Rehabilitation MedicineVU University Medical CenterAmsterdam Movement SciencesAmsterdamthe Netherlands
| | - Diane F van Rappard
- Department of Child NeurologyCenter for Childhood White Matter DisordersVU University Medical Center and Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Laura A van de Pol
- Department of Child NeurologyCenter for Childhood White Matter DisordersVU University Medical Center and Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Marjo S van der Knaap
- Department of Child NeurologyCenter for Childhood White Matter DisordersVU University Medical Center and Amsterdam NeuroscienceAmsterdamthe Netherlands
| | | | - Jules G Becher
- Department of Rehabilitation MedicineVU University Medical CenterAmsterdam Movement SciencesAmsterdamthe Netherlands
| | - Nicole I Wolf
- Department of Child NeurologyCenter for Childhood White Matter DisordersVU University Medical Center and Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation MedicineVU University Medical CenterAmsterdam Movement SciencesAmsterdamthe Netherlands
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54
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Booth ATC, Buizer AI, Meyns P, Oude Lansink ILB, Steenbrink F, van der Krogt MM. The efficacy of functional gait training in children and young adults with cerebral palsy: a systematic review and meta-analysis. Dev Med Child Neurol 2018; 60:866-883. [PMID: 29512110 DOI: 10.1111/dmcn.13708] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2018] [Indexed: 11/28/2022]
Abstract
AIM The aim of this systematic review was to investigate the effects of functional gait training on walking ability in children and young adults with cerebral palsy (CP). METHOD The review was conducted using standardized methodology, searching four electronic databases (PubMed, Embase, CINAHL, Web of Science) for relevant literature published between January 1980 and January 2017. Included studies involved training with a focus on actively practising the task of walking as an intervention while reporting outcome measures relating to walking ability. RESULTS Forty-one studies were identified, with 11 randomized controlled trials included. There is strong evidence that functional gait training results in clinically important benefits for children and young adults with CP, with a therapeutic goal of improved walking speed. Functional gait training was found to have a moderate positive effect on walking speed over standard physical therapy (effect size 0.79, p=0.04). Further, there is weaker yet relatively consistent evidence that functional gait training can also benefit walking endurance and gait-related gross motor function. INTERPRETATION There is promising evidence that functional gait training is a safe, feasible, and effective intervention to target improved walking ability in children and young adults with CP. The addition of virtual reality and biofeedback can increase patient engagement and magnify effects. WHAT THIS PAPER ADDS Functional gait training is a safe, feasible, and effective intervention to improve walking ability. Functional gait training shows larger positive effects on walking speed than standard physical therapy. Walking endurance and gait-related gross motor function can also benefit from functional gait training. Addition of virtual reality and biofeedback shows promise to increase engagement and improve outcomes.
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Affiliation(s)
- Adam T C Booth
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Department of Clinical Applications and Research, Motek Medical BV, Amsterdam, the Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Pieter Meyns
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Faculty of Medicine and Life Sciences, REVAL Rehabilitation Research Center - BIOMED Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Irene L B Oude Lansink
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Frans Steenbrink
- Department of Clinical Applications and Research, Motek Medical BV, Amsterdam, the Netherlands
| | - Marjolein M van der Krogt
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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55
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Romei M, Oudenhoven LM, van Schie PEM, van Ouwerkerk WJR, van der Krogt MM, Buizer AI. Evolution of gait in adolescents and young adults with spastic diplegia after selective dorsal rhizotomy in childhood: A 10 year follow-up study. Gait Posture 2018; 64:108-113. [PMID: 29894977 DOI: 10.1016/j.gaitpost.2018.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/20/2018] [Accepted: 06/03/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Short-term benefit on gait of selective dorsal rhizotomy (SDR) surgery, which relieves spasticity of the lower extremities has been demonstrated in children with cerebral palsy (CP). However very little is known of the evolution of gait when patients become adolescents and young adults. RESEARCH QUESTION How does the gait pattern evolve in adolescents and young adults who underwent SDR during childhood? METHODS A longitudinal study was performed including 19 ambulant patients with spastic diplegia due to CP or other causes (mean age at SDR: 6.6 ± 1.6 years) who were assessed four times: pre-SDR, 2 years post- SDR, 5 years post-SDR and at least 10 years post-SDR. From 2D video recordings, Edinburgh Visual Gait Score and lower limb joint kinematic parameters were calculated. RESULTS Our data show that the improvement in the gait pattern obtained short-term after SDR continues during into adolescence and adulthood. Ten years after SDR all patients improved compared to baseline. Considering the lower limb joint kinematics, most notable improvements were found at knee and ankle joints. Compared to the evaluation before SDR, the range of motion of the knee increased: the knee was more extended at initial contact and knee flexion in midswing improved. Excessive ankle plantar flexion was reduced during the entire gait cycle. Only minor changes were found at hip and pelvis. Eight patients underwent additional orthopaedic surgery in the years after SDR, and the present findings should be considered as a combination of SDR, development and additional treatment. SIGNIFICANCE We demonstrate lasting improvement of gait quality in ambulant patients with spastic diplegia who underwent SDR during childhood when they become adolescents and young adults.
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Affiliation(s)
- Marianna Romei
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
| | - Laura M Oudenhoven
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
| | - Petra E M van Schie
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
| | | | - Marjolein M van der Krogt
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
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56
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van de Pol LA, Vermeulen RJ, van 't Westende C, van Schie PEM, Bolster EAM, van Ouwerkerk PWJR, Strijers RL, Becher JG, Stadhouder A, de Graaf P, Buizer AI. Risk Factors for Dystonia after Selective Dorsal Rhizotomy in Nonwalking Children and Adolescents with Bilateral Spasticity. Neuropediatrics 2018; 49:44-50. [PMID: 29112992 DOI: 10.1055/s-0037-1607395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We recently showed a beneficial effect of selective dorsal rhizotomy (SDR) on daily care and comfort in nonwalking children with severe bilateral spasticity. However, despite careful selection, some patients showed dystonia after the intervention, in which cases caregivers tended to be less satisfied with the result.The aim of this study is to identify risk factors for dystonia after SDR in children and adolescents with severe bilateral spasticity (GMFCS levels IV/V).Clinical and MRI risk factors for dystonia after SDR were studied in our cohort of 24 patients. Patients with clinical evidence of dystonia and brain MRI showing basal ganglia abnormalities were excluded for SDR.Nine of 24 patients (38%) showed some degree of dystonia after SDR. There was a significant association between the cause of spasticity and dystonia after SDR; in six (67%) patients with a congenital disorder, dystonia was present versus three (20%) with an acquired disorder (Chi-squared test: C(1) = 5.23, p = 0.02).This study allows more optimal selection of patients that may benefit from SDR. Patients with an acquired cause of spasticity, when selected carefully on clinical examination and MRI, rarely show dystonia after SDR. However, patients with an underlying congenital disorder have a considerable risk of dystonia after SDR.
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Affiliation(s)
- Laura A van de Pol
- Department of Child Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - R Jeroen Vermeulen
- Child Neurology, Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Petra E M van Schie
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Eline A M Bolster
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | | | - Rob L Strijers
- Department of Clinical Neurophysiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Jules G Becher
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Agnita Stadhouder
- Department of Orthopaedic Surgery, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Pim de Graaf
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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57
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van de Pol LA, Vermeulen RJ, van 't Westende C, van Schie PEM, Bolster EAM, van Ouwerkerk PWJR, Strijers RL, Becher JG, Stadhouder A, de Graaf P, Buizer AI. Erratum: Risk Factors for Dystonia after Selective Dorsal Rhizotomy in Nonwalking Children and Adolescents with Bilateral Spasticity. Neuropediatrics 2018; 49:e1. [PMID: 29241261 DOI: 10.1055/s-0037-1613692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Laura A van de Pol
- Department of Child Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - R Jeroen Vermeulen
- Child Neurology, Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Petra E M van Schie
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Eline A M Bolster
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | | | - Rob L Strijers
- Department of Clinical Neurophysiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Jules G Becher
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Agnita Stadhouder
- Department of Orthopaedic Surgery, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Pim de Graaf
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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58
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Ancillao A, van der Krogt MM, Buizer AI, Witbreuk MM, Cappa P, Harlaar J. Analysis of gait patterns pre- and post- Single Event Multilevel Surgery in children with Cerebral Palsy by means of Offset-Wise Movement Analysis Profile and Linear Fit Method. Hum Mov Sci 2017; 55:145-155. [PMID: 28829950 DOI: 10.1016/j.humov.2017.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/16/2017] [Accepted: 08/08/2017] [Indexed: 10/19/2022]
Abstract
Gait analysis is used for the assessment of walking ability of children with cerebral palsy (CP), to inform clinical decision making and to quantify changes after treatment. To simplify gait analysis interpretation and to quantify deviations from normality, some quantitative synthetic descriptors were developed over the years, such as the Movement Analysis Profile (MAP) and the Linear Fit Method (LFM), but their interpretation is not always straightforward. The aims of this work were to: (i) study gait changes, by means of synthetic descriptors, in children with CP that underwent Single Event Multilevel Surgery; (ii) compare the MAP and the LFM on these patients; (iii) design a new index that may overcome the limitations of the previous methods, i.e. the lack of information about the direction of deviation or its source. Gait analysis exams of 10 children with CP, pre- and post-surgery, were collected and MAP and LFM were computed. A new index was designed asa modified version of the MAP by separating out changes in offset (named OC-MAP). MAP documented an improvement in the gait pattern after surgery. The highest effect was observed for the knee flexion/extension angle. However, a worsening was observed as an increase in anterior pelvic tilt. An important source of gait deviation was recognized in the offset between observed tracks and reference. OC-MAP allowed the assessment of the offset component versus the shape component of deviation. LFM provided results similar to OC-MAP offset analysis but could not be considered reliable due to intrinsic limitations. As offset in gait features played an important role in gait deviation, OC-MAP synthetic analysis was proposed as a novel approach to a meaningful parameterisation of global deviations in gait patterns of subjects with CP and gait changes after treatment.
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Affiliation(s)
- Andrea Ancillao
- Dept. of Mechanical and Aerospace Engineering, "Sapienza" University of Rome, Via Eudossiana 18, 00184 Roma, Italy; Dept. of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Marjolein M van der Krogt
- Dept. of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Annemieke I Buizer
- Dept. of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Melinda M Witbreuk
- Dept. of Orthopedic Surgery, VU University Medical Center, Amsterdam Movement Sciences, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
| | - Paolo Cappa
- Dept. of Mechanical and Aerospace Engineering, "Sapienza" University of Rome, Via Eudossiana 18, 00184 Roma, Italy
| | - Jaap Harlaar
- Dept. of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
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Bolster EAM, Balemans ACJ, Brehm MA, Buizer AI, Dallmeijer AJ. Energy cost during walking in association with age and body height in children and young adults with cerebral palsy. Gait Posture 2017; 54:119-126. [PMID: 28288332 DOI: 10.1016/j.gaitpost.2017.02.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 02/10/2017] [Accepted: 02/26/2017] [Indexed: 02/02/2023]
Abstract
AIM This cross-sectional study into children and young adults with cerebral palsy (CP) aimed to assess the association of gross energy cost (EC), net EC and net nondimensional (NN) EC during walking with age and body height, compared to typically developing (TD) peers. METHOD Data was collected in 128 participants with CP (mean age 11y9mo; GMFCS I,n=48; II,n=56; III, n=24) and in 63 TD peers (mean age 12y5mo). Energy cost was assessed by measuring the oxygen consumption during over-ground walking at comfortable speed. Outcome measures derived from the assessment included the gross and net EC, and NN EC. Differences between the groups in the association between gross, net and NN EC with age and body height, were investigated with regression analyses and interaction effects (p<0.05). RESULTS Interaction effects for age and body height by group were not significant, indicating similar associations for gross, net and NN EC with age or body height among groups. The models showed a significant decline for gross, net and NN EC with increasing age per year (respectively -0.201Jkg-1m-1; -0.073Jkg-1m-1; -0.007) and body height per cm (respectively -0.057Jkg-1m-1; -0.021Jkg-1m-1; -0.002). INTERPRETATION Despite higher gross and net EC values for CP compared to TD participants , similar declines in EC outcomes can be expected with growth for participants aged 4-22 years with CP. All energy cost outcomes showed a decline with growth, indicating that correcting for this decline is required when evaluating changes in gross EC, and, to a lesser extent, in net and NN EC in response to treatment or from natural course over time.
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Affiliation(s)
- Eline A M Bolster
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, The Netherlands.
| | - Astrid C J Balemans
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, The Netherlands; Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center, De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
| | - Merel-Anne Brehm
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, The Netherlands; Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, The Netherlands.
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, The Netherlands.
| | - Annet J Dallmeijer
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, The Netherlands.
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Buizer AI, van Schie PEM, Bolster EAM, van Ouwerkerk WJ, Strijers RL, van de Pol LA, Stadhouder A, Becher JG, Vermeulen RJ. Effect of selective dorsal rhizotomy on daily care and comfort in non-walking children and adolescents with severe spasticity. Eur J Paediatr Neurol 2017; 21:350-357. [PMID: 27908676 DOI: 10.1016/j.ejpn.2016.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 09/12/2016] [Accepted: 09/20/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND In non-walking children with severe spasticity, daily care can be difficult and many patients suffer from pain. Selective dorsal rhizotomy (SDR) reduces spasticity in the legs, and therefore has the potential to improve daily care and comfort. AIM To examine effects of SDR on daily care and comfort in non-walking children with severe spasticity due to different underlying neurological conditions. METHODS Medical history, changes in daily care and comfort and satisfaction with outcome were assessed retrospectively in non-walking children who underwent SDR in our center, with a mean follow-up of 1y 7m (range 11m-4y 3m). All eligible patients (n = 24, years 2009-2014) were included. RESULTS Mean age at SDR was 12y 4m (SD 4y 3m, range 2y 8m-19y 3m). Associated orthopaedic problems were frequent. Seven patients underwent scoliosis correction in the same session. Most improvements were reported in dressing (n = 16), washing (n = 12) and comfort (n = 10). Median score for satisfaction was 7 on a scale of 10 (range 1-9). SDR resulted in reduction of spasticity in leg muscles. In nine patients dystonia was recorded post-operatively, mainly in children with congenital malformations and syndromes. INTERPRETATION SDR is a single event intervention that can improve daily care and comfort in non-walking children with severe spasticity, and can safely be combined with scoliosis correction. Despite the improvements, satisfaction is variable. Careful attention is necessary for risk factors for dystonia, which may be unmasked after SDR.
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Affiliation(s)
- A I Buizer
- Department of Rehabilitation Medicine, Research Institute MOVE, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - P E M van Schie
- Department of Rehabilitation Medicine, Research Institute MOVE, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - E A M Bolster
- Department of Rehabilitation Medicine, Research Institute MOVE, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - W J van Ouwerkerk
- Department of Neurosurgery, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - R L Strijers
- Department of Clinical Neurophysiology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - L A van de Pol
- Department of Child Neurology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - A Stadhouder
- Department of Orthopaedic Surgery, Research Institute MOVE, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - J G Becher
- Department of Rehabilitation Medicine, Research Institute MOVE, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - R J Vermeulen
- Department of Neurology, Maastricht University Medical Center+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
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61
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Sloot LH, Bar-On L, van der Krogt MM, Aertbeliën E, Buizer AI, Desloovere K, Harlaar J. Motorized versus manual instrumented spasticity assessment in children with cerebral palsy. Dev Med Child Neurol 2017; 59:145-151. [PMID: 27363603 DOI: 10.1111/dmcn.13194] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2016] [Indexed: 01/08/2023]
Abstract
AIM We compared the outcomes of manual and motorized instrumented ankle spasticity assessments in children with cerebral palsy (CP). METHOD Ten children with spastic CP (three males, seven females; mean age 11y [standard deviation 3y], range 6-14y; Gross Motor Function Classification System levels I-III) were included. During motorized assessments, fast (100°/s) rotations were imposed around the ankle joint by a motor-driven footplate; during manual assessments, rotations of comparable speed were applied by a therapist using a foot orthotic. Angular range of motion, maximum velocity, acceleration, work, and muscle activity (electromyography [EMG]) of the triceps surae and tibialis anterior were compared during passive muscle stretch between motorized and manual assessments. Both movement profiles were also compared to CP gait ankle movement profile. RESULTS The imposed movement profile differed between methods, with the motorized assessment reaching higher maximum acceleration. Despite equal maximum velocity, the triceps surae were more often activated in motorized assessments, with low agreement of 44% to 72% (κ≤0) for EMG onset occurrence between methods. The manually applied ankle velocity profile matched more closely with the gait profile. INTERPRETATION The differences in acceleration possibly account for the different muscle responses, which may suggest acceleration, rather than velocity-dependency of the stretch reflex. Future prototypes of instrumented spasticity assessments should standardize movement profiles, preferably by developing profiles that mimic functional tasks such as walking.
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Affiliation(s)
- Lizeth H Sloot
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
| | - Lynn Bar-On
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, the Netherlands.,Department of Rehabilitation Sciences, Research Group for Neuromotor Rehabilitation, KU Leuven, Leuven, Belgium
| | - Marjolein M van der Krogt
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
| | - Erwin Aertbeliën
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, Research Group for Neuromotor Rehabilitation, KU Leuven, Leuven, Belgium
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
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Warnink-Kavelaars J, Vermeulen RJ, Buizer AI, Becher JG. Botulinum neurotoxin treatment in children with cerebral palsy: validation of a needle placement protocol using passive muscle stretching and relaxing. Dev Med Child Neurol 2016; 58:1281-1287. [PMID: 27381267 DOI: 10.1111/dmcn.13176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2016] [Indexed: 11/28/2022]
Abstract
AIM To validate a detailed intramuscular needle placement protocol using passive muscle stretching and relaxing for botulinum neurotoxin type A (BoNT-A) treatment in the lower extremity of children with spastic cerebral palsy (CP), with verification by electrical stimulation. METHOD A prospective observational study was performed in 75 children with spastic CP who received regular BoNT-A treatment under general anaesthesia (52 males, 23 females; mean age 8y 9mo, SD 3y 7mo, range 4-18y; mean body mass index 16.2, SD 3.7, range 7.7-26.7). A total of 1084 intramuscular needle placements using passive muscle stretching and relaxing were verified by electrical stimulation. Primary outcome was the positive predictive value. RESULTS Intramuscular needle placement in the muscles adductor brevis, adductor longus, gracilis, semimembranosus, semitendinosus, biceps femoris, rectus femoris, and lateral and medial heads of the gastrocnemius and soleus had a positive predictive value ranging from 85.7% to 100% (95% confidence interval ranging from 71.5-89.9% to 91.4-100%). INTERPRETATION This validated detailed protocol for intramuscular needle placement using passive muscle stretching and relaxing for BoNT-A treatment in the lower extremity of children with spastic CP is reliable and has a high positive predictive value.
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Affiliation(s)
- Jessica Warnink-Kavelaars
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - R Jeroen Vermeulen
- Child Neurology, Department of Neurology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Jules G Becher
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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Haberfehlner H, Jaspers RT, Rutz E, Becher JG, Harlaar J, van der Sluijs JA, Witbreuk MM, Romkes J, Freslier M, Brunner R, Maas H, Buizer AI. Knee Moment-Angle Characteristics and Semitendinosus Muscle Morphology in Children with Spastic Paresis Selected for Medial Hamstring Lengthening. PLoS One 2016; 11:e0166401. [PMID: 27861523 PMCID: PMC5115739 DOI: 10.1371/journal.pone.0166401] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 10/30/2016] [Indexed: 11/18/2022] Open
Abstract
To increase knee range of motion and improve gait in children with spastic paresis (SP), the semitendinosus muscle (ST) amongst other hamstring muscles is frequently lengthened by surgery, but with variable success. Little is known about how the pre-surgical mechanical and morphological characteristics of ST muscle differ between children with SP and typically developing children (TD). The aims of this study were to assess (1) how knee moment-angle characteristics and ST morphology in children with SP selected for medial hamstring lengthening differ from TD children, as well as (2) how knee moment-angle characteristics and ST morphology are related. In nine SP and nine TD children, passive knee moment-angle characteristics and morphology of ST (i.e. fascicle length, muscle belly length, tendon length, physiological cross-sectional area, and volume) were assessed by hand-held dynamometry and freehand 3D ultrasound, respectively. At net knee flexion moments above 0.5 Nm, more flexed knee angles were found for SP compared to TD children. The measured knee angle range between 0 and 4 Nm was 30% smaller in children with SP. Muscle volume, physiological cross-sectional area, and fascicle length normalized to femur length were smaller in SP compared to TD children (62%, 48%, and 18%, respectively). Sixty percent of the variation in knee angles at 4 Nm net knee moment was explained by ST fascicle length. Altered knee moment-angle characteristics indicate an increased ST stiffness in SP children. Morphological observations indicate that in SP children planned for medial hamstring lengthening, the longitudinal and cross-sectional growth of ST muscle fibers is reduced. The reduced fascicle length can partly explain the increased ST stiffness and, hence, a more flexed knee joint in these SP children.
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Affiliation(s)
- Helga Haberfehlner
- Laboratory for Myology, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
- MOVE Research Institute Amsterdam, The Netherlands
| | - Richard T. Jaspers
- Laboratory for Myology, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
- MOVE Research Institute Amsterdam, The Netherlands
- * E-mail:
| | - Erich Rutz
- Pediatric Orthopaedic Department, University Children’s Hospital Basle (UKBB), Basle, Switzerland
- Laboratory for Movement Analysis, University Children's Hospital Basle (UKBB), Basle, Switzerland
| | - Jules G. Becher
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
- MOVE Research Institute Amsterdam, The Netherlands
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
- MOVE Research Institute Amsterdam, The Netherlands
| | - Johannes A. van der Sluijs
- MOVE Research Institute Amsterdam, The Netherlands
- Department of Orthopaedic Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Melinda M. Witbreuk
- MOVE Research Institute Amsterdam, The Netherlands
- Department of Orthopaedic Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Jacqueline Romkes
- Laboratory for Movement Analysis, University Children's Hospital Basle (UKBB), Basle, Switzerland
| | - Marie Freslier
- Laboratory for Movement Analysis, University Children's Hospital Basle (UKBB), Basle, Switzerland
| | - Reinald Brunner
- Pediatric Orthopaedic Department, University Children’s Hospital Basle (UKBB), Basle, Switzerland
- Laboratory for Movement Analysis, University Children's Hospital Basle (UKBB), Basle, Switzerland
| | - Huub Maas
- Laboratory for Myology, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
- MOVE Research Institute Amsterdam, The Netherlands
| | - Annemieke I. Buizer
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
- MOVE Research Institute Amsterdam, The Netherlands
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64
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Grootveld LR, van Schie PEM, Buizer AI, Jeroen Vermeulen R, van Ouwerkerk WJR, Strijers RLM, Becher JJG. Sudden falls as a persistent complication of selective dorsal rhizotomy surgery in children with bilateral spasticity: report of 3 cases. J Neurosurg Pediatr 2016; 18:192-5. [PMID: 27104630 DOI: 10.3171/2016.2.peds15527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Selective dorsal rhizotomy (SDR) surgery is a well-established treatment for ambulatory children with bilateral spastic paresis and is performed to eliminate spasticity and improve walking. The objective of this case report is to describe sudden falls as a persistent complication of SDR. The authors report on 3 patients with bilateral spastic paresis, aged 12, 6, and 7 years at the time of surgery. The percentage of transected dorsal rootlets was around 40% at the L2-S1 levels. Sudden falls were reported with a frequency of several a day, continuing for years after SDR. The falls were often triggered by performing dual tasks as well as occurring in the transition from sitting to standing, during running, after strenuous exercise, or following a fright. Patients also had residual hyperesthesia and dysesthesia of the foot sole. The authors hypothesize that the sudden falls are caused by a muscle inhibition reflex of the muscles in the legs, as an abnormal reaction to a sensory stimulus that is perceived with increased intensity by a patient with hyperesthesia. A favorable effect of gabapentin medication supports this hypothesis.
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Affiliation(s)
| | | | | | - R Jeroen Vermeulen
- Department of Child Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Rob L M Strijers
- Clinical Neurophysiology, VU University Medical Center, Amsterdam; and
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65
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Haberfehlner H, Maas H, Harlaar J, Becher JG, Buizer AI, Jaspers RT. Freehand three-dimensional ultrasound to assess semitendinosus muscle morphology. J Anat 2016; 229:591-9. [PMID: 27271461 PMCID: PMC5013067 DOI: 10.1111/joa.12501] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2016] [Indexed: 11/26/2022] Open
Abstract
In several neurological disorders and muscle injuries, morphological changes of the m. semitendinosus (ST) are presumed to contribute to movement limitations around the knee. Freehand three-dimensional (3D) ultrasound (US), using position tracking of two-dimensional US images to reconstruct a 3D voxel array, can be used to assess muscle morphology in vivo. The aims of this study were: (i) to introduce a newly developed 3D US protocol for ST; and (ii) provide a first comparison of morphological characteristics determined by 3D US with those measured on dissected cadaveric muscles. Morphological characteristics of ST (e.g. muscle belly length, tendon length, fascicle length and whole muscle volume, and volumes of both compartments) were assessed in six cadavers using a 3D US protocol. Subsequently, ST muscles were removed from the body to measure the same morphological characteristics. Mean differences between morphological characteristics measured by 3D US and after dissection were smaller than 10%. Intra-class correlation coefficients (ICCs) were higher than 0.75 for all variables except for the lengths of proximal fascicles (ICC = 0.58). Measurement of the volume of proximal compartment by 3D US was not feasible, due to low US image quality proximally. We conclude that the presented 3D US protocol allows for reasonably accurate measurements of key morphological characteristics of ST muscle.
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Affiliation(s)
- Helga Haberfehlner
- Laboratory for Myology, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, VU University Medical Center, MOVE Research Institute Amsterdam, The Netherlands
| | - Huub Maas
- Laboratory for Myology, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, The Netherlands
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, VU University Medical Center, MOVE Research Institute Amsterdam, The Netherlands
| | - Jules G Becher
- Department of Rehabilitation Medicine, VU University Medical Center, MOVE Research Institute Amsterdam, The Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, VU University Medical Center, MOVE Research Institute Amsterdam, The Netherlands
| | - Richard T Jaspers
- Laboratory for Myology, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, The Netherlands
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66
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Kerkum YL, Harlaar J, Buizer AI, van den Noort JC, Becher JG, Brehm MA. An individual approach for optimizing ankle-foot orthoses to improve mobility in children with spastic cerebral palsy walking with excessive knee flexion. Gait Posture 2016; 46:104-11. [PMID: 27131186 DOI: 10.1016/j.gaitpost.2016.03.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 02/04/2016] [Accepted: 03/02/2016] [Indexed: 02/02/2023]
Abstract
Ankle-Foot Orthoses (AFOs) are commonly prescribed to promote gait in children with cerebral palsy (CP). The AFO prescription process is however largely dependent on clinical experience, resulting in confusing results regarding treatment efficacy. To maximize efficacy, the AFO's mechanical properties should be tuned to the patient's underlying impairments. This study aimed to investigate whether the efficacy of a ventral shell AFO (vAFO) to reduce knee flexion and walking energy cost could be improved by individually optimizing AFO stiffness in children with CP walking with excessive knee flexion. Secondarily, the effect of the optimized vAFO on daily walking activity was investigated. Fifteen children with spastic CP were prescribed with a hinged vAFO with adjustable stiffness. Effects of a rigid, stiff, and flexible setting on knee angle and the net energy cost (EC) [Jkg(-1)m(-1)] were assessed to individually select the optimal stiffness. After three months, net EC, daily walking activity [stridesmin(-1)] and knee angle [deg] while walking with the optimized vAFO were compared to walking with shoes-only. A near significant 9% (p=0.077) decrease in net EC (-0.5Jkg(-1)m(-1)) was found for walking with the optimized vAFO compared to shoes-only. Daily activity remained unchanged. Knee flexion in stance was reduced by 2.4° (p=0.006). These results show that children with CP who walk with excessive knee flexion show a small, but significant reduction of knee flexion in stance as a result of wearing individually optimized vAFOs. Data suggest that this also improves gait efficiency for which an individual approach to AFO prescription is emphasized.
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Affiliation(s)
- Yvette L Kerkum
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Josien C van den Noort
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Jules G Becher
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Merel-Anne Brehm
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands; Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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67
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van der List JP, Witbreuk MM, Buizer AI, van der Sluijs JA. The head-shaft angle of the hip in early childhood: a comparison of reference values for children with cerebral palsy and normally developing hips. Bone Joint J 2015; 97-B:1291-5. [PMID: 26330599 DOI: 10.1302/0301-620x.97b9.35655] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The recognition of hips at risk of displacement in children with cerebral palsy (CP) is a difficult problem for the orthopaedic surgeon. The Gross Motor Function Classification System (GMFCS) and head-shaft angle (HSA) are prognostic factors for hip displacement. However, reference values for HSA are lacking. This study describes and compares the development of HSA in normal hips and children with CP. We selected 33 children from a retrospective cohort with unilateral developmental dysplasia of the hip (DDH) (five boys, 28 girls) and 50 children (35 boys, 15 girls) with CP with GMFCS levels II to V. HSA of normal developing hips was measured at the contralateral hip of unilateral DDH children (33 hips) and HSA of CP children was measured in both hips (100 hips). Measurements were taken from the radiographs of the children at age two, four and seven years. The normal hip HSA decreased by 2° per year (p < 0.001). In children with CP with GMFCS levels II and III HSA decreased by 0.6° (p = 0.046) and 0.9° (p = 0.049) per year, respectively. The HSA did not alter significantly in GMFCS levels IV and V. Between the ages of two and eight years, the HSA decreases in normal hips and CP children with GMFCS level, II to III but does not change in GMFCS levels IV to V. As HSA has a prognostic value for hip displacement, these reference values may help the orthopaedic surgeon to predict future hip displacement in children with CP.
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Affiliation(s)
- J P van der List
- Research Institute MOVE VU University Medical Center, De Boelelaan 1117, P.O. Box 7057, 1081 HV Amsterdam, The Netherlands
| | - M M Witbreuk
- Research Institute MOVE VU University Medical Center, De Boelelaan 1117, P.O. Box 7057, 1081 HV Amsterdam, The Netherlands
| | - A I Buizer
- Research Institute MOVE VU University Medical Center, De Boelelaan 1117, P.O. Box 7057, 1081 HV Amsterdam, The Netherlands
| | - J A van der Sluijs
- Research Institute MOVE VU University Medical Center, De Boelelaan 1117, P.O. Box 7057, 1081 HV Amsterdam, The Netherlands
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68
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Kerkum YL, Buizer AI, van den Noort JC, Becher JG, Harlaar J, Brehm MA. The Effects of Varying Ankle Foot Orthosis Stiffness on Gait in Children with Spastic Cerebral Palsy Who Walk with Excessive Knee Flexion. PLoS One 2015; 10:e0142878. [PMID: 26600039 PMCID: PMC4658111 DOI: 10.1371/journal.pone.0142878] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 10/28/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction Rigid Ankle-Foot Orthoses (AFOs) are commonly prescribed to counteract excessive knee flexion during the stance phase of gait in children with cerebral palsy (CP). While rigid AFOs may normalize knee kinematics and kinetics effectively, it has the disadvantage of impeding push-off power. A spring-like AFO may enhance push-off power, which may come at the cost of reducing the knee flexion less effectively. Optimizing this trade-off between enhancing push-off power and normalizing knee flexion in stance is expected to maximize gait efficiency. This study investigated the effects of varying AFO stiffness on gait biomechanics and efficiency in children with CP who walk with excessive knee flexion in stance. Fifteen children with spastic CP (11 boys, 10±2 years) were prescribed with a ventral shell spring-hinged AFO (vAFO). The hinge was set into a rigid, or spring-like setting, using both a stiff and flexible performance. At baseline (i.e. shoes-only) and for each vAFO, a 3D-gait analysis and 6-minute walk test with breath-gas analysis were performed at comfortable speed. Lower limb joint kinematics and kinetics were calculated. From the 6-minute walk test, walking speed and the net energy cost were determined. A generalized estimation equation (p<0.05) was used to analyze the effects of different conditions. Compared to shoes-only, all vAFOs improved the knee angle and net moment similarly. Ankle power generation and work were preserved only by the spring-like vAFOs. All vAFOs decreased the net energy cost compared to shoes-only, but no differences were found between vAFOs, showing that the effects of spring-like vAFOs to promote push-off power did not lead to greater reductions in walking energy cost. These findings suggest that, in this specific group of children with spastic CP, the vAFO stiffness that maximizes gait efficiency is primarily determined by its effect on knee kinematics and kinetics rather than by its effect on push-off power. Trial Registration Dutch Trial Register NTR3418
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Affiliation(s)
- Yvette L. Kerkum
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
- * E-mail:
| | - Annemieke I. Buizer
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Josien C. van den Noort
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Jules G. Becher
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Merel-Anne Brehm
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
- Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Kerkum YL, Houdijk H, Brehm MA, Buizer AI, Kessels MLC, Sterk A, van den Noort JC, Harlaar J. The Shank-to-Vertical-Angle as a parameter to evaluate tuning of Ankle-Foot Orthoses. Gait Posture 2015; 42:269-74. [PMID: 26050873 DOI: 10.1016/j.gaitpost.2015.05.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 03/31/2015] [Accepted: 05/19/2015] [Indexed: 02/02/2023]
Abstract
The effectiveness of an Ankle-Foot Orthosis footwear combination (AFO-FC) may be partly dependent on the alignment of the ground reaction force with respect to lower limb joint rotation centers, reflected by joint angles and moments. Adjusting (i.e. tuning) the AFO-FC's properties could affect this alignment, which may be guided by monitoring the Shank-to-Vertical-Angle. This study aimed to investigate whether the Shank-to-Vertical-Angle during walking responds to variations in heel height and footplate stiffness, and if this would reflect changes in joint angles and net moments in healthy adults. Ten subjects walked on an instrumented treadmill and performed six trials while walking with bilateral rigid Ankle-Foot Orthoses. The AFO-FC heel height was increased, aiming to impose a Shank-to-Vertical-Angle of 5°, 11° and 20°, and combined with a flexible or stiff footplate. For each trial, the Shank-to-Vertical-Angle, joint flexion-extension angles and net joint moments of the right leg at midstance were averaged over 25 gait cycles. The Shank-to-Vertical-Angle significantly increased with increasing heel height (p<0.001), resulting in an increase in knee flexion angle and internal knee extensor moment (p<0.001). The stiff footplate reduced the effect of heel height on the internal knee extensor moment (p=0.030), while the internal ankle plantar flexion moment increased (p=0.035). Effects of heel height and footplate stiffness on the hip joint were limited. Our results support the potential to use the Shank-to-Vertical-Angle as a parameter to evaluate AFO-FC tuning, as it is responsive to changes in heel height and reflects concomitant changes in the lower limb angles and moments.
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Affiliation(s)
- Yvette L Kerkum
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
| | - Han Houdijk
- MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University, Amsterdam, The Netherlands; Heliomare Rehabilitation, Research and Development, Wijk aan Zee, The Netherlands
| | - Merel-Anne Brehm
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands; Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Manon L C Kessels
- MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University, Amsterdam, The Netherlands
| | - Arjan Sterk
- MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University, Amsterdam, The Netherlands
| | - Josien C van den Noort
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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70
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Haberfehlner H, Maas H, Harlaar J, Newsum IE, Becher JG, Buizer AI, Jaspers RT. Assessment of net knee moment-angle characteristics by instrumented hand-held dynamometry in children with spastic cerebral palsy and typically developing children. J Neuroeng Rehabil 2015; 12:67. [PMID: 26272620 PMCID: PMC4536590 DOI: 10.1186/s12984-015-0056-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 07/13/2015] [Indexed: 08/21/2023] Open
Abstract
Background The limited range of motion during walking in children with spastic cerebral palsy (SCP) may be the result of altered mechanical characteristics of muscles and connective tissues around the knee joint. Measurement of static net knee moment-angle relation will provide insights into these alterations, for which instrumented hand-held dynamometry may be applied. The aims of this study were: (1) to test the measurement error of the estimated net knee moment-angle characteristics, (2) to determine the correlation between knee extension angle measurement at a standardized knee moment and popliteal angle from common physical examination and (3) to compare net knee moment–angle characteristics in SCP versus typically developing children. Methods With the child lying in sideward position, the knee was extended by moving the lower leg by a hand-held force transducer on a low friction cart. Force data were collected for a range of knee angles. Data were excluded when activity (EMG) levels of knee extensor and flexor muscles exceeded the EMG level during rest by more than two standard deviations. The net knee flexion moments were calculated from recorded force data and measured moment arm. Reliability for knee angles corresponding with 0.5, 1, 2, 3, and 4 Nm knee net flexion moments was assessed by standard error of measurements (SEM) and smallest detectable difference (SDD). Results For between day comparison, SEMs were about 5° and SDDs were below 14° for knee angles at 1-4 Nm net knee flexion moments. In SCP children, the knee angle measured at 4 Nm knee flexion moment was not related to the popliteal angle (r = 0.52). The slope at 4 Nm of the knee moment-angle curve in SCP children was significantly higher than that in typically developing children. Conclusions The presented knee hand-held dynamometry allows assessment of net knee flexion moment-knee angle characteristics in typically developing and SCP children and can be used to identify clinically relevant changes as a result of treatment. Overall stiffness of structures that contribute to the net knee flexion moment at the knee (i.e. muscles, tendons, ligaments) is elevated in SCP children. Electronic supplementary material The online version of this article (doi:10.1186/s12984-015-0056-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Helga Haberfehlner
- Faculty of Human Movement Sciences, VU University Amsterdam, Van der Boechorststraat 9, 1081, BT, Amsterdam, The Netherlands. .,Department of Rehabilitation Medicine, VU University Medical Center, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands. .,MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, The Netherlands, Van der Boechorststraat 9, 1081, BT, Amsterdam, The Netherlands.
| | - Huub Maas
- Faculty of Human Movement Sciences, VU University Amsterdam, Van der Boechorststraat 9, 1081, BT, Amsterdam, The Netherlands. .,MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, The Netherlands, Van der Boechorststraat 9, 1081, BT, Amsterdam, The Netherlands.
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, VU University Medical Center, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands. .,MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, The Netherlands, Van der Boechorststraat 9, 1081, BT, Amsterdam, The Netherlands.
| | - Irene E Newsum
- Department of Rehabilitation Medicine, VU University Medical Center, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands.
| | - Jules G Becher
- Department of Rehabilitation Medicine, VU University Medical Center, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands. .,MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, The Netherlands, Van der Boechorststraat 9, 1081, BT, Amsterdam, The Netherlands.
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, VU University Medical Center, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands.
| | - Richard T Jaspers
- Faculty of Human Movement Sciences, VU University Amsterdam, Van der Boechorststraat 9, 1081, BT, Amsterdam, The Netherlands. .,MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, The Netherlands, Van der Boechorststraat 9, 1081, BT, Amsterdam, The Netherlands.
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van der Krogt MM, Sloot LH, Buizer AI, Harlaar J. Kinetic comparison of walking on a treadmill versus over ground in children with cerebral palsy. J Biomech 2015; 48:3577-83. [PMID: 26315918 DOI: 10.1016/j.jbiomech.2015.07.046] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 07/24/2015] [Accepted: 07/30/2015] [Indexed: 11/26/2022]
Abstract
Kinetic outcomes are an essential part of clinical gait analysis, and can be collected for many consecutive strides using instrumented treadmills. However, the validity of treadmill kinetic outcomes has not been demonstrated for children with cerebral palsy (CP). In this study we compared ground reaction forces (GRF), center of pressure, and hip, knee and ankle moments, powers and work, between overground (OG) and self-paced treadmill (TM) walking for 11 typically developing (TD) children and 9 children with spastic CP. Considerable differences were found in several outcome parameters. In TM, subjects demonstrated lower ankle power generation and more absorption, and increased hip moments and work. This shift from ankle to hip strategy was likely due to a more backward positioning of the hip and a slightly more forward trunk lean. In mediolateral direction, GRF and hip and knee joint moments were increased in TM due to wider step width. These findings indicate that kinetic data collected on a TM cannot be readily compared with OG data in TD children and children with CP, and that treadmill-specific normative data sets should be used when performing kinetic gait analysis on a treadmill.
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Affiliation(s)
- Marjolein M van der Krogt
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
| | - Lizeth H Sloot
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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Kerkum YL, Brehm MA, van Hutten K, van den Noort JC, Harlaar J, Becher JG, Buizer AI. Acclimatization of the gait pattern to wearing an ankle-foot orthosis in children with spastic cerebral palsy. Clin Biomech (Bristol, Avon) 2015; 30:617-22. [PMID: 25854606 DOI: 10.1016/j.clinbiomech.2015.03.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 03/23/2015] [Accepted: 03/23/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ankle-foot orthoses can be prescribed to improve gait in children with cerebral palsy. Before evaluating the effects of ankle-foot orthoses on gait, a period to adapt or acclimatize is usually applied. It is however unknown whether an acclimatization period is actually needed to reliably evaluate the effect of a new orthosis on gait. This study aimed to investigate whether specific gait parameters in children with cerebral palsy would change within an acclimatization period after being provided with new ankle-foot orthoses. METHODS Ten children with cerebral palsy, walking with excessive knee flexion in midstance (8 boys; mean (SD) 10.2 (1.9) years; Gross Motor Function Classification System levels I-II) were provided with ventral shell ankle-foot orthoses. The orthoses were worn in combination with the child's own shoes and tuned, based on ground reaction force alignment with respect to the lower limb joints. Directly after tuning (T0) and four weeks later (T1), 3D-gait analysis was performed using an optoelectronic motion capture system and a force plate. From this assessment, ten spatiotemporal, kinematic and kinetic gait parameters were derived for the most affected leg. Differences in parameters between T0 and T1 were analyzed using paired t-tests or Wilcoxon signed rank tests (P<0.05). FINDINGS Over the course of four weeks, no significant differences (P ≥ 0.080) were observed for any investigated parameter. INTERPRETATION These results imply that the biomechanical effect of ventral shell ankle-foot orthoses on gait in independent walking children with cerebral palsy is immediately apparent, i.e., there is no further change after acclimatization.
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Affiliation(s)
- Yvette L Kerkum
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
| | - Merel-Anne Brehm
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands; Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Kim van Hutten
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Josien C van den Noort
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Jules G Becher
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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Kerkum YL, Harlaar J, Buizer AI, van den Noort JC, Becher JG, Brehm MA. Optimising Ankle Foot Orthoses for children with cerebral palsy walking with excessive knee flexion to improve their mobility and participation; protocol of the AFO-CP study. BMC Pediatr 2013; 13:17. [PMID: 23374998 PMCID: PMC3568048 DOI: 10.1186/1471-2431-13-17] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 01/24/2013] [Indexed: 11/30/2022] Open
Abstract
Background Ankle-Foot-Orthoses with a ventral shell, also known as Floor Reaction Orthoses (FROs), are often used to reduce gait-related problems in children with spastic cerebral palsy (SCP), walking with excessive knee flexion. However, current evidence for the effectiveness (e.g. in terms of walking energy cost) of FROs is both limited and inconclusive. Much of this ambiguity may be due to a mismatch between the FRO ankle stiffness and the patient’s gait deviations. The primary aim of this study is to evaluate the effect of FROs optimised for ankle stiffness on the walking energy cost in children with SCP, compared to walking with shoes alone. In addition, effects on various secondary outcome measures will be evaluated in order to identify possible working mechanisms and potential predictors of FRO treatment success. Method/Design A pre-post experimental study design will include 32 children with SCP, walking with excessive knee flexion in midstance, recruited from our university hospital and affiliated rehabilitation centres. All participants will receive a newly designed FRO, allowing ankle stiffness to be varied into three configurations by means of a hinge. Gait biomechanics will be assessed for each FRO configuration. The FRO that results in the greatest reduction in knee flexion during the single stance phase will be selected as the subject’s optimal FRO. Subsequently, the effects of wearing this optimal FRO will be evaluated after 12–20 weeks. The primary study parameter will be walking energy cost, with the most important secondary outcomes being intensity of participation, daily activity, walking speed and gait biomechanics. Discussion The AFO-CP trial will be the first experimental study to evaluate the effect of individually optimised FROs on mobility and participation. The evaluation will include outcome measures at all levels of the International Classification of Functioning, Disability and Health, providing a unique set of data with which to assess relationships between outcome measures. This will give insights into working mechanisms of FROs and will help to identify predictors of treatment success, both of which will contribute to improving FRO treatment in SCP in term. Trial registration This study is registered in the Dutch Trial Register as NTR3418.
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Affiliation(s)
- Yvette L Kerkum
- Department of Rehabilitation Medicine, VU University Medical Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
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Buizer AI, de Sonneville LMJ, Veerman AJP. Effects of chemotherapy on neurocognitive function in children with acute lymphoblastic leukemia: a critical review of the literature. Pediatr Blood Cancer 2009; 52:447-54. [PMID: 19061221 DOI: 10.1002/pbc.21869] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Chemotherapy-only treatment has increasingly become the standard of treatment for childhood acute lymphoblastic leukemia (ALL). The objective of this review is to assess the present state of knowledge of the neurocognitive effects of central nervous system (CNS)-directed chemotherapy in children with ALL, and to formulate directions for future research. We performed a review of studies published since 1997, that included an ALL group treated with chemotherapy only and a control group. Twenty-one studies met our inclusion criteria. There is evidence of subtle long-term neurocognitive deficits survivors of childhood ALL after treatment with chemotherapy only. These involve mainly processes of attention and of executive functioning, while global intellectual function is relatively preserved. Young age at diagnosis and female sex emerged as risk factors.
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Affiliation(s)
- Annemieke I Buizer
- Department of Pediatric Hematology-Oncology, VU University Medical Center, Amsterdam, The Netherlands.
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Buizer AI, de Sonneville LMJ, van den Heuvel-Eibrink MM, Veerman AJP. Behavioral and educational limitations after chemotherapy for childhood acute lymphoblastic leukemia or Wilms tumor. Cancer 2006; 106:2067-75. [PMID: 16568441 DOI: 10.1002/cncr.21820] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The improved prognosis of childhood cancer makes monitoring of functional outcome important. The purpose of this study was to evaluate behavioral and educational functioning in survivors of childhood acute lymphoblastic leukemia (ALL) or a Wilms tumor. In this study, children with ALL received central nervous system directed chemotherapy without cranial irradiation. METHODS In a multicenter study, behavioral functioning and school performance was examined in 199 children age 4 to 18. Sixty-four children were at least 1 year from finishing treatment with chemotherapy for ALL (n = 28) or a Wilms tumor (n = 36). They were compared with siblings (n = 37) and with a control group of healthy schoolchildren (n = 98). RESULTS A moderately increased risk of behavioral and educational problems was found in children with ALL but not in children with Wilms tumor. School performance was poorer in children with ALL attending primary school compared with same-age peers; however, the rate of utilization of special education services was low. Teacher-rated behavior and mathematics performance was correlated with attention function in children with ALL. An excess of problem behavior and underperformance at school was found in the ALL high-risk group compared with the standard-risk group. No differences were found between siblings and controls. CONCLUSION Evidence is provided of subtle but significant behavioral and educational problems in survivors of childhood ALL, but no dysfunctions in survivors of a Wilms tumor. Careful follow-up of children with ALL treated with chemotherapy only is warranted.
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Affiliation(s)
- Annemieke I Buizer
- Department of Pediatric Hematology-Oncology, VU University Medical Center, Amsterdam, Netherlands.
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Buizer AI, De Sonneville LMJ, van den Heuvel-Eibrink MM, Njiokiktjien C, Veerman AJP. Visuomotor control in survivors of childhood acute lymphoblastic leukemia treated with chemotherapy only. J Int Neuropsychol Soc 2005; 11:554-65. [PMID: 16212682 DOI: 10.1017/s1355617705050666] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2004] [Revised: 04/12/2005] [Accepted: 04/14/2005] [Indexed: 11/06/2022]
Abstract
Treatment for childhood acute lymphoblastic leukemia (ALL), which includes CNS prophylaxis, is associated with central and peripheral neurotoxicity. The purpose of the present study was to analyze the effects of chemotherapy on various levels of visuomotor control in survivors of childhood ALL treated without cranial irradiation, and to identify risk factors for possible deficits. Visuomotor function was compared between children after treatment for ALL (n = 34), children after treatment for Wilms tumor, which consists of non-CNS directed chemotherapy (n = 38), and healthy controls (n = 151). Three tasks were administered: a simple visual reaction time task and two tasks measuring visuomotor control with one requiring a higher level of cognitive control than the other. Visuomotor deficits were detected only in the ALL group, with poorer performance restricted to the condition requiring the highest level of control. Significant risk factors for poorer performance were female gender and a short time since end of treatment, and a trend was found for a young age at diagnosis. A high cumulative methotrexate dose was an adverse predictive factor in girls. The results indicate that chemotherapy-induced central neurotoxicity in childhood ALL treatment is associated with higher order visuomotor control deficits. Girls appear to be particularly vulnerable.
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Affiliation(s)
- Annemieke I Buizer
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands.
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Buizer AI, de Sonneville LMJ, van den Heuvel-Eibrink MM, Veerman AJP. Chemotherapy and attentional dysfunction in survivors of childhood acute lymphoblastic leukemia: effect of treatment intensity. Pediatr Blood Cancer 2005; 45:281-90. [PMID: 15806539 DOI: 10.1002/pbc.20397] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Central nervous system (CNS) directed chemotherapy is replacing prophylactic cranial irradiation in treatment protocols for childhood acute lymphoblastic leukemia (ALL), mainly to reduce long-term neuropsychological sequelae. We evaluated the effects of chemotherapy on attentional function in survivors of ALL and examined whether possible deficits are related to treatment intensity. METHODS In a multi-center study, we compared attentional function in 36 children at least 1 year after finishing treatment with chemotherapy only for ALL, with a cancer control group consisting of 39 Wilms tumor patients and with 110 healthy children. We differentiated between standard- and intensified ALL treatment. The role of previously reported risk factors for neuropsychological deficits was also assessed. RESULTS After chemotherapy, attentional deficits were detected in patients with ALL, but not in Wilms tumor patients. Children treated according to standard ALL protocols performed worse than healthy controls on only 1 of 10 outcome measures (P = 0.004), while those who had received intensified treatment performed worse on four outcome measures (0.0001 < P < 0.004). Higher treatment intensity, young age at diagnosis, and female gender were associated with worse performance. CONCLUSIONS CNS-directed chemotherapy, even in the absence of cranial irradiation, is associated with attentional dysfunction in survivors of childhood ALL, particularly in case of intensified treatment protocols. These sequelae stress the importance of reducing doses of neurotoxic chemotherapy as much as possible in the design of future treatment protocols for ALL.
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Affiliation(s)
- Annemieke I Buizer
- Department of Pediatrics, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
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Klok AM, Buizer AI, Polman CH, Postmus PE, Polak BC. Intermediate uveitis and polyneuropathy in an elderly patient due to sarcoidosis. Neuroophthalmology 1999. [DOI: 10.1076/noph.21.3.171.3910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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