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Wang X, Fu X, Li W, Wang Q, Zhang K, Yan S. Dynamic electromyography findings of the lower leg muscles during walking in spastic cerebral palsy children with hindfoot valgus. Clin Biomech (Bristol, Avon) 2023; 106:106008. [PMID: 37257273 DOI: 10.1016/j.clinbiomech.2023.106008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 05/14/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Hindfoot valgus is one of the most prevalent foot deformities in cerebral palsy children. Investigating the muscle activation patterns of cerebral palsy children with hindfoot valgus is crucial to understand their abnormal gait different from typically developing children. METHODS Electromyography data of 20 cerebral palsy children with hindfoot valgus and 20 typically developing children were recorded for tibialis anterior, peroneal longus, and gastrocnemius medialis. The activation onset and offset times, normalized peak electromyography amplitude, average electromyography amplitude and integral electromyography amplitude for 20 completed cycles were averaged for data analysis. The co-activation index and activation percentage of peroneal longus were used to evaluate the co-activation level for tibialis anterior and peroneal longus muscles. FINDINGS Compared with typically developing children, the activation onset of tibialis anterior and the activation offset of tibialis anterior, peroneal longus, and gastrocnemius medialis were significantly delayed in cerebral palsy children; moreover, the muscle activation durations of tibialis anterior, peroneal longus, and gastrocnemius medialis were significantly longer, and the normalized average electromyography amplitude of tibialis anterior, peroneal longus and gastrocnemius medialis, and the normalized integral electromyography amplitude of tibialis anterior were significantly lower in cerebral palsy children. Furthermore, for cerebral palsy children, the co-activation index was greater, and the peroneal longus muscles activation percentage was lower in the stance phase and greater in the swing phase than that of typically developing children. INTERPRETATION The lower leg muscle activation patterns in cerebral palsy children were found to be abnormal.
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Affiliation(s)
- Xuesen Wang
- School of Biomedical Engineering, Capital Medical University, Beijing, China; Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiaohu Fu
- Rehabilitation Department of Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Wei Li
- Department of Rehabilitation, Affiliated Hospital of Binzhou Medical College, Shandong, China
| | - Qining Wang
- Robotics Research Group, College of Engineering, Peking University, Beijing, China
| | - Kuan Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing, China; Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical application, Capital Medical University, Beijing, China.
| | - Songhua Yan
- School of Biomedical Engineering, Capital Medical University, Beijing, China; Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical application, Capital Medical University, Beijing, China.
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Boulay C, Sangeux M, Authier G, Jacquemier M, Merlo A, Chabrol B, Jouve JL, Gracies JM, Pesenti S. Improved Gait and Radiological Measurements After injection of Botulinum Toxin Into Peroneus Longus in Young Children With USCP and Equinovalgus Gait. Pediatr Neurol 2023; 142:1-9. [PMID: 36848724 DOI: 10.1016/j.pediatrneurol.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/08/2022] [Accepted: 01/31/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Children with cerebral palsy develop foot deformities due to a combination of factors including muscle shortening, hypertonia, weakness, and cocontraction of muscles acting at the ankle joint resulting in an altered gait pattern. We hypothesized these factors affect the peroneus longus (PL) and tibialis anterior (TA) muscles couple in children who develop equinovalgus gait first followed by planovalgus foot deformities. Our aim was to evaluate the effects of abobotulinum toxin A injection to the PL muscle, in a cohort of children with unilateral spastic cerebral palsy and equinovalgus gait. METHODS This was a prospective cohort study. The children were examined within 12 months before and after injection to their PL muscle. Twenty-five children of mean age 3.4 (S.D.: 1.1) years were recruited. RESULTS We found significant improvement in foot radiology measures. Passive extensibility of the triceps surae did not change, whereas active dorsiflexion increased significantly. Nondimensional walking speed increased by 0.1 (95% confidence interval [CI], [0.07, 0.16]; P < 0.001), and the Edinburgh visual gait score improved by 2.8 (95% CI, [-4.06, -1.46]; P < 0.001). Electromyography showed increased recruitment for gastrocnemius medialis (GM) and TA but not for PL during the reference exercises (standing on tip toes for GM/PL, active dorsiflexion for TA) and decreased activation percentages for PL/GM and TA across sub-phases of gait. CONCLUSIONS One key advantage of treating the PL muscle only might be to address foot deformities without interfering with the main plantar flexors that are instrumental to support body weight during gait.
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Affiliation(s)
- Christophe Boulay
- Pediatric Neurology Department, Timone Children's Hospital, Marseille, France; Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children's Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France.
| | - Morgan Sangeux
- Murdoch Children's Research Institute, Melbourne, Australia; University Children's Hospital Basel, Basel, Switzerland
| | - Guillaume Authier
- Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children's Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | - Michel Jacquemier
- Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children's Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | - Andrea Merlo
- Gait&Motion Analysis Laboratory, Sol et Salus Hospital, Torre Pedrera di Rimini, Italy
| | - Brigitte Chabrol
- Pediatric Neurology Department, Timone Children's Hospital, Marseille, France
| | - Jean-Luc Jouve
- Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children's Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | - Jean-Michel Gracies
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, France; UR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), Créteil, France
| | - Sébastien Pesenti
- Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children's Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
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Boulay C, Sangeux M, Authier G, Jacquemier M, Merlo A, Chabrol B, Jouve JL, Gracies JM, Pesenti S. Reduced plantar-flexors extensibility but improved selective motor control associated with age in young children with unilateral cerebral palsy and equinovalgus gait. J Electromyogr Kinesiol 2022; 65:102665. [DOI: 10.1016/j.jelekin.2022.102665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/20/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022] Open
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Recurrence of Equinus Foot in Cerebral Palsy following Its Correction-A Meta-Analysis. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9030339. [PMID: 35327713 PMCID: PMC8947726 DOI: 10.3390/children9030339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/21/2022] [Accepted: 02/26/2022] [Indexed: 11/23/2022]
Abstract
Background: Recurrence in cerebral palsy (CP) patients who have undergone operative or non-operative correction varies greatly from one study to another. Therefore, we conducted this meta-analysis to determine the pooled rate of equinus recurrence following its correction either surgically or non-surgically. Methods: Nine electronic databases were searched from inception to 6 May 2021, and the search was updated on 13 August 2021. We included all studies that reported the recurrence rate of equinus following its correction among CP patients. The primary outcome was recurrence, where data were reported as a pooled event (PE) rate and its corresponding 95% confidence interval (CI). We used the Cochrane’s risk of bias (RoB-II) tool and ROBINS-I tool to assess the quality of included randomized and non-randomized trials, respectively. We conducted subgroup analyses to identify the sources of heterogeneity. Results: The overall rate of recurrence was 0.15 (95% CI: 0.05−0.18; I2 = 88%; p < 0.01). Subgroup analyses indicated that the laterality of CP, study design, and intervention type were significant contributors to heterogeneity. The recurrence rate of equinus differed among interventions; it was highest in the multilevel surgery group (PE = 0.27; 95% CI: 0.19−0.38) and lowest in the Ilizarov procedure group (PE = 0.10; 95% CI: 0.04−0.24). Twelve studies had a low risk of bias, eight had a moderate risk, and nine had a serious risk of bias. Conclusion: The recurrence of equinus following its correction, either surgically or non-surgically, in CP patients is notably high. However, due to the poor quality of available evidence, our findings should be interpreted with caution. Future studies are still warranted to determine the actual risk of equinus recurrence in CP.
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Vinti M, Saikia MJ, Donoghue J, Mankodiya K, Kerman KL. A modified surface EMG biomarker for gait assessment in spastic cerebral palsy. Hum Mov Sci 2021; 80:102875. [PMID: 34736019 DOI: 10.1016/j.humov.2021.102875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Muscle clinical metrics are crucial for spastic cocontraction management in children with Cerebral Palsy (CP). We investigated whether the ankle plantar flexors cocontraction index (CCI) normalized with respect to the bipedal heel rise (BHR) approach provides more robust spastic cocontraction estimates during gait than those obtained through the widely accepted standard maximal isometric plantar flexion (IPF). METHODS Ten control and 10 CP children with equinus gait pattern performed the BHR and IPF testing and walked barefoot 10-m distance. We compared agonist medial gastrocnemius EMG during both testing and CCIs obtained as the ratios of antagonist EMG during swing phase of gait and either BHR or IPF agonist EMG. RESULTS Agonist EMG values from the BHR were: (i) internally reliable (Cronbach's α = 0.993), (ii) ~50 ± 0.4% larger than IPF, (iii) and positively correlated. Derived CCIs were significantly smaller (p < 0.05) in both populations. CONCLUSION The bipedal heel rise approach may be accurate enough to reveal greater agonist activity of plantar flexors than the maximal isometric plantar flexion and seems to be more appropriate to obtain cocontraction estimates during swing of gait. SIGNIFICANCE This modified biomarker may represent a step forward towards improved accuracy of spastic gait management in pediatric.
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Affiliation(s)
- Maria Vinti
- Department of Pediatrics, Hasbro Children's Hospital, Providence, RI 02905, USA.
| | - Manob Jyoti Saikia
- Center for Applied Brain and Cognitive Sciences, Tufts University, Medford, MA 02155, USA
| | - John Donoghue
- Department of Neuroscience, Brown University, Providence, RI 02906, USA
| | - Kunal Mankodiya
- Department of Electrical, Computer and Biomedical Engineering, University of Rhode Island, RI 02881, USA
| | - Karen L Kerman
- Department of Pediatrics, Hasbro Children's Hospital, Providence, RI 02905, USA
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Is the Prevalence of Equinus Foot in Cerebral Palsy Overestimated? Results from a Meta-Analysis of 4814 Feet. J Clin Med 2021; 10:jcm10184128. [PMID: 34575239 PMCID: PMC8465417 DOI: 10.3390/jcm10184128] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 01/04/2023] Open
Abstract
Background: Equinus is a common foot deformity in patients with cerebral palsy (CP). However, its prevalence is scarcely reported in the literature. Therefore, we conducted this review to estimate the prevalence of equinus foot in CP. Methods: Eight databases were searched. Our primary outcome was the prevalence of equinus foot in CP patients. Subgroup analysis was conducted based on study design, the laterality of CP, and whether equinus foot was defined or not. Results: The prevalence of equinus foot in CP was 93% (95% CI: 71–99). The prevalence was 99% (95% CI: 55–100), 96% (95% CI: 57–100), and 65% (95% CI: 37–86) in unilateral, both, and bilateral CP, respectively. Based on study design, equinus foot prevalence was 92% (95% CI: 34–100) in case series and 62% (95% CI: 47–74) in cohort studies. Four studies reported definition criteria for equinus foot, with a pooled prevalence rate of equinus foot of 99% (95% CI: 36–100) compared to a rate of 89% (95% CI: 59–98) among studies that lacked a definition criterion. Conclusions: This is the first meta-analysis to address the prevalence of equinus foot in CP patients. Although its prevalence is very high, our findings should be interpreted with caution due to the presence of multiple limitations, such as the lack of standardized definition criteria for equinus foot, the inappropriate study design, the wide confidence interval of equinus foot rate, and the small number of studies investigating it as a primary outcome.
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Ma N, Sclavos N, Passmore E, Thomason P, Graham K, Rutz E. Three-Dimensional Gait Analysis in Children Undergoing Gastrocsoleus Lengthening for Equinus Secondary to Cerebral Palsy. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:98. [PMID: 33499373 PMCID: PMC7911110 DOI: 10.3390/medicina57020098] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/17/2021] [Accepted: 01/19/2021] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Equinus is the most common deformity in children with cerebral palsy, and surgical lengthening of the gastrocsoleus muscle-tendon unit is the most commonly performed operation for children with cerebral palsy. Treatment outcomes of orthopaedic surgery can be measured objectively with three-dimensional gait analysis. This study examined the quality of evidence for gastrocsoleus lengthening surgery based on objective measures. Materials and Methods: A search was performed with Medline, Embase and PubMed from 1990 to 25 August 2020 using the keywords "cerebral palsy", "equinus", "surgery" and "gait analysis". Only studies of gastrocsoleus lengthening surgery using three-dimensional gait analysis were included, yielding 34 studies. Results: Fourteen studies reported swing phase kinematics and all studies reported a significant improvement. Rates of recurrent equinus and calcaneus were reported in 21 studies and varied widely based on follow-up period and surgical technique. Conclusions: Poor study quality and marked variability in study samples and interventions made comparison difficult. Future studies should consider prospective design, controls or comparison groups and more detailed breakdowns of outcomes by cerebral palsy subtype, sagittal gait pattern, and equinus type in order to allow more rigorous treatment recommendations to be made.
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Affiliation(s)
- Norine Ma
- Australia and Hugh Williamson Gait Laboratory, Pediatric Orthopedic Department, The Royal Children’s Hospital, Parkville, Melbourne, VIC 3052, Australia; (N.M.); (N.S.); (E.P.); (P.T.); (K.G.)
| | - Nicholas Sclavos
- Australia and Hugh Williamson Gait Laboratory, Pediatric Orthopedic Department, The Royal Children’s Hospital, Parkville, Melbourne, VIC 3052, Australia; (N.M.); (N.S.); (E.P.); (P.T.); (K.G.)
| | - Elyse Passmore
- Australia and Hugh Williamson Gait Laboratory, Pediatric Orthopedic Department, The Royal Children’s Hospital, Parkville, Melbourne, VIC 3052, Australia; (N.M.); (N.S.); (E.P.); (P.T.); (K.G.)
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
- Faculty of Engineering and Information Technology, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Pam Thomason
- Australia and Hugh Williamson Gait Laboratory, Pediatric Orthopedic Department, The Royal Children’s Hospital, Parkville, Melbourne, VIC 3052, Australia; (N.M.); (N.S.); (E.P.); (P.T.); (K.G.)
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
| | - Kerr Graham
- Australia and Hugh Williamson Gait Laboratory, Pediatric Orthopedic Department, The Royal Children’s Hospital, Parkville, Melbourne, VIC 3052, Australia; (N.M.); (N.S.); (E.P.); (P.T.); (K.G.)
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Erich Rutz
- Australia and Hugh Williamson Gait Laboratory, Pediatric Orthopedic Department, The Royal Children’s Hospital, Parkville, Melbourne, VIC 3052, Australia; (N.M.); (N.S.); (E.P.); (P.T.); (K.G.)
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, VIC 3052, Australia
- Medical Faculty, The University of Basel, 4001 Basel, Switzerland
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Campanini I, Cosma M, Manca M, Merlo A. Added Value of Dynamic EMG in the Assessment of the Equinus and the Equinovarus Foot Deviation in Stroke Patients and Barriers Limiting Its Usage. Front Neurol 2020; 11:583399. [PMID: 33329327 PMCID: PMC7717981 DOI: 10.3389/fneur.2020.583399] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/07/2020] [Indexed: 11/30/2022] Open
Abstract
Equinus (EFD) and equinovarus foot deviation (EVFD) are the most frequent lower limb deformities in stroke survivors. The equinus component can be triggered by a combination of dorsiflexor deficits, plantar flexor overactivity, muscle stiffness, and contractures. The varus component is typically due to an imbalance between invertor and evertor muscle actions. An improvement in identifying its causes leads to a more targeted treatment. These deformities are typically assessed via a thorough clinical evaluation including the assessment of range of motions, force, spasticity, pain, and observational gait analysis. Diagnostic nerve blocks are also being increasingly used. An advantage of dynamic electromyography (dEMG) is the possibility of measuring muscle activity, overactivity or lack thereof, during specific movements, e.g., activity of both ankle plantar flexors and dorsiflexors during the swing phase of gait. Moreover, fine-wire electrodes can be used to measure the activity of deep muscles, e.g., the tibialis posterior. An impediment to systematic use of dEMG in the assessment of EFD and EVFD, as a complimentary tool to the clinical evaluation, is a lack of evidence of its usefulness. Unfortunately, there are few studies found in literature. In order to fill this void, we studied three pairs of patients suffering from chronic hemiparesis consequent to a stroke, with EFD or EVFD. At the initial evaluation they all displayed the same clinical traits, very similar walking patterns, and an overlapping gait kinematics. However, the patterns of muscle activity differed considerably. dEMG data acquired during walking provided information that was not available from the sole clinical assessment. The contribution of this information to the subsequent clinical and rehabilitation process was discusses along with the barriers that limit the use of dEMG as a routine tool in neurorehabilitation.
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Affiliation(s)
- Isabella Campanini
- LAM-Motion Analysis Laboratory, Neuromotor and Rehabilitation Department, S. Sebastiano Hospital, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Michela Cosma
- Motion Analysis Laboratory, Department of Neuroscience and Rehabilitation, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Mario Manca
- Rehabilitation Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Andrea Merlo
- LAM-Motion Analysis Laboratory, Neuromotor and Rehabilitation Department, S. Sebastiano Hospital, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Merlo Bioengineering, Parma, Italy
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Campanini I, Disselhorst-Klug C, Rymer WZ, Merletti R. Surface EMG in Clinical Assessment and Neurorehabilitation: Barriers Limiting Its Use. Front Neurol 2020; 11:934. [PMID: 32982942 PMCID: PMC7492208 DOI: 10.3389/fneur.2020.00934] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/20/2020] [Indexed: 12/23/2022] Open
Abstract
This article addresses the potential clinical value of techniques based on surface electromyography (sEMG) in rehabilitation medicine with specific focus on neurorehabilitation. Applications in exercise and sport pathophysiology, in movement analysis, in ergonomics and occupational medicine, and in a number of related fields are also considered. The contrast between the extensive scientific literature in these fields and the limited clinical applications is discussed. The "barriers" between research findings and their application are very broad, and are longstanding, cultural, educational, and technical. Cultural barriers relate to the general acceptance and use of the concept of objective measurement in a clinical setting and its role in promoting Evidence Based Medicine. Wide differences between countries exist in appropriate training in the use of such quantitative measurements in general, and in electrical measurements in particular. These differences are manifest in training programs, in degrees granted, and in academic/research career opportunities. Educational barriers are related to the background in mathematics and physics for rehabilitation clinicians, leading to insufficient basic concepts of signal interpretation, as well as to the lack of a common language with rehabilitation engineers. Technical barriers are being overcome progressively, but progress is still impacted by the lack of user-friendly equipment, insufficient market demand, gadget-like devices, relatively high equipment price and a pervasive lack of interest by manufacturers. Despite the recommendations provided by the 20-year old EU project on "Surface EMG for Non-Invasive Assessment of Muscles (SENIAM)," real international standards are still missing and there is minimal international pressure for developing and applying such standards. The need for change in training and teaching is increasingly felt in the academic world, but is much less perceived in the health delivery system and clinical environments. The rapid technological progress in the fields of sensor and measurement technology (including sEMG), assistive devices, and robotic rehabilitation, has not been driven by clinical demands. Our assertion is that the most important and urgent interventions concern enhanced education, more effective technology transfer, and increased academic opportunities for physiotherapists, occupational therapists, and kinesiologists.
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Affiliation(s)
- Isabella Campanini
- LAM-Motion Analysis Laboratory, Neuromotor and Rehabilitation Department, San Sebastiano Hospital, Correggio, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Catherine Disselhorst-Klug
- Department of Rehabilitation & Prevention Engineering, Institute of Applied Medical Engineering, RWTH Aachen University, Aachen, Germany
| | - William Z. Rymer
- Shirley Ryan Ability Lab, Single Motor Unit Laboratory, Chicago, IL, United States
| | - Roberto Merletti
- Laboratory for Engineering of the Neuromuscular System (LISiN), Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
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Muscle Shortening and Spastic Cocontraction in Gastrocnemius Medialis and Peroneus Longus in Very Young Hemiparetic Children. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2328601. [PMID: 29951529 PMCID: PMC5987331 DOI: 10.1155/2018/2328601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 03/15/2018] [Accepted: 04/12/2018] [Indexed: 11/17/2022]
Abstract
Objectives Muscle shortening and spastic cocontraction in ankle plantar flexors may alter gait since early childhood in cerebral palsy (CP). We evaluated gastrosoleus complex (GSC) length, and gastrocnemius medialis (GM) and peroneus longus (PL) activity during swing phase, in very young hemiparetic children with equinovalgus. Methods This was an observational, retrospective, and monocentric outpatient study in a pediatric hospital. Ten very young hemiparetic children (age 3 ± 1 yrs) were enrolled. These CP children were assessed for muscle extensibility (Tardieu scale XV1) in GSC (angle of arrest during slow-speed passive ankle dorsiflexion with the knee extended) and monitored for GM and PL electromyography (EMG) during the swing phase of gait. The swing phase was divided into three periods (T1, T2, and T3), in which we measured a cocontraction index (CCI), ratio of the Root Mean Square EMG (RMS-EMG) from each muscle during that period to the peak 500 ms RMS-EMG obtained from voluntary plantar flexion during standing on tiptoes (from several 5-second series, the highest RMS value was computed over 500 ms around the peak). Results On the paretic side: (i) the mean XV1-GSC was 100° (8°) (median (SD)) versus 106° (3°) on the nonparetic side (p = 0.032, Mann-Whitney); (ii) XV1-GSC diminished with age between ages of 2 and 5 (Spearman, ρ = 0.019); (iii) CCIGM and CCIPL during swing phase were higher than on the nonparetic side (CCIGM, 0.32 (0.20) versus 0.15 (0.09), p < 0.01; CCIPL, 0.52 (0.30) versus 0.24 (0.17), p < 0.01), with an early difference significant for PL from T1 (p = 0.03). Conclusions In very young hemiparetic children, the paretic GSC may rapidly shorten in the first years of life. GM and PL cocontraction during swing phase are excessive, which contributes to dynamic equinovalgus. Muscle extensibility (XV1) may have to be monitored and preserved in the first years of life in children with CP. Additional measurements of cocontraction may further help target treatments with botulinum toxin, especially in peroneus longus.
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Planovalgus foot deformity in cerebral palsy corrected by botulinum toxin injection in the peroneus longus: Clinical and radiological evaluations in young children. Ann Phys Rehabil Med 2015; 58:316-21. [DOI: 10.1016/j.rehab.2015.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 08/20/2015] [Accepted: 09/09/2015] [Indexed: 11/21/2022]
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Agostini V, Nascimbeni A, Gaffuri A, Knaflitz M. Multiple gait patterns within the same Winters class in children with hemiplegic cerebral palsy. Clin Biomech (Bristol, Avon) 2015; 30:908-14. [PMID: 26239583 DOI: 10.1016/j.clinbiomech.2015.07.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 07/09/2015] [Accepted: 07/20/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous literature hypothesized that Winters type I are mainly characterized by a hypo-activation of dorsiflexors and type II by hyperactivation of plantarflexors around initial contact. However, it is currently not known if hemiplegic children belonging to the same Winters class really share the same muscle activation patterns, although this information might have relevant clinical implications in the patient management. METHODS Gait data of 38 hemiplegic cerebral palsy children (16 Winters type I, 22 Winters type II) were analyzed, focusing on the foot and shank. A 2.5-minute walk test was considered, corresponding to more than 100 gait cycles for each child, analyzing the muscle activation patterns of tibialis anterior and gastrocnemius lateralis. The large stride-to-stride variability of gait data was handled in an innovative way, processing separately: 1) distinct foot-floor contact patterns, and for each specific foot-floor contact pattern 2) distinct muscle "activation modalities", averaging only across gait cycles with the same number of activations, and obtaining, in both cases, the pattern frequency-of-occurrence. FINDINGS At least 2 representative foot-floor contact patterns within each Winters group, and up to 4-5 distinct muscle activation patterns were documented. INTERPRETATION It cannot be defined a predominant muscle activation pattern specific for a Winters group. For a correct clinical assessment of a hemiplegic child, it is advisable to record and properly analyze gait signals during a longer period of time (2-3 min), rather than (subjectively) selecting a few "clean" gait cycles, since these cycles may not be representative of the patient's gait.
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Affiliation(s)
- Valentina Agostini
- Dipartimento di Elettronica e Telecomunicazioni, Politecnico di Torino, Torino, Italy.
| | - Alberto Nascimbeni
- Rehabilitation Unit, S. Croce Hospital, A.S.L. TO5, Moncalieri (TO), Italy.
| | - Andrea Gaffuri
- Rehabilitation Unit, S. Croce Hospital, A.S.L. TO5, Moncalieri (TO), Italy.
| | - Marco Knaflitz
- Dipartimento di Elettronica e Telecomunicazioni, Politecnico di Torino, Torino, Italy.
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Vinti M, Gracies J, Merlo A, Bayle N, Viehweger E, Authier G, Chabrol B, Boulay C. Spastic co-contraction of gastrocnemius medialis and peroneus longus during swing phase of gait in hemiplegic children. Ann Phys Rehabil Med 2015. [DOI: 10.1016/j.rehab.2015.07.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Planovalgus foot deformity in hemiplegic children: A clinical and radiological evaluation after botulinum toxin injection in peroneus longus. Ann Phys Rehabil Med 2015. [DOI: 10.1016/j.rehab.2015.07.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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15
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Boulay C, Jacquemier M, Pomero V, Castanier E, Authier G, Chabrol B, Bollini G, Jouve JL, Viehweger E. Dynamic EMG of peroneus longus in hemiplegic children with equinovarus. Ann Phys Rehabil Med 2014; 57:185-92. [DOI: 10.1016/j.rehab.2014.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 02/12/2014] [Accepted: 02/14/2014] [Indexed: 10/25/2022]
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16
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Sim YJ, Lee DR, Yi CH. Immediate Effect of Fabric Ankle-Foot Orthosis on Spatiotemporal Gait Parameters in Children With Spastic Cerebral Palsy. ACTA ACUST UNITED AC 2014. [DOI: 10.12674/ptk.2014.21.1.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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