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Dimakopoulos R, Syrogiannopoulos G, Grivea I, Dailiana Z, Youroukos S, Spinou A. Kinematic and Temporospatial Changes in Children with Cerebral Palsy during the Initial Stages of Gait Development. Dev Neurorehabil 2022; 25:10-18. [PMID: 33872103 DOI: 10.1080/17518423.2021.1914763] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To identify changes in the gait kinematics and temporospatial parameters of children with bilateral Cerebral Palsy (CP) at 8 months after the onset of independent walking and identify differences to Typical Development (TD) children at the onset of independent walking and at 8 months follow up. METHOD Sixteen children with bilateral CP, GMFCS levels I and II, and 15 TD children were recruited. Gait kinematics and temporospatial parameters were recorded using a 3-D gait analysis system; the sagittal plane of the lower limb joints was analyzed. Baseline measurements were recorded at the individual's onset of independent walking and follow up was after 8 months. RESULTS Compared to baseline, children with bilateral CP demonstrated increased (mean difference ± SE) plantar flexion (11.79 ± 2.96), single support (0.04 ± 0.01), step length (0.2 ± 0.05) and stride length (0.4 ± 0.09), at follow up; all p < .05. Compared to TD children, they also had lower gait speed (0.16 ± 0.05), higher single support (0.02 ± 0.01) and lower maximum knee extension (9.14 ± 4.49) during the swing phase, at baseline and follow up (0.1 ± 0.04, 0.05 ± 0.01, 23.04 ± 4.17, respectively); all p < .05. CONCLUSION There are changes in the sagittal plane kinematics and temporospatial parameters of the gait during the first 8 months of independent walking. These indicate gait maturation changes and highlight the impact of walking experience on the gait characteristics of children with bilateral CP.
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Affiliation(s)
- Rigas Dimakopoulos
- Department of Pediatrics, University of Thessaly, Faculty of Medicine, Larissa, Greece.,Laboratory of Neuromuscular and Cardiovascular Study of Motion, Physiotherapy Department, University of West Attica, Greece
| | | | - Ioanna Grivea
- Department of Pediatrics, University of Thessaly, Faculty of Medicine, Larissa, Greece
| | - Zoe Dailiana
- Department of Orthopaedic Surgery, University of Thessaly, Faculty of Medicine, Larissa, Greece
| | - Sotirios Youroukos
- 1st Pediatric Clinic, University of Athens, "Agia Sofia" Children's Hospital, Athens, Greece
| | - Arietta Spinou
- Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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2
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Flux E, van der Krogt MM, Harlaar J, Buizer AI, Sloot LH. Functional assessment of stretch hyperreflexia in children with cerebral palsy using treadmill perturbations. J Neuroeng Rehabil 2021; 18:151. [PMID: 34663392 PMCID: PMC8522046 DOI: 10.1186/s12984-021-00940-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/08/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND As hyperactive muscle stretch reflexes hinder movement in patients with central nervous system disorders, they are a common target of treatment. To improve treatment evaluation, hyperactive reflexes should be assessed during activities as walking rather than passively. This study systematically explores the feasibility, reliability and validity of sudden treadmill perturbations to evoke and quantify calf muscle stretch reflexes during walking in children with neurological disorders. METHODS We performed an observational cross-sectional study including 24 children with cerebral palsy (CP; 6-16 years) and 14 typically developing children (TD; 6-15 years). Short belt accelerations were applied at three different intensities while children walked at comfortable speed. Lower leg kinematics, musculo-tendon lengthening and velocity, muscle activity and spatiotemporal parameters were measured to analyze perturbation responses. RESULTS We first demonstrated protocol feasibility: the protocol was completed by all but three children who ceased participation due to fatigue. All remaining children were able to maintain their gait pattern during perturbation trials without anticipatory adaptations in ankle kinematics, spatiotemporal parameters and muscle activity. Second, we showed the protocol's reliability: there was no systematic change in muscle response over time (P = 0.21-0.54) and a bootstrapping procedure indicated sufficient number of perturbations, as the last perturbation repetition only reduced variability by ~ 2%. Third, we evaluated construct validity by showing that responses comply with neurophysiological criteria for stretch reflexes: perturbations superimposed calf muscle lengthening (P < 0.001 for both CP and TD) in all but one participant. This elicited increased calf muscle activity (359 ± 190% for CP and 231 ± 68% for TD, both P < 0.001) in the gastrocnemius medialis muscle, which increased with perturbation intensity (P < 0.001), according to the velocity-dependent nature of stretch reflexes. Finally, construct validity was shown from a clinical perspective: stretch reflexes were 1.7 times higher for CP than TD for the gastrocnemius medialis muscle (P = 0.017). CONCLUSIONS The feasibility and reliability of the protocol, as well as the construct validity-shown by the exaggerated velocity-dependent nature of the measured responses-strongly support the use of treadmill perturbations to quantify stretch hyperreflexia during gait. We therefore provided a framework which can be used to inform clinical decision making and treatment evaluation.
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Affiliation(s)
- Eline Flux
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, PO Box 7057, 1007MB, Amsterdam, The Netherlands.
| | - Marjolein M van der Krogt
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, PO Box 7057, 1007MB, Amsterdam, The Netherlands
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, PO Box 7057, 1007MB, Amsterdam, The Netherlands
- Department Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
- Department Orthopedics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, PO Box 7057, 1007MB, Amsterdam, The Netherlands
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
| | - Lizeth H Sloot
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, PO Box 7057, 1007MB, Amsterdam, The Netherlands
- Institute for Computer Engineering, Heidelberg University, Heidelberg, Germany
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3
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Daly C. Factors associated with increased terminal swing knee flexion in cerebral palsy. Gait Posture 2021; 89:126-131. [PMID: 34280883 DOI: 10.1016/j.gaitpost.2021.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 06/09/2021] [Accepted: 07/14/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Increased terminal swing knee flexion (TSKF) impacts on step length, walking efficiency and may lead to knee flexion in stance in cerebral palsy (CP). Surgical lengthening of the hamstrings is often used to address this issue, but outcomes are inconsistent. There is an established association between TSKF and functional shortening or reduced lengthening velocity of the hamstrings. However, the aetiology of increased TSKF in CP is complex and additional associated factors are not well understood. An examination of clinical and kinematic factors associated with increased TSKF may demonstrate this complexity, highlight the multifactorial nature of this feature and provide a basis for enhanced treatment decision making. RESEARCH QUESTION What kinematic and clinical factors are associated with TSKF in individuals with CP?. METHODS A retrospective database review was conducted. Individuals with bilateral CP were identified and a subset was extracted which represented the full spectrum of degree of TSKF in the database. The total dataset for analysis was n = 88. Associations between absolute clinical and kinematic data and TSKF were explored using correlation analysis, linear and multivariate regression. Time series data were examined across quartiles using statistical parametric mapping analysis of variance (SPM ANOVA). RESULTS Increased TSKF was associated with overall gait impairment (GDI), degree of knee flexion throughout the stride, knee extension velocity, hamstring lengthening characteristics and functional status (GMFCS). There was no relationship to walking speed or clinical measures of hamstring extensibility on clinical assessment. SIGNIFICANCE TSKF is associated with multiple factors which clinicians need to consider when devising treatment strategies. Caution is advised when relying on degree of TSKF to independently guide surgical decision-making.
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Affiliation(s)
- Colm Daly
- Gait Laboratory, Central Remedial Clinic, Vernon Ave, Dublin 3, Ireland.
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4
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Elnaggar RK. An Analytical Insight Into How Walking Speed and Spatial and Temporal Symmetry Are Related to Ankle Dysfunctions in Children With Hemiplegic Cerebral Palsy. Am J Phys Med Rehabil 2021; 100:458-464. [PMID: 32858535 DOI: 10.1097/phm.0000000000001576] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The aim of the study was to identify the major determining factors among ankle dysfunctions for walking speed and symmetry in children with hemiplegic cerebral palsy. DESIGN This was a prospective analysis that included 52 children with hemiplegic cerebral palsy, aged between 5 and 8 yrs, had mild spasticity, and were functioning at Gross Motor Function Classification System level I or II. The dorsiflexor and plantar flexor strength, dynamic spasticity (represented by gastrocnemius muscle lengthening velocity during stance phase), plantar flexors stiffness, ankle joint position sense, and walking performance (spatiotemporal parameter) were assessed. RESULTS The least absolute shrinkage and selection operator regression analyses showed that the dorsiflexor strength of the paretic limb was the major determining factor of walking speed (R2 = 0.38, P < 0.001). Dynamic spasticity of the plantar flexors explained a portion of the variance in walking speed (R2 = 0.15, P < 0.001) and the highest portion of the variance in spatial walking symmetry (R2 = 0.18, P = 0.002). In addition, the ankle joint position sense was the primary determinant of temporal walking symmetry (R2 = 0.10, P = 0.021). CONCLUSIONS In children with hemiplegic cerebral palsy, walking speed is mostly influenced by dorsiflexor muscle strength, temporal walking symmetry is associated with the joint position sense, whereas spatial walking symmetry is explicated by the dynamic spasticity of the plantar flexor muscles.
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Affiliation(s)
- Ragab K Elnaggar
- From the Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia; and Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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5
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Bar-On L, Aertbeliën E, Van Campenhout A, Molenaers G, Desloovere K. Treatment Response to Botulinum Neurotoxin-A in Children With Cerebral Palsy Categorized by the Type of Stretch Reflex Muscle Activation. Front Neurol 2020; 11:378. [PMID: 32581991 PMCID: PMC7280486 DOI: 10.3389/fneur.2020.00378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 04/14/2020] [Indexed: 11/13/2022] Open
Abstract
While Botulinum NeuroToxin-A (BoNT-A) injections are frequently used to reduce the effects of hyperactive stretch reflexes in children with cerebral palsy (CP), the effects of this treatment vary strongly. Previous research, combining electromyography (EMG) with motion analysis, defined different patterns of stretch reflex muscle activation in muscles, those that reacted more to a change in velocity (velocity dependent -VD), and those that reacted more to a change in length (length dependent -LD). The aim of this study was to investigate the relation between the types of stretch reflex muscle activation in the semitendinosus with post-BoNT-A outcome as assessed passively and with 3D gait analysis in children with spastic CP. Eighteen children with spastic CP (10 bilaterally involved) between the ages of 12 and 18 years were assessed before and on average, 8 weeks post-treatment. EMG and motion analysis were used to assess the degree and type of muscle activation dependency in the semitendinosus during passive knee extensions performed at different joint angular velocities. Three-dimensional gait analysis was used to assess knee gait kinematics as a measure of functional outcome. Pre-treatment, 9 muscles were classified as VD and 9 as LD, but no differences between the groups were evident in the baseline knee gait kinematics. Post-treatment, stretch reflex muscle activation decreased significantly in both groups but the reduction was more pronounced in those muscles classified pre-treatment as VD (-72% vs. -50%, p = 0.005). In the VD group, these changes were accompanied by greater knee extension at initial contact and during the swing phase of gait. In the LD group, there was significantly increased post-treatment knee hyperextension in late stance. Although results vary between patients, the reduction of stretch reflex muscle activation in the semitendinosus generally translated to an improved functional outcome, as assessed with 3D gait analysis. However, results were less positive for those muscles with pre-treatment length-dependent type of stretch reflex muscle activation. The study demonstrates the relevance of categorizing the type of stretch reflex muscle activation as a possible predictor of treatment response.
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Affiliation(s)
- Lynn Bar-On
- Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam Movement Sciences, Amsterdam, Netherlands.,Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Erwin Aertbeliën
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium.,ROB Core Lab, Flanders Make, Leuven, Belgium
| | - Anja Van Campenhout
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospital Leuven, Leuven, Belgium
| | - Guy Molenaers
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospital Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospital Leuven, Leuven, Belgium
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6
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Papageorgiou E, Simon-Martinez C, Molenaers G, Ortibus E, Van Campenhout A, Desloovere K. Are spasticity, weakness, selectivity, and passive range of motion related to gait deviations in children with spastic cerebral palsy? A statistical parametric mapping study. PLoS One 2019; 14:e0223363. [PMID: 31603897 PMCID: PMC6788679 DOI: 10.1371/journal.pone.0223363] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 09/19/2019] [Indexed: 01/17/2023] Open
Abstract
This study aimed to identify the relationships between clinical impairments and gait deviations in children with cerebral palsy (CP). A retrospective convenience sample of 367 children with CP was selected (3–18 years old) and divided in two groups based on clinical symptomatology [unilateral (uCP) / bilateral CP (bCP), (n = 167/200)]. All children underwent a three-dimensional gait analysis and a standardized clinical examination. Gait was inspected on a vector level (all sagittal motions combined), and an individual joint level (pelvis, hip, knee and ankle joint motions). Statistical non-parametric mapping was applied to identify specific parts of the gait cycle displaying relationships between the gait deviations of both groups and the impairment scores of spasticity, weakness, selectivity, and passive range of motion. Impairment scores were summarized in two ways: a) composite impairment scores (e.g. combined spasticity of all assessed muscles acting around the hip, knee and ankle joints) and b) joint specific impairment scores (e.g. spasticity of the muscles acting around the knee joint). Results showed that the vector and most of the individual motions were related to the composite scores. Direct and carry-over relationships were found between certain individual motions and joint impairment scores (around the same or neighboring joints, respectively). All correlations were more prominent for children with bCP compared to uCP, especially regarding the relationships of gait deviations with weakness and reduced selectivity. In conclusion, this study enabled the mapping of relationships between clinical impairments and gait deviations in children with CP, by identifying specific parts of the gait cycle that are related to each of these impairments. These results provide a comprehensive description of these relationships, while simultaneously highlighting the differences between the two CP groups. Integration of these findings could lead to a better understanding of the pathophysiology of gait deviations and, eventually, support individualized treatment planning.
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Affiliation(s)
- Eirini Papageorgiou
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
- * E-mail:
| | | | - Guy Molenaers
- KU Leuven Department of Development and Regeneration, Leuven, Belgium
- Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium
| | - Els Ortibus
- KU Leuven Department of Development and Regeneration, Leuven, Belgium
| | - Anja Van Campenhout
- KU Leuven Department of Development and Regeneration, Leuven, Belgium
- Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium
| | - Kaat Desloovere
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
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7
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Liew BXW, Morris S, Netto K. Defining gait patterns using Parallel Factor 2 (PARAFAC2): A new analysis of previously published data. J Biomech 2019; 90:133-137. [PMID: 31076170 DOI: 10.1016/j.jbiomech.2019.04.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 11/17/2022]
Abstract
Three-dimensional gait analysis (3D-GA) is commonly used to answer clinical questions of the form "which joints and what variables are most affected during when". When studying high-dimensional datasets, traditional dimension reduction methods (e.g. principal components analysis) require "data flattening", which may make the ensuing solutions difficult to interpret. The aim of the present study is to present a case study of how a multi-dimensional dimension reduction technique, Parallel Factor 2 (PARAFAC2), provides a clinically interpretable set of solutions to typical biomechanical datasets where different variables are collected during walking and running. Three-dimensional kinematic and kinetic data used for the present analyses came from two publicly available datasets on walking (n = 33) and running (n = 28). For each dataset, a four-dimensional array was constructed as follows: Mode A was time normalized cycle points; mode B was the number of participants multiplied by the number of speed conditions tested; mode C was the number of joint degrees of freedom, and mode D was variable (angle, velocity, moment, power). Five factors for walking and four factors for running were extracted which explained 79.23% and 84.64% of their dataset's variance. The factor which explains the greatest variance was swing-phase sagittal plane knee kinematics (walking), and kinematics and kinetics (running). Qualitatively, all extracted factors increased in magnitude with greater speed in both walking and running. This study is a proof of concept that PARAFAC2 is useful for performing dimension reduction and producing clinically interpretable solutions to guide clinical decision making.
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Affiliation(s)
- Bernard X W Liew
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK.
| | - Susan Morris
- School of Physiotherapy and Exercise Sciences, Curtin University, GPO Box U1987, Perth, WA 6845, Australia
| | - Kevin Netto
- School of Physiotherapy and Exercise Sciences, Curtin University, GPO Box U1987, Perth, WA 6845, Australia
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Banky M, Ryan HK, Clark R, Olver J, Williams G. Do clinical tests of spasticity accurately reflect muscle function during walking: A systematic review. Brain Inj 2017; 31:440-455. [DOI: 10.1080/02699052.2016.1271455] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Megan Banky
- Physiotherapy Department, Epworth Hospital, Melbourne, Australia
- Faculty of Science, Health, Education and Engineering, The University of Sunshine Coast, Queensland, Australia
- Epworth Monash Rehabilitation Medicine Unit, Melbourne, Australia
| | - Hannah K. Ryan
- Physiotherapy Department, Epworth Hospital, Melbourne, Australia
| | - Ross Clark
- Faculty of Science, Health, Education and Engineering, The University of Sunshine Coast, Queensland, Australia
| | - John Olver
- Physiotherapy Department, Epworth Hospital, Melbourne, Australia
- Epworth Monash Rehabilitation Medicine Unit, Melbourne, Australia
| | - Gavin Williams
- Physiotherapy Department, Epworth Hospital, Melbourne, Australia
- Epworth Monash Rehabilitation Medicine Unit, Melbourne, Australia
- Physiotherapy Department, The University of Melbourne, Melbourne, Australia
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Sloot LH, van den Noort JC, van der Krogt MM, Bruijn SM, Harlaar J. Can Treadmill Perturbations Evoke Stretch Reflexes in the Calf Muscles? PLoS One 2015; 10:e0144815. [PMID: 26669665 PMCID: PMC4682928 DOI: 10.1371/journal.pone.0144815] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 11/24/2015] [Indexed: 11/19/2022] Open
Abstract
Disinhibition of reflexes is a problem amongst spastic patients, for it limits a smooth and efficient execution of motor functions during gait. Treadmill belt accelerations may potentially be used to measure reflexes during walking, i.e. by dorsal flexing the ankle and stretching the calf muscles, while decelerations show the modulation of reflexes during a reduction of sensory feedback. The aim of the current study was to examine if belt accelerations and decelerations of different intensities applied during the stance phase of treadmill walking can evoke reflexes in the gastrocnemius, soleus and tibialis anterior in healthy subjects. Muscle electromyography and joint kinematics were measured in 10 subjects. To determine whether stretch reflexes occurred, we assessed modelled musculo-tendon length and stretch velocity, the amount of muscle activity, as well as the incidence of bursts or depressions in muscle activity with their time delays, and co-contraction between agonist and antagonist muscle. Although the effect on the ankle angle was small with 2.8±1.0°, the perturbations caused clear changes in muscle length and stretch velocity relative to unperturbed walking. Stretched muscles showed an increasing incidence of bursts in muscle activity, which occurred after a reasonable electrophysiological time delay (163-191 ms). Their amplitude was related to the muscle stretch velocity and not related to co-contraction of the antagonist muscle. These effects increased with perturbation intensity. Shortened muscles showed opposite effects, with a depression in muscle activity of the calf muscles. The perturbations only slightly affected the spatio-temporal parameters, indicating that normal walking was retained. Thus, our findings showed that treadmill perturbations can evoke reflexes in the calf muscles and tibialis anterior. This comprehensive study could form the basis for clinical implementation of treadmill perturbations to functionally measure reflexes during treadmill-based clinical gait analysis.
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Affiliation(s)
- Lizeth H. Sloot
- Dept. of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
| | - Josien C. van den Noort
- Dept. of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
| | - Marjolein M. van der Krogt
- Dept. of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
| | - Sjoerd M. Bruijn
- MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University, Amsterdam, the Netherlands
- Department of Orthopedics, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Jaap Harlaar
- Dept. of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
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10
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Spasticity and its contribution to hypertonia in cerebral palsy. BIOMED RESEARCH INTERNATIONAL 2015; 2015:317047. [PMID: 25649546 PMCID: PMC4306250 DOI: 10.1155/2015/317047] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 12/15/2014] [Indexed: 11/23/2022]
Abstract
Spasticity is considered an important neural contributor to muscle hypertonia in children with cerebral palsy (CP). It is most often treated with antispasticity medication, such as Botulinum Toxin-A. However, treatment response is highly variable. Part of this variability may be due to the inability of clinical tests to differentiate between the neural (e.g., spasticity) and nonneural (e.g., soft tissue properties) contributions to hypertonia, leading to the terms “spasticity” and “hypertonia” often being used interchangeably. Recent advancements in instrumented spasticity assessments offer objective measurement methods for distinction and quantification of hypertonia components. These methods can be applied in clinical settings and their results used to fine-tune and improve treatment. We reviewed current advancements and new insights with respect to quantifying spasticity and its contribution to muscle hypertonia in children with CP. First, we revisit what is known about spasticity in children with CP, including the various definitions and its pathophysiology. Second, we summarize the state of the art on instrumented spasticity assessment in CP and review the parameters developed to quantify the neural and nonneural components of hypertonia. Lastly, the impact these quantitative parameters have on clinical decision-making is considered and recommendations for future clinical and research investigations are discussed.
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11
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Loi EC, Buysse CA, Price KS, Jaramillo TM, Pico EL, Hansen AB, Feldman HM. Myofascial Structural Integration Therapy on Gross Motor Function and Gait of Young Children with Spastic Cerebral Palsy: A Randomized Controlled Trial. Front Pediatr 2015; 3:74. [PMID: 26442234 PMCID: PMC4564770 DOI: 10.3389/fped.2015.00074] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 08/19/2015] [Indexed: 11/29/2022] Open
Abstract
Though the cause of motor abnormalities in cerebral palsy is injury to the brain, structural changes in muscle and fascia may add to stiffness and reduced function. This study examined whether myofascial structural integration therapy, a complementary treatment that manipulates muscle and fascia, would improve gross motor function and gait in children <4 years with cerebral palsy. Participants (N = 29) were enrolled in a randomized controlled trial (NCT01815814, https://goo.gl/TGxvwd) or Open Label Extension. The main outcome was the Gross Motor Function Measure-66 assessed at 3-month intervals. Gait (n = 8) was assessed using the GAITRite(®) electronic walkway. Parents completed a survey at study conclusion. Comparing Treatment (n = 15) and Waitlist-Control groups (n = 9), we found a significant main effect of time but no effect of group or time × group interaction. The pooled sample (n = 27) showed a main effect of time, but no significantly greater change after treatment than between other assessments. Foot length on the affected side increased significantly after treatment, likely indicating improvement in the children's ability to approach a heel strike. Parent surveys indicated satisfaction and improvements in the children's quality of movement. MSI did not increase the rate of motor skill development, but was associated with improvement in gait quality.
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Affiliation(s)
- Elizabeth C Loi
- Department of Pediatrics, Stanford University School of Medicine , Palo Alto, CA , USA
| | - Christina A Buysse
- Department of Pediatrics, Stanford University School of Medicine , Palo Alto, CA , USA
| | - Karen S Price
- Advanced Rolfing, Private Practice , Palo Alto, CA , USA
| | - Theresa M Jaramillo
- Physical Therapy and Rehabilitation Science, University of California San Francisco , San Francisco, CA , USA
| | - Elaine L Pico
- Pediatric Rehabilitation, Santa Clara Valley Medical Center , San Jose, CA , USA
| | - Alexis B Hansen
- Department of Family Medicine, Providence Milwaukie Hospital , Milwaukie, OR , USA
| | - Heidi M Feldman
- Department of Pediatrics, Stanford University School of Medicine , Palo Alto, CA , USA
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12
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Bar-On L, Molenaers G, Aertbeliën E, Monari D, Feys H, Desloovere K. The relation between spasticity and muscle behavior during the swing phase of gait in children with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:3354-3364. [PMID: 25240217 DOI: 10.1016/j.ridd.2014.07.053] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 07/25/2014] [Accepted: 07/29/2014] [Indexed: 06/03/2023]
Abstract
There is much debate about how spasticity contributes to the movement abnormalities seen in children with spastic cerebral palsy (CP). This study explored the relation between stretch reflex characteristics in passive muscles and markers of spasticity during gait. Twenty-four children with CP underwent 3D gait analysis at three walking velocity conditions (self-selected, faster and fastest). The gastrocnemius (GAS) and medial hamstrings (MEHs) were assessed at rest using an instrumented spasticity assessment that determined the stretch-reflex threshold, expressed in terms of muscle lengthening velocity. Muscle activation was quantified with root mean square electromyography (RMS-EMG) during passive muscle stretch and during the muscle lengthening periods in the swing phase of gait. Parameters from passive stretch were compared to those from gait analysis. In about half the children, GAS peak muscle lengthening velocity during the swing phase of gait did not exceed its stretch reflex threshold. In contrast, in the MEHs the threshold was always exceeded. In the GAS, stretch reflex thresholds were positively correlated to peak muscle lengthening velocity during the swing phase of gait at the faster (r = 0.46) and fastest (r = 0.54) walking conditions. In the MEHs, a similar relation was found, but only at the faster walking condition (r = 0.43). RMS-EMG during passive stretch showed moderate correlations to RMS-EMG during the swing phase of gait in the GAS (r = 0.46-0.56) and good correlations in the MEHs (r = 0.69-0.77) at all walking conditions. RMS-EMG during passive stretch showed no correlations to peak muscle lengthening velocity during gait. We conclude that a reduced stretch reflex threshold in the GAS and MEHs constrains peak muscle lengthening velocity during gait in children with CP. With increasing walking velocity, this constraint is more marked in the GAS, but not in the MEHs. Hyper-activation of stretch reflexes during passive stretch is related to muscle activation during the swing phase of gait, but has a limited contribution to reduced muscle lengthening velocity during swing. Larger studies are required to confirm these results, and to investigate the contribution of other impairments such as passive stiffness and weakness to reduced muscle lengthening velocity during the swing phase of gait.
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Affiliation(s)
- Lynn Bar-On
- KU Leuven Department of Rehabilitation Sciences, Tervuursevest 101, 3001 Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospital, Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium.
| | - Guy Molenaers
- Clinical Motion Analysis Laboratory, University Hospital, Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium; KU Leuven Department of Development and Regeneration, Herestraat 49 box 7003, 3000 Leuven, Belgium; Department of Orthopedics, University Hospital, Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium.
| | - Erwin Aertbeliën
- KU Leuven Department of Mechanical Engineering, Celestijnenlaan 300b box 2420, 3001 Leuven, Belgium.
| | - Davide Monari
- Clinical Motion Analysis Laboratory, University Hospital, Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium; KU Leuven Department of Mechanical Engineering, Celestijnenlaan 300b box 2420, 3001 Leuven, Belgium.
| | - Hilde Feys
- KU Leuven Department of Rehabilitation Sciences, Tervuursevest 101, 3001 Leuven, Belgium.
| | - Kaat Desloovere
- KU Leuven Department of Rehabilitation Sciences, Tervuursevest 101, 3001 Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospital, Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium.
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