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Willaert J, Martino G, Desloovere K, Van Campenhout A, Ting LH, De Groote F. Increased muscle responses to balance perturbations in children with cerebral palsy can be explained by increased sensitivity to center of mass movement. Gait Posture 2024; 107:121-129. [PMID: 36990910 PMCID: PMC10517062 DOI: 10.1016/j.gaitpost.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/17/2023] [Accepted: 03/22/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Balance impairments are common in children with cerebral palsy (CP). Muscle activity during perturbed standing is higher in children with CP than in typically developing (TD) children, but we know surprisingly little about how sensorimotor processes for balance control are altered in CP. Sensorimotor processing refers to how the nervous system translates incoming sensory information about body motion into motor commands to activate muscles. In healthy adults, muscle activity in response to backward support-surface translations during standing can be reconstructed by center of mass (CoM) feedback, i.e., by a linear combination of delayed (due to neural transmission times) CoM displacement, velocity, and acceleration. The level of muscle activity in relation to changes in CoM kinematics, i.e., the feedback gains, provides a metric of the sensitivity of the muscle response to CoM perturbations. RESEARCH QUESTION Can CoM feedback explain reactive muscle activity in children with CP, yet with higher feedback gains than in TD children? METHODS We perturbed standing balance by backward support-surface translations of different magnitudes in 20 children with CP and 20 age-matched TD children and investigated CoM feedback pathways underlying reactive muscle activity in the triceps surae and tibialis anterior. RESULTS Reactive muscle activity could be reconstructed by delayed feedback of CoM kinematics and hence similar sensorimotor pathways might underlie balance control in children with CP and TD children. However, sensitivities of both agonistic and antagonistic muscle activity to CoM displacement and velocity were higher in children with CP than in TD children. The increased sensitivity of balance correcting responses to CoM movement might explain the stiffer kinematic response, i.e., smaller CoM movement, observed in children with CP. SIGNIFICANCE The sensorimotor model used here provided unique insights into how CP affects neural processing underlying balance control. Sensorimotor sensitivities might be a useful metric to diagnose balance impairments.
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Affiliation(s)
- J Willaert
- Department of Movement Sciences, KU Leuven, Belgium.
| | - G Martino
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Tech, Atlanta, GA, United States
| | - K Desloovere
- Department of Rehabilitation Sciences, KU Leuven - UZ Leuven, Belgium
| | - A Van Campenhout
- Department of Development and Regeneration, KU Leuven - UZ Leuven, Belgium
| | - L H Ting
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Tech, Atlanta, GA, United States; Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States
| | - F De Groote
- Department of Movement Sciences, KU Leuven, Belgium
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Allah NEA, Kamal HM, El-Nabie WAEHA. Association between pelvic inclination and balance in children with spastic diplegia. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2023. [DOI: 10.1186/s43161-022-00115-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Abstract
Background
Children with spastic diplegia experience gait abnormalities and problems caused by deficits in balance, motor control, and spasticity. Abnormal pelvic inclination is common in patients with diplegia which may result in poor pelvic balance.
Purpose
This study was conducted to investigate the relation between pelvic inclination and standing balance in children with spastic diplegia.
Subjects and methods
Thirty children with spastic diplegic cerebral palsy from both sexes, aged from 5 to 14 years participated in this study. Their degree of spasticity ranged from 1 to 1+ according to Modified Ashworth Scale and they were on level I or II on Gross Motor Function Classification System. Pelvic inclination angle was measured by using the formetric instrumentation system during standing position while standing balance was assessed by the Biodex Balance System.
Results
There was a statistically significant relation between pelvic inclination and the overall, anteroposterior, and mediolateral stability indices of standing balance (P < 0.05).
Conclusion
The obtained results suggested that there was significant correlation between balance and pelvic inclination in children with diplegic cerebral palsy.
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Özal C, Aksoy S, Kerem Günel M. Postural Control Alterations in Children with Mild Forms of Spastic Cerebral Palsy. Pediatric Health Med Ther 2022; 13:367-376. [DOI: 10.2147/phmt.s378451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/13/2022] [Indexed: 11/24/2022] Open
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Hegazy RG, Abdel-Aziem AA. Effect of Whole-Body Vibration Exercise on Hamstrings-to-Quadriceps Ratio, Walking Performance, and Postural Control in Children With Hemiparetic Cerebral Palsy: A Randomized Controlled Trial. J Manipulative Physiol Ther 2022; 45:660-670. [PMID: 37318391 DOI: 10.1016/j.jmpt.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 03/23/2023] [Accepted: 04/12/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the effect of whole-body vibration (WBV) exercises combined with traditional physiotherapy on the hamstrings-to-quadriceps (H:Q) ratio, walking ability, and control of posture in children with hemiparetic cerebral palsy (CP). METHODS A total of 34 children with spastic hemiparetic CP (boys and girls) participated in this 2-arm, parallel, randomized controlled trial. The inclusion criteria were spasticity ranging from 1 to 1+, gross level skills (I and II), at least 1 meter tall, standing alone, and walking forward and backward. They were randomly allocated to the control group (traditional physiotherapy) and study group and were treated by the same physiotherapy program combined with WBV training (3 times per week for 2 successive months). Quadriceps and hamstring muscle strength, walking performance, and postural control were evaluated before and after intervention by a blinded assessor. RESULTS The post-intervention values of the hamstring and quadriceps muscle force, gross motor function, and stability indices of the 2 groups were higher than the pre-values (P < .05). In addition, the post-values of the study group were higher than those of the control group (P < .05). Regarding the H:Q ratio, there was no significant difference between pre-values or the post-values of both groups (P = .948 and P = .397, respectively). There were no significant differences between the pre- and post-values of each group (P = .500 and P = .195, respectively). CONCLUSION Eight weeks of WBV training combined with traditional physiotherapy was more effective than traditional physiotherapy alone in improving walking ability and postural control. Furthermore, the combined intervention strengthened the quadriceps and hamstring muscles, with no change in the H:Q ratio in children with hemiparetic CP.
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Affiliation(s)
- Rania G Hegazy
- Department of Pediatric Physical Therapy, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Amr A Abdel-Aziem
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza, Egypt.
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Arnoni JLB, Lima CRG, Verdério BN, Kleiner AFR, de Campos AC, Rocha NACF. Active Videogame Training Combined with Conventional Therapy Alters Body Oscillation in Children with Cerebral Palsy: A Randomized Controlled Trial. Games Health J 2022; 11:252-261. [PMID: 35687479 DOI: 10.1089/g4h.2021.0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective: Assess the effect of nonimmersive virtual reality (VR) training as complementary rehabilitation on body oscillation in children with cerebral palsy (CP) while standing on different bases of support and surfaces. Materials and Methods: Twenty-three children with unilateral CP randomly allocated to an intervention group (IG, n = 12) or control group (CG, n = 11). The IG underwent two weekly 50-minute sessions of VR training over 8 weeks, associated with conventional therapy, while the CG was submitted to two 45-minute sessions of conventional neurodevelopmental-based physiotherapy a week over the same time period. Participants were evaluated on a force platform under control conditions (CCs) (rigid surface, feet parallel); semitandem stance; flexible surface (FS) with feet parallel; and flexible surface in a semitandem (FSST) stance. The effect of the group and time factors on the center of pressure oscillation variables was analyzed by repeated-measures analysis of variance (ANOVA), with significance set at 0.05. Results: The main effect observed was for time on the FS, with a decline in the amplitude of mediolateral (ML Amp) (P = 0.01) and mediolateral root mean square (P = 0.01) after intervention. In the IG, ML Amp also declined after intervention under CCs (P = 0.02) and total velocity increased for FSST (P = 0.04). The percentage change was significant only in the IG. Conclusion: VR training as complementary rehabilitation can help improve body oscillation in children with CP and mild functional impairment. Nonimmersive VR can be considered a complementary tool for the physical rehabilitation of children with CP. This study was registered with the Brazilian Clinical Trials Registry (RBR-3zty4w).
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Affiliation(s)
- Joice Luiza Bruno Arnoni
- Neuropediatrics Section, Department of Physiotherapy, Federal University of Sao Carlos, Sao Carlos, Brazil
| | | | - Bruna Nayara Verdério
- Neuropediatrics Section, Department of Physiotherapy, Federal University of Sao Carlos, Sao Carlos, Brazil
| | | | - Ana Carolina de Campos
- Neuropediatrics Section, Department of Physiotherapy, Federal University of Sao Carlos, Sao Carlos, Brazil
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Shears A, Yan G, Mortimer H, Cross E, Sapuan S, Kadambari S, Luck S, Heath PT, Walter S, Fidler KJ. Vestibular and balance dysfunction in children with congenital CMV: a systematic review. Arch Dis Child Fetal Neonatal Ed 2022; 107:fetalneonatal-2021-323380. [PMID: 35545420 PMCID: PMC9606507 DOI: 10.1136/archdischild-2021-323380] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/31/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This systematic review evaluates vestibular and balance dysfunction in children with congenital cytomegalovirus (cCMV), makes recommendations for clinical practice and informs future research priorities. DESIGN MEDLINE, Embase, EMCARE, BMJ Best Practice, Cochrane Library, DynaMed Plus and UpToDate were searched from inception to 20 March 2021 and graded according to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria. PATIENTS Children with cCMV diagnosed within 3 weeks of life from either blood, saliva and/or urine (using either PCR or culture). INTERVENTION Studies of vestibular function and/or balance assessments. MAIN OUTCOME MEASURES Vestibular function and balance. RESULTS 1371 studies were identified, and subsequently 16 observational studies were eligible for analysis, leading to an overall cohort of 600 children with cCMV. All studies were of low/moderate quality. In 12/16 studies, vestibular function tests were performed. 10/12 reported vestibular dysfunction in ≥40% of children with cCMV. Three studies compared outcomes for children with symptomatic or asymptomatic cCMV at birth; vestibular dysfunction was more frequently reported in children with symptomatic (22%-60%), than asymptomatic cCMV (0%-12.5%). Two studies found that vestibular function deteriorated over time: one in children (mean age 7.2 months) over 10 months and the other (mean age 34.7 months) over 26 months. CONCLUSIONS Vestibular dysfunction is found in children with symptomatic and asymptomatic cCMV and in those with and without hearing loss. Audiovestibular assessments should be performed as part of neurodevelopmental follow-up in children with cCMV. Case-controlled longitudinal studies are required to more precisely characterise vestibular dysfunction and help determine the efficacy of early supportive interventions. PROSPERO REGISTRATION CRD42019131656.
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Affiliation(s)
- Annalie Shears
- Department of Paediatrics, Royal Manchester Children's Hospital, Manchester, UK
- Academic Paediatrics, Royal Alexandra Children's Hospital, Brighton, UK
| | - Georgina Yan
- Academic Paediatrics, Royal Alexandra Children's Hospital, Brighton, UK
- Department of Neonatology, University College London EGA Institute for Women's Health, London, UK
| | - Harriet Mortimer
- Medicine, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Elizabeth Cross
- Department of Infectious Diseases, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
| | - Shari Sapuan
- Paediatric Infectious Diseases Research Group, St George's University of London, London, UK
| | - Seilesh Kadambari
- Department of Paediatrics, University of Oxford Oxford Vaccine Group, Oxford, Oxfordshire, UK
- NIHR Oxford Biomedical Research Centre, Oxford, Oxfordshire, UK
| | | | - Paul T Heath
- Paediatric Infectious Diseases Research Group, St George's University of London, London, UK
| | - Simone Walter
- Department of Audiovestibular Medicine, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Katy J Fidler
- Academic Paediatrics, Royal Alexandra Children's Hospital, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
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Roostaei M, Raji P, Kalantari KK, Faghihzadeh E, Fragala-Pinkham M. Effect of upper extremity constraints on functional and dynamic postural control in children with hemiplegic cerebral palsy. Dev Neurorehabil 2022; 25:281-288. [PMID: 34971522 DOI: 10.1080/17518423.2021.2020351] [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: 10/19/2022]
Abstract
PURPOSE To compare the effects of upper extremity constraints on functional and dynamic postural control in children with hemiplegic cerebral palsy. MATERIALS AND METHODS Twelve children with hemiplegic cerebral palsy and 12 typically developing children ages 5 to 12 years (GMFCS I-II) were evaluated with the Timed Up and Go (TUG) and Biodex Balance System during three upper extremity (UE) conditions: 1) Free UEs (no constraints), 2) Simple UE constraint (unaffected/dominant UE constrained with a sling), and 3) Difficult UE constraint (Simple constraint plus the other UE holding cup of water). RESULTS The UE condition had significant effects on Overall Stability Index (OSI) (F(2,44) = 24.899, p < .001), Medial-Lateral Stability Index (MLSI) (F(2,44) = 4.380, p = .018), Anterior-Posterior Stability Index (F(2,44) = 6.187, p = .004), and TUG scores (F(2,44) = 113.372, p < .001). Group was significant for OSI (F(1,22) = 7.906, p = .010), MLSI (F(1,22) = 13.113, p = .002), and TUG (F(1,22) = 36.282, p < .001). CONCLUSIONS The upper extremity appears to have a role in maintaining functional balance and postural stability in children with hemiplegic cerebral palsy and should be considered during intervention programs.
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Affiliation(s)
- Meysam Roostaei
- Department of Occupational Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Parvin Raji
- Department of Occupational Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Khosro Khademi Kalantari
- Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Faghihzadeh
- Department of Biostatistics and Epidemiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Maria Fragala-Pinkham
- Department of Physical Therapy and Occupational Therapy, Boston Children's Hospital, Boston, MA, USA
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Jung H, Choi YE. The Psychometric Properties of the Trunk Impairment Scale in Children with Cerebral Palsy. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9030435. [PMID: 35327807 PMCID: PMC8946874 DOI: 10.3390/children9030435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/12/2022] [Accepted: 03/15/2022] [Indexed: 11/16/2022]
Abstract
The Trunk Impairment Scale (TIS) measures static and dynamic seated trunk control in children with cerebral palsy (CP) who have postural control problems. Studies have investigated the reliability and validity of the TIS. However, the fitness and difficulty of the scale items have not been investigated. This study used Rasch analysis to test the construct validity of TIS for children with CP. TIS data were collected from 60 children with CP and analyzed for person and item fit, item difficulty, rating scale suitability, and separation reliability. Principal component analyses of residuals revealed that TIS had unidimensionality. Five misfit items (static sitting balance (SSB) items 2 and 3, dynamic sitting balance (DSB) items 4 and 5, and coordination (COO) item 3) were identified. DSB8 is the most difficult item, followed by DSB3 and COO4. On the other hand, the SSB3 item was found to be a relatively easy item. The rating scales demonstrated that out of the three subscales, SSB, DSB, and COO, only the SSB subscale did not meet the appropriate criteria. We demonstrated that statistical item analysis with the Rasch model could provide valuable information related to psychometric properties.
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Affiliation(s)
- Hyerim Jung
- Department of Occupational Therapy, Baekseok University, Cheonan 31065, Korea;
| | - Young-Eun Choi
- Department of Physical Therapy, College of Health Medicine, Kaya University, Gimhae 50830, Korea
- Correspondence: ; Tel.: +82-55-330-1190; Fax: +82-55-344-5285
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Evaluation of sitting and standing postural balance in cerebral palsy by center-of-pressure measurement using force plates: comparison with clinical measurements. Gait Posture 2022; 92:110-115. [PMID: 34839205 DOI: 10.1016/j.gaitpost.2021.11.024] [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] [Received: 04/11/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Center-of-pressure (CoP) measurements have been studied for assessing balance control. While CoP measurements using force plates have been used to assess standing balance in children with cerebral palsy (CP), it has not been assessed in a sitting position, which specifically reflects trunk postural control. RESEARCH QUESTION The purpose of this study was to compare CoP measurements using force plates during both standing and sitting trials with the Pediatric Balance Scale (PBS) in children with spastic CP. METHODS We recruited 26 children with spastic CP (7.8 ± 3.4 years, 4-13 years) and used the PBS, a validated evaluation tool that measures static and dynamic balance control. We took CoP measurements using force plates during sitting and standing. For both trials, subjects stayed still for 10 s with their eyes open or closed. We calculated the CoP velocity, mediolateral (ML) and anteroposterior (AP) velocity, and ML and AP displacements of CoP. RESULTS AND SIGNIFICANCE During standing trials, static PBS standing scores negatively correlated with more AP displacement and velocity than ML displacement and velocity (p < 0.05). During sitting trials, dynamic PBS sitting scores negatively correlated with ML displacement and velocity (p < 0.05). CoP parameters in the ML direction of the sitting position and CoP parameters in the AP direction of the standing position may better reflect the balance control in children with spastic CP.
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Marron A, Brady K, Kiernan D. Parental subjective assessment of gait limitations: Comparison with objective gait variables. Gait Posture 2022; 92:218-222. [PMID: 34871926 DOI: 10.1016/j.gaitpost.2021.11.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/16/2021] [Accepted: 11/28/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Subjective assessment is an important part of clinical examination providing quality insights into impairments of body structure and functions. Research into the associations between parental perceptions of gait in children with cerebral palsy (CP) and objective clinical gait measures is limited. RESEARCH QUESTION What are the parental perceived gait limitations in children with CP and are these perceptions associated with objective clinical gait analysis? METHODS Parent questionnaires were retrospectively analysed for children with CP who attended our gait analysis laboratory over a 24-month period. Perceived walking limitations caused by pain, weakness, lack of endurance, mental ability, safety concerns, and balance were recorded on a 5-point Likert scale. Normalised gait speed, normalised step length and the Gait Deviation Index (GDI) were calculated. Differences between responses were assessed using Chi-squared tests with Dunn's post hoc test with Bonferroni adjustment. Spearman's rank correlations were performed to determine the relationship between responses and gait parameters. RESULTS Data from 251 participants were included, mean age 9 ± 3.4 years, Gross Motor Function Classification System (GMFCS) level I = 158, II = 64 and III = 29. Balance was perceived to limit walking to the greatest extent, followed by weakness, lack of endurance, safety concerns, pain and mental ability. This rank was consistent across GMFCS levels I, II and III. Perceived balance limitations showed the strongest correlations with objective gait variables, GDI (r = -0.31 p = 0.000), normalised step length (r = -0.30 p = 0.0000) and normalised gait speed (r = -0.24 p = 0.0001). SIGNIFICANCE Subjective gait perceptions provide a valuable indication of gait function but are weakly associated with objective clinical gait analysis. Outcome measures that are sensitive to changes in balance may be more responsive to parental concerns and help to satisfy their goals and expectations.
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Affiliation(s)
- A Marron
- Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland.
| | - K Brady
- Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland
| | - D Kiernan
- Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland
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Acceptability and feasibility of a vestibular nerve stimulation headset protocol in children with cerebral palsy. BMC Pediatr 2022; 22:34. [PMID: 35016677 PMCID: PMC8750849 DOI: 10.1186/s12887-021-03093-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/23/2021] [Indexed: 11/18/2022] Open
Abstract
Background Research suggests electrical Vestibular Nerve Stimulation (VeNS) may improve balance for people with neurological impairments. This study aimed to assess the feasibility and acceptability of a VeNS headset protocol in children with cerebral palsy (CP). Methods Children aged 5–18 years with ambulant CP, their parents, and healthcare professionals were recruited via social media. Children completed a battery of balance tests and wore a sham VeNS headset one hour per day for four weeks. Perspectives on the balance tests and headset were ascertained from children, parents and healthcare professionals using semi-structured interviews. Interview data were analysed thematically. Results Two families and four healthcare professionals participated. Balance outcome measures were fully completed and deemed acceptable. Adherence with wearing the headset was 89–100% but discomfort with self-adhesive electrodes was reported. Four themes emerged from interview data: headset issues, perceptions about VeNS, the importance of balance, and modifications for future study. Conclusions Although the VeNS headset had high acceptability, the volunteer sample was small, potentially suggesting limited interest in VeNS as a treatment for children with CP, or reluctance to trial a ‘non-active’ headset. Recruitment via clinicians known to the family and use of an ‘active’ headset may increase participation in future research. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-03093-1.
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Pierret J, Caudron S, Paysant J, Beyaert C. Impaired postural control of axial segments in children with cerebral palsy. Gait Posture 2021; 86:266-272. [PMID: 33819768 DOI: 10.1016/j.gaitpost.2021.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Sensorimotor control of axial segments, which develops during childhood and is not mature until adolescence, is essential for the development of balance control during motor activities. Children with cerebral palsy (CP) have deficits in postural control when standing or walking, including less stabilization of the head and trunk which could affect postural control. RESEARCH QUESTION Is dynamic stabilization of axial segments during an unstable sitting task deficient in children with CP compared to typically developing children? Is this deficit correlated with the deficit of postural control during standing? METHOD Seventeen children with CP (GMFCS I-II) and 17 typically-developing children from 6 to 12 years old were rated on the Trunk Control Measurement Scale (TCMS). In addition, posturography was evaluated in participants while they maintained their balance in stable sitting, unstable sitting, and quiet standing, under "eyes open" and "eyes closed" conditions. In sitting tasks, the participants had to remain stable while being prevented from using the lower and upper limbs (i.e. to ensure the involvement of axial segments alone). RESULTS Children with CP compared to TD children had significantly larger surface area, mean velocity and RMS values of CoP displacements measured during the unstable sitting task and the standing task, under both "eyes open" and "eyes closed" conditions. No significant group effects were observed during the stable sitting task. The TCMS total score was significantly lower, indicating trunk postural deficit, in the CP group than in the TD group and was significantly correlated with postural variables in the sitting and standing tasks. SIGNIFICANCE Children with CP indeed have a specific impairment in the postural control of axial segments. Since the postural control of axial segments is important for standing and walking, its impairment should be taken into account in rehabilitation programs for children with CP.
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Affiliation(s)
- Jonathan Pierret
- Université de Lorraine, DevAH (EA3450 Développement, Adaptation & Handicap), F-54000, Nancy, France; Institut Régional de Réadaptation, Centre Louis Pierquin, UGECAM du Nord-Est, Nancy, France.
| | - Sébastien Caudron
- Université de Lorraine, DevAH (EA3450 Développement, Adaptation & Handicap), F-54000, Nancy, France; Univ. Grenoble Alpes, CNRS, LPNC, 38000 Grenoble, France.
| | - Jean Paysant
- Université de Lorraine, DevAH (EA3450 Développement, Adaptation & Handicap), F-54000, Nancy, France; Institut Régional de Réadaptation, Centre Louis Pierquin, UGECAM du Nord-Est, Nancy, France.
| | - Christian Beyaert
- Université de Lorraine, DevAH (EA3450 Développement, Adaptation & Handicap), F-54000, Nancy, France; Institut Régional de Réadaptation, Centre Louis Pierquin, UGECAM du Nord-Est, Nancy, France.
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Kinect V2-Based Gait Analysis for Children with Cerebral Palsy: Validity and Reliability of Spatial Margin of Stability and Spatiotemporal Variables. SENSORS 2021; 21:s21062104. [PMID: 33802731 PMCID: PMC8002565 DOI: 10.3390/s21062104] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/15/2021] [Accepted: 03/13/2021] [Indexed: 12/17/2022]
Abstract
Children with cerebral palsy (CP) have high risks of falling. It is necessary to evaluate gait stability for children with CP. In comparison to traditional motion capture techniques, the Kinect has the potential to be utilised as a cost-effective gait stability assessment tool, ensuring frequent and uninterrupted gait monitoring. To evaluate the validity and reliability of this measurement, in this study, ten children with CP performed two testing sessions, of which gait data were recorded by a Kinect V2 sensor and a referential Motion Analysis system. The margin of stability (MOS) and gait spatiotemporal metrics were examined. For the spatiotemporal parameters, intraclass correlation coefficient (ICC2,k) values were from 0.83 to 0.99 between two devices and from 0.78 to 0.88 between two testing sessions. For the MOS outcomes, ICC2,k values ranged from 0.42 to 0.99 between two devices and 0.28 to 0.69 between two test sessions. The Kinect V2 was able to provide valid and reliable spatiotemporal gait parameters, and it could also offer accurate outcome measures for the minimum MOS. The reliability of the Kinect V2 when assessing time-specific MOS variables was limited. The Kinect V2 shows the potential to be used as a cost-effective tool for CP gait stability assessment.
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Towns M, Lindsay S, Arbour-Nicitopoulos K, Mansfield A, Wright FV. Balance confidence and physical activity participation of independently ambulatory youth with cerebral palsy: an exploration of youths' and parents' perspectives. Disabil Rehabil 2020; 44:2305-2316. [PMID: 33186057 DOI: 10.1080/09638288.2020.1830191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM Youth with cerebral palsy generally participate in less physical activity than typically developing peers. In adults with physical disabilities, balance confidence is a strong predictor of participation and community re-integration. However, balance confidence has not been studied in youth with cerebral palsy. METHOD Qualitative descriptive methodology with interviews of eight youth with cerebral palsy (9-17 years old, three girls) in Gross Motor Function Classification System Levels I-III, and eight parents (five mothers) of youth with cerebral palsy (9-17 years old, two girls) in Levels I-III. RESULTS Three themes arose: (1) youth in Gross Motor Function Classification System Levels I-II are more concerned about losing their balance during physical activities than those in Level III; (2) when balance is lost, embarrassment and frustration are more common than fear, especially for those in Levels I-II; and (3) social factors can create a favorable participation environment when balance confidence is low, especially for youth in Levels I-II. CONCLUSION Balance confidence may have greater influence on physical activity participation for youth in Gross Motor Function Classification System Levels I-II than those in Level III. Youth in Levels I-II may draw greater benefit from interventions targeting balance confidence when addressing physical activity goals.IMPLICATIONS FOR REHABILITATIONBalance confidence may have a greater influence on activity avoidance for youth with cerebral palsy in Gross Motor Function Classification System Levels I and II (who are independently ambulatory without walkers or cane(s)) than for those in Level II (who use walkers or cane(s) to ambulate).Youth who are independently ambulatory without walkers or cane(s) may benefit more from interventions directed at balance confidence (e.g., enactive mastery and verbal persuasion) to address their physical activity participation goals.For youth who are independently ambulatory without walkers or cane(s), addressing factors that could reduce the influence of balance confidence on physical activity participation, such as providing a positive and supportive social environment in which to participate, may be beneficial.
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Affiliation(s)
- Megan Towns
- Bloorview Research Institute, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Sally Lindsay
- Bloorview Research Institute, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Kelly Arbour-Nicitopoulos
- Bloorview Research Institute, Toronto, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Avril Mansfield
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Evaluative Clinical Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - F Virginia Wright
- Bloorview Research Institute, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
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15
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Szopa A, Domagalska-Szopa M, Siwiec A, Kwiecień-Czerwieniec I. Canonical correlation between body-posture deviations and gait disorders in children with cerebral palsy. PLoS One 2020; 15:e0234654. [PMID: 32544177 PMCID: PMC7297316 DOI: 10.1371/journal.pone.0234654] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 05/30/2020] [Indexed: 11/18/2022] Open
Abstract
Children with Cerebral Palsy (CP) show the postural constraints while standing, and gait disorders, resulting from both primary and secondary impairments of brain injury. In our previous studies, several characteristic postural and gait patterns in children with unilateral as well as with bilateral CP were defined, and the relationship between these patterns was demonstrated. The purpose of present study was to identify which features of body posture deviation during standing were strongly related to gait deviations in independently ambulatory children with CP. For this aim we explored the cross-relationship between features of body posture while standing examined by surface topography and the selected gait parameters from three-dimensional instrumented gait analysis in one hundred twenty children with cerebral palsy, aged between 7 and 13 years, who were able to walk independently. First, our study documented that that sagittal misalignment of the spine curvature was significantly related to kinematic deviations such as deviations of pelvic tilt, inadequate swing phase and knee flexion, and peak dorsiflexion in stance. Second, the study shows that the static asymmetry of pelvis and trunk was significantly associated with kinematic deviations during gait cycle such as pelvic rotation, hip abduction in swing, ROM of knee flexion, peak dorsiflexion in stance. Based on obtained results and referring to our previous findings it can be assumed that the first model of the relationship between postural deviation and gait disturbances, called 'postural and gait complex of disorders in sagittal plane', is related to children with bilateral CP, whereas the second model 'postural and gait complex of disorders in coronal plane' to children with unilateral CP. The clinical applications of this study relate to the early recognition of particular features of postural deviation using surface topography, instead of more difficult and demanding expensive tools 3-D gait analysis.
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Affiliation(s)
- Andrzej Szopa
- Department of Physiotherapy, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Małgorzata Domagalska-Szopa
- Department of Medical Rehabilitation, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Andrzej Siwiec
- Pediatrics Center John Paul II in Sosnowiec, Sosnowiec, Poland
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16
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Topley D, McConnell K, Kerr C. A systematic review of vestibular stimulation in cerebral palsy. Disabil Rehabil 2020; 43:3291-3297. [PMID: 32212976 DOI: 10.1080/09638288.2020.1742802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Identify the types and dosage of vestibular stimulation interventions in persons with cerebral palsy (CP), and establish the efficacy of these interventions on balance and function. MATERIALS AND METHODS This systematic review followed Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols to search for studies evaluating vestibular stimulation interventions in persons with CP. Information sources included MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials, clinicaltrials.gov and the World Health Organisation registry. Methodological quality was assessed by two independent reviewers using the Methodological Index of Non-Randomised Studies (MINORS) and Cochrane Risk of Bias Tool. RESULTS Five articles were included. Three randomised studies were judged to have high risk of bias in at least one domain of the Cochrane Risk of Bias Tool. Two non-randomised studies were rated as low methodological quality using the MINORS tool. All studies used exercise-based vestibular stimulation, but there was little homogeneity regarding dosage. Findings related to efficacy of vestibular stimulation were inconsistent. CONCLUSIONS Clinical practice recommendations cannot be made due to lack of high quality studies and heterogeneity of treatment protocols. Future research should address theory-driven selection of intervention, establish dosage, use psychometrically robust tools and include all ages of persons with CP.IMPLICATIONS FOR REHABILITATIONOptimal intervention parameters for vestibular stimulation cannot be determined from existing literature.Further studies to describe vestibular stimulation intervention components and duration are warranted.In practice, use of valid and reliable balance and gross motor function outcome measures are essential if using vestibular stimulation techniques with people with CP, as the efficacy of these interventions has not been clearly demonstrated.Investigation of electrical Vestibular Nerve Stimulation in people with CP is warranted.
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Affiliation(s)
- Daniel Topley
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Karen McConnell
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Claire Kerr
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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17
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Dadashi F, Shahroki A, Nourian R, Irani A, Molavi M, Rafieenazari Z, Mirbagheri MM, Mirbagheri A. The Effects of Repetitive Transcranial Magnetic Stimulation (rTMS) on Balance Control in Children with Cerebral Palsy. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:5241-5244. [PMID: 31947040 DOI: 10.1109/embc.2019.8857361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cerebral palsy (CP) is a neurological disorder which can result in balance and mobility impairments. Four children with spastic CP participated and randomly assigned to experimental and control groups. The experimental group received 1-Hz repetitive Transcranial Magnetic Stimulation (rTMS) four times a week for 3 weeks, and the control group received sham rTMS using the similar experimental protocol. Each rTMS session lasted for 20 minutes. Postural balance was quantified by analyzing the center of pressure (COP) signal of a force plate according to the Romberg test. The balance was also evaluated using the Berg Balance Scale (BBS). The evaluations were done before and after the treatment. COP signal features showed up to 70% improvement following rTMS treatment, whereas there was no notable improvements in the control group. Similarly the BBS assessment presented balance enhancement only in the experimental group. These results, particularly under closed eye foam condition may imply an improvement in proprioception system.Our findings suggested that rTMS has a potential to be used as a therapeutic method to improve postural balance in children with CP.
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18
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Zhang C, Colquitt G, Miller F, Shen Y, Modlesky CM. Preferential deficit of fat-free soft tissue in the appendicular region of children with cerebral palsy and proposed statistical models to capture the deficit. Clin Nutr 2020; 39:1541-1550. [PMID: 31924383 DOI: 10.1016/j.clnu.2019.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/20/2019] [Accepted: 06/22/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Cerebral palsy (CP) is a neurological disorder characterized by a profound skeletal muscle deficit. However, whether there is a regional-specific skeletal muscle deficit in children with CP is unknown. The purpose of this study was to determine whether fat-free soft tissue mass (FFST), a commonly used surrogate for skeletal muscle mass, is more compromised in the limbs than in the trunk in children with CP. A second purpose was to determine whether physical characteristics can be used to accurately estimate appendicular FFST (AFFST) in children with CP. METHODS Forty-two children with CP (4-13 y) and 42 typically developing children matched to children with CP for sex, age and race were studied. Whole body FFST (FFSTwhole), FFST in the upper limbs (FFSTupper), FFST in the lower limbs (FFSTlower), the ratio of AFFST to height (AFFST/ht), the ratio of AFFST to height2 (AFFST/ht2) and non-appendicular FFST were estimated from dual-energy X-ray absorptiometry. Statistical models were developed to estimate AFFST, AFFST/ht and AFFST/ht2 in both groups of children, and the leave-one-out method was used to validate the models. RESULTS Children with CP had 21% lower FFSTwhole, 30% lower AFFST, 34% lower FFSTlower, 14% lower non-appendicular FFST, 23% lower AFFST/ht, 19% lower AFFST/ht2 and 9% lower AFFST/FFSTwhole (all p < 0.05). Statistical models developed using data from typically developing children overestimated AFFST, AFFST/ht and AFFST/ht2 by 35%, 30% and 21% (all p < 0.05), respectively, in children with CP. Separate models developed using data from children with CP yielded better accuracy, with the estimated results highly correlated (r2 = 0.78, 0.66 and 0.50, respectively; all p < 0.001) and not different from calculated AFFST, AFFST/ht and AFFST/ht2 (all p > 0.99). However, when the difference in estimated values and measured values of AFFST, AFFST/ht and AFFST/ht2 were plotted against measured values, there was an inverse relationship (r = -0.38, -0.47 and -0.61, respectively, all p < 0.05). CONCLUSION Children with CP have a remarkable deficit in FFST that is more pronounced in the appendicular than in the non-appendicular region and more pronounced in the lower than in the upper limbs. Preliminary models developed using data from children with CP can provide reasonable estimates of AFFST and indexes of AFFST relative to height, but further development of the models may be needed.
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Affiliation(s)
- Chuan Zhang
- Department of Kinesiology, University of Georgia, Athens, GA, USA
| | - Gavin Colquitt
- Department of Health Sciences and Kinesiology, Georgia Southern University, Statesboro, GA, USA
| | - Freeman Miller
- Department of Orthopedics, Nemours AI duPont Hospital for Children, Wilmington, DE, USA
| | - Ye Shen
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, USA
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19
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Short- and Mid-Term Improvement of Postural Balance after a Neurorehabilitation Program via Hippotherapy in Patients with Sensorimotor Impairment after Cerebral Palsy: A Preliminary Kinetic Approach. Brain Sci 2019; 9:brainsci9100261. [PMID: 31569505 PMCID: PMC6826615 DOI: 10.3390/brainsci9100261] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/24/2019] [Accepted: 09/28/2019] [Indexed: 11/16/2022] Open
Abstract
There is still a lack of studies focused on trunk neurorehabilitation. Accordingly, it is unclear which therapeutic modalities are the most effective in improving static/dynamic balance after brain damage. We designed a pilot study on hippotherapy to assess its short- and mid-term effect on dynamic postural balance in patients with moderate-to-severe sensorimotor impairment secondary to cerebral palsy. Five patients aged 15.4 ± 6.1 years old were recruited. All of them had moderate-to-severe alterations of the muscle tone with associated postural balance impairment. Standing and walking were also impaired. Ten minutes horse riding simulator followed by twenty minutes hippotherapy session were conducted during five session days separated by one week each. We analyzed the displacement of the Center of Pressure (COP) on the sitting surface of the simulator’s saddle by means of a customized pressure pad. We measured the general behavior of the COP displacement as well as the postural adjustments when pace changed from walk to trot to walk during the sessions and among sessions. Statistical analysis revealed an improved postural control both by the end of the session and from session 1 to session 5. These results suggest that hippotherapy might support regularization of postural control in a long-term neurorehabilitation context.
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20
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The cross-sectional relationships between age, standing static balance, and standing dynamic balance reactions in typically developing children. Gait Posture 2019; 73:20-25. [PMID: 31299500 PMCID: PMC6707867 DOI: 10.1016/j.gaitpost.2019.07.128] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/11/2019] [Accepted: 07/02/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Static balance performance is a common metric for evaluating the development of postural control in children. Less is known about the potentially independent development of dynamic balance performance. RESEARCH QUESTION How does age relate to static (i.e. postural sway) and dynamic (i.e. stepping thresholds) standing balance performance, and what is the relationship between postural sway and stepping thresholds? METHODS Twenty-six typically developing children (12 males, 14 females; 5-12 years of age) were recruited for this cross-sectional study. Static balance performance was quantified as the total path length during a postural sway assessment using a force platform with conditions of eyes open and eyes closed. Dynamic balance performance was quantified using a single-stepping threshold assessment, whereby participants attempted to prevent a step in response to treadmill-induced perturbations in the anterior and posterior directions. Relationships between age and body-size scaled measures of static and dynamic balance performance were assessed using Spearman rank correlations. RESULTS There was a weak correlation between age and postural sway (|rs| < 0.10, p > 0.68), but a moderate-to-strong correlation between age and single-stepping thresholds (rs > 0.68, p < 0.001). A weak correlation was found between postural sway and single-stepping thresholds (|rs| < 0.20, p > 0.39). SIGNIFICANCE Dynamic, but not static standing balance performance, may improve with typical development between the ages of 5 and 12 years. Static and dynamic balance should be considered as unique constructs when assessed in children.
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21
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Surgent OJ, Dadalko OI, Pickett KA, Travers BG. Balance and the brain: A review of structural brain correlates of postural balance and balance training in humans. Gait Posture 2019; 71:245-252. [PMID: 31082657 PMCID: PMC6594858 DOI: 10.1016/j.gaitpost.2019.05.011] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 05/03/2019] [Accepted: 05/05/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Balance challenges are associated with not only the aging process but also a wide variety of psychiatric and neurological disorders. However, relatively little is known regarding the neural basis of balance and the effects of balance interventions on the brain. RESEARCH QUESTION This review synthesizes the existing literature to answer the question: What are the key brain structures associated with balance? METHODS This review examined 37 studies that assessed brain structures in relation to balance assessment or intervention. These studies provided 234 findings implicating 71 brain structures. The frequency of implication for each structure was examined based upon specific methodological parameters, including study design (assessment/intervention), type of balance measured (static/dynamic), population (clinical/non-clinical), and imaging analysis technique (region of interest [ROI]/voxel-based morphometry [VBM]). RESULTS Although a number of structures were associated with balance across the brain, the most frequently implicated structures included the cerebellum, basal ganglia, thalamus, hippocampus, inferior parietal cortex, and frontal lobe regions. Findings in the cerebellum and brainstem were most common in studies with clinical populations, studies that used an ROI approach, and studies that measured dynamic balance. Findings in the frontal, occipital, and parietal regions were also more common in studies that measured dynamic compared to static balance. SIGNIFICANCE While balance appears to be a whole-brain phenomenon, a subset of structures appear to play a key role in balance and are likely implicated in balance disorders. Some of these structures (i.e., the cerebellum, basal ganglia and thalamus) have a well-appreciated role in balance, whereas other regions (i.e., hippocampus and inferior parietal cortex) are not commonly thought to be associated with balance and therefore may provide alternative explanations for the neural basis of balance. Key avenues for future research include understanding the roles of all regions involved in balance across the lifespan and in different clinical populations.
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Affiliation(s)
- Olivia J. Surgent
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705, USA.,Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI 53705, USA.,Department of Psychiatry, University of Wisconsin-Madison, 6001 Research Park Boulevard, Madison, Wisconsin, 53719, USA
| | - Olga I. Dadalko
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705, USA
| | - Kristen A. Pickett
- Occupational Therapy Program in the Department of Kinesiology, University of Wisconsin-Madison, 2185 Medical Sciences Center, 1300 University Avenue, Madison, WI 53706, USA.,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Brittany G. Travers
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705, USA.,Occupational Therapy Program in the Department of Kinesiology, University of Wisconsin-Madison, 2185 Medical Sciences Center, 1300 University Avenue, Madison, WI 53706, USA
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22
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Abd El-Nabie WAEH, Saleh MSM. Trunk and pelvic alignment in relation to postural control in children with cerebral palsy. J Back Musculoskelet Rehabil 2019; 32:125-130. [PMID: 30248038 DOI: 10.3233/bmr-181212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Trunk-pelvic mal-alignment and postural control deficit are common problems facing children with cerebral palsy (CP). OBJECTIVE The aim of this study was to investigate the relation of trunk and pelvic alignment with postural control in children with diplegic CP. METHODS Seventy seven children with spastic diplegic CP, aged from 6 to 8 years with level II on Gross Motor Function Classification System, participated in this study. Trunk imbalance, lateral deviation of the spine and pelvic tilt were evaluated by using Formetric instrumentation system while postural control was assessed by using Pediatric Balance Scale. RESULTS The results showed that there was a moderate negative correlation of trunk imbalance, lateral deviation of the spine and pelvic tilt with postural control (-0.44, -0.59 and -0.57, respectively). CONCLUSIONS Increased trunk imbalance, lateral deviation of the spine and pelvic tilt may be associated with decreased postural control ability in children with diplegic CP.
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23
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Arnoni JLB, Pavão SL, Dos Santos Silva FP, Rocha NACF. Effects of virtual reality in body oscillation and motor performance of children with cerebral palsy: A preliminary randomized controlled clinical trial. Complement Ther Clin Pract 2019; 35:189-194. [PMID: 31003657 DOI: 10.1016/j.ctcp.2019.02.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/30/2018] [Accepted: 02/21/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Virtual reality is an adjuvant technique to rehabilitation of children with cerebral palsy (CP). It has been gaining prominence in this field because of its accessibility and great levels of motivation it promotes in treatment. However, there is a lack of studies addressing the effects of virtual reality-based therapy on activity levels regarding postural stability, especially considering the level of evidence presented by studies addressing this issue. Therefore, we aim to evaluate the effects of intervention in body sway and gross motor function of children with CP using an active video game. MATERIALS AND METHODS In this blind randomized controlled trial, fifteen children with CP, Gross Motor Function Classification System (GMFCS) I-II, regularly attending conventional physical therapy programs, were randomly assigned to an intervention (IG:n = 7) or to a control group (CG:n = 8). In both groups, children remained attending conventional therapy. In addition, IG underwent intervention using an active video game twice a week for 45 min and eight weeks. Standing body sway was assessed using a force plate, and Gross Motor Function Measure (GMFM) dimensions D (Standing) and E (Walking, Running and Jumping) were tested. RESULTS Following the virtual reality-based intervention, the IG only showed significant improvements in the GMFM dimensions D (p = 0.021) and E (p = 0.008). Improvements were clinically significant (D = 10.8%; E = 14.0%). For the CG, no variable analyzed showed differences after eight weeks. CONCLUSIONS Intervention using an active video game is a promising tool that can improve the gross motor function of children with CP, GMFCS I-II.
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Affiliation(s)
- Joice Luiza Bruno Arnoni
- Department of Physiotherapy, Neuropediatrics Section, Federal University of São Carlos, Rod. Washington Luis, Km 235, 13565-905, São Carlos, SP, Brazil.
| | - Silvia Leticia Pavão
- Department of Physiotherapy, Neuropediatrics Section, Federal University of São Carlos, Rod. Washington Luis, Km 235, 13565-905, São Carlos, SP, Brazil
| | - Fernanda Pereira Dos Santos Silva
- Department of Physiotherapy, Neuropediatrics Section, Federal University of São Carlos, Rod. Washington Luis, Km 235, 13565-905, São Carlos, SP, Brazil
| | - Nelci Adriana Cicuto Ferreira Rocha
- Department of Physiotherapy, Neuropediatrics Section, Federal University of São Carlos, Rod. Washington Luis, Km 235, 13565-905, São Carlos, SP, Brazil
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da Costa CSN, Pavão SL, Visicato LP, de Campos AC, Rocha NACF. Effects of sensory manipulations on the dynamical structure of center-of-pressure trajectories of children with cerebral palsy during sitting. Hum Mov Sci 2019; 63:1-9. [PMID: 30472351 DOI: 10.1016/j.humov.2018.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 11/08/2018] [Accepted: 11/18/2018] [Indexed: 11/16/2022]
Abstract
AIM To investigate the effects of manipulating visual information and the compliance of the support surface on the area of sway and dynamical trajectories of center-of-pressure (CoP) in children with CP and children with typical development during static sitting. METHODS 32 typical children, 14 children with mild CP and 12 with moderate-to-severe CP were tested for CoP sway during static sitting under four sensory conditions: (1) eyes open on a rigid surface; (2) eyes closed on a rigid surface; (3) eyes open on foam; (4) eyes closed on foam. RESULTS Children with moderate-to-severe CP showed greater regularity and local stability of dynamical CoP trajectories and lower complexity in their motor patterns than typical children and children with mild CP. Moreover, removing vision and sitting on a compliant surface reduced the regularity of CoP trajectories. CONCLUSION Children with CP were able to adjust the structure and complexity of their postural control responses to sensory challenges, although the structure of their postural responses was poorer than in typical children.
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Affiliation(s)
- Carolina Souza Neves da Costa
- Department of Physiotherapy, Neuropediatrics Section, Federal University of São Carlos, Rod. Washington Luis, km 235, 13565-905 São Carlos-SP, Brazil
| | - Silvia Leticia Pavão
- Department of Physiotherapy, Neuropediatrics Section, Federal University of São Carlos, Rod. Washington Luis, km 235, 13565-905 São Carlos-SP, Brazil.
| | - Livia Pessarelli Visicato
- Department of Physiotherapy, Neuropediatrics Section, Federal University of São Carlos, Rod. Washington Luis, km 235, 13565-905 São Carlos-SP, Brazil
| | - Ana Carolina de Campos
- Department of Physiotherapy, Neuropediatrics Section, Federal University of São Carlos, Rod. Washington Luis, km 235, 13565-905 São Carlos-SP, Brazil
| | - Nelci Adriana C F Rocha
- Department of Physiotherapy, Neuropediatrics Section, Federal University of São Carlos, Rod. Washington Luis, km 235, 13565-905 São Carlos-SP, Brazil
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25
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Bryant L, Brunner M, Hemsley B. A review of virtual reality technologies in the field of communication disability: implications for practice and research. Disabil Rehabil Assist Technol 2019; 15:365-372. [PMID: 30638092 DOI: 10.1080/17483107.2018.1549276] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Technology devices and applications including virtual reality (VR) are increasingly used in healthcare research and practice as tools to promote health and wellbeing. However, there is limited research examining the potential for VR to enable improved communication for people with communication disability.Aims: To review: (a) current research using VR in speech-language pathology; and (b) the ethical and safety considerations of VR research, to inform an agenda for future research applying VR in the field of speech-language pathology.Main contribution: This review reveals that there is an emergent body of literature applying VR to improve or develop physical, psychological and communication interventions. Use of non-immersive virtual environments to provide speech-language pathology assessment or intervention for people with communication disability has demonstrated positive outcomes, with emerging evidence of the transfer of functional communication skills from virtual to real-world environments. However, the use of VR technology and immersive virtual environments in communication disability practice and research introduces safety and ethical issues that must be carefully considered.Conclusions: Research employing VR is in its infancy in the field of speech-language pathology. Early evidence from other healthcare disciplines suggests that VR is an engaging means of delivering immersive and interactive training to build functional skills that can be generalized to the real world. While the introduction of new technology requires careful consideration of research ethics and patient safety, future VR communication research could proceed safely with adequate engagement of interdisciplinary teams and technology specialists.Implications for rehabilitationImmersive virtual reality may be used in rehabilitation to simulate natural environments to practice and develop communication skills.The sense of immersion that can be achieved using virtual reality may promote the generalization of skills learnt during clinical rehabilitation to real-world situations.Ethical and safety considerations, including cybersecurity and cybersickness, must be carefully monitored during all virtual reality research.
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Affiliation(s)
- Lucy Bryant
- Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - Melissa Brunner
- Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - Bronwyn Hemsley
- Graduate School of Health, University of Technology Sydney, Ultimo, Australia
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26
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El Shemy SA. Effect of Treadmill Training With Eyes Open and Closed on Knee Proprioception, Functional Balance and Mobility in Children With Spastic Diplegia. Ann Rehabil Med 2018; 42:854-862. [PMID: 30613079 PMCID: PMC6325311 DOI: 10.5535/arm.2018.42.6.854] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 06/15/2018] [Indexed: 01/14/2023] Open
Abstract
Objective To investigate the effect of treadmill training with eyes open (TEO) and closed (TEC) on the knee joint position sense (JPS), functional balance and mobility in children with spastic diplegia. Methods Forty-five children with spastic diplegia aged 11–13 years participated in this study. They were randomly assigned to three groups of equal number. The control group (CON) underwent designed physical therapy program whereas, the study groups (TEO and TEC) underwent the same program, in addition to treadmill gait training with eyes open and closed, respectively. Outcome measures were the degree of knee joint position error, functional balance and mobility. Measurements were taken before and after 12 weeks of intervention. Results After training, the three groups showed statistically significant improvement in all measured outcomes, compared to the baseline with non-significant change in the knee JPS in the CON group. When comparing posttreatment results, the TEC group showed greater significant improvement in all measured outcomes, than the TEO and CON groups. Conclusion Treadmill training with eyes open and closed is effective in rehabilitation of children with diplegia, but blocked vision treadmill training has more beneficial effect.
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Affiliation(s)
- Samah Attia El Shemy
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Lee CH, Sun TL. Evaluation of postural stability based on a force plate and inertial sensor during static balance measurements. J Physiol Anthropol 2018; 37:27. [PMID: 30545421 PMCID: PMC6293511 DOI: 10.1186/s40101-018-0187-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 11/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous research on balance mostly focused on the assessment, training, and improvements of balance through interventions. We investigated tools commonly used to study static balance. Differences in postural stability were analyzed using multiscale entropy (MSE) and feature analysis. METHODS A force plate and inertial sensor were used to collect acceleration and center-of-pressure (COP) nonlinear signals. MSE was also used to detect fractal correlations and assess the complexity of univariate data complexity. Fifteen healthy subjects participated in the experiments. Each stood on a force plate and wore a sensor while attempting to maintain postural stability for 30 s in four randomized experiments to evaluate their static balance via a copositive experiment with eyes open/closed and with standing on one foot or both feet. A Wilcoxon-signed rank test was used to confirm that the conditions were significant. Considering the effect of the assessment tools, the influence of the visual and lower limb systems on postural stability was assessed and the results from the inertial sensor and force plate experiments were compared. RESULTS Force plate usage provided more accurate readings when completing static balance tasks based on the visual system, whereas an inertial sensor was preferred for lower-limb tasks. Further, the eyes-open-standing-on-one-foot case involved the highest complexity at the X, Y, and Z axes for acceleration and at the ML axis for COP compared with other conditions, from which the axial directions can be identified. CONCLUSIONS The findings suggested investigation of different evaluation tool choices that can be easily adapted to suit different needs. The results for the complexity index and traditional balance indicators were comparable in their implications on different conditions. We used MSE to determine the equipment that measures the postural stability performance. We attempted to generalize the applications of complexity index to tasks and training characteristics and explore different tools to obtain different results. TRIAL REGISTRATION This study was approved by the Research Ethics Committee of National Taiwan University and classified as expedited on August 24, 2017. The committee is organized under and operates in accordance with Social and Behavioral Research Ethical Principles and Regulations of National Taiwan University and government laws and regulations.
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Affiliation(s)
- Chia-Hsuan Lee
- Department of Industrial Management, National Taiwan University of Science and Technology, No. 43, Sec. 4, Keelung Road, Da'an District, Taipei, 106, Republic of China
| | - Tien-Lung Sun
- Department of Industrial Engineering and Management, Yuan Ze University, 135 Yuan Tung Road, Chungli District, Taoyuan, 320, Republic of China.
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Zarkou A, Lee SCK, Prosser LA, Hwang S, Jeka J. Stochastic resonance stimulation improves balance in children with cerebral palsy: a case control study. J Neuroeng Rehabil 2018; 15:115. [PMID: 30526617 PMCID: PMC6288963 DOI: 10.1186/s12984-018-0467-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 11/21/2018] [Indexed: 12/22/2022] Open
Abstract
Background Stochastic Resonance (SR) Stimulation has been used to enhance balance in populations with sensory deficits by improving the detection and transmission of afferent information. Despite the potential promise of SR in improving postural control, its use in individuals with cerebral palsy (CP) is novel. The objective of this study was to investigate the immediate effects of electrical SR stimulation when applied in the ankle muscles and ligaments on postural stability in children with CP and their typically developing (TD) peers. Methods Ten children with spastic diplegia (GMFCS level I- III) and ten age-matched TD children participated in this study. For each participant the SR sensory threshold was determined. Then, five different SR intensity levels (no stimulation, 25, 50, 75, and 90% of sensory threshold) were used to identify the optimal SR intensity for each subject. The optimal SR and no stimulation condition were tested while children stood on top of 2 force plates with their eyes open and closed. To assess balance, the center of pressure velocity (COPV) in anteroposterior (A/P) and medial-lateral (M/L) direction, 95% COP confidence ellipse area (COPA), and A/P and M/L root mean square (RMS) measures were computed and compared. Results For the CP group, SR significantly decreased COPV in A/P direction, and COPA measures compared to the no stimulation condition for the eyes open condition. In the eyes closed condition, SR significantly decreased COPV only in M/L direction. Children with CP demonstrated greater reduction in all the COP measures but the RMS in M/L direction during the eyes open condition compared to their TD peers. The only significant difference between groups in the eyes closed condition was in the COPV in M/L direction. Conclusions SR electrical stimulation may be an effective stimulation approach for decreasing postural sway and has the potential to be used as a therapeutic tool to improve balance. Applying subject-specific SR stimulation intensities is recommended to maximize balance improvements. Overall, balance rehabilitation interventions in CP might be more effective if sensory facilitation methods, like SR, are utilized by the clinicians. Trial registration ClinicalTrials.gov identifier NCT02456376; 28 May 2015 (Retrospectively registered); https://clinicaltrials.gov/ct2/show/NCT02456376.
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Affiliation(s)
- Anastasia Zarkou
- Spinal Cord Injury Research Laboratory, Crawford Research Institute, Shepherd Center, 2020 Peachtree Rd NW, Atlanta, GA, 30309, USA.
| | - Samuel C K Lee
- Program in Biomechanics and Movement Science & Department of Physical Therapy, University of Delaware, 540 S. College Ave, Newark, DE, 19713, USA.,Shriners Hospital for Children, 3551 North Broad Street, Philadelphia, PA, 19140, USA
| | - Laura A Prosser
- University of Pennsylvania & The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Sungjae Hwang
- Department of Kinesiology, University of Maryland Eastern Shore, William P. Hytche Center Room 1124, Princess Anne, MD, 21853, USA
| | - John Jeka
- Department of Kinesiology, University of Delaware, 540 S. College Ave, Newark, DE, 19713, USA
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Song S, Lee K, Jung S, Park S, Cho H, Lee G. Effect of Horizontal Whole-Body Vibration Training on Trunk and Lower-Extremity Muscle Tone and Activation, Balance, and Gait in a Child with Cerebral Palsy. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1292-1300. [PMID: 30377290 PMCID: PMC6223197 DOI: 10.12659/ajcr.910468] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patient: Male, 10 Final Diagnosis: Cerebral palsy Symptoms: Movement disorder Medication: — Clinical Procedure: — Specialty: Rehabilitation
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Affiliation(s)
- Sunhae Song
- Department of Physical Therapy, Graduate School of Kyungnam University, Changwon, South Korea
| | - Kyeongbong Lee
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Seoul, South Korea
| | - Sunhye Jung
- Department of Physical Therapy, Graduate School of Kyungnam University, Changwon, South Korea
| | - Suho Park
- Department of Physical Therapy, Graduate School of Kyungnam University, Changwon, South Korea
| | - Hyunrae Cho
- Department of Physical Therapy, Masan University, Changwon, South Korea
| | - Gyuchang Lee
- Department of Physical Therapy, Kyungnam University, Changwon, South Korea
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Ateş F, Yucesoy CA. Botulinum toxin type-A affects mechanics of non-injected antagonistic rat muscles. J Mech Behav Biomed Mater 2018; 84:208-216. [DOI: 10.1016/j.jmbbm.2018.05.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/18/2018] [Accepted: 05/16/2018] [Indexed: 11/27/2022]
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Pavão SL, de Campos AC, Rocha NACF. Age-related Changes in Postural Sway During Sit-to-stand in Typical Children and Children with Cerebral Palsy. J Mot Behav 2018; 51:185-192. [DOI: 10.1080/00222895.2018.1454396] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Silvia Leticia Pavão
- Physical Therapy Department, Neuropediatrics Sector, Federal University of São Carlos, São Carlos-SP, Brazil
| | - Ana Carolina de Campos
- Physical Therapy Department, Neuropediatrics Sector, Federal University of São Carlos, São Carlos-SP, Brazil
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Ritzmann R, Stark C, Krause A. Vibration therapy in patients with cerebral palsy: a systematic review. Neuropsychiatr Dis Treat 2018; 14:1607-1625. [PMID: 29950843 PMCID: PMC6018484 DOI: 10.2147/ndt.s152543] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The neurological disorder cerebral palsy (CP) is caused by unprogressive lesions of the immature brain and affects movement, posture, and the musculoskeletal system. Vibration therapy (VT) is increasingly used to reduce the signs and symptoms associated with this developmental disability. The purpose of this narrative review was systematically to appraise published research regarding acute and long-term effects of VT on functional, neuromuscular, and structural parameters. Systematic searches of three electronic databases identified 28 studies that fulfilled the inclusion criteria. Studies were analyzed to determine participant characteristics, VT-treatment protocols, effect on gross motor function (GMF), strength, gait, posture, mobility, spasticity, reflex excitability, muscle tone, mass, and bone strength within this population, and outcome measures used to evaluate effects. The results revealed that one acute session of VT reduces reflex excitability, spasticity, and coordination deficits. Subsequently, VT has a positive effect on the ability to move, manifested for GMF, strength, gait, and mobility in patients with CP. Effects persist up to 30 minutes after VT. Long-term effects of VT manifest as reduced muscle tone and spasticity occurring concomitantly with improved movement ability in regard to GMF, strength, gait, and mobility, as well as increased muscle mass and bone-mineral density. Posture control remained unaffected by VT. In conclusion, the acute and chronic application of VT as a nonpharmacological approach has the potential to ameliorate CP symptoms, achieving functional and structural adaptations associated with significant improvements in daily living. Even though further studies including adult populations validating the neuromuscular mechanisms underlying the aforementioned adaptations should be fostered, growing scientific evidence supports the effectiveness of VT in regard to supplementing conventional treatments (physiotherapy and drugs). Therefore, VT could reduce CP-associated physical disability and sensorimotor handicaps. Goals for patients and their caregivers referring to greater independence and improved safety may be achieved more easily and time efficiently.
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Affiliation(s)
- Ramona Ritzmann
- Department of Sport Science, University of Freiburg, Freiburg, Germany
| | - Christina Stark
- Children's and Adolescent's Hospital, University of Cologne, Cologne, Germany.,Cologne Centre for Musculoskeletal Biomechanics (CCMB), University of Cologne, Cologne, Germany
| | - Anne Krause
- Institute of Training and Computer Science in Sport, German Sport University Cologne, Cologne, Germany
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Domagalska-Szopa M, Szopa A. Postural orientation and standing postural alignment in ambulant children with bilateral cerebral palsy. Clin Biomech (Bristol, Avon) 2017; 49:22-27. [PMID: 28830044 DOI: 10.1016/j.clinbiomech.2017.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 08/14/2017] [Accepted: 08/15/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Standing postural alignment in children with cerebral palsy is usually altered by central postural control disorders. The primary aim of this study is to describe body alignment in a quiet standing position in ambulatory children with bilateral cerebral palsy compared with children with typical development. METHODS Fifty-eight children with bilateral cerebral palsy (aged 7-13years) and 45 age-matched children with typical development underwent a surface topography examination based on Moiré topography and were classified according to their sagittal postural profiles. FINDINGS The following eight grouping variables were extracted using a data reduction technique: angle of trunk inclination, pelvic tilt, and lordosis, the difference between kyphosis and lordosis, angle of vertebral lateral curvature, shoulder inclination, and shoulder and pelvic rotation. According to the cluster analysis results, 25% of the participants were classified into Cluster 1, 9% into Cluster 2, 49% in Cluster 3, and 17% in Cluster 4. INTERPRETATION Three different postural patterns emerged in accordance with the sagittal postural profiles in children with bilateral cerebral palsy and were defined as follows: 1) a lordotic postural pattern corresponding to forward-leaning posture; 2) a swayback postural pattern corresponding to backward-leaning posture; and 3) a balanced postural pattern corresponding to balanced posture.
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Affiliation(s)
- Małgorzata Domagalska-Szopa
- Department of Medical Rehabilitation, School of Health Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Medyków 12, Poland.
| | - Andrzej Szopa
- Department of Physiotherapy, School of Health Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Medyków 12, Poland.
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Panibatla S, Kumar V, Narayan A. Relationship Between Trunk Control and Balance in Children with Spastic Cerebral Palsy: A Cross-Sectional Study. J Clin Diagn Res 2017; 11:YC05-YC08. [PMID: 29207820 DOI: 10.7860/jcdr/2017/28388.10649] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 07/06/2017] [Indexed: 11/24/2022]
Abstract
Introduction Trunk control is impaired in children with Cerebral Palsy (CP) thus influencing their functional balance. However, there is a paucity of literature determining the relationship between trunk control and balance in children with CP. Aim To find the relationship between trunk control and balance by means of Trunk Control Measurement Scale (TCMS) and Paediatric Balance Scale (PBS). Materials and Methods Twenty four children {age range 8-14 years, Gross Motor Function Classification System (GMFCS) Level I-III} with spastic CP were recruited and evaluated using TCMS and PBS. The results were expressed as summary measures median (M) and Inter-Quartile Range (IQR). The correlation of TCMS and PBS were done using Spearman's correlation coefficient. A p-value <0.05 was considered statistically significant. Results The children obtained a median score of 52 out of 58 on the TCMS and 50 out of 56 on PBS. There was a significantly strong correlation with rs=0.77 and p<0.01. A strong correlation (p<0.01) was seen between static, dynamic and total components of TCMS and PBS. The median scores of TCMS and PBS had a strong correlation for boys with rs=0.74 and very strong correlation for girls with rs=0.84. Based on the type of spastic CP, diplegics had a very strong correlation with rs=0.85. While based on GMFCS levels, Level II and Level III had a very strong correlation (For level II rs=0.81 and level III rs=0.86) and weak correlation for level I (rs=0.27). Conclusion Based on gender, topography and severity of the motor impairment both trunk control and balance are impaired to a different degree in children with CP. The findings of this study showed a high positive correlation between trunk control and balance in children with spastic CP.
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Affiliation(s)
- Sivatejaa Panibatla
- Senior Resident, Department of Physiotherapy, Kasturba Medical College, Manipal University, Mangaluru, Karnataka, India
| | - Vijaya Kumar
- Associate Professor, Department of Physiotherapy, Kasturba Medical College, Manipal University, Mangaluru, Karnataka, India
| | - Amitesh Narayan
- Professor and Head, Department of Physiotherapy, Kasturba Medical College, Manipal University, Mangaluru, Karnataka, India
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Zhou J, Butler EE, Rose J. Neurologic Correlates of Gait Abnormalities in Cerebral Palsy: Implications for Treatment. Front Hum Neurosci 2017; 11:103. [PMID: 28367118 PMCID: PMC5355477 DOI: 10.3389/fnhum.2017.00103] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 02/20/2017] [Indexed: 01/17/2023] Open
Abstract
Cerebral palsy (CP) is the most common movement disorder in children. A diagnosis of CP is often made based on abnormal muscle tone or posture, a delay in reaching motor milestones, or the presence of gait abnormalities in young children. Neuroimaging of high-risk neonates and of children diagnosed with CP have identified patterns of neurologic injury associated with CP, however, the neural underpinnings of common gait abnormalities remain largely uncharacterized. Here, we review the nature of the brain injury in CP, as well as the neuromuscular deficits and subsequent gait abnormalities common among children with CP. We first discuss brain injury in terms of mechanism, pattern, and time of injury during the prenatal, perinatal, or postnatal period in preterm and term-born children. Second, we outline neuromuscular deficits of CP with a focus on spastic CP, characterized by muscle weakness, shortened muscle-tendon unit, spasticity, and impaired selective motor control, on both a microscopic and functional level. Third, we examine the influence of neuromuscular deficits on gait abnormalities in CP, while considering emerging information on neural correlates of gait abnormalities and the implications for strategic treatment. This review of the neural basis of gait abnormalities in CP discusses what is known about links between the location and extent of brain injury and the type and severity of CP, in relation to the associated neuromuscular deficits, and subsequent gait abnormalities. Targeted treatment opportunities are identified that may improve functional outcomes for children with CP. By providing this context on the neural basis of gait abnormalities in CP, we hope to highlight areas of further research that can reduce the long-term, debilitating effects of CP.
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Affiliation(s)
- Joanne Zhou
- Department of Orthopaedic Surgery, Stanford UniversityStanford, CA, USA; Motion and Gait Analysis Lab, Lucile Packard Children's HospitalPalo Alto, CA, USA
| | - Erin E Butler
- Thayer School of Engineering, Dartmouth CollegeHanover, NH, USA; Neukom Institute for Computational Sciences, Dartmouth CollegeHanover, NH, USA
| | - Jessica Rose
- Department of Orthopaedic Surgery, Stanford UniversityStanford, CA, USA; Motion and Gait Analysis Lab, Lucile Packard Children's HospitalPalo Alto, CA, USA
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Jung HK, Chung E, Lee BH. A comparison of the balance and gait function between children with Down syndrome and typically developing children. J Phys Ther Sci 2017; 29:123-127. [PMID: 28210057 PMCID: PMC5300823 DOI: 10.1589/jpts.29.123] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 10/17/2016] [Indexed: 11/27/2022] Open
Abstract
[Purpose] The purpose of this study was to compare the balance and gait functions of
children with Down syndrome and typically developing children according to age. [Subjects
and Methods] The subjects were 16 children with Down syndrome and 20 children with typical
development. The one leg standing test, Romberg’s test (open eyes/closed eyes), sharpened
Romberg’s (open eyes/closed eyes), functional reaching test and GAITRite were used for
this study in order to measure the children’s balance and gait function. [Results] The
results of this study showed that static-dynamic balance ability, spatio-temporal gait
parameters and quality of life were statistically and significantly different in Down
syndrome children compared to typically developing children. [Conclusion] These results
suggest that the balance and gait ability of typically developing children improves during
growth, whereas those of children with Down syndrome remain low despite independent gait.
Therefore, constant therapeutic intervention for balance and gait function is necessary
after independent gait development in Down syndrome children.
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Affiliation(s)
- Hee-Kyoung Jung
- Graduate School of Physical Therapy, Sahmyook University, Republic of Korea
| | - EunJung Chung
- Department of Physical Therapy, Andong Science College, Republic of Korea
| | - Byoung-Hee Lee
- Department of Physical Therapy, Sahmyook University, Republic of Korea
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Ryu K, Ali A, Kwon M, Lee C, Kim Y, Lee G, Kim J. Effects of assisted aquatic movement and horseback riding therapies on emotion and brain activation in patients with cerebral palsy. J Phys Ther Sci 2016; 28:3283-3287. [PMID: 28174435 PMCID: PMC5276744 DOI: 10.1589/jpts.28.3283] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 08/02/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to determine the effects of assisted aquatic movement and horseback riding therapies on emotion and brain activation in patients with cerebral palsy. [Subjects and Methods] Thirty-two right-handed patients with cerebral palsy (18 male, 14 female) whose ages ranged from 8 to 48 years participated in this experiment. Their cerebral palsy levels ranged from 1 to 3. The participants were assigned to one of three groups according to the experimental conditions: an assisted aquatic movement therapy group, a horseback riding therapy group, or a control group. Electroencephalograms, the Feeling Scale and the Felt Arousal Scale were examined as dependent variables. [Results] Analysis of self-reported data demonstrated a significant positive improvement in the emotions of participants in the assisted aquatic movement therapy group in comparison with the control group. With regard to the electroencephalogram analysis, the results of this study showed increased alpha power in the assisted aquatic movement therapy group compared with the horseback riding and control groups. [Conclusion] The results of this study suggest that professionals can consider assisted aquatic movement therapy as an effective therapeutic intervention for the improvement of mental health and brain activation.
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Affiliation(s)
- Kwangmin Ryu
- Department of Physical Education, Kyungpook National
University, Republic of Korea
| | - Asif Ali
- Department of Physical Education, The Islamia University of
Bahawalpur, Pakistan
| | - Minji Kwon
- Department of Physical Education, Kyungpook National
University, Republic of Korea
| | - Changyoung Lee
- Department of Physical Education, Kyungpook National
University, Republic of Korea
| | - Yujin Kim
- Department of Physical Education, Kyungpook National
University, Republic of Korea
| | - Gyusung Lee
- Department of Physical Education, Kyungpook National
University, Republic of Korea
| | - Jingu Kim
- Department of Physical Education, Kyungpook National
University, Republic of Korea
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Iwata T, Takaoka S, Sakamoto M, Maeda E, Nakamura M, Liu XJ, Murata K. Characteristics of hand tremor and postural sway in patients with fetal-type Minamata disease. J Toxicol Sci 2016; 41:757-763. [PMID: 27853104 DOI: 10.2131/jts.41.757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
About forty certified patients aged around 50 years old existed as living witnesses to fetal-type Minamata disease (methylmercury poisoning due to in utero exposure) in Minamata, Japan in 2006. Computerized hand tremor and postural sway tests with spectral analysis were conducted for 24 of them and in matched control subjects to examine the pathophysiological feature of neuromotor function. The tremor intensities of the patients with fetal-type Minamata disease were significantly larger than those of the 67 controls at every frequency band for both hands. In the patients, proportions for intensity at 1-6 Hz of both hands were larger, but those of the intensity at 6-10 Hz were smaller compared with the controls. The center frequency of a tremor was significantly lower in the patients than in the controls. Only eight males of the 24 patients were examined to evaluate postural sway because of extremely low scores in activities of daily living in the remaining. Most of the postural sway parameters obtained with eyes open and closed were significantly larger in the patients than in the male controls. Likewise, Romberg quotients of postural sway in anterior-posterior direction were significantly higher in the patients. In conclusion, the patients with fetal-type Minamata disease of our study showed a larger tremor of low frequency at less than 6 Hz and postural instability. Spectral analyses of computerized hand tremor and postural sway are suggested to be useful for assessing the pathophysiological change, related to a lesion of the cerebellum, resulting from prenatal methylmercury exposure.
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Affiliation(s)
- Toyoto Iwata
- Department of Environmental Health Sciences, Akita University Graduate School of Medicine
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Pham HP, Eidem A, Hansen G, Nyquist A, Vik T, Sæther R. Validity and Responsiveness of the Trunk Impairment Scale and Trunk Control Measurement Scale in Young Individuals with Cerebral Palsy. Phys Occup Ther Pediatr 2016; 36:440-52. [PMID: 26890372 DOI: 10.3109/01942638.2015.1127867] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM This study examines construct validity and responsiveness of the Trunk Impairment Scale (TIS) and Trunk Control Measurement Scale (TCMS) in individuals with cerebral palsy (CP). METHODS Twenty-six individuals with CP (nine males), 8-29 years (mean age 17.6) with gross motor function corresponding to GMFCS I-IV, participated in three weeks of intensive and varied physical training at a health sports center. Trunk control was assessed with the TIS (includes three subscales) and TCMS (includes three subscales), and gross motor function with the Gross Motor Function Measure 66 item set (GMFM-66-IS), before and after the training period. The GMFM-66-IS was used as a comparison measure. RESULTS The median score of the TCMS subscale dynamic sitting balance, reaching (DSB-R), increased from 6 to 7 (range: 1-10; p = .031), and there was a median change of 3 points in GMFM-66-IS score (p = .036). There were no significant changes in the TIS. The correlations (Spearman's rho), between the TIS, TCMS, and the GMFM-66-IS (pre-scores), ranged between 0.57 and 0.75 (p< .003). Correlations between change scores (pre- and post-scores) were low, and not statistically significant. However, the TCMS DSB-R change score correlated significantly with hours spent on "trunk-targeted training" like paddling/rowing (rho = 0.66; p = .003) and horseback riding (rho = 0.54; p = .011). CONCLUSIONS Our results support construct validity of the TIS and TCMS in young individuals with CP, whereas responsiveness could not be documented. However, the correlations between the TCMS DSB-R change score and hours spent on ''trunk-targeted training'' suggest that this subscale may have the potential to be used in intervention studies.
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Affiliation(s)
- Hong Phi Pham
- a Department of Laboratory Medicine, Children's and Women's Health , Norwegian University of Science and Technology , Trondheim , Norway
| | - Anita Eidem
- b Clinic for Clinical Services , St. Olavs University Hospital , Trondheim , Norway
| | - Gry Hansen
- c Department of Pediatrics , St. Olavs Hospital, University Hospital of Trondheim , Trondheim, Norway
| | - Astrid Nyquist
- d Beitostølen Healthsports Center , Øystre Slidre , Norway
| | - Torstein Vik
- a Department of Laboratory Medicine, Children's and Women's Health , Norwegian University of Science and Technology , Trondheim , Norway.,c Department of Pediatrics , St. Olavs Hospital, University Hospital of Trondheim , Trondheim, Norway
| | - Rannei Sæther
- a Department of Laboratory Medicine, Children's and Women's Health , Norwegian University of Science and Technology , Trondheim , Norway.,c Department of Pediatrics , St. Olavs Hospital, University Hospital of Trondheim , Trondheim, Norway
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Dependence of Gait Deviation on Weight-Bearing Asymmetry and Postural Instability in Children with Unilateral Cerebral Palsy. PLoS One 2016; 11:e0165583. [PMID: 27788247 PMCID: PMC5082807 DOI: 10.1371/journal.pone.0165583] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 10/16/2016] [Indexed: 11/22/2022] Open
Abstract
Postural control deficits have been suggested to be a major component of gait disorders in children with cerebral palsy. The purpose of this study was to investigate the relationship between postural stability and treadmill walking, in children with unilateral cerebral palsy, by defining dependence between the posturographic weight-bearing distribution and center of pressure (CoP) sway during quiet standing with Gillette Gait Index and the 16 distinct gait parameters that composed the Gillette Gait Index. Forty-five children with unilateral cerebral palsy from 7–12 years of age were included in this study. A posturographic procedure and 3-dimensional instrumented gait analysis was developed. In general, across the entire tested group, the significant correlations concerned only the asymmetry of the weight bearing and a few of the distinct gait parameters that compose the Gillette Gait Index; moreover, correlation coefficients were low. The division of subjects into two clinical subgroups: children that exhibited a tendency to overload (1) and to underload (2) the affected body side, modified the results of the explored relationships. Our findings revealed that the difficulties experienced by children with hemiplegia while controlled in a standing position result from tendency to excessively or insufficiently load the affected lower limbs, and thus establishes a direct relationship with inadequate affected peak ankle DF in both stance and swing gait phases. Given the presented relationship between postural instability and deviation of the particular gait parameters in children with unilateral cerebral palsy, a follow-up study will be needed to determine the therapeutic approaches that will be most effective in promoting increased improvement in gait pattern, as well as the static and dynamic balance in standing.
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Lazzari RD, Politti F, Belina SF, Collange Grecco LA, Santos CA, Dumont AJL, Lopes JBP, Cimolin V, Galli M, Santos Oliveira C. Effect of Transcranial Direct Current Stimulation Combined With Virtual Reality Training on Balance in Children With Cerebral Palsy: A Randomized, Controlled, Double-Blind, Clinical Trial. J Mot Behav 2016; 49:329-336. [DOI: 10.1080/00222895.2016.1204266] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Roberta Delasta Lazzari
- Master's and Doctoral Programs in Rehabilitation Sciences, Movement Analysis Lab, University Nove de Julho, São Paulo, Brazil
| | - Fabiano Politti
- Professor, Master's and Doctoral Programmes in Rehabilitation Sciences, University Nove de Julho, São Paulo, Brazil
| | - Stefany Ferreira Belina
- Master's and Doctoral Programs in Rehabilitation Sciences, Movement Analysis Lab, University Nove de Julho, São Paulo, Brazil
| | - Luanda André Collange Grecco
- Master's and Doctoral Programs in Rehabilitation Sciences, Movement Analysis Lab, University Nove de Julho, São Paulo, Brazil
| | - Cibele Almeida Santos
- Master's and Doctoral Programs in Rehabilitation Sciences, Movement Analysis Lab, University Nove de Julho, São Paulo, Brazil
| | | | - Jamile Benite Palma Lopes
- Master's and Doctoral Programs in Rehabilitation Sciences, Movement Analysis Lab, University Nove de Julho, São Paulo, Brazil
| | - Veronica Cimolin
- Professor, Instituto Politécnico de Milano, Department of Electronics, Information and Bioengineering, Politecnico di Milano, “Luigi Divieti” Lab, Milan, Italy
| | - Manuela Galli
- Professor, Instituto Politécnico de Milano, Department of Electronics, Information and Bioengineering, Politecnico di Milano, “Luigi Divieti” Lab, Milan, Italy
- IRCCS “San Raffaele Pisana”, Tosinvest Sanità, Roma, Italy
| | - Cláudia Santos Oliveira
- Master's and Doctoral Programs in Rehabilitation Sciences, Movement Analysis Lab, University Nove de Julho, São Paulo, Brazil
- Professor, Master's and Doctoral Programmes in Rehabilitation Sciences, University Nove de Julho, São Paulo, Brazil
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Lidbeck C, Bartonek Å, Yadav P, Tedroff K, Åstrand P, Hellgren K, Gutierrez-Farewik EM. The role of visual stimuli on standing posture in children with bilateral cerebral palsy. BMC Neurol 2016; 16:151. [PMID: 27557808 PMCID: PMC4997695 DOI: 10.1186/s12883-016-0676-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 08/17/2016] [Indexed: 11/15/2022] Open
Abstract
Background In children with bilateral cerebral palsy (CP) maintaining a standing position can be difficult. The fundamental motor task of standing independently is achieved by an interaction between the visual, somatosensory, and vestibular systems. In CP, the motor disorders are commonly accompanied by sensory and perceptual disturbances. Our aims were to examine the influence of visual stimuli on standing posture in relation to standing ability. Methods Three dimensional motion analysis with surface electromyography was recorded to describe body position, body movement, and muscle activity during three standing tasks: in a self-selected position, while blindfolded, and during an attention-demanding task. Participants were twenty-seven typically-developing (TD) children and 36 children with bilateral CP, of which 17 required support for standing (CP-SwS) and 19 stood without support (CP-SwoS). Results All children with CP stood with a more flexed body position than the TD children, even more pronounced in the children in CP-SwS. While blindfolded, the CP-SwS group further flexed their hips and knees, and increased muscle activity in knee extensors. In contrast, the children in CP-SwoS maintained the same body position but increased calf muscle activity. During the attention-demanding task, the children in CP-SwoS stood with more still head and knee positions and with less muscle activity. Conclusions Visual input was important for children with CP to maintain a standing position. Without visual input the children who required support dropped into a further crouched position. The somatosensory and vestibular systems alone could not provide enough information about the body position in space without visual cues as a reference frame. In the children who stood without support, an intensified visual stimulus enhanced the ability to maintain a quiet standing position. It may be that impairments in the sensory systems are major contributors to the difficulties to stand erect in children with CP.
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Affiliation(s)
- Cecilia Lidbeck
- Department of Women's and Children's Health, Karolinska Institutet, SE-171 76, Stockholm, Sweden.
| | - Åsa Bartonek
- Department of Women's and Children's Health, Karolinska Institutet, SE-171 76, Stockholm, Sweden
| | - Priti Yadav
- Royal Institute of Technology, KTH Mechanics, Stockholm, Sweden.,Royal Institute of Technology, KTH BioMEx Center, Stockholm, Sweden
| | - Kristina Tedroff
- Department of Women's and Children's Health, Karolinska Institutet, SE-171 76, Stockholm, Sweden
| | - Per Åstrand
- Department of Women's and Children's Health, Karolinska Institutet, SE-171 76, Stockholm, Sweden
| | - Kerstin Hellgren
- Department of Clinical Neuroscience, Karolinska Institutet, SE-171 76, Stockholm, Sweden
| | - Elena M Gutierrez-Farewik
- Department of Women's and Children's Health, Karolinska Institutet, SE-171 76, Stockholm, Sweden.,Royal Institute of Technology, KTH Mechanics, Stockholm, Sweden.,Royal Institute of Technology, KTH BioMEx Center, Stockholm, Sweden
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Karabicak GO, Balcı NC, Gulsen M, Ozturk B, Cetin N. The effect of postural control and balance on femoral anteversion in children with spastic cerebral palsy. J Phys Ther Sci 2016; 28:1696-700. [PMID: 27390397 PMCID: PMC4932038 DOI: 10.1589/jpts.28.1696] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 02/15/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of the study was to investigate the relationships between femoral
anteversion and functional balance and postural control in children with spastic cerebral
palsy. [Subjects and Methods] Twenty children with spastic cerebral palsy (mean age=12.4 ±
4.5) with grosss motor functional classification system levels I, II, and III were
recruited for this study. Functional balance was evaluated using the Pediatric Balance
Scale, postural control was evaluated using the Trunk Control Measurement Scale, and
femoral anteversion was assessed with a handheld goniometer using the great trochanter
prominence method. [Results] The results indicated that there was significant correlation
between femoral anteversion and Trunk Control Measurement Scale dynamic reaching score.
There were no significant correlation between femoral anteversion and the Trunk Control
Measurement Scale static sitting balance, Trunk Control Measurement Scale selective
movement control, total Trunk Control Measurement Scale and Pediatric Balance Scale
results. [Conclusion] Increased femoral anteversion has not correlation with functional
balance, static sitting, and selective control of the trunk. Femoral anteversion is
related to dynamic reaching activities of the trunk, and this may be the result of
excessive internal pelvic rotation. It is important for the health professionals to
understand that increased femoral anteversion needs to be corrected because in addition to
leading to femoral internal rotation during walking, it also effects dynamic reaching
activities of spastic children with cerebral palsy.
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Affiliation(s)
- Gul Oznur Karabicak
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Baskent University, Turkey
| | - Nilay Comuk Balcı
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Baskent University, Turkey
| | - Mustafa Gulsen
- Physiotherapy Program, Vocational School of Health Sciences, Baskent University, Turkey
| | - Basar Ozturk
- Ergotherapy Department, Faculty of Health Sciences, Biruni University, Turkey
| | - Nuri Cetin
- Department of Physical Medicine and Rehabilitation, Baskent University Ankara Hospital, Turkey
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Butler EE, Steele KM, Torburn L, Gamble JG, Rose J. Clinical motion analyses over eight consecutive years in a child with crouch gait: a case report. J Med Case Rep 2016; 10:157. [PMID: 27301473 PMCID: PMC4908800 DOI: 10.1186/s13256-016-0920-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 04/29/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND This case report provides a unique look at the progression of crouch gait in a child with cerebral palsy over an 8-year time period, through annual physical examinations, three-dimensional gait analyses, and evaluation of postural balance. Our patient received regular botulinum toxin-A injections, casting, and physical therapy but no surgical interventions. CASE PRESENTATION A white American boy with spastic diplegic cerebral palsy was evaluated annually by clinical motion analyses, including physical examination, joint kinematics, electromyography, energy expenditure, and standing postural balance tests, from 6 to 13 years of age. These analyses revealed that the biomechanical factors contributing to our patient's crouch gait were weak plantar flexors, short and spastic hamstrings, moderately short hip flexors, and external rotation of the tibiae. Despite annual recommendations for surgical lengthening of the hamstrings, the family opted for non-surgical treatment through botulinum toxin-A injections, casting, and exercise. Our patient's crouch gait improved between ages 6 and 9, then worsened at age 10, concurrent with his greatest body mass index, increased plantar flexor weakness, increased standing postural sway, slowest normalized walking speed, and greatest walking energy expenditure. Although our patient's maximum knee extension in stance improved by 14 degrees at 13 years of age compared to 6 years of age, peak knee flexion in swing declined, his ankles became more dorsiflexed, his hips became more internally rotated, and his tibiae became more externally rotated. From 6 to 9 years of age, our patient's minimum stance-phase knee flexion varied in an inverse relationship with his body mass index; from 10 to 13 years of age, changes in his minimum stance-phase knee flexion paralleled changes in his body mass index. CONCLUSIONS The motor deficits of weakness, spasticity, shortened muscle-tendon lengths, and impaired selective motor control were highlighted by our patient's clinical motion analyses. Overall, our patient's crouch gait improved mildly with aggressive non-operative management and a supportive family dedicated to regular home exercise. The annual clinical motion analyses identified changes in motor deficits that were associated with changes in the child's walking pattern, suggesting that these analyses can serve to track the progression of children with spastic cerebral palsy.
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Affiliation(s)
- Erin E Butler
- The William H. Neukom Institute for Computational Science, Dartmouth College, Sudikoff Hall, Hanover, NH, 03755, USA.
| | - Katherine M Steele
- Department of Mechanical Engineering, University of Washington, 3600 E Stevens Way NE, Box 352600, Seattle, WA, 98195, USA
| | - Leslie Torburn
- Motion & Gait Analysis Laboratory, Lucile Packard Children's Hospital at Stanford, 321 Middlefield Road, Menlo Park, CA, 94025, USA
| | - James G Gamble
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 770 Welch Road, Suite 400, Palo Alto, CA, 94304, USA
| | - Jessica Rose
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 770 Welch Road, Suite 400, Palo Alto, CA, 94304, USA
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Rumberg F, Bakir MS, Taylor WR, Haberl H, Sarpong A, Sharankou I, Lebek S, Funk JF. The Effects of Selective Dorsal Rhizotomy on Balance and Symmetry of Gait in Children with Cerebral Palsy. PLoS One 2016; 11:e0152930. [PMID: 27043310 PMCID: PMC4820221 DOI: 10.1371/journal.pone.0152930] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 03/20/2016] [Indexed: 12/27/2022] Open
Abstract
Aim Cerebral palsy (CP) is associated with dysfunction of the upper motor neuron and results in balance problems and asymmetry during locomotion. Selective dorsal rhizotomy (SDR) is a surgical procedure that results in reduced afferent neuromotor signals from the lower extremities with the aim of improving gait. Its influence on balance and symmetry has not been assessed. The aim of this prospective cohort study was to evaluate the impact of SDR on balance and symmetry during walking. Methods 18 children (10 girls, 8 boys; age 6 years (y) 3 months (m), SD 1y 8m) with bilateral spastic CP and Gross Motor Function Classification System levels I to II underwent gait analysis before and 6 to 12 months after SDR. Results were compared to 11 typically developing children (TDC; 6 girls, 5 boys; age 6y 6m, SD 1y 11m). To analyse balance, sway velocity, radial displacement and frequency were calculated. Symmetry ratios were calculated for balance measures and spatio-temporal parameters during walking. Results Most spatio-temporal parameters of gait, as well as all parameters of balance, improved significantly after SDR. Preoperative values of symmetry did not vary considerably between CP and TDC group and significant postoperative improvement did not occur. Interpretation The reduction of afferent signalling through SDR improves gait by reducing balance problems rather than enhancing movement symmetry.
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Affiliation(s)
- Franziska Rumberg
- Paediatric Orthopaedic Surgery and Neuroorthopaedics, Department of Orthopaedics, Center for Musculoskeletal Surgery (CMSC), Charité –Universitätsmedizin Berlin, Berlin, Germany
| | - Mustafa Sinan Bakir
- Paediatric Orthopaedic Surgery and Neuroorthopaedics, Department of Orthopaedics, Center for Musculoskeletal Surgery (CMSC), Charité –Universitätsmedizin Berlin, Berlin, Germany
| | | | - Hannes Haberl
- Section of Paediatric Neurosurgery, Department of Neurosurgery, University of Ulm, Ulm, Germany
| | - Akosua Sarpong
- Social Paediatric Center, Charité –Universitätsmedizin Berlin, Berlin, Germany
| | - Ilya Sharankou
- Julius Wolff Institute, Charité –Universitätsmedizin Berlin, Berlin, Germany
| | - Susanne Lebek
- Paediatric Orthopaedic Surgery and Neuroorthopaedics, Department of Orthopaedics, Center for Musculoskeletal Surgery (CMSC), Charité –Universitätsmedizin Berlin, Berlin, Germany
| | - Julia F. Funk
- Paediatric Orthopaedic Surgery and Neuroorthopaedics, Department of Orthopaedics, Center for Musculoskeletal Surgery (CMSC), Charité –Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
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Functional Task Constraints Foster Enhanced Postural Control in Children With Cerebral Palsy. Phys Ther 2016; 96:348-54. [PMID: 26112256 DOI: 10.2522/ptj.20140425] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 06/08/2015] [Indexed: 02/09/2023]
Abstract
BACKGROUND Postural instability is a classical characteristic of cerebral palsy (CP), but it has not been examined during functional play activity. Recent work has demonstrated that when motor tasks are made functionally more relevant, performance improves, even in children with movement pathology. It is possible that in a disease state, the underlying control mechanisms that are associated with healthy physiology must be elicited. OBJECTIVE The study objective was to explore the utility of the functional play task methodology as a more rich and interpretable approach to the quantification of postural instability in children with CP. DESIGN Postural stability measures obtained from a cross-sectional cohort of children with CP (n=30) were compared with stability measures taken from children with typical development (n=30) during a single measurement period. METHODS Postural stability data were obtained with a portable force platform system. Postural sway was quantified during a precision manual functional play task. A baseline condition (no task) also was included. Postural sway variability and postural sway regularity were analyzed with analyses of variance. RESULTS There was an apparent difference in postural control (greater irregularity, greater sway variability) during quiet stance between children with CP and peers with typical development; this difference was mitigated during the performance of the precision functional play task. LIMITATIONS A small and nonprobability sample of convenience may limit the findings of this study. CONCLUSIONS The findings illustrate flexibility and adaptability in the postural control system despite the pathological features associated with CP.
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Kang KD, Yun SW, Chung U, Kim TH, Park JH, Park IH, Han DH. Effects of methylphenidate on body index and physical fitness in Korean children with attention deficit hyperactivity disorder. Hum Psychopharmacol 2016; 31:76-82. [PMID: 26756111 DOI: 10.1002/hup.2514] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 11/11/2015] [Accepted: 11/24/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The side effects of methylphenidate (MPH) on growth remain a controversial concern. This study aimed to investigate the effect of MPH on clinical symptoms, growth, and physical fitness in Korean children. METHODS Fifty male children with attention deficit hyperactivity disorder (ADHD) treated with methylphenidate (MPH-ADHD), 69 MPH-naïve male children with ADHD (Naïve-ADHD), and 60 age-matched and sex-matched healthy control subjects were recruited. Intelligence quotient (IQ), clinical symptoms of ADHD, body index (height, weight, and body mass index [BMI]), and physical fitness (muscular strength, endurance, flexibility, agility, speed, and balance) were assessed. RESULTS Total IQ and performance IQ scores were significantly different among the three groups, as were mean Korean Attention Deficit Hyperactivity Disorder (K-ARS)-total, K-ARS-inattention, and K-ARS-hyperactivity scores. There was no significant difference in height, weight, or BMI among the three groups. There were significant differences in skill-related fitness scores for balance (healthy controls > MPH-ADHD > Naïve-ADHD) and agility shuttle test time (healthy controls < MPH-ADHD < Naïve-ADHD). CONCLUSIONS Our findings support the effectiveness of MPH treatment for improving IQ, attention, and balance and agility measures of skill-related fitness in Korean children with ADHD. MPH was not associated with growth delays in height, weight, and BMI.
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Affiliation(s)
- Kyoung Doo Kang
- Department of Industry Academic Cooperation Foundation, Chung Ang University, Seoul, Korea
| | - Sin Weon Yun
- Department of Pediatrics, Chung Ang University Hospital, Seoul, Korea
| | - Unsun Chung
- Department of Psychiatry, Kyoungpook University Hospital, Kyoungpook, Korea
| | - Tae Ho Kim
- Department of Psychiatry, Konkuk University Hospital, Chungju, Korea
| | - Jeong Ha Park
- Department of Psychiatry, Chung Ang University Hospital, Seoul, Korea
| | - In Hui Park
- Eoram Middle School, Namyangju-si, Gyeonggi-do, Korea
| | - Doug Hyun Han
- Department of Psychiatry, Chung Ang University Hospital, Seoul, Korea
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Susko T, Swaminathan K, Krebs HI. MIT-Skywalker: A Novel Gait Neurorehabilitation Robot for Stroke and Cerebral Palsy. IEEE Trans Neural Syst Rehabil Eng 2016; 24:1089-1099. [PMID: 26929056 DOI: 10.1109/tnsre.2016.2533492] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The MIT-Skywalker is a novel robotic device developed for the rehabilitation or habilitation of gait and balance after a neurological injury. It represents an embodiment of the concept exhibited by passive walkers for rehabilitation training. Its novelty extends beyond the passive walker quintessence to the unparalleled versatility among lower extremity devices. For example, it affords the potential to implement a novel training approach built upon our working model of movement primitives based on submovements, oscillations, and mechanical impedances. This translates into three distinct training modes: discrete, rhythmic, and balance. The system offers freedom of motion that forces self-directed movement for each of the three modes. This paper will present the technical details of the robotic system as well as a feasibility study done with one adult with stroke and two adults with cerebral palsy. Results of the one-month feasibility study demonstrated that the device is safe and suggested the potential advantages of the three modular training modes that can be added or subtracted to tailor therapy to a particular patient's need. Each participant demonstrated improvement in common clinical and kinematic measurements that must be confirmed in larger randomized control clinical trials.
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Federolf PA. A novel approach to study human posture control: “Principal movements” obtained from a principal component analysis of kinematic marker data. J Biomech 2016; 49:364-70. [DOI: 10.1016/j.jbiomech.2015.12.030] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 12/08/2015] [Accepted: 12/16/2015] [Indexed: 10/22/2022]
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Mansouri M, Clark AE, Seth A, Reinbolt JA. Rectus femoris transfer surgery affects balance recovery in children with cerebral palsy: A computer simulation study. Gait Posture 2016; 43:24-30. [PMID: 26669947 DOI: 10.1016/j.gaitpost.2015.08.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 07/06/2015] [Accepted: 08/13/2015] [Indexed: 02/02/2023]
Abstract
Stiff-knee gait is a troublesome movement disorder among children with cerebral palsy (CP), where peak swing phase knee flexion is diminished due to over-activity of the rectus femoris muscle. A common treatment for stiff-knee gait, rectus femoris transfer surgery, moves the muscle's distal tendon from the patella to the sartorius insertion on the tibia. As a biarticular muscle, rectus femoris may play a role in motor control and have unrecognized benefits for maintaining balance. We used musculoskeletal modeling, neuromuscular control, and forward dynamic simulation to investigate the role of rectus femoris tendon transfer surgery on balance recovery after support-surface perturbations for children with CP adopting two different crouched postures. We combined both high-level supraspinal and low-level spinal signals to generate 92 muscle excitations for tracking experimental whole body center of mass positions and velocities. Stability during balance recovery was evaluated by the minimum distance between the extrapolated center of mass and base of support boundary (bmin) and the minimum time to reach the boundary (TtBmin). The balance recovery of pre-surgical simulations (bmin=2.3+1.1cm, TtBmin=0.2+0.1s) were different (p=0.02), on average, than post-surgical simulations (bmin=-4.9+11.4cm, TtBmin=-0.1+0.3s) of rectus femoris transfers. The moderate crouch simulations (bmin=2.4+0.4cm, TtBmin=0.2+0.03s) were more stable than the mild crouch simulations (bmin=1.2+0.3cm, TtBmin=0.1+0.02s) following anterior translations of the support surface. These findings suggest that tendon transfer of rectus femoris affects balance recovery in children with CP.
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Affiliation(s)
- Misagh Mansouri
- Mechanical, Aerospace and Biomedical Engineering, University of Tennessee, Knoxville, TN, USA.
| | - Ashley E Clark
- Mechanical, Aerospace and Biomedical Engineering, University of Tennessee, Knoxville, TN, USA
| | - Ajay Seth
- Bioengineering, Stanford University, Stanford, CA, USA
| | - Jeffrey A Reinbolt
- Mechanical, Aerospace and Biomedical Engineering, University of Tennessee, Knoxville, TN, USA
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