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Selective motor control correlates with gross motor ability, functional balance and gait performance in ambulant children with bilateral spastic cerebral palsy. Gait Posture 2023; 99:9-13. [PMID: 36283302 DOI: 10.1016/j.gaitpost.2022.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 09/21/2022] [Accepted: 10/16/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Selective motor control (SMC) is a fundamental component of typical human motion. As a result of brain damage, impaired SMC often leads to difficulties with coordination, balance, gait efficiency and symmetry. RESEARCH QUESTION What is the association between impaired SMC and lower limb motor ability, functional balance and gait performance in children with bilateral spastic cerebral palsy (CP)? METHODS Thirty-six children (aged 5-16 years) with spastic bilateral CP in Gross Motor Function Classification System (GMFCS) level I to II were included in this study. SMC was assessed using Selective Control Assessment of the Lower Extremity (SCALE). Gross motor function was assessed using Gross Motor Function Measure-88 items D and E dimension (GMFM-88 D&E). Functional balance was assessed using Pediatric Balance Scale (PBS) and Timed Up and Go Test (TUG). Gait quality was assessed using Edinburg Visual Gait Score (EVGS) and 10-Meter Walk Test (10MWT). Spearman's rank correlation analyses were used to determine the association between SMC and other factors. RESULTS Correlation analyses showed that SCALE was strongly positively correlated with GMFM-88 (D&E) (rs=0.756, p < 0.001), PBS (rs=0.769, p < 0.001), and height-normalized fast walking speed (rs=0.632, p < 0.001), and strongly negatively correlated with TUG (rs=-0.766, p < 0.001) and EVGS (rs=-0.893, p < 0.001). SIGNIFICANCE Lower extremity SMC deficits are associated with poor gross motor function and balance control, more severe overall gait deviations and decreased fast walking speed in children with bilateral spastic CP. Physical therapy should include interventions that promote selective motor control in order to improve overall functional ability.
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Abd-Elmonem AM, Ali HA, Saad-Eldien SS, Rabiee A, Abd El-Nabie WA. Effect of physical training on motor function of ambulant children with diplegia after selective dorsal rhizotomy: A randomized controlled study. NeuroRehabilitation 2023; 53:547-556. [PMID: 38143389 DOI: 10.3233/nre-230098] [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] [Indexed: 12/26/2023]
Abstract
BACKGROUND Children with spastic diplegia experience tonicity, lack of selective motor control, subnormal postural stability and delayed motor development. Selective dorsal rhizotomy followed by physical therapy is a permanent procedure aimed to alleviate hypertonicity. OBJECTIVE To explore the efficacy of selective dorsal rhizotomy (SDR) followed by a physical training on gross motor function (GMF), functional balance, walking capacity, selective motor control (SMC) and energy cost of walking (ECW) of ambulant children with spastic diplegia. METHODS Forty-two children with spastic diplegia aged 5 to 8 years were randomly assigned into the control or SDR-group. Both groups received a designed physical training of progressive functional strength training and standard orthotic management (SOM) 3 times a week for 6 months. GMF, functional balance, ECW, functional capacity and SMC were assessed by gross motor function measure (GMfM-88), pediatric balance scale (PBS), energy expenditure index (EEI), six-minute walking test (6MWT) and selective control assessment of lower extremity (SCALE), respectively. Assessment was carried out before the treatment (baseline), after 6 months (post I) and 1-year follow-up (post II). RESULTS From baseline to post I and post II assessments, changes of GMF, functional balance, ECW, functional capacity and SMC within the control and SDR groups showed significant improvements (P < 0.001). Moreover, group comparison showed significant differences in favor of the SDR group. CONCLUSION Integrated physical training followed SDR demonstrated qualitative changes and enhancement in motor function, achieved by spasticity reduction.
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Affiliation(s)
- Amira M Abd-Elmonem
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Hazem A Ali
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Sara S Saad-Eldien
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Center for Physical Medicine, Rehabilitation and Rheumatology, Al-Agouza Hospital, Giza, Egypt
| | - Ahmed Rabiee
- Department of Neurosurgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Walaa A Abd El-Nabie
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Asymmetric Gait Analysis Using a DTW Algorithm with Combined Gyroscope and Pressure Sensor. SENSORS 2021; 21:s21113750. [PMID: 34071372 PMCID: PMC8199135 DOI: 10.3390/s21113750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/20/2021] [Accepted: 05/27/2021] [Indexed: 02/02/2023]
Abstract
Walking is one of the most basic human activities. Various diseases may be caused by abnormal walking, and abnormal walking is mostly caused by disease. There are various characteristics of abnormal walking, but in general, it can be judged as asymmetric walking. Generally, spatiotemporal parameters can be used to determine asymmetric walking. The spatiotemporal parameter has the disadvantage that it does not consider the influence of the diversity of patterns and the walking speed. Therefore, in this paper, we propose a method to analyze asymmetric walking using Dynamic Time Warping (DTW) distance, a time series analysis method. The DTW distance was obtained by combining gyroscope data and pressure data. The experiment was carried out by performing symmetrical walking and asymmetrical walking, and asymmetric walking was performed as a simulation of hemiplegic walking by fixing one ankle using an auxiliary device. The proposed method was compared with the existing asymmetric gait analysis method. As a result of the experiment, a p-value lower than 0.05 was obtained, which proved that there was a statistically significant difference.
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Chirurgische Therapieoptionen bei spastischen Bewegungsstörungen der Extremitäten. Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-020-01033-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Zusammenfassung
Hintergrund
Schäden des 1. Motoneurons führen zu spastischen Lähmungen an den Extremitäten, die bei Kindern und Erwachsenen einschneidende Veränderungen der Bewegungsfähigkeit zur Folge haben und Lebensqualität sowie -teilhabe durch Funktionsverlust und Schmerzen einschränken.
Methode
Auf Grundlage eigener Behandlungserfahrungen in Verbindung mit einer PubMed-Literaturrecherche werden aktuelle Diagnose- und Behandlungsverfahren sowie deren Kombinationen vorgestellt.
Ergebnisse
Prinzipiell stehen Physio- und Ergotherapie mit vereinbarten alltagsrelevanten Therapiezielen, Medikamente (Botulinumtoxin und Baclofen) und Orthetik im Vordergrund. Chirurgische Maßnahmen an Muskeln, Sehnen, Gelenken und Knochen können dem betroffenen Patienten zu verbesserter Beweglichkeit, Wachstumskorrektur und vereinfachter Alltagsbewältigung verhelfen. Die selektive Neurektomie bei fokaler Spastik erlebt derzeit eine Renaissance. Die intrathekale Baclofentherapie kann bei entsprechend hoher Katheterlage auch eine Tonusreduktion an der oberen Extremität erreichen.
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Jiang W, Zhan Q, Wang J, Mei R, Xiao B. Intraoperative neurophysiological monitoring in selective dorsal rhizotomy (SDR). BRAIN SCIENCE ADVANCES 2020. [DOI: 10.26599/bsa.2020.9050009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
For decades, intraoperative neurophysiological monitoring (IONM) has been used to guide selective dorsal rhizotomy (SDR) for the treatment of spastic cerebral palsy (CP). Electromyography (EMG) interpretation methods, which are the core of IONM, have never been fully discussed and addressed, and their importance and necessity in SDR have been questioned for years. However, outcomes of CP patients who have undergone IONM-guided SDR have been favorable, and surgery-related complications are extremely minimal. In this paper, we review the history of evolving EMG interpretation methods as well as their neuroelectrophysiological basis.
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Affiliation(s)
- Wenbin Jiang
- Department of Neurosurgery, Shanghai Children’s Hospital, Shanghai Jiaotong University, Shanghai 200062, China
| | - Qijia Zhan
- Department of Neurosurgery, Shanghai Children’s Hospital, Shanghai Jiaotong University, Shanghai 200062, China
| | - Junlu Wang
- Department of Neurosurgery, Shanghai Children’s Hospital, Shanghai Jiaotong University, Shanghai 200062, China
| | - Rong Mei
- Department of Neurosurgery, Shanghai Children’s Hospital, Shanghai Jiaotong University, Shanghai 200062, China
| | - Bo Xiao
- Department of Neurosurgery, Shanghai Children’s Hospital, Shanghai Jiaotong University, Shanghai 200062, China
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Chakraborty S, Nandy A, Kesar TM. Gait deficits and dynamic stability in children and adolescents with cerebral palsy: A systematic review and meta-analysis. Clin Biomech (Bristol, Avon) 2020; 71:11-23. [PMID: 31677546 DOI: 10.1016/j.clinbiomech.2019.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/19/2019] [Accepted: 09/08/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Studies have demonstrated that ambulatory children and adolescents with cerebral palsy demonstrate atypical gait patterns. Out of numerous gait variables, identification of the most deteriorated gait parameters is important for targeted and effective gait rehabilitation. Therefore, this study aimed to identify the gait parameters with the most discriminating nature to distinguish cerebral palsy gait from normal gait. METHODS Multiple databases were searched to include studies on ambulatory children and adolescents with cerebral palsy that included gait (spatio-temporal, kinematic, and kinetic) and dynamic stability variables. FINDINGS Of 68 studies that met the inclusion criteria, 35 studies were included in the meta analysis. Effect size was used to assess the discriminative strength of each variable. A large effect (≥ 0.8) of cerebral palsy on double limb support time (Standardized Mean Difference = 0.98), step length (Standardized Mean Difference = 1.65), step width (Standardized Mean Difference = 1.21), stride length (Standardized Mean Difference = 1.75), and velocity (Standardized Mean Difference = 1.42) was observed at preferred-walking speed. At fast-walking speed, some gait variables (i.e. velocity and stride length) exhibited larger effect size compared to preferred-walking speed. For some kinematic variables (e.g. range of motion of pelvis), the effect size varied across the body planes. INTERPRETATION Our systematic review detects the most discriminative features of cerebral palsy gait. Non-uniform effects on joint kinematics across the anatomical planes support the importance of 3D gait analysis. Differential effects at fast versus preferred speeds emphasize the importance of measuring gait at a range of speeds.
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Affiliation(s)
- Saikat Chakraborty
- Machine Intelligence and Bio-motion Research Lab., Department of Computer Science and Engineering, National Institute of Technology, Rourkela, India. saikat.scgmail.com
| | - Anup Nandy
- Machine Intelligence and Bio-motion Research Lab., Department of Computer Science and Engineering, National Institute of Technology, Rourkela, India
| | - Trisha M Kesar
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, USA
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Davidson B, Elkaim LM, Lipsman N, Ibrahim GM. Editorial. An ethical framework for deep brain stimulation in children. Neurosurg Focus 2019; 45:E11. [PMID: 30173615 DOI: 10.3171/2018.7.focus18219] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Benjamin Davidson
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario
| | - Lior M Elkaim
- 2Faculty of Medicine, Université de Montréal, Québec
| | - Nir Lipsman
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario.,3Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Ontario; and
| | - George M Ibrahim
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario.,4Division of Neurosurgery, Hospital for Sick Children, Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, University of Toronto, Ontario, Canada
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O’Sullivan R, Leonard J, Quinn A, Kiernan D. The short-term effects of selective dorsal rhizotomy on gait compared to matched cerebral palsy control groups. PLoS One 2019; 14:e0220119. [PMID: 31361785 PMCID: PMC6667201 DOI: 10.1371/journal.pone.0220119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/09/2019] [Indexed: 11/21/2022] Open
Abstract
Objectives To examine the short-term effects of selective dorsal rhizotomy (SDR) ± soft-tissue surgery on gait in cerebral palsy (CP) compared to matched controls with no surgical intervention. Methods Participants had gait analysis before and one year after SDR. Non SDR participants were retrospectively matched for age and all significant gait parameters. The SDR group was further subdivided into those who had concomitant orthopaedic surgery and those who had SDR only. Results The SDR group consisted of 29 participants (mean age 5.8 years at baseline, 7.7 years at follow-up). Of these, 13 had concomitant orthopaedic surgery. The non SDR group consisted of 18 participants (mean age at baseline 6.1 years, 8.1 years at follow-up). SDR ± soft-tissue surgery significantly improved step-lengths, knee flexion at initial contact and mid-stance, ankle dorsiflexion, foot progression and timing of peak knee flexion. None of these improvements in gait were seen without surgical intervention. While more improvements were seen in those who had SDR and orthopaedic surgery, SDR only resulted in improved step-lengths, knee extension, foot progression and timing of peak knee flexion. Conclusions SDR ± soft-tissue surgery results in short-term improvements in gait which are not seen without surgical intervention. While those who had SDR and soft-tissue surgery demonstrated more changes in gait, many improvements were attributable to SDR only.
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Affiliation(s)
| | - Jane Leonard
- Central Remedial Clinic, Clontarf, Dublin, Ireland
| | - Aoife Quinn
- Central Remedial Clinic, Clontarf, Dublin, Ireland
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Psychometric properties of measures of gait quality and walking performance in young people with Cerebral Palsy: A systematic review. Gait Posture 2017; 58:30-40. [PMID: 28711651 DOI: 10.1016/j.gaitpost.2017.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 06/30/2017] [Accepted: 07/02/2017] [Indexed: 02/02/2023]
Abstract
Availability of outcome measures (OMs) with robust psychometric properties is an essential prerequisite for the evaluation of interventions designed to address gait deterioration in young people with Cerebral Palsy (CP). This review evaluates evidence for the reliability, validity and responsiveness of outcome measures of gait quality and walking performance in young people with CP. A systematic search was performed in MEDLINE, CINAHL, PubMed and Scopus. Articles that met the eligibility criteria were selected. Methodological quality of studies was independently rated by two raters using the modified COnsensus-based Standard for the selection of health status Measurement INstruments checklist. Strength of evidence was rated using standardised guidelines. Best evidence synthesis was scored according to Cochrane criteria. Fifty-one articles reporting on 18 distinct OMs were included for review. Best evidence synthesis indicated a moderate to strong evidence for the reliability for OMs of walking performance but conflicting evidence for the reliability of OMs of gait quality. The evidence for responsiveness for all OMs included in this review was rated as 'unknown'. The limitations of using the modified COSMIN scoring for small sample sizes are acknowledged. Future studies of high methodological quality are needed to explore the responsiveness of OMs assessing gait quality and walking performance in young people with CP.
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Rumberg F, Bakir MS, Taylor WR, Haberl H, Sarpong A, Sharankou I, Lebek S, Funk JF. Correction: The Effects of Selective Dorsal Rhizotomy on Balance and Symmetry of Gait in Children with Cerebral Palsy. PLoS One 2017; 12:e0177585. [PMID: 28481936 PMCID: PMC5421804 DOI: 10.1371/journal.pone.0177585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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