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Johnson KA, McDaniel JT, Graham HK, Robertson ET, McIntosh S, Wallace JP, Albright DL. A Geospatial Analysis of Social and Structural Determinants of Health and High HIV Prevalence in Alabama, USA. J Community Health 2024; 49:385-393. [PMID: 38032459 DOI: 10.1007/s10900-023-01309-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE This study utilizes geospatial analytic techniques to examine HIV hotspots in Alabama leveraging Medicaid utilization data. METHODS This cross-sectional study leveraged Medicaid utilization data from Alabama's 67 counties, averaging 9,861 Medicaid recipients aged > 18 years old per county. We used Alabama Medicaid administrative claims data from January 1, 2016, to December 31, 2020, to identify individuals with HIV. Using Microsoft SQL Server, we obtained the average annual count of HIV Medicaid claims in each of the 67 Alabama counties (numerator) and the number of adult Medicaid recipients in each county (denominator), and standardized with a multiplier of 100,000. We also examined several other area-level summary variables (e.g., non-high school completion, income greater than four times the federal poverty level, social associations, urbanicity/rurality) as social and structural determinants of health. County-boundary choropleth maps were created representing the geographic distribution of HIV rates per 100,000 adult Medicaid recipients in Alabama. Leveraging ESRI ArcGIS and local indicators of spatial association (LISA), results were examined using local Moran's I to identify geographic hotspots. RESULTS Eleven counties had HIV rates higher than 100 per 100,000. Three were hotspots. Being an HIV hotspot was significantly associated with relatively low educational attainment and less severe poverty than other areas in the state. CONCLUSIONS Findings suggesting that the HIV clusters in Alabama were categorized by significantly less severe poverty and lower educational attainment can aid ongoing efforts to strategically target resources and end the HIV epidemic in U.S.' Deep South.
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Affiliation(s)
- K A Johnson
- School of Social Work, The University of Alabama, Tuscaloosa, AL, USA
| | - J T McDaniel
- Public Health, Southern Illinois University, Carbondale, IL, USA
| | - H K Graham
- Educational Studies in Psychology, The University of Alabama, Tuscaloosa, AL, USA
| | - E T Robertson
- Department of Political Science, The University of Alabama, Box 870306, Tuscaloosa, AL, 35487-0314, USA
| | - S McIntosh
- Department of Political Science, The University of Alabama, Box 870306, Tuscaloosa, AL, 35487-0314, USA
| | - J P Wallace
- Public Health, Southern Illinois University, Carbondale, IL, USA
- School of Human Sciences, Southern Illinois University, Carbondale, IL, USA
| | - David L Albright
- Department of Political Science, The University of Alabama, Box 870306, Tuscaloosa, AL, 35487-0314, USA.
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Howard JJ, Joumaa V, Robinson KG, Lee SK, Akins RE, Syed F, Shrader MW, Huntley JS, Graham HK, Leonard T, Herzog W. Collagenase treatment decreases muscle stiffness in cerebral palsy: A preclinical ex vivo biomechanical analysis of hip adductor muscle fiber bundles. Dev Med Child Neurol 2023; 65:1639-1645. [PMID: 37198748 DOI: 10.1111/dmcn.15637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 05/19/2023]
Abstract
AIM To determine the dose-response relationship of collagenase Clostridium histolyticum (CCH) on collagen content and the change in muscle fiber bundle stiffness after ex vivo treatment of adductor longus biopsies with CCH in children with cerebral palsy (CP). METHOD Biopsy samples of adductor longus from children with CP (classified in Gross Motor Function Classification System levels IV and V) were treated with 0 U/mL, 200 U/mL, 350 U/mL, or 500 U/mL CCH; percentage collagen reduction was measured to determine the dose-response. Peak and steady-state stresses were determined at 1%, 2.5%, 5%, and 7.5% strain increments; Young's modulus was calculated. RESULTS Eleven patients were enrolled (nine males, two females, mean age at surgery 6 years 5 months; range: 2-16 years). A linear CCH dose-response relationship was determined. Peak and steady-state stress generation increased linearly at 5.9/2.3mN/mm2 , 12.4/5.3mN/mm2 , 22.2/9.7mN/mm2 , and 33.3/15.5mN/mm2 at each percentage strain increment respectively. After CCH treatment, peak and steady-state stress generation decreased to 3.2/1.2mN/mm2 , 6.5/2.9mN/mm2 , 12.2/5.7mN/mm2 , and 15.4/7.7mN/mm2 respectively (p < 0.004). Young's modulus decreased from 205 kPa to 100 kPa after CCH (p = 0.003). INTERPRETATION This preclinical ex vivo study provides proof of concept for the use of collagenase to decrease muscle stiffness in individuals with CP.
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Affiliation(s)
- Jason J Howard
- Department of Orthopedic Surgery, Nemours Children's Hospital, Delaware, Wilmington, DE, USA
| | - Venus Joumaa
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Karyn G Robinson
- Nemours Biomedical Research, Nemours Children's Health, Wilmington, DE, USA
| | - Stephanie K Lee
- Nemours Biomedical Research, Nemours Children's Health, Wilmington, DE, USA
| | - Robert E Akins
- Nemours Biomedical Research, Nemours Children's Health, Wilmington, DE, USA
| | - Faizan Syed
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - M Wade Shrader
- Department of Orthopedic Surgery, Nemours Children's Hospital, Delaware, Wilmington, DE, USA
| | - James S Huntley
- Division of Orthopedic Surgery, Department of Surgery, Sidra Medicine, Doha, Qatar
| | - H Kerr Graham
- Department of Orthopaedic Surgery, University of Melbourne, Hugh Williamson Gait Laboratory, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Timothy Leonard
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Walter Herzog
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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Ulusaloglu AC, Asma A, Rogers KJ, Shrader MW, Graham HK, Howard JJ. The influence of tone on proximal femoral and acetabular geometry in neuromuscular hip displacement: A comparison of cerebral palsy and spinal muscular atrophy. J Child Orthop 2022; 16:121-127. [PMID: 35620131 PMCID: PMC9127888 DOI: 10.1177/18632521221084184] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/09/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The aim of this article was to compare longitudinal changes in hip morphology in cerebral palsy (hypertonic) and spinal muscular atrophy (hypotonic) to examine the influence of muscle tone on development of hip displacement. METHODS Children with spinal muscular atrophy (Types I and II) and cerebral palsy (Gross Motor Function Classification System IV and V) with hip displacement (migration percentage >30%) were included. Head shaft angle, migration percentage, and acetabular index were measured at T1 (1-2.5 years), T2 (3-5 years), and T3 (6-8 years). Analysis of variance testing and linear regression were utilized. RESULTS Sixty patients (cerebral palsy, N = 41; spinal muscular atrophy, N = 19) were included. Hip displacement occurred earlier in spinal muscular atrophy (34 months) than cerebral palsy (49 months) (p = 0.003). Head shaft angle was high and did not change between T1, T2, and T3, but significant changes in migration percentage were found (cerebral palsy: 23%, 36%, 45% (p < 0.01) and spinal muscular atrophy: 37%, 57%, 61% (p = 0.02)). Migration percentage increased by age in cerebral palsy (r = 0.41, p < 0.001), but not in spinal muscular atrophy (r = 0.18, p = 0.09). Acetabular index increased with migration percentage (cerebral palsy: r = 0.41, p < 0.001; spinal muscular atrophy: r = 0.48, p < 0.001). CONCLUSION Persistent lateral physeal tilt by head shaft angle was found for both spinal muscular atrophy and cerebral palsy. Abnormal physeal alignment may be causally related to weakness of the hip abductor muscles rather than spasticity or muscle imbalance, resulting in coxa valga and secondary acetabular dysplasia. LEVEL OF EVIDENCE III (case-control study).
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Affiliation(s)
| | - Ali Asma
- Nemours Children’s Hospital, Delaware,
Wilmington, DE, USA
| | | | | | - H Kerr Graham
- Department of Orthopaedic Surgery,
University of Melbourne, Melbourne, VIC, Australia,Hugh Williamson Gait Laboratory, Royal
Children’s Hospital, Melbourne, VIC, Australia
| | - Jason J Howard
- Nemours Children’s Hospital, Delaware,
Wilmington, DE, USA,Jason J Howard, Department of Orthopaedics,
Nemours Children’s Hospital, Delaware, 1600 Rockland Road, Wilmington, DE 19803,
USA.
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4
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Graham HK. Fractures of the Distal Radial Metaphysis in Children: Which Ones Need Reduction?: Commentary on an article by Topi Laaksonen, MD, et al.: "Epidemiology, Treatment, and Treatment Quality of Overriding Distal Metaphyseal Radial Fractures in Children and Adolescents". J Bone Joint Surg Am 2022; 104:297. [PMID: 35113832 DOI: 10.2106/jbjs.21.01206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- H Kerr Graham
- University of Melbourne, Parkville, Victoria, Australia
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Shore BJ, McCarthy J, Shrader MW, Graham HK, Veerkamp M, Rutz E, Chambers H, Davids JR, Narayanan U, Novacheck TF, Pierz K, Dreher T, Rhodes J, Shilt J, Theologis T, Van Campenhout A, Kay RM. Anterior distal femoral hemiepiphysiodesis in children with cerebral palsy: Establishing surgical indications and techniques using the modified Delphi method and literature review. J Child Orthop 2022; 16:65-74. [PMID: 35615394 PMCID: PMC9124914 DOI: 10.1177/18632521221087529] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The purpose of this study was to develop consensus for the surgical indications of anterior distal femur hemiepiphysiodesis in children with cerebral palsy using expert surgeon opinion through a modified Delphi technique. METHODS The panel used a 5-level Likert-type scale to record agreement or disagreement with 27 statements regarding anterior distal femur hemiepiphysiodesis. Consensus was defined as at least 80% of responses being in the highest or lowest 2 of the Likert-type ratings. General agreement was defined as 60%-79% falling into the highest or lowest 2 ratings. RESULTS For anterior distal femur hemiepiphysiodesis, 27 statements were surveyed: consensus or general agreement among the panelists was achieved for 22 of 27 statements (22/27, 82%) and 5 statements had no agreement (5/27, 18%). There was general consensus that anterior distal femur hemiepiphysiodesis is indicated for ambulatory children with cerebral palsy, with at least 2 years growth remaining, and smaller (<30 degrees) knee flexion contractures and for minimally ambulatory children to aid in standing/transfers. Consensus was achieved regarding the importance of close radiographic follow-up after screw insertion to identify or prevent secondary deformity. There was general agreement that percutaneous screws are preferred over anterior plates due to the pain and irritation associated with plates. Finally, it was agreed that anterior distal femur hemiepiphysiodesis was not indicated in the absence of a knee flexion contracture. CONCLUSION Anterior distal femur hemiepiphysiodesis can be used to treat fixed knee flexion contractures in the setting of crouch gait, but other associated lever arm dysfunctions must be addressed by single-event multilevel surgery. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Benjamin J Shore
- Boston Children’s Hospital, Boston, MA, USA,Benjamin J. Shore, Boston Children’s Hospital, Boston, MA 02115, USA.
| | - James McCarthy
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - M Wade Shrader
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - H Kerr Graham
- The Royal Children’s Hospital Melbourne, Melbourne, VIC, Australia
| | - Matthew Veerkamp
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Erich Rutz
- The Royal Children’s Hospital Melbourne, Melbourne, VIC, Australia
| | | | - Jon R Davids
- Shriners Hospitals for Children—Northern California, Sacramento, CA, USA
| | | | - Tom F Novacheck
- Gillette Children’s Specialty Healthcare, Saint Paul, MN, USA
| | | | | | | | | | | | | | - Robert M Kay
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
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Willoughby KL, Ang SG, Thomason P, Rutz E, Shore B, Buckland AJ, Johnson MB, Graham HK. Epidemiology of scoliosis in cerebral palsy: A population-based study at skeletal maturity. J Paediatr Child Health 2022; 58:295-301. [PMID: 34453468 PMCID: PMC9291795 DOI: 10.1111/jpc.15707] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/26/2021] [Accepted: 08/09/2021] [Indexed: 11/27/2022]
Abstract
AIM This study investigated the prevalence of scoliosis in a large, population-based cohort of individuals with cerebral palsy (CP) at skeletal maturity to identify associated risk factors that may inform scoliosis surveillance. METHODS Young people with CP born between 1990 and 1992 were reviewed through routine orthopaedic review or a transition clinic. Classification of CP was recorded by movement disorder, distribution, gross and fine motor function. Clinical examination was undertaken and those with clinical evidence of scoliosis or risk factors had radiographs of the spine. Scoliosis severity was measured and categorised by Cobb angle. RESULTS Two hundred and ninety-two individuals were evaluated (78% of the birth cohort) at a mean age of 21 years, 4 months (range 16-29 years). Scoliosis (Cobb angle >10°) was found in 41%, with strong associations to the Gross Motor Function Classification System (GMFCS), Manual Abilities Classification System (MACS) and dystonic/mixed movement disorders. Those at GMFCS V were 23.4 times (95%CI 9.9-55.6) more likely to develop scoliosis than those at GMFCS I. Severe curves (Cobb >40°, 13% of the cohort) were found almost exclusively in those functioning at GMFCS IV and V, and were 18.2 times (95%CI 6.9-48.5) more likely to occur in those with dystonia than those with spasticity. CONCLUSIONS Scoliosis was very common in young people with CP, with prevalence and severity strongly associated with GMFCS and MACS level and dystonic movement disorder. Severe curves were almost exclusively found in non-ambulant children. Clinical screening for scoliosis should occur for all children with CP, with radiographic surveillance focusing on those functioning at GMFCS IV and V.
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Affiliation(s)
- Kate L Willoughby
- Orthopaedic DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia,Gait Lab and Orthopaedics Research GroupMurdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - Soon Ghee Ang
- Orthopaedic DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia,Present address:
Mercy HealthMelbourneVictoriaAustralia
| | - Pam Thomason
- Gait Lab and Orthopaedics Research GroupMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Hugh Williamson Gait Analysis LaboratoryThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Erich Rutz
- Orthopaedic DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia,Gait Lab and Orthopaedics Research GroupMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Hugh Williamson Gait Analysis LaboratoryThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Benjamin Shore
- Orthopaedic DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia,Present address:
Orthopaedic DepartmentBoston Children's HospitalBostonMassachusettsUSA
| | - Aaron J Buckland
- Orthopaedic DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Michael B Johnson
- Orthopaedic DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia,Gait Lab and Orthopaedics Research GroupMurdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - H Kerr Graham
- Orthopaedic DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia,Gait Lab and Orthopaedics Research GroupMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Hugh Williamson Gait Analysis LaboratoryThe Royal Children's HospitalMelbourneVictoriaAustralia,Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia
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Gibson N, Wynter M, Thomason P, Baker F, Burnett H, Graham HK, Kentish M, Love SC, Maloney E, Stannage K, Willoughby K. Australian hip surveillance guidelines at 10 years: New evidence and implementation. J Pediatr Rehabil Med 2022; 15:31-37. [PMID: 35311729 DOI: 10.3233/prm-220017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Optimum management of hip displacement in children with cerebral palsy (CP) is facilitated by an approach that focuses on anticipatory and preventive measures. Hip surveillance programs for children with CP were developed at the beginning of the new millennium, with the purpose of identifying hip displacement sufficiently early to permit a choice of effective management options. In the early years, hip surveillance was guided by epidemiological analysis of population-based studies of prevalence. In Australia, a National Hip Surveillance in CP Working Group was first convened in 2005. This resulted in a 2008 Consensus Statement of recommendations published and endorsed by Australasian Academy of Cerebral Palsy and Developmental Medicine (AusACPDM). The group undertook that the recommendations should be reviewed every 5 years to ensure currency and congruency with the emerging evidence base. As new evidence became available, hip surveillance guidelines developed, with the most recent 2020 Australian Hip Surveillance Guidelines endorsed by the AusACPDM. Implementing comprehensive hip surveillance programs has now been shown to improve the natural history of hip dislocations and improve quality of life. Standardised hip surveillance programs can also facilitate planning for multicentre research through harmonisation of data collection. This, in turn, can help with the identification of robust new evidence that is based on large cohort or population studies. Here a review of evidence informing the updated 2020 Hip Surveillance Guidelines is presented.
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Affiliation(s)
- Noula Gibson
- Department of Physiotherapy, Perth Children's Hospital, Nedlands, WA, Australia.,Curtin University, School of Physiotherapy and Exercise Science, Perth, WA, Australia
| | - Meredith Wynter
- Department of Paediatric Rehabilitation, Queensland Children's Hospital, South Brisbane, QLD, Australia.,University of Queensland, Child Health Research Centre, Brisbane, QLD, Australia
| | - Pam Thomason
- The Royal Children's Hospital, Hugh Williamson Gait Laboratory, Parkville, VIC, Australia
| | - Felicity Baker
- Women's and Children's Hospital, Paediatric Rehabilitation Department, North Adelaide, SA, Australia
| | - Heather Burnett
- Hunter New England Local Health District, HNEkids Rehab, New Lambton, NSW, Australia
| | - H Kerr Graham
- The Royal Children's Hospital, Hugh Williamson Gait Laboratory, Parkville, VIC, Australia.,Department of Orthopaedics, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Megan Kentish
- Department of Paediatric Rehabilitation, Queensland Children's Hospital, South Brisbane, QLD, Australia.,University of Queensland, Child Health Research Centre, Brisbane, QLD, Australia
| | - Sarah C Love
- University of Notre Dame, School of Physiotherapy, Fremantle, WA, Australia.,SensesWA, WA, Australia
| | - Eliza Maloney
- The Royal Hobart Hospital, State-Wide Paediatric Rehabilitation, Hobart, TAS, Australia
| | - Katherine Stannage
- Department of Orthopaedics, Perth Children's Hospital, Australia, Nedlands, WA, Australia
| | - Kate Willoughby
- Department of Orthopaedics, The Royal Children's Hospital, Parkville, VIC, Australia.,Murdoch Children's Research Institute, Gait Lab and Orthopaedics Research Group, Parkville, VIC, Australia
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Buckland AJ, Woo D, Kerr Graham H, Vasquez-Montes D, Cahill P, Errico TJ, Sponseller PD. Residual lumbar hyperlordosis is associated with worsened hip status 5 years after scoliosis correction in non-ambulant patients with cerebral palsy. Spine Deform 2021; 9:1125-1136. [PMID: 33523455 DOI: 10.1007/s43390-020-00281-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 12/26/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cerebral palsy (CP) is a static encephalopathy with progressive musculoskeletal pathology. Non-ambulant children (GMFCS IV and V) with CP have high rates of spastic hip disease and neuromuscular scoliosis. The effect of spinal fusion and spinal deformity on hip dislocation following total hip arthroplasty has been well studied, however in CP this remains largely unknown. This study aimed to identify factors associated with worsening postoperative hip status (WHS) following corrective spinal fusion in children with GMFCS IV and V CP. METHODS Retrospective review of GMFSC IV and V CP patients in a prospective multicenter database undergoing spinal fusion, with 5 years follow-up. WHS was determined by permutations of baseline (BL), 1 year, 2 years, and 5 years hip status and defined by a change from an enlocated hip at BL that became subluxated, dislocated or resected post-op, or a subluxated hip that became dislocated or resected. Hip status was analyzed against patient demographics, hip position, surgical variables, and coronal and sagittal spinal alignment parameters. Cutoff values for parameters at which the relationship with hip status was significant was determined using receiver operating characteristic curves. Logistic regression determined odds ratios for predictors of WHS. RESULTS Eighty four patients were included. 37 (44%) had WHS postoperatively. ROC analysis and logistic regression demonstrated that the only spinopelvic alignment parameter that significantly correlated with WHS was lumbar hyperlordosis (T12-L5) > 60° (p = 0.028), OR = 2.77 (CI 1.10-6.94). All patients showed an increase in pre-to-postop LL. Change in LL pre-to-postop was no different between groups (p = 0.318), however the WHS group was more lordotic at BL and postop (pre44°/post58° vs pre32°/post51° in the no change group). Age, sex, Risser, hip position, levels fused, coronal parameters, global sagittal alignment (SVA), thoracic kyphosis, and reoperation were not associated with WHS. CONCLUSION Postoperative hyperlordosis(> 60°) is a risk factor for WHS at 5 years after spinal fusion in non-ambulant CP patients. WHS likely relates to anterior pelvic tilt and functional acetabular retroversion due to hyperlordosis, as well as loss of protective lumbopelvic motion causing anterior femoracetabular impingement. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Aaron J Buckland
- Department of Orthopaedic Surgery, Spine Research Center, NYU Langone Health, NYU Langone Orthopedic Hospital, 306 East 15th Street, New York, NY, 10003, USA. .,The Royal Children's Hospital, University of Melbourne, Melbourne, Australia. .,Melbourne Orthopaedic Group, Melbourne, Australia.
| | - Dainn Woo
- Department of Orthopaedic Surgery, Spine Research Center, NYU Langone Health, NYU Langone Orthopedic Hospital, 306 East 15th Street, New York, NY, 10003, USA
| | - H Kerr Graham
- The Royal Children's Hospital, University of Melbourne, Melbourne, Australia
| | - Dennis Vasquez-Montes
- Department of Orthopaedic Surgery, Spine Research Center, NYU Langone Health, NYU Langone Orthopedic Hospital, 306 East 15th Street, New York, NY, 10003, USA
| | - Patrick Cahill
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Thomas J Errico
- Department of Orthopaedic Surgery, Spine Research Center, NYU Langone Health, NYU Langone Orthopedic Hospital, 306 East 15th Street, New York, NY, 10003, USA
| | - Paul D Sponseller
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
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Wong P, Fransch S, Gallagher C, Francis KL, Khot A, Rutz E, Graham HK. Split anterior tibialis tendon transfer to peroneus brevis for spastic equinovarus in children with hemiplegia. J Child Orthop 2021; 15:279-290. [PMID: 34211605 PMCID: PMC8223092 DOI: 10.1302/1863-2548.15.210033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The aim of this study is to report the safety and eff-cacy of soft-tissue surgery incorporating split transfer of tibi-alis anterior to peroneus brevis (SPLATT-PB) for children with hemiplegic spastic equinovarus. METHODS This was a retrospective case series of children and adolescents with spastic hemiplegia who had a novel combination of SPLATT-TB, intramuscular tenotomy of tibialis posterior and either spasticity management or gastrocsole-us lengthening as the index surgery. The principal outcome measures were changes in pain and difficulty with shoe wear and radiological parameters obtained from weight-bearing anteroposterior and lateral radiographs of the affected foot before and after surgery. RESULTS A total of 63 patients with symptomatic spastic equinovarus met the inclusion criteria. Mean age at surgery was 9.8 years (6 to 18) and the mean follow-up was seven years (range 3 to 10 years). Foot pain and problems with shoe wear improved after surgery. Seven radiological criteria showed a clinically and statistically significant improvement at follow-up, the majority being in the normal range. There were 11 surgical adverse events, all classified as Modified Cla-vien-Dindo Grade II. Three patients required further surgery for recurrent equinus, eight patients required further surgery for valgus deformities and four patients required bony surgery for residual varus deformities. CONCLUSION Soft-tissue surgery for spastic equinovarus was successful in the majority of children with spastic hemiplegia, particularly between ages eight and 12 years, resulting in a plantigrade, flexible foot with minimal pain or limitations in shoe-wear. Children younger than 8 years at index surgery were more prone to overcorrection into valgus. Children older than 12 years had persistent varus deformities requiring bony surgery. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Peter Wong
- Orthopaedic Department, The Royal Children’s Hospital, Melbourne, Australia
| | - Shaneil Fransch
- Orthopaedic Department, The Royal Children’s Hospital, Melbourne, Australia
| | - Charles Gallagher
- Orthopaedic Department, The Royal Children’s Hospital, Melbourne, Australia
| | | | - Abhay Khot
- Orthopaedic Department, The Royal Children’s Hospital, Melbourne, Australia
| | - Erich Rutz
- Orthopaedic Department, The Royal Children’s Hospital, Melbourne, Australia
| | - H. Kerr Graham
- Orthopaedic Department, The Royal Children’s Hospital, Melbourne, Australia,Department of Paediatrics, University of Melbourne.,Correspondence should be sent to H. Kerr Graham Department of Orthopaedic Surgery Royal Children’s Hospital Flemington Road Parkville, Victoria, Australia E-mail:
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Kay RM, Pierz K, McCarthy J, Graham HK, Chambers H, Davids JR, Narayanan U, Novacheck TF, Rhodes J, Rutz E, Shilt J, Shore BJ, Veerkamp M, Shrader MW, Theologis T, Van Campenhout A, Dreher T. Distal rectus femoris surgery in children with cerebral palsy: results of a Delphi consensus project. J Child Orthop 2021; 15:270-278. [PMID: 34211604 PMCID: PMC8223080 DOI: 10.1302/1863-2548.15.210044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The purpose of this study was for an international panel of experts to establish consensus indications for distal rectus femoris surgery in children with cerebral palsy (CP) using a modified Delphi method. METHODS The panel used a five-level Likert scale to record agreement or disagreement with 33 statements regarding distal rectus femoris surgery. The panel responded to statements regarding general characteristics, clinical indications, computerized gait data, intraoperative techniques and outcome measures. Consensus was defined as at least 80% of responses being in the highest or lowest two of the five Likert ratings, and general agreement as 60% to 79% falling into the highest or lowest two ratings. There was no agreement if neither threshold was reached. RESULTS Consensus or general agreement was reached for 17 of 33 statements (52%). There was general consensus that distal rectus femoris surgery is better for stiff knee gait than is proximal rectus femoris release. There was no consensus about whether the results of distal rectus femoris release were comparable to those following distal rectus femoris transfer. Gross Motor Function Classification System (GMFCS) level was an important factor for the panel, with the best outcomes expected in children functioning at GMFCS levels I and II. The panel also reached consensus that they do distal rectus femoris surgery less frequently than earlier in their careers, in large part reflecting the narrowing of indications for this surgery over the last decade. CONCLUSION This study can help paediatric orthopaedic surgeons optimize decision-making for, and outcomes of, distal rectus femoris surgery in children with CP. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Robert M. Kay
- Chilldren’s Hospital Los Angeles, Los Angeles, California, United States,Correspondence should be sent to: Robert M. Kay, MD, Children’s Orthopaedic Center, Children’s Hospital Los Angeles, 4650 Sunset Blvd., #69, Los Angeles CA, United States 90027. E-mail:
| | - Kristan Pierz
- Connecticut Children’s Hospital, Hartford, Connecticut, United States
| | - James McCarthy
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
| | | | - Henry Chambers
- Rady Children’s Hospital, San Diego, California, United States
| | - Jon R. Davids
- Shriners Hospitals for Children-Northern California, Sacramento, California, United States
| | | | - Tom F. Novacheck
- Gillette Children’s Specialty Healthcare, Saint Paul, Minnesota, United States
| | - Jason Rhodes
- Children’s Hospital Colorado, Aurora, Colorado, United States
| | - Erich Rutz
- The Royal Children’s Hospital, Melbourne, Australia
| | - Jeffrey Shilt
- Texas Children’s Hospital, Houston, Texas, United States
| | | | - Matthew Veerkamp
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
| | - M. Wade Shrader
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States
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Mackay J, Thomason P, Sangeux M, Passmore E, Francis K, Graham HK. The impact of symptomatic femoral neck anteversion and tibial torsion on gait, function and participation in children and adolescents. Gait Posture 2021; 86:144-149. [PMID: 33725582 DOI: 10.1016/j.gaitpost.2021.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 02/04/2021] [Accepted: 03/03/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Torsional deformities of the lower limbs in children and adolescents are a common cause of in-toeing gait and cause gait deviations. The purpose of this study was to examine the relationship of children and adolescents with suspected Idiopathic Torsional Deformities (ITD) and pain, gait function, activity and participation. METHODS A retrospective review of all children and adolescents who attended our Centre over a 5-year period for evaluation of the effect of ITD. All children completed three-dimensional gait analysis (3DGA), standardized physical examination, medical imaging and the Pediatric Outcomes Data Collection Instrument (PODCI). Statistical analysis was completed using two sample t-tests, Pearson's Correlation and linear regression. RESULTS Fifty children and adolescents, 40 females and 10 males with a mean age of 13.5 years were included. Children reported a high prevalence of pain(86%), had increased internal hip rotation(p = 0.002) and decreased external hip rotation(p < 0.001) on physical examination when compared to published normative data. Medical imaging showed a mean(SD) femoral neck anteversion (FNA) of 38°(13°) and external tibial torsion of 39°(12°). Mean(SD) PODCI score was 32(16), indicating these children are functioning below their typically developing peers. The 3DGA kinematics show deviations from typical data including hip rotation, foot progression, pelvic tilt, hip flexion and knee extension. Observed mild kinetic deviations were within typical limits. The relationship between FNA and gait parameters, FNA and PODCI and gait and PODCI were weak. SIGNIFICANCE These children and adolescents have altered gait and experience pain leading to impaired function and diminished participation. Therefore, ITD is not purely a cosmetic issue.
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Affiliation(s)
- Jessie Mackay
- Hugh Williamson Gait Analysis Laboratory, The Royal Children's Hospital, 50 Flemington Road, Parkville, Melbourne, Victoria, 3052, Australia; Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, 3052, Australia.
| | - Pam Thomason
- Hugh Williamson Gait Analysis Laboratory, The Royal Children's Hospital, 50 Flemington Road, Parkville, Melbourne, Victoria, 3052, Australia; Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, 3052, Australia.
| | - Morgan Sangeux
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, 3052, Australia.
| | - Elyse Passmore
- Hugh Williamson Gait Analysis Laboratory, The Royal Children's Hospital, 50 Flemington Road, Parkville, Melbourne, Victoria, 3052, Australia; Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, 3052, Australia; The University of Melbourne, 50 Flemington Road, Parkville, Victoria, 3052, Australia.
| | - Kate Francis
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, 3052, Australia.
| | - H Kerr Graham
- Hugh Williamson Gait Analysis Laboratory, The Royal Children's Hospital, 50 Flemington Road, Parkville, Melbourne, Victoria, 3052, Australia; Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, 3052, Australia; The University of Melbourne, 50 Flemington Road, Parkville, Victoria, 3052, Australia.
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12
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Davoli GBDQ, Chaves TC, Lopes M, Martinez EZ, Sobreira CFDR, Graham HK, Mattiello-Sverzut AC. The cross-cultural adaptation, construct validity, and intra-rater reliability of the functional mobility scale in Brazilian Portuguese for children and adolescents with spina bifida. Disabil Rehabil 2021; 44:4862-4870. [PMID: 33879009 DOI: 10.1080/09638288.2021.1913650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this study was to perform a cross-cultural adaptation of the Functional Mobility Scale (FMS) to Brazilian Portuguese and analyse its construct validity and intra-rater reliability in a sample of caregivers of children and adolescents with spina bifida (SB). MATERIAL AND METHODS The cross-cultural adaptation followed five stages: two forward translations, synthesis, back-translation, committee review and pre-testing (n = 20). Construct validity was assessed by comparing the FMS with the classifications of Hoffer and Schoenmakers (n = 40). Intra-rater reliability was assessed by comparing the ratings of 14 caregivers, on two occasions. Kendall's tau correlation coefficient was used to test the construct validity of the FMS, while the kappa coefficient was used to test intra-rater reliability. RESULTS Caregivers reported no difficulties with completing the FMS in Brazilian Portuguese. Construct validity tests showed positive correlations between the distances of 5 m (house), 50 m (school) and 500 m (community) in the FMS and the classifications of Hoffer (τ = 0.84; τ = 0.90; τ = 0.68; p < 0.01) and Schoenmakers (τ = 0.83; τ = 0.89; τ = 0.76; p < 0.01), respectively. Excellent intra-rater reliability (kappa = 0.9-1.0) was found for all three distances in the FMS. CONCLUSIONS The FMS in Brazilian Portuguese showed acceptable intra-rater reliability and construct validity when used to measure the mobility level of patients with SB. We recommend its use in clinical practice and research.Implications for RehabilitationA valid and reliable instrument for assessing the mobility of patients with SB;A cross-cultural and adapted FMS in Brazilian Portuguese;An instrument for therapeutic and functional approaches outside the clinicalsetting;The FMS in the Brazilian Portuguese online version shows mistranslations.
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Affiliation(s)
| | - Thais Cristina Chaves
- Department of Health Science, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Mariane Lopes
- Department of Health Science, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Edson Zangiacomi Martinez
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - H Kerr Graham
- Department of Orthopaedics, Royal Children's Hospital, University of Melbourne, Victoria, Australia
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Graham HK, Thomason P, Willoughby K, Hastings-Ison T, Stralen RV, Dala-Ali B, Wong P, Rutz E. Musculoskeletal Pathology in Cerebral Palsy: A Classification System and Reliability Study. Children (Basel) 2021; 8:252. [PMID: 33807084 PMCID: PMC8004848 DOI: 10.3390/children8030252] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/09/2021] [Accepted: 03/16/2021] [Indexed: 02/01/2023]
Abstract
This article presents a classification of lower limb musculoskeletal pathology (MSP) for ambulant children with cerebral palsy (CP) to identify key features from infancy to adulthood. The classification aims to improve communication, and to guide referral for interventions, which if timed appropriately, may optimise long-term musculoskeletal health and function. Consensus was achieved by discussion between staff in a Motion Analysis Laboratory (MAL). A four-stage classification system was developed: Stage 1: Hypertonia: Abnormal postures are dynamic. Stage 2: Contracture: Fixed shortening of one or more muscle-tendon units. Stage 3: Bone and joint deformity: Torsional deformities and/or joint instability (e.g., hip displacement or pes valgus), usually accompanied by contractures. Stage 4: Decompensation: Severe pathology where restoration of optimal joint and muscle-tendon function is not possible. Reliability of the classification was tested using the presentation of 16 clinical cases to a group of experienced observers, on two occasions, two weeks apart. Reliability was found to be very good to excellent, with mean Fleiss' kappa ranging from 0.72 to 0.84. Four-stages are proposed to classify lower limb MSP in children with CP. The classification was reliable in a group of clinicians who work together. We emphasise the features of decompensated MSP in the lower limb, which may not always benefit from reconstructive surgery and which can be avoided by timely intervention.
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Affiliation(s)
- H. Kerr Graham
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia;
- Hugh Williamson Gait Laboratory, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (P.T.); (T.H.-I.); (P.W.)
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia;
- Orthopaedic Department, The Royal Children’s Hospital, Parkville, VIC 3052, Australia
| | - Pam Thomason
- Hugh Williamson Gait Laboratory, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (P.T.); (T.H.-I.); (P.W.)
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia;
| | - Kate Willoughby
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia;
- Orthopaedic Department, The Royal Children’s Hospital, Parkville, VIC 3052, Australia
| | - Tandy Hastings-Ison
- Hugh Williamson Gait Laboratory, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (P.T.); (T.H.-I.); (P.W.)
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia;
| | - Renee Van Stralen
- Department of Orthopedic Surgery, Sophia Children’s Hospital, Erasmus MC, 3015GD Rotterdam, The Netherlands;
| | - Benan Dala-Ali
- Orthopaedic Department, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK;
| | - Peter Wong
- Hugh Williamson Gait Laboratory, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (P.T.); (T.H.-I.); (P.W.)
- Orthopaedic Department, The Royal Children’s Hospital, Parkville, VIC 3052, Australia
| | - Erich Rutz
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia;
- Hugh Williamson Gait Laboratory, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (P.T.); (T.H.-I.); (P.W.)
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia;
- Orthopaedic Department, The Royal Children’s Hospital, Parkville, VIC 3052, Australia
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14
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Tang MJ, Graham HK, Davidson KE. Botulinum Toxin A and Osteosarcopenia in Experimental Animals: A Scoping Review. Toxins (Basel) 2021; 13:toxins13030213. [PMID: 33799488 PMCID: PMC8001269 DOI: 10.3390/toxins13030213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/11/2021] [Accepted: 03/11/2021] [Indexed: 01/24/2023] Open
Abstract
We conducted a scoping review to investigate the effects of intramuscular injection of Botulinum Toxin A (BoNT-A) on bone morphology. We investigated if the muscle atrophy associated with Injection of BoNT-A had effects on the neighboring bone. We used the search terms: osteopenia, bone atrophy, Botulinum Toxin A, Micro-CT, mice or rat. The following databases were searched: Medline, Embase, PubMed and the Cochrane Library, between 1990 and 2020. After removal of duplicates, 228 abstracts were identified of which 49 studies satisfied our inclusion and exclusion criteria. The majority of studies (41/49) reported a quantitative reduction in at least one measure of bone architecture based on Micro-CT. The reduction in the ratio of bone volume to tissue volume varied from 11% to 81% (mean 43%) according to the experimental set up and study time points. While longer term studies showed muscle recovery, no study showed complete recovery of all bone properties at the termination of the study. In experimental animals, intramuscular injection of BoNT-A resulted in acute muscle atrophy and acute degradation of the neighboring bone segment. These findings may have implications for clinical protocols in the use of Botulinum Toxin in children with cerebral palsy, with restraint recommended in injection protocols and consideration for monitoring bone density. Clinical studies in children with cerebral palsy receiving injections of Botulinum are indicated.
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Affiliation(s)
- Min Jia Tang
- Department of Orthopaedics, The Royal Children’s Hospital, Parkville, VIC 3052, Australia;
| | - H. Kerr Graham
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3010, Australia;
| | - Kelsey E. Davidson
- Department of Orthopedics, Shriners Hospitals for Children, Chicago, IL 60707, USA
- Correspondence:
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Chia K, Fischer I, Thomason P, Graham HK, Sangeux M. A Decision Support System to Facilitate Identification of Musculoskeletal Impairments and Propose Recommendations Using Gait Analysis in Children With Cerebral Palsy. Front Bioeng Biotechnol 2020; 8:529415. [PMID: 33330408 PMCID: PMC7729091 DOI: 10.3389/fbioe.2020.529415] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 10/28/2020] [Indexed: 01/12/2023] Open
Abstract
The identification of musculoskeletal impairments from gait analysis in children with cerebral palsy is a complex task, as is formulating (surgical) recommendations. In this paper, we present how we built a decision support system based on gait kinematics, anthropometrics, and physical examination data. The decision support system was trained to learn the association between these data and the list of impairments and recommendations formulated historically by experienced clinicians. Our aim was 2-fold, train a computational model that would be representative of data-based clinical reasoning in our center, and support new or junior clinicians by providing pre-processed impairments and recommendations with the associated supportive evidence. We present some of the challenges we faced, such as the issues of dimensionality reduction for kinematic data, missing data imputations, class imbalance and choosing an appropriate model evaluation metric. Most models, i.e., one model for each impairments and recommendations, achieved a weighted Brier score lower than 0.20, and sensitivity and specificity greater than 0.70 and 0.80, respectively. The results of the models are accessible through a web-based application which displays the probability predictions as well as the (up to) 5 best predictors.
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Affiliation(s)
- Kohleth Chia
- Murdoch Children’s Research Institute, Melbourne, VIC, Australia
| | - Igor Fischer
- Murdoch Children’s Research Institute, Melbourne, VIC, Australia
| | - Pam Thomason
- The Royal Children’s Hospital Melbourne, Parkville, VIC, Australia
| | - H. Kerr Graham
- The Royal Children’s Hospital Melbourne, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Morgan Sangeux
- Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- The Royal Children’s Hospital Melbourne, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
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16
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Toovey R, Willoughby KL, Hodgson JM, Graham HK, Reddihough DS. More than an X-ray: Experiences and perspectives of parents of children with cerebral palsy when engaging in hip surveillance. J Paediatr Child Health 2020; 56:130-135. [PMID: 31206912 DOI: 10.1111/jpc.14537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 05/23/2019] [Indexed: 11/30/2022]
Abstract
AIM We explored the experiences of parents of children with cerebral palsy (CP) when engaging in hip surveillance for their child and aimed to identify the barriers and facilitators they encounter. METHODS We conducted a pragmatic qualitative study through five focus groups conducted with 23 parents and primary care givers of young people with cerebral palsy. A semi-structured topic guide was used to facilitate discussion. Recordings were transcribed verbatim and transcripts analysed using content analysis. RESULTS Six major categories emerged: (i) hip surveillance is a shared responsibility; (ii) knowledge is empowering; (iii) hip surveillance should be proactive rather than reactive; (iv) consistency and support from health professionals is valuable; (v) good communication is crucial; and (vi) challenges associated with having an X-ray may not be appreciated. Participants made recommendations related to: service model enhancements, information provision and improving both communication and the experience of having an X-ray. CONCLUSION Despite having a good understanding of the need and importance of hip surveillance for their child, several barriers to parent engagement exist. Findings will inform the implementation of a family-centred model for hip surveillance and may be relevant to those undertaking or planning the implementation of hip surveillance in other areas.
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Affiliation(s)
- Rachel Toovey
- Centre of Research Excellence in Cerebral Palsy, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Kate L Willoughby
- Centre of Research Excellence in Cerebral Palsy, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Orthopaedic Department, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Jan M Hodgson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - H Kerr Graham
- Centre of Research Excellence in Cerebral Palsy, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Orthopaedic Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Dinah S Reddihough
- Centre of Research Excellence in Cerebral Palsy, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Victoria, Australia
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18
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Affiliation(s)
| | - H Kerr Graham
- Orthopaedic Department, The Royal Children's Hospital, Parkville, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia
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Howard JJ, Huntley JS, Graham HK, Herzog WL. Intramuscular injection of collagenase clostridium histolyticum may decrease spastic muscle contracture for children with cerebral palsy. Med Hypotheses 2019; 122:126-128. [DOI: 10.1016/j.mehy.2018.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/25/2018] [Accepted: 11/08/2018] [Indexed: 11/24/2022]
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Willoughby KL, Toovey R, Hodgson JM, Graham HK, Reddihough DS. Health professionals' experiences and barriers encountered when implementing hip surveillance for children with cerebral palsy. J Paediatr Child Health 2019; 55:32-41. [PMID: 29975007 DOI: 10.1111/jpc.14108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 04/17/2018] [Accepted: 05/28/2018] [Indexed: 11/29/2022]
Abstract
AIM This study aimed to explore health professionals' experiences of implementing hip surveillance for young people with cerebral palsy (CP) and to identify any barriers they encounter. METHODS A cross-sectional web-based survey of health professionals supporting children with CP was conducted. Responses were analysed through mixed methods. Responses to items presented as ordinal scales were analysed using descriptive statistics, and open-ended responses through a qualitative approach to identify themes. RESULTS A total of 32 paediatricians, 2 rehabilitation specialists and 50 physiotherapists completed the survey, with respondents working within both hospital- and community-based settings. Barriers most frequently reported were inconsistency in radiology practice and reporting (35%), parent engagement (32%), limited communication between clinicians (31%), lack of clarity in lines of responsibility (27%) and forgetting to undertake surveillance (26%). Four major themes were identified through qualitative analysis: (i) recognition of the importance of clinical guidelines to hip surveillance; (ii) the value of each role in the team around a child; (iii) the challenge of sharing responsibility; and (iv) the importance of communication in facilitating collaboration. CONCLUSIONS Barriers can be encountered at each phase of the hip surveillance process, but there are also factors that act as facilitators. Locally, the results will inform the development of an enhanced state-wide approach to hip surveillance for all children with CP. The identified barriers do not appear unique to the local context, and the findings may be transferable to other settings. Awareness of the potential barriers and facilitators would be valuable to those implementing hip surveillance in other areas.
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Affiliation(s)
- Kate L Willoughby
- Centre of Research Excellence in Cerebral Palsy, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Orthopaedic Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Rachel Toovey
- Centre of Research Excellence in Cerebral Palsy, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jan M Hodgson
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - H Kerr Graham
- Centre of Research Excellence in Cerebral Palsy, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Orthopaedic Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Dinah S Reddihough
- Centre of Research Excellence in Cerebral Palsy, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Victoria, Australia
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Shih STF, Tonmukayakul U, Imms C, Reddihough D, Graham HK, Cox L, Carter R. Economic evaluation and cost of interventions for cerebral palsy: a systematic review. Dev Med Child Neurol 2018; 60:543-558. [PMID: 29319155 DOI: 10.1111/dmcn.13653] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2017] [Indexed: 11/30/2022]
Abstract
AIM Economic appraisal can help guide policy-making for purchasing decisions, and treatment and management algorithms for health interventions. We conducted a systematic review of economic studies in cerebral palsy (CP) to inform future research. METHOD Economic studies published since 1970 were identified from seven databases. Two reviewers independently screened abstracts and extracted data following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Any discrepancies were resolved by discussion. RESULTS Of 980 identified references, 115 were included for full-text assessment. Thirteen articles met standard criteria for a full economic evaluation, two as partial economic evaluations, and 18 as cost studies. Six were full economic evaluations alongside clinical studies or randomized controlled trials, whereas seven involved modelling simulations. The economic case for administration of magnesium sulfate for imminent preterm birth is compelling, achieving both health gain and cost savings. Current literature suggests intrathecal baclofen therapy and botulinum toxin injection are cost-effective, but stronger evidence for long-term effects is needed. Lifestyle and web-based interventions are inexpensive, but broader measurement of outcomes is required. INTERPRETATION Prevention of CP would avoid significant economic burden. Some treatments and interventions have been shown to be cost-effective, although stronger evidence of clinical effectiveness is needed. What this paper adds Cost-effectiveness evidence shows prevention is the most significant strategy. Some treatments are cost-effective, but stronger evidence for long-term effectiveness is required. Comparison of treatment costs is challenging owing to variations in methodologies and varying clinical indications.
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Affiliation(s)
- Sophy T F Shih
- Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Utsana Tonmukayakul
- Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Christine Imms
- Centre for Disability and Development Research, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Dinah Reddihough
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,The University of Melbourne, Parkville, Victoria, Australia
| | - H Kerr Graham
- Royal Children's Hospital, Parkville, Victoria, Australia
| | - Liz Cox
- Victorian Managed Insurance Authority, Melbourne, Victoria, Australia
| | - Rob Carter
- Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Geelong, Victoria, Australia
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Thomason P, Tan A, Donnan A, Rodda J, Graham HK, Narayanan U. The Gait Outcomes Assessment List (GOAL): validation of a new assessment of gait function for children with cerebral palsy. Dev Med Child Neurol 2018; 60:618-623. [PMID: 29573409 DOI: 10.1111/dmcn.13722] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2018] [Indexed: 10/17/2022]
Abstract
AIM We investigated the validity of the Gait Outcomes Assessment List (GOAL), as an assessment of gait function in children with cerebral palsy (CP). METHOD We studied a prospective cohort of 105 children with CP (Gross Motor Function Classification System [GMFCS] levels I-III; 65 males, 40 females; mean [SD] age 11y 11mo [3y 5mo], range 6-20y), who attended gait assessment over a 10-month period. Parents completed the GOAL, Functional Mobility Scale (FMS), and Functional Assessment Questionnaire (FAQ) during their child's gait evaluation. Ninety children completed instrumented gait analysis (IGA). Total GOAL and domain scores, Gait Profile Score (GPS), and Gait Variable Scores were calculated. RESULTS The total GOAL discriminated between GMFCS levels (mean [SD] GMFCS level I, 72.5 [12.7]; GMFCS level II, 61.4 [13.0]; GMFCS level III, 38.8 [10.6]; [F2,97 =42.4, p<0.001]). Moderate correlations were found between total GOAL and FMS (5m and 50m r=0.59; 500m r=0.66) and FAQ walking (r=0.77) and activities list (r=0.75, p<0.01). There was a moderate negative correlation between total GOAL and GPS (r=-0.59) and gait appearance domain and GPS (r=-0.52, p<0.01). INTERPRETATION The GOAL is a valid assessment of gait function in ambulant children with CP. It has the potential to improve understanding of the child's and parents' priorities and thus, in conjunction with IGA, provide a more balanced assessment across the domains of the World Health Organization's International Classification of Functioning, Disability and Health. WHAT THIS PAPER ADDS The Gait Outcomes Assessment List (GOAL) can discriminate between Gross Motor Function Classification System levels. The GOAL correlates with standard functional assessments and gait analysis. Used with gait analysis, the GOAL provides comprehensive assessment across all International Classification of Functioning, Disability and Health domains.
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Affiliation(s)
- Pam Thomason
- Hugh Williamson Gait Analysis Laboratory, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Annie Tan
- Department of Paediatrics, The University of Melbourne, Carlton, VIC, Australia
| | - Alice Donnan
- Department of Paediatrics, The University of Melbourne, Carlton, VIC, Australia
| | - Jill Rodda
- The Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - H Kerr Graham
- Hugh Williamson Gait Analysis Laboratory, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Unni Narayanan
- Division of Orthopaedics, Hospital for Sick Children, Toronto, ON, Canada
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van de Velde SK, Cashin M, Johari R, Blackshaw R, Khot A, Graham HK. Symptomatic hallux valgus and dorsal bunion in adolescents with cerebral palsy: clinical and biomechanical factors. Dev Med Child Neurol 2018. [PMID: 29517110 DOI: 10.1111/dmcn.13724] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIM The prevalence of severely symptomatic deformities of the first metatarsophalangeal (MTP) joint in adolescents with cerebral palsy (CP) requiring arthrodesis is unknown. Recent literature regarding these deformities is limited. We studied the presentation of severe, symptomatic deformities of the first ray in a large population of children and adolescents with CP and their association with gross motor function, CP subtype, and other musculoskeletal deformities. METHOD We identified 41 patients with CP and a symptomatic deformity of the first MTP joint, managed by arthrodesis, from a large population based database over a 21-year period. Information recorded included demographics, CP subtype, Gross Motor Function Classification System (GMFCS), clinical presentation, and radiological features. RESULTS Adolescents with spastic diplegia, at GMFCS levels II and III, were the most common group to develop symptomatic hallux valgus. In contrast, non-ambulant adolescents, at GMFCS levels IV and V, with dystonia or mixed tone, more commonly had dorsal bunions. INTERPRETATION The type of first MTP joint deformity in patients with CP may be predicted by the type and distribution of movement disorder, and by GMFCS level. Specific patterns of associated musculoskeletal deformities may contribute to the development of these disorders and may provide a guide to surgical management. WHAT THIS PAPER ADDS The prevalence of severe bunions requiring fusion surgery was 2%. The two types of bunion were hallux valgus and dorsal bunion. The type of bunion can be identified on both clinical and radiological grounds. The cerebral palsy subtype is predictive of the type of bunion.
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Affiliation(s)
- Samuel K van de Velde
- Orthopaedic Department, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Megan Cashin
- Orthopaedic Department, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Ratna Johari
- Orthopaedic Department, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Rachel Blackshaw
- Orthopaedic Department, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Abhay Khot
- Orthopaedic Department, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - H Kerr Graham
- Orthopaedic Department, The Royal Children's Hospital, Parkville, Victoria, Australia.,NHMRC Centre of Research Excellence in Cerebral Palsy, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia.,The University of Melbourne, Parkville, Victoria, Australia
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Passmore E, Graham HK, Sangeux M. Defining the medial-lateral axis of the femur: Medical imaging, conventional and functional calibration methods lead to differences in hip rotation kinematics for children with torsional deformities. J Biomech 2018; 69:156-163. [DOI: 10.1016/j.jbiomech.2018.01.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 01/09/2018] [Accepted: 01/14/2018] [Indexed: 11/29/2022]
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25
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Graham HK, Thomason P, Sangeux M. Is the Knee the Key to Long-Term Gait Function in Cerebral Palsy?: Commentary on an article by Elizabeth R. Boyer, PhD, et al.: "Long-Term Outcomes of Distal Femoral Extension Osteotomy and Patellar Tendon Advancement in Individuals with Cerebral Palsy". J Bone Joint Surg Am 2018; 100:e6. [PMID: 29298270 DOI: 10.2106/jbjs.17.01357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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26
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Dreher T, Thomason P, Švehlík M, Döderlein L, Wolf SI, Putz C, Uehlein O, Chia K, Steinwender G, Sangeux M, Graham HK. Long-term development of gait after multilevel surgery in children with cerebral palsy: a multicentre cohort study. Dev Med Child Neurol 2018; 60:88-93. [PMID: 29171016 DOI: 10.1111/dmcn.13618] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2017] [Indexed: 11/29/2022]
Abstract
AIM We investigated the long-term efficacy and safety of multilevel surgery (MLS) in ambulatory children with bilateral spastic cerebral palsy (CP). METHOD Two hundred and thirty-one children were evaluated at short term (1.1y, SD 0.4) and long term (9.1y, SD 3.0) follow-up using clinical examination and gait analysis. MLS was investigated by studying changes in the Gait Profile Score (GPS) referenced to the minimally important clinical difference. RESULTS Ambulatory children aged 10 years and 7 months (SD 2y 11mo) at MLS in Gross Motor Function Classification System levels I (19), II (144), and III (68) showed a decrease (improvement) in preoperative GPS from 16.3° (SD 4.8) to 11.3° (SD 3.2) at short-term follow-up, an improvement of 5°. At long-term follow-up, GPS was maintained at 11.4° (SD 3.1). Overall, 177 (76.6%) children maintained their improvement in GPS after 9 years. INTERPRETATION Multilevel surgery is a safe and effective surgical intervention, which leads to a significant improvement in gait kinematics in children with bilateral spastic CP. This study improves our understanding of MLS in the long term and will help to inform families and children when planning for MLS. WHAT THIS PAPER ADDS Largest study of multilevel surgery (MLS) for children with bilateral spastic cerebral palsy, with longest follow-up. MLS resulted in significant long-term improvements in gait function. Minor adverse events were common, while events requiring intervention were uncommon (4% of children). Thirty-nine per cent of children required additional surgery during follow-up. 'Single-event multilevel surgery' was changed to the more realistic term 'multilevel surgery'.
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Affiliation(s)
- Thomas Dreher
- Clinic for Orthopaedic and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Pam Thomason
- Hugh Williamson Gait Analysis Laboratory, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Martin Švehlík
- Paediatric Orthopaedic Unit, Department of Paediatric Surgery, Medical University of Graz, Graz, Austria
| | - Leonhard Döderlein
- Orthopaedic Hospital for Children, Behandlungszentrum, Aschau im Chiemgau, Germany
| | - Sebastian I Wolf
- Clinic for Orthopaedic and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Cornelia Putz
- Clinic for Orthopaedic and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Oliver Uehlein
- Clinic for Orthopaedic and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Kohleth Chia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Gerhardt Steinwender
- Paediatric Orthopaedic Unit, Department of Paediatric Surgery, Medical University of Graz, Graz, Austria
| | - Morgan Sangeux
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - H K Graham
- The University of Melbourne, Carlton, Victoria, Australia
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27
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Georgiadis AG, Thomason P, Willoughby K, Graham HK. Screening and referral for children with physical disabilities. J Paediatr Child Health 2017; 53:1111-1117. [PMID: 29044835 DOI: 10.1111/jpc.13735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 08/30/2017] [Indexed: 11/30/2022]
Abstract
The clinical care of children with physical disabilities is a major priority for paediatricians and paediatric orthopaedic surgeons. Cerebral palsy (CP) is the prototypical condition and remains the most common cause of physical disability in developed countries. The incidence is approximately 2 per 1000 live births, translating to between 600 and 700 new children per annum in Australia, with approximately 34 000 children and adults currently living with CP. This figure is predicted to rise inexorably over the next 20 years. The care of children with physical disabilities, including those with CP, is usually coordinated by paediatricians, general practitioners and allied health teams including physiotherapists, with input from paediatric orthopaedic surgeons when appropriate. The emphasis in care for children with CP has moved from 'reactive' to 'proactive'. In the past, children are often referred when symptomatic, for example when a hip dislocation had occurred and became painful. The emphasis now is on coordinated, multidisciplinary care in which musculoskeletal manifestations of disability are identified by screening programmes. Systematic screening, especially when population-based and linked to a register, avoids children getting 'lost in the system'. Early and more effective interventions may be offered for the prevention of contractures, dislocation of the hip and spinal deformities. In this review, we will focus on the assessment of gait in children with physical disabilities, and monitoring for hip and spine deformity.
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Affiliation(s)
- Andrew G Georgiadis
- Orthopaedic Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Pam Thomason
- Gait Laboratory, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Kate Willoughby
- Orthopaedic Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Centre of Research Excellence in Cerebral Palsy, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - H Kerr Graham
- Orthopaedic Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Gait Laboratory, Royal Children's Hospital, Melbourne, Victoria, Australia.,Centre of Research Excellence in Cerebral Palsy, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Orthopaedic Department, University of Melbourne, Melbourne, Victoria, Australia
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28
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Langton AK, Graham HK, McConnell JC, Sherratt MJ, Griffiths CEM, Watson REB. Organization of the dermal matrix impacts the biomechanical properties of skin. Br J Dermatol 2017; 177:818-827. [PMID: 28132410 DOI: 10.1111/bjd.15353] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Human skin has the crucial roles of maintaining homeostasis and protecting against the external environment. Skin offers protection against mechanical trauma due to the reversible deformation of its structure; these biomechanical properties are amenable to dynamic testing using noninvasive devices. OBJECTIVES To characterize the biomechanical properties of young, black African/African-Caribbean and white Northern European skin from different anatomical sites, and to relate underlying skin architecture to biomechanical function. METHODS Using cutometry and ballistometry, the biomechanical properties of buttock and dorsal forearm skin were determined in black African/African-Caribbean (n = 18) and white Northern European (n = 20) individuals aged 18-30 years. Skin biopsies were obtained from a subset of the volunteers (black African/African-Caribbean, n = 5; white Northern European, n = 6) and processed for histological and immunohistochemical detection of the major elastic fibre components and fibrillar collagens. RESULTS We have determined that healthy skin from young African and white Northern European individuals has similar biomechanical properties (F3): the skin is resilient (capable of returning to its original position following deformation, R1), exhibits minimal fatigue (R4) and is highly elastic (R2, R5 and R7). At the histological level, skin with these biomechanical properties is imbued with strong interdigitation of the rete ridges at the dermoepidermal junction (DEJ) and candelabra-like arrays of elastic fibres throughout the papillary dermis. Dramatic disruption to this highly organized arrangement of elastic fibres, effacement of the rete ridges and alterations to the alignment of the fibrillar collagens is apparent in the white Northern European forearm and coincides with a marked decline in biomechanical function. CONCLUSIONS Maintenance of skin architecture - both epidermal morphology and elastic fibre arrangement - is essential for optimal skin biomechanical properties. Disruption to underlying skin architecture, as observed in the young white Northern European forearm, compromises biomechanical function.
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Affiliation(s)
- A K Langton
- Centre for Dermatology Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester, U.K.,NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
| | - H K Graham
- Centre for Dermatology Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester, U.K.,NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
| | - J C McConnell
- Division of Cell Matrix Biology and Regenerative Medicine, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, U.K
| | - M J Sherratt
- Division of Cell Matrix Biology and Regenerative Medicine, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, U.K
| | - C E M Griffiths
- Centre for Dermatology Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester, U.K.,NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
| | - R E B Watson
- Centre for Dermatology Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester, U.K.,NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
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29
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Wawrzuta J, Willoughby KL, Molesworth C, Ang SG, Shore BJ, Thomason P, Graham HK. Hip health at skeletal maturity: a population-based study of young adults with cerebral palsy. Dev Med Child Neurol 2016; 58:1273-1280. [PMID: 27312016 DOI: 10.1111/dmcn.13171] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2016] [Indexed: 12/01/2022]
Abstract
AIM We studied 'hip health' in a population-based cohort of adolescents and young adults with cerebral palsy to investigate associations between hip morphology, pain, and gross motor function. METHOD Ninety-eight young adults (65 males, 33 females) from the birth cohort were identified as having developed hip displacement (migration percentage >30) and were reviewed at a mean age of 18 years 10 months (range 15-24y). Hip morphology was classified using the Melbourne Cerebral Palsy Hip Classification Scale (MCPHCS). Severity and frequency of pain were recorded using Likert scales. Gross motor function was classified by the Gross Motor Function Classification System (GMFCS). RESULTS Hip pain was reported in 72% of participants. Associations were found between pain scores and both hip morphology and GMFCS. Median pain severity score for MCPHCS grades 1 to 4 was 2 (interquartile range [IQR] 1.0-3.0) compared to 7 (IQR 6.0-8.0) for grades 5 and 6 (severe subluxation or dislocation). Hip surveillance and access to surgery were associated with improved hip morphology and less pain. INTERPRETATION Poor hip morphology at skeletal maturity was associated with high levels of pain. Limited hip surveillance and access to surgery, rather than GMFCS, was associated with poor hip morphology. The majority of young adults who had access to hip surveillance, and preventive and reconstructive surgery, had satisfactory hip morphology at skeletal maturity and less pain.
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Affiliation(s)
- Joanna Wawrzuta
- Orthopaedic Department, The Royal Children's Hospital, Parkville, Vic., Australia.,Department of Paediatrics, University of Melbourne, Carlton, Vic., Australia
| | - Kate L Willoughby
- Orthopaedic Department, The Royal Children's Hospital, Parkville, Vic., Australia.,Centre of Research Excellence in Cerebral Palsy, Murdoch Childrens Research Institute, Parkville, Vic., Australia
| | - Charlotte Molesworth
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, Vic., Australia
| | - Soon Ghee Ang
- Orthopaedic Department, The Royal Children's Hospital, Parkville, Vic., Australia
| | - Benjamin J Shore
- Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Pam Thomason
- Centre of Research Excellence in Cerebral Palsy, Murdoch Childrens Research Institute, Parkville, Vic., Australia.,Hugh Williamson Gait Laboratory, The Royal Children's Hospital, Parkville, Vic., Australia
| | - H Kerr Graham
- Orthopaedic Department, The Royal Children's Hospital, Parkville, Vic., Australia.,Department of Paediatrics, University of Melbourne, Carlton, Vic., Australia.,Centre of Research Excellence in Cerebral Palsy, Murdoch Childrens Research Institute, Parkville, Vic., Australia.,Hugh Williamson Gait Laboratory, The Royal Children's Hospital, Parkville, Vic., Australia
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30
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Adair B, Rodda J, McGinley JL, Graham HK, Morris ME. Kinematic gait deficits at the trunk and pelvis: characteristic features in children with hereditary spastic paraplegia. Dev Med Child Neurol 2016; 58:829-35. [PMID: 26910787 DOI: 10.1111/dmcn.13082] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2016] [Indexed: 11/27/2022]
Abstract
AIM To examine the kinematic gait deviations at the trunk and pelvis of children with hereditary spastic paraplegia (HSP). METHOD This exploratory observational study quantified gait kinematics for the trunk and pelvis from 11 children with HSP (7 males, 4 females) using the Gait Profile Score and Gait Variable Scores (GVS), and compared the kinematics to data from children with typical development using a Mann-Whitney U test. RESULTS Children with HSP (median age 11y 4mo, interquartile range 4y) demonstrated large deviations in the GVS for the trunk and pelvis in the sagittal and coronal planes when compared to the gait patterns of children with typical development (p=0.010-0.020). Specific deviations included increased range of movement for the trunk in the coronal plane and increased excursion of the trunk and pelvis in the sagittal plane. In the transverse plane, children with HSP demonstrated later peaks in posterior pelvic rotation. INTERPRETATION The kinematic gait deviations identified in this study raise questions about the contribution of muscle weakness in HSP. Further research is warranted to determine contributing factors for gait dysfunction in HSP, especially the relative influence of spasticity and weakness.
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Affiliation(s)
- Brooke Adair
- Centre for Disability and Development Research, Australian Catholic University, Fitzroy, Vic., Australia
| | - Jillian Rodda
- Hugh Williamson Gait Laboratory, The Royal Children's Hospital, Parkville, Vic., Australia
| | - Jennifer L McGinley
- Department of Physiotherapy, University of Melbourne, Carlton, Vic., Australia
| | - H Kerr Graham
- Department of Orthopaedic Surgery, The Royal Children's Hospital, Parkville, Vic., Australia
| | - Meg E Morris
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Vic., Australia.,Department of Physiotherapy, Cabrini Healthcare, Malvern, Vic., Australia
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31
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Sangeux M, Passmore E, Graham HK, Tirosh O. The gait standard deviation, a single measure of kinematic variability. Gait Posture 2016; 46:194-200. [PMID: 27131201 DOI: 10.1016/j.gaitpost.2016.03.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 03/17/2016] [Accepted: 03/21/2016] [Indexed: 02/02/2023]
Abstract
Measurement of gait kinematic variability provides relevant clinical information in certain conditions affecting the neuromotor control of movement. In this article, we present a measure of overall gait kinematic variability, GaitSD, based on combination of waveforms' standard deviation. The waveform standard deviation is the common numerator in established indices of variability such as Kadaba's coefficient of multiple correlation or Winter's waveform coefficient of variation. Gait data were collected on typically developing children aged 6-17 years. Large number of strides was captured for each child, average 45 (SD: 11) for kinematics and 19 (SD: 5) for kinetics. We used a bootstrap procedure to determine the precision of GaitSD as a function of the number of strides processed. We compared the within-subject, stride-to-stride, variability with the, between-subject, variability of the normative pattern. Finally, we investigated the correlation between age and gait kinematic, kinetic and spatio-temporal variability. In typically developing children, the relative precision of GaitSD was 10% as soon as 6 strides were captured. As a comparison, spatio-temporal parameters required 30 strides to reach the same relative precision. The ratio stride-to-stride divided by normative pattern variability was smaller in kinematic variables (the smallest for pelvic tilt, 28%) than in kinetic and spatio-temporal variables (the largest for normalised stride length, 95%). GaitSD had a strong, negative correlation with age. We show that gait consistency may stabilise only at, or after, skeletal maturity.
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Affiliation(s)
- Morgan Sangeux
- The Royal Children's Hospital, Melbourne, Australia; The Murdoch Childrens Research Institute, Australia; The University of Melbourne, School of Engineering, Australia.
| | - Elyse Passmore
- The Royal Children's Hospital, Melbourne, Australia; The Murdoch Childrens Research Institute, Australia; The University of Melbourne, School of Engineering, Australia
| | - H Kerr Graham
- The Royal Children's Hospital, Melbourne, Australia; The Murdoch Childrens Research Institute, Australia; The University of Melbourne, Department of Paediatrics, Australia
| | - Oren Tirosh
- The Royal Children's Hospital, Melbourne, Australia
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Chalkiadis GA, Sommerfield D, Low J, Orsini F, Dowden SJ, Tay M, Penrose S, Pirpiris M, Graham HK. Comparison of lumbar epidural bupivacaine with fentanyl or clonidine for postoperative analgesia in children with cerebral palsy after single-event multilevel surgery. Dev Med Child Neurol 2016; 58:402-8. [PMID: 26400818 DOI: 10.1111/dmcn.12930] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2015] [Indexed: 11/30/2022]
Abstract
AIM To compare diazepam use, muscle spasm, analgesia, and side effects when clonidine or fentanyl are added to epidural bupivacaine in children with cerebral palsy after multilevel orthopaedic surgery. METHOD Fifty children were prospectively randomized to receive clonidine (n=24, mean age 10y 10mo [SD 2y 11mo]) or fentanyl (n=26, mean age 10y 11mo [SD 2y 10mo]). RESULTS There was no difference in primary outcome measures: median diazepam use (fentanyl 0, interquartile range [IQR] 0-0; clonidine 0, IQR 0-0; p=0.46), any muscle spasm (no muscle spasms in: fentanyl, 36%; clonidine, 62%; p=0.11), painful muscle spasm (fentanyl 40%; clonidine 25%; p=0.46), or pain score ≥6 (none: fentanyl 44%; clonidine 42%; p=0.29). There were differences in secondary outcome measures: no vomiting (clonidine 63%; fentanyl 20%); vomiting occurred more frequently with fentanyl (32% vomited more than three times; clonidine none; p=0.001). Fentanyl resulted in more oxygen desaturation (at least two episodes: fentanyl 20%; clonidine 0; p<0.001). Clonidine resulted in lower mean (SD) area under the curve for systolic blood pressure (fentanyl 106.5 [11.0]; clonidine 95.7mmHg [7.9]) and heart rate (fentanyl 104.9 beats per minute [13.6]; clonidine 85.3 [11.5]; p<0.001). INTERPRETATION Clonidine and fentanyl provide adequate analgesia with low rates of muscle spasm, resulting in low diazepam use. The choice of epidural additive should be based upon the most tolerable side-effect profile.
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Affiliation(s)
- George A Chalkiadis
- Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Vic., Australia.,Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia
| | - David Sommerfield
- Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Vic., Australia
| | - Janette Low
- Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Vic., Australia
| | - Francesca Orsini
- Murdoch Childrens Research Institute, Melbourne, Vic., Australia
| | - Stephanie J Dowden
- Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Vic., Australia
| | - Michelle Tay
- Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Vic., Australia
| | - Sueann Penrose
- Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Vic., Australia
| | - Marinis Pirpiris
- Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Department of Orthopaedics, Royal Children's Hospital, Melbourne, Vic., Australia
| | - H Kerr Graham
- Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Department of Orthopaedics, Royal Children's Hospital, Melbourne, Vic., Australia
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Pascoe J, Thomason P, Graham HK, Reddihough D, Sabin MA. Body mass index in ambulatory children with cerebral palsy: A cohort study. J Paediatr Child Health 2016; 52:417-21. [PMID: 27145505 DOI: 10.1111/jpc.13097] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 09/14/2015] [Accepted: 10/26/2015] [Indexed: 11/26/2022]
Abstract
AIM Children with cerebral palsy (CP) have reduced levels of physical activity compared with children without physical disability and experience risk factors for becoming overweight or obese. In the Australian CP population, there is little information available about the weight status of children with CP. The aims of this study were to compare the distribution of body mass index (BMI) in a cohort of ambulant children with CP with the BMI distribution of Australian children and explore the relationship between BMI and gross motor function. METHODS A retrospective cohort study of 587 children with CP Gross Motor Function Classification System (GMFCS) levels I-III who attended a Gait Laboratory between July 1995 and January 2012 was carried out. The BMI and Z-score were calculated at each assessment. Data were grouped into the categories of underweight, healthy, overweight and obese according to age-specific and sex-specific percentiles. RESULTS There were 348 boys and 240 girls with a mean age 11.2 (standard deviation 3.2) years. Mean BMI Z-score was 0.11 (standard deviation 1.33). Seven percent of children were underweight, 73.6% healthy, 7.3% overweight and 12.1% obese. This was similar to the distribution of children without disability. The largest percentage of children in the healthy group were classified GMFCS I. The largest percentage of children in the obese group were classified GMFCS III. CONCLUSIONS In this cohort, 19.4% of ambulant children with CP were overweight or obese. This is of concern as BMI may impact on the outcomes of surgical intervention and rehabilitation. Further research is needed to determine the consequences of obesity for children with CP.
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Affiliation(s)
- Jessica Pascoe
- Hugh Williamson Gait Analysis Laboratory, Royal Children's Hospital, Melbourne, Australia
| | - Pam Thomason
- Hugh Williamson Gait Analysis Laboratory, Royal Children's Hospital, Melbourne, Australia.,Murdoch Childrens Research Institute, Melbourne, Australia
| | - H Kerr Graham
- Hugh Williamson Gait Analysis Laboratory, Royal Children's Hospital, Melbourne, Australia.,Murdoch Childrens Research Institute, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia
| | - Dinah Reddihough
- Murdoch Childrens Research Institute, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia.,Department of Developmental Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Matthew A Sabin
- Murdoch Childrens Research Institute, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia.,Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Australia
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Affiliation(s)
- A K Langton
- Centre for Dermatology Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.KCorrespondence: Rachel E.B. Watson
| | - H K Graham
- Centre for Dermatology Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.KCorrespondence: Rachel E.B. Watson
| | - R E B Watson
- Centre for Dermatology Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.KCorrespondence: Rachel E.B. Watson.
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Passmore E, Pandy MG, Graham HK, Sangeux M. Measuring Femoral Torsion In Vivo Using Freehand 3-D Ultrasound Imaging. Ultrasound Med Biol 2016; 42:619-623. [PMID: 26639301 DOI: 10.1016/j.ultrasmedbio.2015.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 10/16/2015] [Accepted: 10/18/2015] [Indexed: 06/05/2023]
Abstract
Despite variation in bone geometry, muscle and joint function is often investigated using generic musculoskeletal models. Patient-specific bone geometry can be obtained from computerised tomography, which involves ionising radiation, or magnetic resonance imaging (MRI), which is costly and time consuming. Freehand 3-D ultrasound provides an alternative to obtain bony geometry. The purpose of this study was to determine the accuracy and repeatability of 3-D ultrasound in measuring femoral torsion. Measurements of femoral torsion were performed on 10 healthy adults using MRI and 3-D ultrasound. Measurements of femoral torsion from 3-D ultrasound were, on average, smaller than those from MRI (mean difference = 1.8°; 95% confidence interval: -3.9°, 7.5°). MRI and 3-D ultrasound had Bland and Altman repeatability coefficients of 3.1° and 3.7°, respectively. Accurate measurements of femoral torsion were obtained with 3-D ultrasound offering the potential to acquire patient-specific bone geometry for musculoskeletal modelling. Three-dimensional ultrasound is non-invasive and relatively inexpensive and can be integrated into gait analysis.
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Affiliation(s)
- Elyse Passmore
- Hugh Williamson Gait Analysis Laboratory, Royal Children's Hospital, Melbourne, Australia; Murdoch Childrens Research Institute, Melbourne, Australia; Department of Mechanical Engineering, University of Melbourne, Melbourne, Australia.
| | - Marcus G Pandy
- Department of Mechanical Engineering, University of Melbourne, Melbourne, Australia
| | - H Kerr Graham
- Hugh Williamson Gait Analysis Laboratory, Royal Children's Hospital, Melbourne, Australia; Murdoch Childrens Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Morgan Sangeux
- Hugh Williamson Gait Analysis Laboratory, Royal Children's Hospital, Melbourne, Australia; Murdoch Childrens Research Institute, Melbourne, Australia; Department of Mechanical Engineering, University of Melbourne, Melbourne, Australia
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Heidt C, Hollander K, Wawrzuta J, Molesworth C, Willoughby K, Thomason P, Khot A, Graham HK. The radiological assessment of pelvic obliquity in cerebral palsy and the impact on hip development. Bone Joint J 2016; 97-B:1435-40. [PMID: 26430022 DOI: 10.1302/0301-620x.97b10.35390] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Pelvic obliquity is a common finding in adolescents with cerebral palsy, however, there is little agreement on its measurement or relationship with hip development at different gross motor function classification system (GMFCS) levels. The purpose of this investigation was to study these issues in a large, population-based cohort of adolescents with cerebral palsy at transition into adult services. The cohort were a subset of a three year birth cohort (n = 98, 65M: 33F, with a mean age of 18.8 years (14.8 to 23.63) at their last radiological review) with the common features of a migration percentage greater than 30% and a history of adductor release surgery. Different radiological methods of measuring pelvic obliquity were investigated in 40 patients and the angle between the acetabular tear drops (ITDL) and the horizontal reference frame of the radiograph was found to be reliable, with good face validity. This was selected for further study in all 98 patients. The median pelvic obliquity was 4° (interquartile range 2° to 8°). There was a strong correlation between hip morphology and the presence of pelvic obliquity (effect of ITDL on Sharpe's angle in the higher hip; rho 7.20 (5% confidence interval 5.59 to 8.81, p < 0.001). This was particularly true in non-ambulant adolescents (GMFCS IV and V) with severe pelvic obliquity, but was also easily detectable and clinically relevant in ambulant adolescents with mild pelvic obliquity. The identification of pelvic obliquity and its management deserves closer scrutiny in children and adolescents with cerebral palsy.
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Affiliation(s)
- C Heidt
- University Children's Hospital Zurich, Steinwiesstrasse 75, Zurich, 8032, Switzerland
| | - K Hollander
- University of Hamburg, Turmweg 2, 20148 Hamburg, Germany
| | - J Wawrzuta
- The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria 3052, Australia
| | - C Molesworth
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria 3052, Australia
| | - K Willoughby
- The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria 3052, Australia
| | - P Thomason
- The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria 3052, Australia
| | - A Khot
- The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria 3052, Australia
| | - H K Graham
- The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria 3052, Australia
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Newton VL, Mcconnell JC, Hibbert SA, Graham HK, Watson RE. Skin aging: molecular pathology, dermal remodelling and the imaging revolution. GIORN ITAL DERMAT V 2015; 150:665-674. [PMID: 26349926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Skin is a multifunctional organ but, alongside every other organ system, is subject to both intrinsic (chronological) and extrinsic (environmental) aging, resulting in a loss of functional capacity. Cutaneous aging manifests as an observable change in the external appearance of the skin, the major accelerator of the aging process being our interactions with our environment, such as chronic exposure to solar irradiation (UV, IR or visible wavelengths of light). The aim of this contribution, therefore, was to provide a review of the pathological mechanisms which may play roles in the development of extrinsic, mainly photo-, aging and to review how these molecular changes impact on the structure of the organ as a whole, resulting in loss of function. Finally, we will describe the advances which are occurring in imaging techniques which may allow further characterisation of aged skin.
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Affiliation(s)
- V L Newton
- Centre for Dermatology Research, Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK -
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Wynter M, Gibson N, Willoughby KL, Love S, Kentish M, Thomason P, Graham HK. Australian hip surveillance guidelines for children with cerebral palsy: 5-year review. Dev Med Child Neurol 2015; 57:808-20. [PMID: 25846730 DOI: 10.1111/dmcn.12754] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2015] [Indexed: 11/30/2022]
Abstract
AIM To ensure hip surveillance guidelines reflect current evidence of factors influencing hip displacement in children with cerebral palsy (CP). METHOD A three-step review process was undertaken: (1) systematic literature review, (2) analysis of hip surveillance databases, and (3) national survey of orthopaedic surgeons managing hip displacement in children with CP. RESULTS Fifteen articles were included in the systematic review. Quantitative analysis was not possible. Qualitative review indicated hip surveillance programmes have decreased the incidence of hip dislocation in populations with CP. The Gross Motor Function Classification System was confirmed as the best indicator of risk for displacement, and evidence was found of hip displacement occurring at younger ages and in young adulthood. Femoral geometry, pelvic obliquity, and scoliosis were linked to progression of hip displacement. A combined data pool of 3366 children from Australian hip surveillance databases supported the effectiveness of the 2008 Consensus Statement to identify hip displacement early. The survey of orthopaedic surgeons supported findings of the systematic review and database analyses. INTERPRETATION This review rationalized changes to the revised and renamed Australian Hip Surveillance Guidelines for Children with Cerebral Palsy 2014, informing frequency of radiographic examination in lower risk groups and continuation of surveillance into adulthood for adolescents with identified risk factors.
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Affiliation(s)
- Meredith Wynter
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Qld
| | - Noula Gibson
- Princess Margaret Hospital for Children, Perth, WA
| | - Kate L Willoughby
- Department of Orthopaedics, The Royal Children's Hospital, Melbourne, Vic
| | - Sarah Love
- Princess Margaret Hospital for Children, Perth, WA
| | - Megan Kentish
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Qld
| | - Pam Thomason
- Hugh Williamson Gait Analysis Laboratory, The Royal Children's Hospital, Melbourne, Vic., Australia
| | - H Kerr Graham
- Department of Orthopaedics, The Royal Children's Hospital, Melbourne, Vic.,Hugh Williamson Gait Analysis Laboratory, The Royal Children's Hospital, Melbourne, Vic., Australia
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Bania TA, Dodd KJ, Baker RJ, Graham HK, Taylor NF. The effects of progressive resistance training on daily physical activity in young people with cerebral palsy: a randomised controlled trial. Disabil Rehabil 2015; 38:620-6. [PMID: 26056856 DOI: 10.3109/09638288.2015.1055376] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To examine if individualised resistance training increases the daily physical activity of adolescents and young adults with bilateral spastic cerebral palsy (CP). METHOD Young people with bilateral spastic CP were randomly assigned to intervention or to usual care. The intervention group completed an individualised lower limb progressive resistance training programme twice a week for 12 weeks in community gymnasiums. The primary outcome was daily physical activity (number of steps, and time sitting and lying). Secondary outcomes included muscle strength measured with a one-repetition maximum (1RM) leg press and reverse leg press. Outcomes were measured at baseline, 12 weeks and 24 weeks. RESULTS From the 36 participants with complete data at 12 weeks, there were no between-group differences for any measure of daily physical activity. There was a likely increase in leg press strength in favour of the intervention group (mean difference 11.8 kg; 95% CI -1.4 to 25.0). No significant adverse events occurred during training. CONCLUSIONS A short-term resistance training programme that may increase leg muscle strength was not effective in increasing daily physical activity. Other strategies are needed to address the low-daily physical activity levels of young people with bilateral spastic CP. IMPLICATIONS FOR REHABILITATION Progressive resistance training may increase muscle strength but does not lead to increases in daily physical activity of young people with bilateral spastic cerebral palsy (CP) and mild to moderate walking disabilities. Other strategies apart from or in addition to resistance training are needed to address the low daily physical activity levels of young people with bilateral spastic CP and mild to moderate walking disabilities.
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Affiliation(s)
- Theofani A Bania
- a Faculty of Health Sciences , La Trobe University , Bundoora, Melbourne , VIC , Australia
| | - Karen J Dodd
- a Faculty of Health Sciences , La Trobe University , Bundoora, Melbourne , VIC , Australia
| | - Richard J Baker
- b Clinical Gait Analysis, University of Salford , Salford , UK , and
| | - H Kerr Graham
- c Department Orthopaedic Surgery , Royal Children's Hospital , Melbourne , VIC , Australia
| | - Nicholas F Taylor
- a Faculty of Health Sciences , La Trobe University , Bundoora, Melbourne , VIC , Australia
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Abstract
We report the results of Vulpius transverse gastrocsoleus recession for equinus gait in 26 children with cerebral palsy (CP), using the Gait Profile Score (GPS), Gait Variable Scores (GVS) and movement analysis profile. All children had an equinus deformity on physical examination and equinus gait on three-dimensional gait analysis prior to surgery. The pre-operative and post-operative GPS and GVS were statistically analysed. There were 20 boys and 6 girls in the study cohort with a mean age at surgery of 9.2 years (5.1 to 17.7) and 11.5 years (7.3 to 20.8) at follow-up. Of the 26 children, 14 had spastic diplegia and 12 spastic hemiplegia. Gait function improved for the cohort, confirmed by a decrease in mean GPS from 13.4° pre-operatively to 9.0° final review (p < 0.001). The change was 2.8 times the minimal clinically important difference (MCID). Thus the improvements in gait were both clinically and statistically significant. The transverse gastrocsoleus recession described by Vulpius is an effective procedure for equinus gait in selected children with CP, when there is a fixed contracture of the gastrocnemius and soleus muscles.
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Affiliation(s)
- A Tinney
- The University of Melbourne, Flemington Road, Parkville, Victoria 3052, Australia
| | - P Thomason
- The Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia
| | - M Sangeux
- The Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia
| | - A Khot
- Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia
| | - H K Graham
- Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia
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Zhou L, Camp M, Gahukamble A, Khot A, Graham HK. Cannulated, locking blade plates for proximal femoral osteotomy in children and adolescents. J Child Orthop 2015; 9:121-7. [PMID: 25802189 PMCID: PMC4417733 DOI: 10.1007/s11832-015-0649-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 03/05/2015] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Proximal femoral osteotomy is the most common major reconstructive surgery in the region of the hip joint in children and adolescents. Given that it may be required across a wide range of ages and indications, appropriate instrumentation is necessary to ensure a technically satisfactory result. Recent developments in fixation include cannulation of the blade plate and locking screw technology. METHODS We conducted a prospective audit of our first 25 patients who had a unilateral or bilateral proximal femoral osteotomy using a recently available system which combines cannulation and locking plate technology. The principal outcome measures were the radiographic position of the osteotomy at the time of union and surgical adverse events. RESULTS Forty-five proximal femoral osteotomies were performed in 25 patients, mean age 8 years (range 3-17 years), for a variety of indications, the most common of which was hip subluxation in children with cerebral palsy. All osteotomies were soundly united by 6 weeks in children and by 3 months in adolescents, in the position achieved intra-operatively. There were no revision procedures and the technical goals of surgery were achieved in all patients. There was one adverse event, a low-grade peri-prosthetic infection, diagnosed at the time of implant removal. CONCLUSIONS In this prospective audit of our first 25 patients, the new system performed well across a wide range of ages, body weights and surgical indications. Further comparative studies will be required to determine whether it offers additional advantages over more traditional systems.
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Affiliation(s)
- Leena Zhou
- Department of Paediatrics, The University of Melbourne, Carlton, VIC 3052 Australia
- Department of Orthopaedics, The Royal Children’s Hospital, Flemington Road, Parkville, VIC 3052 Australia
| | - Mark Camp
- Department of Orthopaedics, The Royal Children’s Hospital, Flemington Road, Parkville, VIC 3052 Australia
| | - Abhay Gahukamble
- Department of Orthopaedics, The Royal Children’s Hospital, Flemington Road, Parkville, VIC 3052 Australia
| | - Abhay Khot
- Department of Paediatrics, The University of Melbourne, Carlton, VIC 3052 Australia
- Department of Orthopaedics, The Royal Children’s Hospital, Flemington Road, Parkville, VIC 3052 Australia
| | - H. Kerr Graham
- Department of Paediatrics, The University of Melbourne, Carlton, VIC 3052 Australia
- Department of Orthopaedics, The Royal Children’s Hospital, Flemington Road, Parkville, VIC 3052 Australia
- Murdoch Childrens Research Institute, Flemington Road, Parkville, VIC 3052 Australia
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Imms C, Novak I, Kerr C, Shields N, Randall M, Harvey A, Graham HK, Reddihough D. Improving allied health professionals' research implementation behaviours for children with cerebral palsy: protocol for a before-after study. Implement Sci 2015; 10:16. [PMID: 25889110 PMCID: PMC4328993 DOI: 10.1186/s13012-014-0202-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 12/23/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cerebral palsy is a permanent disorder of posture and movement caused by disturbances in the developing brain. It affects approximately 1 in every 500 children in developed countries and is the most common form of childhood physical disability. People with cerebral palsy may also have problems with speech, vision and hearing, intellectual difficulties and epilepsy. Health and therapy services are frequently required throughout life, and this care should be effective and evidence informed; however, accessing and adopting new research findings into day-to-day clinical practice is often delayed. METHODS/DESIGN This 3-year study employs a before and after design to evaluate if a multi-strategy intervention can improve research implementation among allied health professionals (AHPs) who work with children and young people with cerebral palsy and to establish if children's health outcomes can be improved by routine clinical assessment. The intervention comprises (1) knowledge brokering with AHPs, (2) access to an online research evidence library, (3) provision of negotiated evidence-based training and education, and (4) routine use of evidence-based measures with children and young people aged 3-18 years with cerebral palsy. The study is being implemented in four organisations, with a fifth organisation acting as a comparison site, across four Australian states. Effectiveness will be assessed using questionnaires completed by AHPs at baseline, 6, 12 and 24 months, and by monitoring the extent of use of evidence-based measures. Children's health outcomes will be evaluated by longitudinal analyses. DISCUSSION Government, policy makers and service providers all seek evidence-based information to support decision-making about how to distribute scarce resources, and families are seeking information to support intervention choices. This study will provide knowledge about what constitutes an efficient, evidence-informed service and which allied health interventions are implemented for children with cerebral palsy. TRIAL REGISTRATION Trial is not a controlled healthcare intervention and is not registered.
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Affiliation(s)
- Christine Imms
- Australian Catholic University, 17 Young Street, Fitzroy, Melbourne, 3065, Australia.
- Murdoch Children's Research Institute, Parkville, 3052, Australia.
| | - Iona Novak
- Cerebral Palsy Alliance, Frenchs Forest, PO Box 6427, NSW, 2086, Sydney, Australia.
- School of Medicine, University of Notre Dame Australia, Broadway, PO Box 944, 2007, Sydney, Australia.
| | - Claire Kerr
- Australian Catholic University, 17 Young Street, Fitzroy, Melbourne, 3065, Australia.
| | - Nora Shields
- La Trobe University, Kingsbury Drive, Bundoora, 3086, Victoria, Australia.
- Northern Health, 1231 Plenty Road, Bundoora, 3083, Victoria, Australia.
| | - Melinda Randall
- Australian Catholic University, 17 Young Street, Fitzroy, Melbourne, 3065, Australia.
- Murdoch Children's Research Institute, Parkville, 3052, Australia.
| | - Adrienne Harvey
- Victorian Paediatric Rehabilitation Service, Murdoch Childrens Research Institute, 50 Flemington Road, Parkville, 3052, Australia.
- Murdoch Children's Research Institute, Parkville, 3052, Australia.
| | - H Kerr Graham
- Hugh Williamson Gait Laboratory, Royal Children's Hospital, Parkville, Australia.
- University of Melbourne, Parkville, Australia.
- Murdoch Children's Research Institute, Parkville, 3052, Australia.
| | - Dinah Reddihough
- University of Melbourne, Parkville, Australia.
- Murdoch Children's Research Institute, Parkville, 3052, Australia.
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Sossai R, Vavken P, Brunner R, Camathias C, Graham HK, Rutz E. Patellar tendon shortening for flexed knee gait in spastic diplegia. Gait Posture 2015; 41:658-65. [PMID: 25701014 DOI: 10.1016/j.gaitpost.2015.01.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 01/14/2015] [Accepted: 01/18/2015] [Indexed: 02/02/2023]
Abstract
UNLABELLED We evaluated the outcome of three different approaches to the management of flexed knee gait patients with spastic diplegia. The three surgical procedures were patellar tendon shortening (PTS), PTS combined with rotational osteotomies of the femur and/or tibia, and PTS combined with supracondylar extension osteotomy (SEO) of the distal femur. The primary outcome measure was gait kinematics. The knee gait variable score (GVS) and the gait profile score (GPS) were derived from gait kinematics. 24 patients (16 male and 8 female), mean age 16.1 years (SD 5.8 years), who had surgery between 2002 and 2008, were followed for a mean of 22 months. Knee extension during gait improved by a mean of 20° throughout the gait cycle, with an improvement in the knee GVS of 14° (p<0.001). The overall gait pattern improved with a mean decrease in GPS of 4.6°. Correction of patella alta was demonstrated by an improvement in the Koshino index from 1.34 pre-operatively to 1.10 post-operatively (p<0.001). Knee and gait kinematics, physical examination measures and Koshino Index improved in all three surgical groups, suggesting that a tailored approach to the correction of flexed knee gait in spastic diplegia is both feasible and appropriate. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Roberto Sossai
- Pediatric Orthopaedic Department, University Children's Hospital, UKBB, Basle, Switzerland.
| | - Patrick Vavken
- Pediatric Orthopaedic Department, University Children's Hospital, UKBB, Basle, Switzerland; Orthopaedic Department, University Hospital Basle, Switzerland; Department of Orthopaedic Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA
| | - Reinald Brunner
- Pediatric Orthopaedic Department, University Children's Hospital, UKBB, Basle, Switzerland
| | - Carlo Camathias
- Pediatric Orthopaedic Department, University Children's Hospital, UKBB, Basle, Switzerland
| | - H Kerr Graham
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia; The University of Melbourne, Melbourne, Victoria, Australia
| | - Erich Rutz
- Pediatric Orthopaedic Department, University Children's Hospital, UKBB, Basle, Switzerland; Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
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Sangeux M, Rodda J, Graham HK. Sagittal gait patterns in cerebral palsy: the plantarflexor-knee extension couple index. Gait Posture 2015; 41:586-91. [PMID: 25604121 DOI: 10.1016/j.gaitpost.2014.12.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 12/23/2014] [Accepted: 12/30/2014] [Indexed: 02/02/2023]
Abstract
The identification of gait patterns in cerebral palsy offers a common language for clinicians and contributes to management algorithms. We describe a quantitative classification of sagittal gait patterns based on the plantarflexor-knee extension couple index. This consists of a scatter plot based on ankle and knee scores, and allows objective identification of the sagittal gait pattern. Sagittal kinematic data from 200 limbs of 100 patients with bilateral spastic cerebral palsy were utilized to validate the algorithm against the assessment of a clinician with expertise in gait pattern identification. A dataset of 776 cerebral palsy patients, 1552 limbs, was used to compare the sagittal gait patterns against k-means statistical clustering. The classification was further explored with respect to the knee kinetics during the middle of stance and physical examination measurements of the gastrocnemius-soleus complex. Two supplementary materials (Appendices 2 and 3) provide in-depth discussion about statistical properties of the plantarflexor-knee extension couple index as well as its relationship with statistical clustering. The plantarflexor-knee extension index achieved 98% accuracy and may be suitable for the computational classification of large patient cohorts and multicentre studies. The sagittal gait patterns were strongly related to k-means statistical clustering and physical examination of the gastrocnemius-soleus complex. Patients in crouch gait had normal soleus and gastrocnemius lengths but spasticity in the gastrocnemius. Patients in jump gait exhibited a short gastrocnemius and soleus and gastrocnemius spasticity. Patients in true equinus presented with a moderately contracted soleus and gastrocnemius and gastrocnemius spasticity. Patients in apparent equinus did not show abnormal physical examination measurements for the gastrocnemius-soleus complex.
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Affiliation(s)
- Morgan Sangeux
- The Royal Children's Hospital, Australia; Murdoch Childrens Research Institute, Australia; The University of Melbourne, Australia.
| | - Jill Rodda
- The Royal Children's Hospital, Australia; Murdoch Childrens Research Institute, Australia; The University of Melbourne, Australia
| | - H Kerr Graham
- The Royal Children's Hospital, Australia; Murdoch Childrens Research Institute, Australia; The University of Melbourne, Australia
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Bania TA, Taylor NF, Baker RJ, Graham HK, Karimi L, Dodd KJ. Gross motor function is an important predictor of daily physical activity in young people with bilateral spastic cerebral palsy. Dev Med Child Neurol 2014; 56:1163-1171. [PMID: 25052563 DOI: 10.1111/dmcn.12548] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2014] [Indexed: 01/23/2023]
Abstract
AIM The aim of the study was to describe daily physical activity levels of adolescents and young adults with bilateral spastic cerebral palsy (CP) and to identify factors that help predict these levels. METHOD Daily physical activity was measured using an accelerometer-based activity monitor in 45 young people with bilateral spastic CP (23 males, 22 females; mean age 18y 6mo [SD 2y 5mo] range 16y 1mo-20y 11mo); classified as Gross Motor Function Classification System (GMFCS) level II or III and with contractures of <20° at hip and knee. Predictor variables included demographic characteristics (age, sex, weight) and physical characteristics (gross motor function, lower limb muscle strength, 6min walk distance). Data were analyzed using the information-theoretic approach, using the Akaike information criterion (AIC) and linear regression. RESULTS Daily activity levels were low compared with published norms. Gross Motor Function Measure Dimension-E (GMFM-E; walking, running, and jumping) was the only common predictor variable in models that best predicted energy expenditure, number of steps, and time spent sitting/lying. GMFM Dimension-D (standing) and bilateral reverse leg press strength contributed to the models that predicted daily physical activity. INTERPRETATION Adolescents and young adults with bilateral spastic CP and mild to moderate walking disabilities have low levels of daily activity. The GMFM-E was an important predictor of daily physical activity.
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Affiliation(s)
- Theofani A Bania
- Faculty of Health Sciences, La Trobe University, Bundoora, Melbourne, Vic., Australia
| | - Nicholas F Taylor
- Faculty of Health Sciences, La Trobe University, Bundoora, Melbourne, Vic., Australia
| | | | - H Kerr Graham
- Royal Children's Hospital, Parkville, Vic., Australia
| | - Leila Karimi
- Faculty of Health Sciences, La Trobe University, Bundoora, Melbourne, Vic., Australia
| | - Karen J Dodd
- Faculty of Health Sciences, La Trobe University, Bundoora, Melbourne, Vic., Australia
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Affiliation(s)
- H K Graham
- The Royal Children's Hospital, Orthopaedic Department, Melbourne, Victoria, Australia
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Burns F, Stewart R, Reddihough D, Scheinberg A, Ooi K, Graham HK. The cerebral palsy transition clinic: administrative chore, clinical responsibility, or opportunity for audit and clinical research? J Child Orthop 2014; 8:203-13. [PMID: 24728956 PMCID: PMC4142880 DOI: 10.1007/s11832-014-0569-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 02/10/2014] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The majority of children with orthopaedic conditions in childhood survive to adult life, and there is a need for many of them to transition to adult services. This includes children with disorders such as club foot or developmental dislocation of the hip as well as those with complex syndromic conditions, bone dysplasias or neuromuscular disorders such as cerebral palsy and myelomeningocele. In many tertiary paediatric centres, transition has become a formal process in which clinicians document and communicate the status of patients who have been under their care to ensure a smooth transfer to adult services. The purpose of this report is to support the need for clear communication when children with cerebral palsy transition to adult services and to suggest that this transition represents a significant opportunity for audit and clinical research. METHODS Some of the factors to be considered in developing a minimum data sheet for the transfer or transition of children with cerebral palsy to adult services are described. CONCLUSION Using the model of adolescents with cerebral palsy transitioning to adult services, orthopaedic surgeons can be encouraged to develop similar methodology and documentation for many other conditions for the purposes of communication, facilitation of transition, audit and clinical research.
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Affiliation(s)
- Fiona Burns
- Orthopaedic Department, The Royal Children’s Hospital, 50 Flemington Road, Parkville, VIC 3052 Australia
| | - Robbie Stewart
- Orthopaedic Department, The Royal Children’s Hospital, 50 Flemington Road, Parkville, VIC 3052 Australia
| | - Dinah Reddihough
- Murdoch Childrens Research Institute, The Royal Children’s Hospital, Parkville, VIC Australia
- The University of Melbourne, Parkville, VIC Australia
| | - Adam Scheinberg
- Murdoch Childrens Research Institute, The Royal Children’s Hospital, Parkville, VIC Australia
- Victorian Paediatric Rehabilitation Service, The Royal Children’s Hospital, Parkville, VIC Australia
| | - Kathleen Ooi
- Young Adults Complex Disability Clinic, St Vincent’s Hospital, Fitzroy, VIC Australia
| | - H. Kerr Graham
- Orthopaedic Department, The Royal Children’s Hospital, 50 Flemington Road, Parkville, VIC 3052 Australia
- Murdoch Childrens Research Institute, The Royal Children’s Hospital, Parkville, VIC Australia
- The University of Melbourne, Parkville, VIC Australia
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Sangeux M, Passmore E, Gomez G, Balakumar J, Graham HK. Slipped capital femoral epiphysis, fixation by single screw in situ: A kinematic and radiographic study. Clin Biomech (Bristol, Avon) 2014; 29:523-30. [PMID: 24768225 DOI: 10.1016/j.clinbiomech.2014.03.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 03/28/2014] [Accepted: 03/31/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Slipped capital femoral epiphysis is known to produce characteristic deformities in the proximal femur, which affect hip motion and may cause a limp. This paper assessed the 3D gait kinematics in adolescents after single screw fixation of moderate to severe, stable, unilateral slipped capital femoral epiphysis. Our goals were to characterize the 3D kinematic patterns and to investigate the correlation between the severity of radiological deformity and severity of gait disturbance. METHODS This was a retrospective study of patients seen at our institution between 2000 and 2009. Antero-posterior and frog lateral X-rays were reviewed to measure: Southwick's lateral slip angle, the alpha angle of Notzli and Klein's line offset. Quantitative 3D gait data was collected using a state of the art motion capture system. Kinematic waveforms were compared using a functional data analysis version of the t-test. FINDINGS There were 30 patients with an average age at pinning of 13y (10-17y). Mean gait profile scores were significantly abnormal for slipped side (10.8°) versus sound side (6.8°), slipped side versus normal (5.6°) and sound side versus normal. There was little statistically significant correlation between severity of radiographic deformity and degree of gait disturbance. INTERPRETATION Major kinematic pattern deviations could be associated with (a) morphology of the proximal femur and potential femoral acetabular impingement problems and (b) leg length discrepancy. Gait analysis was able to quantify the kinematic deviations due to the anatomical deformities.
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Affiliation(s)
- Morgan Sangeux
- The Royal Children's Hospital, Australia; Murdoch Childrens Research Institute, Australia; The University of Melbourne, School of Engineering, Australia.
| | - Elyse Passmore
- The Royal Children's Hospital, Australia; Murdoch Childrens Research Institute, Australia
| | | | | | - H Kerr Graham
- The Royal Children's Hospital, Australia; Murdoch Childrens Research Institute, Australia; The University of Melbourne, Department of Paediatrics, Australia
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Hastings-Ison T, Blackburn C, Opie NL, Graham HK, Rawicki B, Wolfe R, Simpson P, Baker R. Reproducibility of an instrumented measure for passive ankle dorsiflexion in conscious and anaesthetized children with cerebral palsy. Dev Med Child Neurol 2014; 56:378-85. [PMID: 24102238 DOI: 10.1111/dmcn.12276] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2013] [Indexed: 11/26/2022]
Abstract
AIM The aims of this study were to (1) determine whether an instrumented measure will reduce measurement error to less than 5° in children with cerebral palsy (CP), (2) determine agreement and reliability of this instrumented measure in both conscious and anaesthetized participants, and (3) compare the method with previously reported measures. METHOD Thirty-four ambulant children (15 males, 19 females), aged 3 to 9 years, with spastic CP were studied in a tertiary-care paediatric hospital (21 with hemiplegia, 11 with diplegia, and two with quadriplegia). The majority of children functioned at Gross Motor Function Classification System level I (n=11) or II (n=18), with five children at level III. Ankle dorsiflexion at 50% bodyweight was photographed and measured. Each child was measured when conscious and when under mask anaesthesia by two experienced assessors. RESULTS The standard error of measurement (SEM) ranged from 3.9° (anaesthetized; 95% confidence interval [CI] 3.3-4.0°) to 6.7° (conscious; 95% CI 5.3-8.0°). This compared favourably with previously reported dorsiflexion measures (SEM range 6.5-7.8°) in conscious children with CP. Intrarater reliability was good in both conditions (intraclass correlation coefficient [ICC]: range 0.95 [anaesthetized; 95% CI 0.92-0.98] to 0.86 [conscious; 95% CI 0.76-0.95]). The ICC for interrater reliability ranged from 0.87 (anaesthetized; 95% CI 0.81-0.93) to 0.65 (conscious; 95% CI 0.50-0.81). INTERPRETATION Passive ankle dorsiflexion using an instrumented measure has face validity and may assist in the improvement of reproducibility under anaesthesia for clinical research. When an individual is conscious, this technique is not better than trained assessors using conventional goniometry reported in the literature and is not recommended for routine clinical use.
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Affiliation(s)
- Tandy Hastings-Ison
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Vic, Australia
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Thomason P, Graham HK. A systematic review of interventions for children with cerebral palsy: the state of the evidence. Dev Med Child Neurol 2014; 56:390-1. [PMID: 24628590 DOI: 10.1111/dmcn.12417] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Pam Thomason
- Royal Children's Hospital - Hugh Williamson Gait Analysis Laboratory, Parkville, Vic., Australia
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