Characteristic gait kinematics in persons with lumbosacral myelomeningocele

Gutierrez, Elena M.; Bartonek, Åsa; Haglund-Åkerlind, Yvonne; Saraste, Helena

doi:10.1016/s0966-6362(03)00011-0

Cited by 63 publications

(67 citation statements)

References 14 publications

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“…Gait pathologies in children with CP have been well documented in previous publications. [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] It is clear from the available literature that different designs of AFOs can significantly affect the kinetics and kinematics of gait in children with CP. Research has demonstrated effects on velocity, cadence, stride length, step length, double support, single support, ankle plantar flexion, ankle dorsiflexion, ankle power, knee flexion, knee extension and energy efficiency.…”

Section: Normal and Pathological Gaitmentioning

confidence: 99%

The effect of tuning ankle foot orthoses–footwear combination on the gait parameters of children with cerebral palsy

Eddison

Chockalingam

2013

Prosthetics &Amp; Orthotics International

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Background:There are a wide variety of ankle foot orthoses used in clinical practice which are characterised by their design, the material used and the stiffness of that material. Changing any of these three components will alter the effect of the ankle foot orthosis on gait.Objectives:The purpose of this article is to provide an overview on the available research on ankle foot orthosis–footwear combination tuning on the gait characteristics of children with cerebral palsy through a structured review.Study Design:Literature review.Methods:A thorough search of previous studies published in English was conducted within all major databases using relevant phrases without any limits for the dates. These searches were then supplemented by tracking all key references from the appropriate articles identified including hand searching of published books where relevant.Results:To date, there are 947 papers in the literature pertaining to the study of ankle foot orthosis. Of these, 153 investigated the use of ankle foot orthosis for children with cerebral palsy. All the studies included in this review were of a within-subjects design and the evidence levels were generally low.Conclusions:The overall results suggested that ankle foot orthosis–footwear combination tuning has the potential to improve the kinematics and kinetics of gait in children with cerebral palsy. However, the review highlights a lack of well-designed and adequately powered studies.Clinical relevanceWhile the research described in this article indicates an improvement in the gait of children with cerebral palsy following tuning of their ankle foot orthosis–footwear combination, there is still a paucity of research with quantitative data on the effects of kinematics and kinetics of ankle foot orthosis–footwear combination tuning, comparing untuned ankle foot orthosis–footwear combinations with tuned ankle foot orthosis–footwear combination. Furthermore, current research does not identify the effect of tuning on energy efficiency.

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Section: Normal and Pathological Gaitmentioning

confidence: 99%

The effect of tuning ankle foot orthoses–footwear combination on the gait parameters of children with cerebral palsy

Eddison

Chockalingam

2013

Prosthetics &Amp; Orthotics International

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“…Children with myelomeningocele (MMC) with neurological lesions at as low as the sacral and low lumbar levels are generally unable to stand still without external support, despite sufficient muscle strength in hip and knee muscles to walk independently. 3,4 Extensive plantarflexor weakness results in kinematic alterations (such as increased knee flexion, anterior pelvic tilt, and trunk and pelvic rotation), 5 increased vertical excursions, and is associated with an anterior trend in the centre of mass motion. 6 In children with arthrogryposis multiplex congenita (AMC), equinuovarus adductus foot is frequently observed, 7 which is often associated with plantarflexor muscle weakness.…”

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confidence: 99%

Effects of carbon fibre spring orthoses on gait in ambulatory children with motor disorders and plantarflexor weakness

Bartonek

Eriksson

Gutierrez-Farewik

2007

Develop Med Child Neuro

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A consecutive series of 17 children (six males, 11 females; mean age 11y 11mo [SD 4y 5mo]; range 3y 11mo-17y 4mo) with plantarflexor weakness was assessed to compare gait differences between a carbon fibre spring orthosis (CFSO) and participants' regular orthoses. Twelve children had myelomeningocele, four children had arthrogryposis, and one child had neuropathy with peripheral muscle pareses. All participants underwent clinical examination and 3D gait analysis. Parents answered a questionnaire to assess subjective perceptions of the orthoses. Results from 3D gait analysis provided evidence that CFSOs enhance gait function in most participants by improving ankle plantarflexion moment (p<0.001), ankle positive work (p<0.001), and stride length (p<0.001). The CFSO did not suit all participants, which emphasizes the importance of analyzing each patient's needs.During gait, the plantarflexors contribute to knee and ankle stability, restrain the forward rotation of the tibia during stance phase, and conserve energy by minimizing vertical oscillation of the whole-body centre of mass. 1 The positive work done by the plantarflexors during push-off adds to the potential and kinetic energy of the leg, thigh, and upper part of the body, and propels the body forward. 2 Children with various motor disorders exhibit weakness of plantarflexor muscles. Children with myelomeningocele (MMC) with neurological lesions at as low as the sacral and low lumbar levels are generally unable to stand still without external support, despite sufficient muscle strength in hip and knee muscles to walk independently. 3,4 Extensive plantarflexor weakness results in kinematic alterations (such as increased knee flexion, anterior pelvic tilt, and trunk and pelvic rotation), 5 increased vertical excursions, and is associated with an anterior trend in the centre of mass motion. 6 In children with arthrogryposis multiplex congenita (AMC), equinuovarus adductus foot is frequently observed, 7 which is often associated with plantarflexor muscle weakness.Due to the essential role of the plantarflexors in walking, orthotic substitutions are essential in patients with plantarflexor paralysis. 1 In children with MMC at L4 and L5, ankle-foot orthoses (AFOs) have been shown to improve sagittal plane function by reducing excessive ankle dorsiflexion, increasing plantarflexor moment, and reducing crouch and associated knee extensor moments. 8 In the authors' experience, ambulatory children with AMC and unstable feet, ankle, and knee joints also benefit from orthoses, but no gait study has been found in this field.One major challenge in the field of orthotics is to compensate for the plantarflexors' propulsive function, namely, to sustain a plantarflexion moment and to allow simultaneous plantarflexion movement. The posterior-leaf spring AFO was tested in patients with cerebral palsy. While it allowed ankle dorsiflexion in midstance, it was not shown to augment ankle function through storage and return of mechanical or spring energy. 9 Carbon fibre orthoses hav...

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“…In addition, these previous studies conducted human movement analysis using only the human model provided in the commercial 3D motion capture systems. Therefore, they have overlooked the estimation of the kinematic error, which occurs by the selection of the coordinate system [9][10][11][12]. In other words, there have been no studies in which different coordinate systems were applied to human movement analysis to evaluate joint kinematic errors.…”

Section: Introductionmentioning

confidence: 97%

The comparison of joint kinematic error using the absolute and relative coordinate systems for human gait

et al. 2009

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Minimizing artifacts from skin movement is vital for acquiring more accurate kinematic data in human movement analysis. There are several stages that cause skin movement artifacts and these stages depend on the selection of the reference system, the error reduction method and the coordinate system in clinical gait analysis. Due to residual errors, which are applied to the Euler and Bryant angle methods in each stage, significant cumulative errors are generated in the motion analysis procedure. Thus, there is currently a great deal of research focusing on reducing kinematic errors through error reduction methods and kinematic error estimations in relation to the reference system. However, there have been no studies that have systematically examined the effects of the selected coordinate system on the estimation of kinematic errors, because most of these previous studies have been mainly concerned with the analysis of human movement using only the human models that are provided in the commercial 3D motion capture systems.Therefore, we have estimated the differences between the results of human movement analyses using an absolute coordinate system and a relative coordinate system during a gait, in order to establish which system provides a more accurate kinematic analysis at the ankle joint. Six normal adult subjects with no neurological or orthopedic conditions, lower extremity injuries, or recent history of lower extremity surgery were used in this study. The analysis was conducted at a walking speed of 1.35m/s. For the clinical estimation, we used a cardinal plane based on the segmental reference system and the differences were plotted on the planes. From this analysis, when a relative coordinate system was in the gait analysis, the average kinematic error occurring during the gait was determined to be 13.58mm, which was significantly higher than the error generated with an absolute coordinate system. Therefore, although the relative coordinate system can also be used to calculate the ankle joint center during the clinical gait analysis, the absolute coordinate system should be employed in order to obtain more accurate joint kinematic data. In addition, the results from this study can be used as a basis to select an appropriate coordinate system with regards to the diagnostic accuracy level required for various kinds of gait disorders.

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Characteristic gait kinematics in persons with lumbosacral myelomeningocele

Cited by 63 publications

References 14 publications

The effect of tuning ankle foot orthoses–footwear combination on the gait parameters of children with cerebral palsy

The effect of tuning ankle foot orthoses–footwear combination on the gait parameters of children with cerebral palsy

Effects of carbon fibre spring orthoses on gait in ambulatory children with motor disorders and plantarflexor weakness

The comparison of joint kinematic error using the absolute and relative coordinate systems for human gait

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