Gait parameters in children with bilateral spastic cerebral palsy: a systematic review of randomized controlled trials

Gómez-Pérez, Cristina; Font-Llagunes, Josep M.; Martori, Joan Carles; Samsó, Joan Vidal

doi:10.1111/dmcn.14108

Cited by 21 publications

(13 citation statements)

References 58 publications

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“…Surface EMG-derived indices are also used as outcome measures to evaluate the responsiveness to treatments ( 151 ). In clinical practice, real-time sEMG can be used by physiotherapists (a) to control if the movement requested to the patient is performed by the proper target muscle(s) or by means of compensatory mechanisms, (b) as a direct measurement of variations consequent to mobilization, verticalization, trunk fixation, in acute neurological patients, (c) to assess the effect of different orthoses on muscle activation, which can vary toward or away from the normal pattern ( 152 ).…”

Section: Surface Emg Applicationsmentioning

confidence: 99%

Surface EMG in Clinical Assessment and Neurorehabilitation: Barriers Limiting Its Use

et al. 2020

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This article addresses the potential clinical value of techniques based on surface electromyography (sEMG) in rehabilitation medicine with specific focus on neurorehabilitation. Applications in exercise and sport pathophysiology, in movement analysis, in ergonomics and occupational medicine, and in a number of related fields are also considered. The contrast between the extensive scientific literature in these fields and the limited clinical applications is discussed. The “barriers” between research findings and their application are very broad, and are longstanding, cultural, educational, and technical. Cultural barriers relate to the general acceptance and use of the concept of objective measurement in a clinical setting and its role in promoting Evidence Based Medicine. Wide differences between countries exist in appropriate training in the use of such quantitative measurements in general, and in electrical measurements in particular. These differences are manifest in training programs, in degrees granted, and in academic/research career opportunities. Educational barriers are related to the background in mathematics and physics for rehabilitation clinicians, leading to insufficient basic concepts of signal interpretation, as well as to the lack of a common language with rehabilitation engineers. Technical barriers are being overcome progressively, but progress is still impacted by the lack of user-friendly equipment, insufficient market demand, gadget-like devices, relatively high equipment price and a pervasive lack of interest by manufacturers. Despite the recommendations provided by the 20-year old EU project on “Surface EMG for Non-Invasive Assessment of Muscles (SENIAM),” real international standards are still missing and there is minimal international pressure for developing and applying such standards. The need for change in training and teaching is increasingly felt in the academic world, but is much less perceived in the health delivery system and clinical environments. The rapid technological progress in the fields of sensor and measurement technology (including sEMG), assistive devices, and robotic rehabilitation, has not been driven by clinical demands. Our assertion is that the most important and urgent interventions concern enhanced education, more effective technology transfer, and increased academic opportunities for physiotherapists, occupational therapists, and kinesiologists.

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Section: Surface Emg Applicationsmentioning

confidence: 99%

Surface EMG in Clinical Assessment and Neurorehabilitation: Barriers Limiting Its Use

et al. 2020

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“…Treadmill training in cwCP is also effective for gait speed, gait endurance [27], and limb support time, with no significant effects on cadence or stride length [28]. BoNT-A and/or casting, orthopaedic devices, strength training, balance/gait training, and individualised therapy also significantly changed [29] STGPs in children with bilateral spastic CP. Therefore, throughout history, different types of orthotic devices have been used to prevent the appearance of deformities, correcting or reducing those that are already present, and ease gait function by stabilising the lower extremity (LE) in three dimensions of space [30].…”

Section: Introductionmentioning

confidence: 99%

Effects of Dynamic Suit Orthoses on the Spatio-Temporal Gait Parameters in Children with Cerebral Palsy: A Systematic Review

et al. 2021

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Dynamic suit orthoses (DSO) are currently used as a complementary treatment method in children with Cerebral Palsy (cwCP). The aim of this review was to assess the effects of interventions with DSO on the altered spatio-temporal gait parameters (STGPs) in cwCP. An electronic search was conducted in the Web of Science, Scopus, PEDro, Cochrane Library, MEDLINE/PubMed, and CINAHL databases up to July 2021. We included a total of 12 studies, which showed great heterogeneity in terms of design type, sample size, and intervention performed (two employed a Therasuit, three employed the Adeli suit, three employed Theratogs, one employed elastomeric tissue dynamic orthosis, one employed a full-body suit, one employed external belt orthosis, and one employed dynamic orthosis composed of trousers and T-shirt). The Cochrane collaboration’s tool and the Checklist for Measuring Study Quality were used to assess the risk of bias and the methodological quality of the studies. It was variable according to the Checklist for Measuring Study Quality, and it oscillated between eight and 23. The studies of higher methodological quality showed significant post-intervention changes in walking speed (which is the most widely evaluated parameter), cadence, stride length, and step length symmetry. Although the evidence is limited, the intervention with DSO combined with a programme of training/physical therapy seems to have positive effects on the STGPs in cwCP, with the functional improvements that it entails. Despite the immediate effect after one session, a number of sessions between 18 and 60 is recommended to obtain optimum results. Future studies should measure all STGPs, and not only the main ones, such as gait speed, in order to draw more accurate conclusions on the functional improvement of gait after the use of this type of intervention.

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“…This study thereby aimed to explore the correlations between clinical impairments and the entire continuous waveforms of the sagittal plane kinematics of children with either uCP or bCP. The current exploration focused on sagittal plane kinematics, since deviations in this plane are most commonly reported [27–29] and are more repeatable [30–32]. These correlations in question were explored separately for uCP and bCP, since previous studies have provided evidence that impairments in these groups are different, as are the relationships of the impairments with gait deviations [2,10,11].…”

Section: Introductionmentioning

confidence: 99%

Are spasticity, weakness, selectivity, and passive range of motion related to gait deviations in children with spastic cerebral palsy? A statistical parametric mapping study

et al. 2019

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This study aimed to identify the relationships between clinical impairments and gait deviations in children with cerebral palsy (CP). A retrospective convenience sample of 367 children with CP was selected (3–18 years old) and divided in two groups based on clinical symptomatology [unilateral (uCP) / bilateral CP (bCP), (n = 167/200)]. All children underwent a three-dimensional gait analysis and a standardized clinical examination. Gait was inspected on a vector level (all sagittal motions combined), and an individual joint level (pelvis, hip, knee and ankle joint motions). Statistical non-parametric mapping was applied to identify specific parts of the gait cycle displaying relationships between the gait deviations of both groups and the impairment scores of spasticity, weakness, selectivity, and passive range of motion. Impairment scores were summarized in two ways: a) composite impairment scores (e.g. combined spasticity of all assessed muscles acting around the hip, knee and ankle joints) and b) joint specific impairment scores (e.g. spasticity of the muscles acting around the knee joint). Results showed that the vector and most of the individual motions were related to the composite scores. Direct and carry-over relationships were found between certain individual motions and joint impairment scores (around the same or neighboring joints, respectively). All correlations were more prominent for children with bCP compared to uCP, especially regarding the relationships of gait deviations with weakness and reduced selectivity. In conclusion, this study enabled the mapping of relationships between clinical impairments and gait deviations in children with CP, by identifying specific parts of the gait cycle that are related to each of these impairments. These results provide a comprehensive description of these relationships, while simultaneously highlighting the differences between the two CP groups. Integration of these findings could lead to a better understanding of the pathophysiology of gait deviations and, eventually, support individualized treatment planning.

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Gait parameters in children with bilateral spastic cerebral palsy: a systematic review of randomized controlled trials

Cited by 21 publications

References 58 publications

Surface EMG in Clinical Assessment and Neurorehabilitation: Barriers Limiting Its Use

Surface EMG in Clinical Assessment and Neurorehabilitation: Barriers Limiting Its Use

Effects of Dynamic Suit Orthoses on the Spatio-Temporal Gait Parameters in Children with Cerebral Palsy: A Systematic Review

Are spasticity, weakness, selectivity, and passive range of motion related to gait deviations in children with spastic cerebral palsy? A statistical parametric mapping study

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