The influence of spasticity in the lower limb muscles on gait pattern in children with sacral to mid-lumbar myelomeningocele: a gait analysis study

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

doi:10.1016/j.gaitpost.2004.06.003

Cited by 19 publications

(14 citation statements)

References 38 publications

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“…These findings are in accordance with earlier publications [3,5,[15][16][17][18]. Patients with hip dislocation were also significantly more often nonambulators than those with contained hips.…”

Section: Discussionsupporting

confidence: 93%

Associations between orthopaedic findings, ambulation and health-related quality of life in children with myelomeningocele

Danielsson

Bartonek

Levey

et al. 2008

Journal of Children's Orthopaedics

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Purpose Modern principles for treatment of patients with myelomeningocele include early closure of the neural tube defect, neurosurgical treatment of hydrocephalus and treatment aimed at minimizing contractures and joint dislocations. The aim is to achieve a better survival rate and a better quality of life (QOL). Better ambulatory function is thought to improve the management of activities of daily living. This study focused on evaluating which factors might affect ambulation, function and health-related QOL in children with myelomeningocele. Methods Thirty-eight patients with neurological deficit from myelomeningocele were examined in an unbiased follow-up. This included a physical examination using validated methods for ambulatory function and neuromuscular status, chart reviews and evaluation of radiographs in terms of hip dislocation and spine deformity. The Pediatric Evaluation of Disability Inventory (PEDI) was used to measure mobility, self-care and social function, and the Child Health Questionnaire (CHQ-PF50) was used to measure QOL. Results Muscle function class, quadriceps strength, spasticity in hip and/or knee joint muscles and hip flexion contracture as well as the ambulatory level all affected functional mobility as well as self-care/PEDI. Patients with hip dislocation, spinal deformity or those who were mentally retarded also had significantly worse functional mobility. Besides being affected by the severity of the neurological lesion, self-care/PEDI was significantly impaired by hip flexion contracture and absence of functional ambulation. General health-related QOL was significantly lower in this patient group than for US norms. Nonambulatory and mentally retarded patients had a significantly lower physical function of their QOL (CHQ). Conclusions The severity of the disease, i.e. reduced muscle strength and occurrence of spasticity around hip/knee, affected ambulation, functional mobility and self-care. Acquired deformities (hip dislocation and spine deformity) affected functional ambulation only. Patients with reduced functional mobility and self-care experienced lower physical QOL. Children with myelomeningocele had significantly reduced QOL compared to healthy individuals.

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Section: Discussionsupporting

confidence: 93%

Associations between orthopaedic findings, ambulation and health-related quality of life in children with myelomeningocele

Danielsson

Bartonek

Levey

et al. 2008

Journal of Children's Orthopaedics

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“…It has been argued that, in individuals with MMC the presence of spasticity affects walking ability and should be taken into consideration when setting ambulatory goals. 21 Three participants with MMC in the present study had spasticity in muscles spanning the ankle, but the spasticity was not considered to influence initial heel contact negatively, especially as the participants wore orthoses.…”

Section: Resultsmentioning

confidence: 75%

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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“…Kinematics and kinetics of the lower extremity have been studied extensively in children with MM using three-dimensional (3D) motion analysis [14][15][16][17][18]. However, movements of the upper extremity (UE) during walking have only been investigated to a small extent in children with MM [19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Upper extremity dynamics during Lofstrand crutch-assisted gait in children with myelomeningocele

et al. 2009

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The use of quantitative models for evaluating upper extremity (UE) dynamics in children with myelomeningocele (MM) is limited. A biomechanical model for assessment of UE dynamics during Lofstrand crutch-assisted gait in children with MM is presented. This pediatric model may be a valuable tool for clinicians to characterize crutch-assisted gait, which may advance treatment monitoring, crutch prescription, and rehabilitation planning for children with MM. Nine subjects with L3 or L4 level myelodysplasia (mean+/-S.D. age: 11.1+/-3.8 years) were analyzed during forearm crutch-assisted gait: (1) reciprocal gait and (2) swing-through gait. Three-dimensional (3D) dynamics of the UE were acquired and the Pediatric Outcomes Data Collection Instrument (PODCI) was administered. The goal of this study was to determine if meaningful differences occur between gait patterns in UE kinematics and kinetics, and if correlations exist between dynamics and functional outcomes. Temporal-distance parameters showed significant differences between reciprocal and swing-through gait in stride length, and stance duration. All joint ranges of motion were greater during swing-through gait. Thorax, elbow and crutch ranges of motion were found to be significantly different between gait patterns. Kinetic results demonstrated significant differences between reciprocal and swing-through gait, bilaterally, at all joints for the force variables of mean superior/inferior force, range of force, and maximum inferior force. Functional outcomes were strongly correlated with joint dynamics. Accurate quantitative assessment is essential for preventing injury in long-term crutch users. This study has potential for improving clinical intervention strategies and therapeutic planning of ambulation for children with MM.

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The influence of spasticity in the lower limb muscles on gait pattern in children with sacral to mid-lumbar myelomeningocele: a gait analysis study

Cited by 19 publications

References 38 publications

Associations between orthopaedic findings, ambulation and health-related quality of life in children with myelomeningocele

Associations between orthopaedic findings, ambulation and health-related quality of life in children with myelomeningocele

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

Upper extremity dynamics during Lofstrand crutch-assisted gait in children with myelomeningocele

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