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14.16 Distal rectus femoris release versus transfer to treat gait abnormalities of the knee in children with cerebral palsy
Chapter 14. Developmental sensory, motor and mental disorders Moreover, we also noted an "en bloc" operation between the segments C7/T6 and T6/L2 only while walking on a beam. By contrast, pelvis stabilization remains the main reference frame to organize balance control, suggesting that idiopathic scoliosis mainly affects the headtrunk coordination. This project was supported by Cotrel Foundation.
References [1] Assaiante, C. and Amblard, B. Ontogenesis of head stabilization in space during locomotion in children: Influence of visual cues. Experimental Brain Research, 1993; 93:499 515.
[•5]
The effect of ankle foot orthoses on symmetry of weight-bearing and functional ability in children with hemiplegia
T. O'Reilly 1, A. Hunt 1, B. Thomas 2, S. Hogan 2. 1School of Physiotherapy, Faculty of Health Sciences', The University of Sydney, Australia," 2 The Children ~' Hospital at Westmead, Australia Introduction: In children with hemiplegia, a negative cycle of weight
bearing results in asymmetry and reduced bone mineral density. An ankle foot orthosis (AFO) can increase step length on the hemiplegic side and achieve a heel-toe pattern of walking [1]. This study compared the effectiveness of a hinged AFO and a leaf-spring AFO to no AFO, in increasing weight taken through the hemiplegic foot during walking, and in improving functional ability. Method: The study had a single-system, alternating treatment design with replication across three children. During walking, the three AFO conditions were tested in a random order at each of three measurement sessions. In-shoe pressure was recorded using Pedar (Novel TM)insoles and children were tested with a variety of functional performance measures. Results: Both types of AFO caused an increase in the pressure through the heel of the hemiplegic side, and an increase in the time spent on the hemiplegic foot. However, neither of the two AFOs made a difference to the functional ability of the children. There was no difference between the two AFO types. Discussion and Conclusion: While AFOs were effective in improving the weight-bearing symmetry of these children with hemiplegia, there was no demonstrable concomitant improvement in function. Because there was no difference between the AFO types, clinicians should consider factors such as cost and patient preference.
References [1] Romkes J, Brunner R. Comparison of a dynamic and a hinged ankle foot orthosis by gait analysis in patients with hemiplegic cerebral palsy. Gait & Posture 2002; 15:18 24.
[•6]
$87
swing-phase peak knee flexion (PKF) ~<50°; and peak knee flexion >500 occurring later than 77% of the cycle). All data was analyzed statistically. Results: For the group of patients with PNF ~<50 °, this value increased significantly after rectus transfer (p 0.005). Children with PNF >500 and later than 77% of the cycle, showed significant improvement in timing after both procedures (p 0.001; p 0.02). When kinematic parameters were normal before surgery, they did not improve, although patients experienced a significant decrease of muscle contractures. Conclusions: According to the results of this study, RF transfer would be the preferred procedure for those patients with preoperative swing-phase knee flexion ~<50°. For the rest of patients, both procedures brought similar results. We opt for distal RF release, since is technically easier, particularly when one-stage multilevel procedures are being performed.
[1~
Postural stability in adults with developmental dyslexia
K.S.H. Rochelle, J.B. Talcott. Neurosciences Research Institute, Aston University, Aston Triangle, Birmingham B4 7ET, UK Introduction: Developmental dyslexia is a reading disorder associated with sensorimotor difficulties. A recent meta-analytic review of 14 studies of dyslexia and balance [1] yielded an average effect size of d 0.65 (CI: 0.45 0.78) for tests of postural stability and also evidence that the sample of effects was heterogeneous (p < 0.005). Paradigms which modulated vision (p 0.08) were stronger predictors of effect size than dual tasks. The most significant predictor was whether participants were screened for attention deficits (p < 0.001). Methods: Adults with dyslexia and controls (n 35) were tested on a battery of psychometric and literacy measures. They were assessed for postural stability following release of a suspended weight, equivalent to 5% body mass, using real-time motion capture. A 2-second post-perturbation data window was obtained in four conditions (3 unimodal, visual or cutaneous; 1 bimodal, visual and cutaneous). Results: Group differences for postural sway were not significant but effect sizes (rs 0.26 0.47) increased between uni- and bimodal conditions. Sway in the bimodal condition correlated moderately with attention ratings (rs 0.41). Discussion: When perturbation places load on the sensorimotor system with bimodal modulation, some adults with dyslexia may have enhanced difficulty with perceiving and adapting to dynamically changing cues to orientation; alternatively they may have insufficient attentional resources for compensation. Conclusion: Effects of sensorimotor difficulties on postural stability may be augmented by co-existing attention deficits in developmental dyslexia.
References Distal rectus femoris release versus transfer to treat gait abnormalities of the knee in children with cerebral palsy
A. Presedo, M. Mehrafshan, E.M. Laassel, V Topouchian, Y. Mohammad, D. Gouraud, K. Mazda, G.F. Pennegot. H@ital
[1] Rochelle, K.S.H., Talcott, J.B. Taking a step forward: A metaanalytic review of the developmental dyslexia and balance issue, in preparation.
Robert Debr~, Service d'Orthop~die P~diatrique, France
~
Adolescent idiopathic scoliosis (AIS): new findings
Objective: To evaluate the effectiveness of distal rectus femoris (RF) release versus transfer to treat gait abnormalities of the knee in ambulatory children with cerebral palsy. Patients and Methods: Thirty-nine children were included in this study. Thirty patients (55 limbs) underwent RF transfer at a mean age of 11.8 years and nine (16 limbs) underwent distal rectus release at a mean age of 12.5 years. Indications for surgery included RF contracture and abnormal activity during swing phase in dynamic electromyography (EMG), whether with the presence of kinematic characteristics of stiff-knee gait or not. All patients had pre- and postoperative gait analysis and EMG. To evaluate functional outcomes, patients were grouped by pre-operative knee kinematics (normal;
D. Rousi~ 1, R Salvetti 1, Fr. Hamon 1, J.C. Baudrillard2, O. Joly 3, A. Berthoz 3. 1Nordvision, clinique Ambroise Pard Lille, France,"
2Service IRM C.H. Arras', France," SColl~ge de France Paris', France B a c k g r o u n d : AIS are generally considered to be multi-factorial
in origin: genetic factors, left-right asymmetries, neuro-anatomical and neuro-muscular causes. Cranio-facial asymmetries (CFA) are induced by developmental factors as brain growth specially reflected in basicranium asymmetries. CFA cause deformations of orbits & labyrinths affecting the proprio-oculo-labyrinthine system (POLS) causing itself abnormal vestibulospinal outputs. The symptoms appear when the asymmetry is significative.
References [1] Assaiante, C. and Amblard, B. Ontogenesis of head stabilization in space during locomotion in children: Influence of visual cues. Experimental Brain Research, 1993; 93:499 515.
[•5]
The effect of ankle foot orthoses on symmetry of weight-bearing and functional ability in children with hemiplegia
T. O'Reilly 1, A. Hunt 1, B. Thomas 2, S. Hogan 2. 1School of Physiotherapy, Faculty of Health Sciences', The University of Sydney, Australia," 2 The Children ~' Hospital at Westmead, Australia Introduction: In children with hemiplegia, a negative cycle of weight
bearing results in asymmetry and reduced bone mineral density. An ankle foot orthosis (AFO) can increase step length on the hemiplegic side and achieve a heel-toe pattern of walking [1]. This study compared the effectiveness of a hinged AFO and a leaf-spring AFO to no AFO, in increasing weight taken through the hemiplegic foot during walking, and in improving functional ability. Method: The study had a single-system, alternating treatment design with replication across three children. During walking, the three AFO conditions were tested in a random order at each of three measurement sessions. In-shoe pressure was recorded using Pedar (Novel TM)insoles and children were tested with a variety of functional performance measures. Results: Both types of AFO caused an increase in the pressure through the heel of the hemiplegic side, and an increase in the time spent on the hemiplegic foot. However, neither of the two AFOs made a difference to the functional ability of the children. There was no difference between the two AFO types. Discussion and Conclusion: While AFOs were effective in improving the weight-bearing symmetry of these children with hemiplegia, there was no demonstrable concomitant improvement in function. Because there was no difference between the AFO types, clinicians should consider factors such as cost and patient preference.
References [1] Romkes J, Brunner R. Comparison of a dynamic and a hinged ankle foot orthosis by gait analysis in patients with hemiplegic cerebral palsy. Gait & Posture 2002; 15:18 24.
[•6]
$87
swing-phase peak knee flexion (PKF) ~<50°; and peak knee flexion >500 occurring later than 77% of the cycle). All data was analyzed statistically. Results: For the group of patients with PNF ~<50 °, this value increased significantly after rectus transfer (p 0.005). Children with PNF >500 and later than 77% of the cycle, showed significant improvement in timing after both procedures (p 0.001; p 0.02). When kinematic parameters were normal before surgery, they did not improve, although patients experienced a significant decrease of muscle contractures. Conclusions: According to the results of this study, RF transfer would be the preferred procedure for those patients with preoperative swing-phase knee flexion ~<50°. For the rest of patients, both procedures brought similar results. We opt for distal RF release, since is technically easier, particularly when one-stage multilevel procedures are being performed.
[1~
Postural stability in adults with developmental dyslexia
K.S.H. Rochelle, J.B. Talcott. Neurosciences Research Institute, Aston University, Aston Triangle, Birmingham B4 7ET, UK Introduction: Developmental dyslexia is a reading disorder associated with sensorimotor difficulties. A recent meta-analytic review of 14 studies of dyslexia and balance [1] yielded an average effect size of d 0.65 (CI: 0.45 0.78) for tests of postural stability and also evidence that the sample of effects was heterogeneous (p < 0.005). Paradigms which modulated vision (p 0.08) were stronger predictors of effect size than dual tasks. The most significant predictor was whether participants were screened for attention deficits (p < 0.001). Methods: Adults with dyslexia and controls (n 35) were tested on a battery of psychometric and literacy measures. They were assessed for postural stability following release of a suspended weight, equivalent to 5% body mass, using real-time motion capture. A 2-second post-perturbation data window was obtained in four conditions (3 unimodal, visual or cutaneous; 1 bimodal, visual and cutaneous). Results: Group differences for postural sway were not significant but effect sizes (rs 0.26 0.47) increased between uni- and bimodal conditions. Sway in the bimodal condition correlated moderately with attention ratings (rs 0.41). Discussion: When perturbation places load on the sensorimotor system with bimodal modulation, some adults with dyslexia may have enhanced difficulty with perceiving and adapting to dynamically changing cues to orientation; alternatively they may have insufficient attentional resources for compensation. Conclusion: Effects of sensorimotor difficulties on postural stability may be augmented by co-existing attention deficits in developmental dyslexia.
References Distal rectus femoris release versus transfer to treat gait abnormalities of the knee in children with cerebral palsy
A. Presedo, M. Mehrafshan, E.M. Laassel, V Topouchian, Y. Mohammad, D. Gouraud, K. Mazda, G.F. Pennegot. H@ital
[1] Rochelle, K.S.H., Talcott, J.B. Taking a step forward: A metaanalytic review of the developmental dyslexia and balance issue, in preparation.
Robert Debr~, Service d'Orthop~die P~diatrique, France
~
Adolescent idiopathic scoliosis (AIS): new findings
Objective: To evaluate the effectiveness of distal rectus femoris (RF) release versus transfer to treat gait abnormalities of the knee in ambulatory children with cerebral palsy. Patients and Methods: Thirty-nine children were included in this study. Thirty patients (55 limbs) underwent RF transfer at a mean age of 11.8 years and nine (16 limbs) underwent distal rectus release at a mean age of 12.5 years. Indications for surgery included RF contracture and abnormal activity during swing phase in dynamic electromyography (EMG), whether with the presence of kinematic characteristics of stiff-knee gait or not. All patients had pre- and postoperative gait analysis and EMG. To evaluate functional outcomes, patients were grouped by pre-operative knee kinematics (normal;
D. Rousi~ 1, R Salvetti 1, Fr. Hamon 1, J.C. Baudrillard2, O. Joly 3, A. Berthoz 3. 1Nordvision, clinique Ambroise Pard Lille, France,"
2Service IRM C.H. Arras', France," SColl~ge de France Paris', France B a c k g r o u n d : AIS are generally considered to be multi-factorial
in origin: genetic factors, left-right asymmetries, neuro-anatomical and neuro-muscular causes. Cranio-facial asymmetries (CFA) are induced by developmental factors as brain growth specially reflected in basicranium asymmetries. CFA cause deformations of orbits & labyrinths affecting the proprio-oculo-labyrinthine system (POLS) causing itself abnormal vestibulospinal outputs. The symptoms appear when the asymmetry is significative.