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Gait Analysis on use of Bilateral Carbon Fiber AFOs for an Adolescent With Amyoplasia Congenita
Research Posters Research Poster 304908 Gait Analysis on use of Bilateral Carbon Fiber AFOs for an Adolescent With Amyoplasia Congenita Christina Bickley (Shriners Hospitals for Children), Judi Linton, Janet Dawson, Douglas Barnes Research Objectives: To investigate the use of bilateral Carbon FiberAFOs (CF-AFO) in a subject with Amyoplasia Congenita for improvement in gait. Design: Case Study. Setting: Pediatric Specialty Care Hospital with an Instrumented Motion Analysis Center (MAC). Participants: Single case study of a 14 year old with Amyoplasia Congenita. Physical exam results yielded contractures in both ankles and decreased knee flexion bilaterally. Gross strength assessment showed decreased dorsiflexor and ankle evertor/ invertor strength bilaterally. Interventions: Instrumented gait analysis was performed to assess effects of bilateral CF-AFOs on ambulation as compared to Solid Ankle AFOs and Barefoot ambulation. Main Outcome Measure(s): Each walking condition was assessed for improved: knee and ankle motion during gait (kinematics) and power generation during gait (kinetics). Results: Improvements in swing limb clearance, positioning of the ankle at initial contact, increased peak knee flexion in loading noted for both AFOs, however the CF-AFO allowed for increased peak knee flexion in swing and a reduction in trunk flexion. Other benefits of the CF-AFO included improvements in gait moments across the ankle, knee, and hip during the loading response phase of gait. In addition, terminal stance phase of gait showed improvements in power generation at the ankle and knee for the CF- AFOs. The subject reported improved AFO tolerance; decreased tripping and falling; improved standing balance; improved walking ability; and increased shoe selection options with use of CF-AFOs. Conclusion/Discussion: This single subject case study supports the use of bilateral CF-AFOs in a subject with Amyoplasia Congenita to improve gait. Advancing the understanding of effects of CF-AFOs for a broader range of patients with Amyoplasia Congenita needs further investigation. Key Words: Arthrogryposis, Amyoplasia Congenita, Orthotic Devices, Gait, Pediatrics Disclosures: None. Research Poster 322900 Gait Deviations in Children with Osteogenesis Imperfecta Type I Christina Garman (Marquette University), Adam Graf, Joseph Krzak, Peter Smith Gerald Harris Research Objectives: The purpose of this study was to provide a quantitative comparison of gait in a large population of 44 adolescents with Type I OI. Analysis includes description and comparison of classic temporal spatial parameters, the GDI, lower limb kinematics and kinetics. Design: Three dimensional gait analysis was performed with a 14-camera motion analysis system (MX model, Vicon Motion Systems Inc., L.A, CA) and gait parameters were calculated using the Plug-In Gait Model. To evaluate group differences, variables were compared using a multivariate analysis of variance (MANOVA) with a Bonferonni corrected value of p < 0.001. Setting: The study was conducted at Shriners Hospitals for Children, Chicago Motion Analysis Laboratory. Participants: Forty-four subjects with type I (11.7 3.08 yo), and 30 typically developing controls (9.54 3.1 yo). Interventions: Not applicable. Main Outcome Measure(s): Analysis included description and comparison of classic temporal spatial parameters, the GDI, and lower limb kinematics and kinetics. Results: Spatial temporal parameters revealed that walking speed, single support time, stride and step length were lower and double support time was higher in the OI group compared to the TD group. The GDI score was
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e71 lower and external hip rotation angle was higher in the OI group compared to the TD group. Kinetic parameters revealed that peak hip flexor, knee extensor and ankle plantarflexor moments, and power generation at the ankle were lower in the OI group compared to the TD group. Conclusion/Discussion: Results from this in depth analysis contributes to a more robust understanding of gait characteristics in adolescents with Type I OI in order to improve therapeutic intervention for improved mobility, longevity and participation. Key Words: Osteogenesis Imperfecta, Gait, Kinematics, Kinetics Disclosures: None disclosed. Research Poster 308526 Gait Variability is Associated with Reduced Cognitive Function in Individuals with Multiple Sclerosis Katherine Hsieh (University of Illinois at Urbana Champaign), Jacob Sosnoff Research Objectives: To examine the association between gait variability and cognitive function in individuals with multiple sclerosis (MS). Design: Cross-sectional study. Setting: University research laboratory. Participants: Individuals diagnosed with MS (nZ157) were recruited from the community. Participants were excluded if they had significant cognitive impairment as indexed by the Modified Telephone Interview for Cognitive Status. Interventions: Not applicable. Main Outcome Measure(s): In a single testing session participants completed the symbol digit modalities test (SDMT) to assess cognitive processing speed and walked at their comfortable pace across a pressure sensitive walkway. Step length and step time measures were extracted from the walkway. Gait variability was indexed with the coefficient of variation (CV). Results: The age of the sample was 55.611.9 years, with 133 females (72%). Median disability (EDSS) was 5.5 and ranged from 2.0-7.0. Average performance on the SDMT was 49 correct items and ranged from 9 to 87 items. On average step length was 59.1 cm and ranged from 34.6 to 94.6 cm. On average step time was 0.63 s and ranged from 0.4 to 1.6 seconds. On average step length CV was 5.1 and ranged from 0.6 to 20.2, and step time CV was 6.4 and ranged from 1.1 to 36.7. After controlling for age and disability level, a significant linear regression predicting SDMT from step length CV (b Z -.38) and step time CV (b Z -.38) was found (p < 0.001), with R2 Z0.271. Conclusion/Discussion: In individuals with MS, greater step length and step time variability are significantly associated with reduced cognitive processing speed. Future studies should determine if gait variability is a predictor of cognitive decline in MS patients as seen in other neurodegenerative disorders. Key Words: Gait, Variability, Cognition, Neurodegenerative Diseases Disclosures: None.
Research Poster 315933 Global Rating of Change Ratings Derived from the Therapists’ and Patients’ Perspectives Ying-Chih Wang (University of Wisconsin Milwaukee), Bhagwant Sindhu, Sheng-Che Yen, Leigh Lehman Research Objectives: Global rating of change (GROC) scores provide a means of measuring self-perceived change in health status over time. The purposes of the study were to examine GROC scores from the perspective of the patient (GROCp) and the treating therapist (GROCt), their impact on the Minimal Clinically Important Difference (MCID) estimates, and assess the relationships between the GROC scores and scores at admission and discharge. Design: Cross-sectional observational cohort study. Setting: Outpatient rehabilitation.
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e71 lower and external hip rotation angle was higher in the OI group compared to the TD group. Kinetic parameters revealed that peak hip flexor, knee extensor and ankle plantarflexor moments, and power generation at the ankle were lower in the OI group compared to the TD group. Conclusion/Discussion: Results from this in depth analysis contributes to a more robust understanding of gait characteristics in adolescents with Type I OI in order to improve therapeutic intervention for improved mobility, longevity and participation. Key Words: Osteogenesis Imperfecta, Gait, Kinematics, Kinetics Disclosures: None disclosed. Research Poster 308526 Gait Variability is Associated with Reduced Cognitive Function in Individuals with Multiple Sclerosis Katherine Hsieh (University of Illinois at Urbana Champaign), Jacob Sosnoff Research Objectives: To examine the association between gait variability and cognitive function in individuals with multiple sclerosis (MS). Design: Cross-sectional study. Setting: University research laboratory. Participants: Individuals diagnosed with MS (nZ157) were recruited from the community. Participants were excluded if they had significant cognitive impairment as indexed by the Modified Telephone Interview for Cognitive Status. Interventions: Not applicable. Main Outcome Measure(s): In a single testing session participants completed the symbol digit modalities test (SDMT) to assess cognitive processing speed and walked at their comfortable pace across a pressure sensitive walkway. Step length and step time measures were extracted from the walkway. Gait variability was indexed with the coefficient of variation (CV). Results: The age of the sample was 55.611.9 years, with 133 females (72%). Median disability (EDSS) was 5.5 and ranged from 2.0-7.0. Average performance on the SDMT was 49 correct items and ranged from 9 to 87 items. On average step length was 59.1 cm and ranged from 34.6 to 94.6 cm. On average step time was 0.63 s and ranged from 0.4 to 1.6 seconds. On average step length CV was 5.1 and ranged from 0.6 to 20.2, and step time CV was 6.4 and ranged from 1.1 to 36.7. After controlling for age and disability level, a significant linear regression predicting SDMT from step length CV (b Z -.38) and step time CV (b Z -.38) was found (p < 0.001), with R2 Z0.271. Conclusion/Discussion: In individuals with MS, greater step length and step time variability are significantly associated with reduced cognitive processing speed. Future studies should determine if gait variability is a predictor of cognitive decline in MS patients as seen in other neurodegenerative disorders. Key Words: Gait, Variability, Cognition, Neurodegenerative Diseases Disclosures: None.
Research Poster 315933 Global Rating of Change Ratings Derived from the Therapists’ and Patients’ Perspectives Ying-Chih Wang (University of Wisconsin Milwaukee), Bhagwant Sindhu, Sheng-Che Yen, Leigh Lehman Research Objectives: Global rating of change (GROC) scores provide a means of measuring self-perceived change in health status over time. The purposes of the study were to examine GROC scores from the perspective of the patient (GROCp) and the treating therapist (GROCt), their impact on the Minimal Clinically Important Difference (MCID) estimates, and assess the relationships between the GROC scores and scores at admission and discharge. Design: Cross-sectional observational cohort study. Setting: Outpatient rehabilitation.