- Email: [email protected]
14.6 The changes of ankle kinematics in children with cerebral palsy between before and after btx-A injection
Chapter 14. Developmental sensory, motor and mental disorders
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specific constraints. Typical characteristics of this deficient adaptation are a top-down recruitment of postural muscles, a high degree of antagonistic co-activation during external perturbations (but not during reaching) and a lack or an incomplete modulation of the EMGamplitude. Conclusion: A cranio-caudal recruitment order and an excessive degree of antagonistic co-activation might represent strategies to cope with a lacking ability to modulate muscular amplitude. How could the child train this ability? Suggestions will be given.
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Binocular coordination of saccades at far and near viewing distance in children with vertigo
M.P. Bucci 1, Z. Kapoula 1, Q. Yang 1, D. Br~mond-Gignac2, S. Wiener-Vacher3. 1LPPA, CNRS UMR 7124 Coll~gede France,
11, place M. Berthelot, 75005 Paris', France," 2H@ital Robert Debrd, service d'Ophtalmologie, SH@ital Robert Debrd, service O.R.L. 48, Bld Sdrurie~ 75019 Paris', France Introduction: We reported [1,2] that children with symptoms of vertigo but normal vestibular function, revealed abnormal convergence eye movements (long latency and duration, poor accuracy). We tested whether vergence abnormalities affect other oculomotor aspects, as the quality of binocular coordination of saccades. Methods: LEDs were used to stimulate visually-guided saccades at far and close viewing distance; eye movements from 14 children were recorded. Results: At far distance disconjugacy of the eyes during the saccades and the fixation drift after the saccade was small (5% and 3% of the amplitude of saccade, respectively); these values are similar to those reported in normal children [3]. In contrast, at near distance, binocular coordination of saccades was worst than in normal children: 9% and 5% respectively. Conclusions: Poor binocular coordination of saccades and during fixation could lead to transient double vision at near distance. Based on these results, we predict abnormal binocular coordination of the VOR, but this needs further investigation. Poor binocular coordination of saccades and of the VOR could affect gaze stabilisation leading to vertigo.
References [1] Bucci MR Kapoula Z, Yang Q, Wiener-Vacher S, Br~mondGignac D. Abnormality of vergence latency in children with vertigo. J Neurology 2004; 251:204 213. [2] Bucci MR Kapoula Z, Yang Q, Br~mond-Gignac D, WienerVaccher S. Speed-accuracy of saccades, vergence and combined eye movements in children with vertigo. Exp Brain Res 2004; 157:286 295. [3] Yang Q, Kapoula Z. Binocular coordination of saccades at far and at near in children and in adults. Journal of Vision 2003; 3(8): 554 561.
Results: In the counting condition, the walking speed could be reduced up to 50%, with possible disruption of the linear relationships between stride length/cadence and walking speed. In four out of five children, moreover, math trials were associated with partial correction of kinematic abnormalities typical of the heel-strike gait of HTW (premature heel-off and/or reversal of the second rocker), as well as with a shift of the ankle joint range of motion toward more dorsiflexed value s. Discussion and Conclusion: Result indicate that cognitive factors might contribute to the expression of abnormal gait pattern in a subpopulation of subjects with HTW. This findings might have potential consequences for the diagnosis and treatment of this condition.
References [1] Crenna P. Fedrizzi E., Andreucci E., Frigo C., Bono R. The heel-contact gait pattern of habitual toe walkers. Gait & Posture, published in digital form.
I•.•
S.S. Eun 1 , S. Miyano 1 , C.I. Park 2, E.S. Park 2, J. Chu 3. 1Dept. of Rehabilitation Medicine, Jikei Univ. School of Medicine, Japan," Dept. of Rehabilitation Medicine, Yonsei Univ. College of Medicine, Korea," ORehabilitation Medicine, Hospital of the University of Pennsylvania, USA Introduction: The purpose of this study was to provide objective
information on the outcome of botulinum toxin-A treatment for the detection of abnormal ankle motion in cerebral palsy patients by using three-dimensional motion analysis system. Method: Recruited into the study were thirteen ambulatory cerebral palsy (CP) children ages 2 11 years old. Botulinum toxin A (BTXA) was injected into spastic gastrocnemius muscle of 19 legs (both leg of 6 diplegics and an affected leg of 7 hemiplegics). A clinical assessment and gait analysis were performed on the same day and two weeks after the first injection. Kinematics data were obtained by motion analyzer (Vicon 370 M.A). The smoothness of ankle range of motion (ROM) were quantified by the jerk-cost (JC) function. Before and after treatment comparisons were calculated using Wilcoxon test. Results: The kinematic data showed significant improvements in the active ankle ROM of both groups at two weeks. The smoothness of the ankle motion improved significantly in patients with hemiplegia at two weeks (p < 0.05), however, there were no significant improvements in diplegic CR Discussion: JC function provided useful information for the ankle kinematics as well as ROM. Conclusion: BTX injection improved smoothness in ankle motion in hemiplegic CP more than in diplegic CR
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Effects of a cognitive task on gait kinematics of habitual toe walkers
P. Crenna, A. Marzegan, L. Salvadori, L. San&in. Laboratory for
Analysis of Movement in Children Pierfranco & Luisa Mariani, Institute of Human Physiology L Faculty of Medicine, University of Milan, via Mangiagalli 32, 1-20133, Milan, Italy Introduction: Habitual Toe Walking (HTW) is a condition whereby
children preferentially adopt a tip-toe gait pattern in the absence of signs of neuro-muscular impairment. In addition to peripheral factors, a contribution from higher level central control has been postulated [1]. The present study was aimed at further testing this hypothesis using a dual task paradigm. Methods: By means of standard gait analysis we studied the effects a cognitive task (counting backwards) on the gait pattern of five school-age children exhibiting facultative toe walking.
The changes of ankle kinematics in children with cerebral palsy between before and after btx-A injection
Measuring hip and knee intra-limb coordination in gait of normal children: implications for children with cerebral palsy
S. Farmer, C. Stewart. Orthotic Research and Locomotor Assessment
Unit, Robert Jones' And Agnes' Hunt Orthopaedic and District NHS Trust, Oswestty, Shropshire, SYI O 7AG, UK Introduction: Normal infants walk independently at about 12 months.
Supported walking and early independent walking show synchronous hip and knee flexion followed by hip and knee extension [1]. As gait matures there is dissociation of this tight synchrony. Children with cerebral palsy often lack this normal intra-limb coordination [2]. We present data of intra-limb coordination (ILC) of normal children as a precursor to work in children with cerebral palsy. Method: A convenience sample of 16 normal children (6 13 years, mean 9.6 years) was recruited. 3-dimensional gait data were collected for 10 walks for each subject. The coefficient of multiple correlation (CMC) was calculated for intra-subject repeatability of hip and knee
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specific constraints. Typical characteristics of this deficient adaptation are a top-down recruitment of postural muscles, a high degree of antagonistic co-activation during external perturbations (but not during reaching) and a lack or an incomplete modulation of the EMGamplitude. Conclusion: A cranio-caudal recruitment order and an excessive degree of antagonistic co-activation might represent strategies to cope with a lacking ability to modulate muscular amplitude. How could the child train this ability? Suggestions will be given.
I1~
Binocular coordination of saccades at far and near viewing distance in children with vertigo
M.P. Bucci 1, Z. Kapoula 1, Q. Yang 1, D. Br~mond-Gignac2, S. Wiener-Vacher3. 1LPPA, CNRS UMR 7124 Coll~gede France,
11, place M. Berthelot, 75005 Paris', France," 2H@ital Robert Debrd, service d'Ophtalmologie, SH@ital Robert Debrd, service O.R.L. 48, Bld Sdrurie~ 75019 Paris', France Introduction: We reported [1,2] that children with symptoms of vertigo but normal vestibular function, revealed abnormal convergence eye movements (long latency and duration, poor accuracy). We tested whether vergence abnormalities affect other oculomotor aspects, as the quality of binocular coordination of saccades. Methods: LEDs were used to stimulate visually-guided saccades at far and close viewing distance; eye movements from 14 children were recorded. Results: At far distance disconjugacy of the eyes during the saccades and the fixation drift after the saccade was small (5% and 3% of the amplitude of saccade, respectively); these values are similar to those reported in normal children [3]. In contrast, at near distance, binocular coordination of saccades was worst than in normal children: 9% and 5% respectively. Conclusions: Poor binocular coordination of saccades and during fixation could lead to transient double vision at near distance. Based on these results, we predict abnormal binocular coordination of the VOR, but this needs further investigation. Poor binocular coordination of saccades and of the VOR could affect gaze stabilisation leading to vertigo.
References [1] Bucci MR Kapoula Z, Yang Q, Wiener-Vacher S, Br~mondGignac D. Abnormality of vergence latency in children with vertigo. J Neurology 2004; 251:204 213. [2] Bucci MR Kapoula Z, Yang Q, Br~mond-Gignac D, WienerVaccher S. Speed-accuracy of saccades, vergence and combined eye movements in children with vertigo. Exp Brain Res 2004; 157:286 295. [3] Yang Q, Kapoula Z. Binocular coordination of saccades at far and at near in children and in adults. Journal of Vision 2003; 3(8): 554 561.
Results: In the counting condition, the walking speed could be reduced up to 50%, with possible disruption of the linear relationships between stride length/cadence and walking speed. In four out of five children, moreover, math trials were associated with partial correction of kinematic abnormalities typical of the heel-strike gait of HTW (premature heel-off and/or reversal of the second rocker), as well as with a shift of the ankle joint range of motion toward more dorsiflexed value s. Discussion and Conclusion: Result indicate that cognitive factors might contribute to the expression of abnormal gait pattern in a subpopulation of subjects with HTW. This findings might have potential consequences for the diagnosis and treatment of this condition.
References [1] Crenna P. Fedrizzi E., Andreucci E., Frigo C., Bono R. The heel-contact gait pattern of habitual toe walkers. Gait & Posture, published in digital form.
I•.•
S.S. Eun 1 , S. Miyano 1 , C.I. Park 2, E.S. Park 2, J. Chu 3. 1Dept. of Rehabilitation Medicine, Jikei Univ. School of Medicine, Japan," Dept. of Rehabilitation Medicine, Yonsei Univ. College of Medicine, Korea," ORehabilitation Medicine, Hospital of the University of Pennsylvania, USA Introduction: The purpose of this study was to provide objective
information on the outcome of botulinum toxin-A treatment for the detection of abnormal ankle motion in cerebral palsy patients by using three-dimensional motion analysis system. Method: Recruited into the study were thirteen ambulatory cerebral palsy (CP) children ages 2 11 years old. Botulinum toxin A (BTXA) was injected into spastic gastrocnemius muscle of 19 legs (both leg of 6 diplegics and an affected leg of 7 hemiplegics). A clinical assessment and gait analysis were performed on the same day and two weeks after the first injection. Kinematics data were obtained by motion analyzer (Vicon 370 M.A). The smoothness of ankle range of motion (ROM) were quantified by the jerk-cost (JC) function. Before and after treatment comparisons were calculated using Wilcoxon test. Results: The kinematic data showed significant improvements in the active ankle ROM of both groups at two weeks. The smoothness of the ankle motion improved significantly in patients with hemiplegia at two weeks (p < 0.05), however, there were no significant improvements in diplegic CR Discussion: JC function provided useful information for the ankle kinematics as well as ROM. Conclusion: BTX injection improved smoothness in ankle motion in hemiplegic CP more than in diplegic CR
I1~ I1~
Effects of a cognitive task on gait kinematics of habitual toe walkers
P. Crenna, A. Marzegan, L. Salvadori, L. San&in. Laboratory for
Analysis of Movement in Children Pierfranco & Luisa Mariani, Institute of Human Physiology L Faculty of Medicine, University of Milan, via Mangiagalli 32, 1-20133, Milan, Italy Introduction: Habitual Toe Walking (HTW) is a condition whereby
children preferentially adopt a tip-toe gait pattern in the absence of signs of neuro-muscular impairment. In addition to peripheral factors, a contribution from higher level central control has been postulated [1]. The present study was aimed at further testing this hypothesis using a dual task paradigm. Methods: By means of standard gait analysis we studied the effects a cognitive task (counting backwards) on the gait pattern of five school-age children exhibiting facultative toe walking.
The changes of ankle kinematics in children with cerebral palsy between before and after btx-A injection
Measuring hip and knee intra-limb coordination in gait of normal children: implications for children with cerebral palsy
S. Farmer, C. Stewart. Orthotic Research and Locomotor Assessment
Unit, Robert Jones' And Agnes' Hunt Orthopaedic and District NHS Trust, Oswestty, Shropshire, SYI O 7AG, UK Introduction: Normal infants walk independently at about 12 months.
Supported walking and early independent walking show synchronous hip and knee flexion followed by hip and knee extension [1]. As gait matures there is dissociation of this tight synchrony. Children with cerebral palsy often lack this normal intra-limb coordination [2]. We present data of intra-limb coordination (ILC) of normal children as a precursor to work in children with cerebral palsy. Method: A convenience sample of 16 normal children (6 13 years, mean 9.6 years) was recruited. 3-dimensional gait data were collected for 10 walks for each subject. The coefficient of multiple correlation (CMC) was calculated for intra-subject repeatability of hip and knee