Assessment of ambulatory potential in children with cerebral palsy

Ah.struc~ts I/) Gait & Posture from differences

in underlying

pathology

or in the detailed

5 (1997)

76-89

77

Discussion

orthotic specification

We conclude that the PCA methodology is able to identify intergroup differences tn variability of gait possibly related to type and severity of spasticity and deviations from normality. Future work with age matched controls will identify the soune of these differences. I.

2.

Darwish, H.Z., Hulliger. M. & Myles. S.T. (1995). Different mechamsm may underlie spasttc diplegic gait. In Proceedings of rhe Annual Scienrific Meering of the European Society for Movement Analysis in Children 4, p. 14. Mah, C.D., Hulliger. M., Lee. R.G. & O’Callaghan. I (1994). Quantitative analysis of human movement synergies: consrmctive pattern analysis for gait. Mom Behavior 26. 83-102.

Joumai of Supported

by NCE Canada

Al! ~~JTTIIROPOi~Oil?:IIC

::iX:LY

J~cobso:~ Central

Reeerrch

Z.S.,

Institute

and Alberta

Heritage Foundation

3'"~‘CTIOJAL Buzhekin

G:~iF;JIAL

for Medical

Research.

aoa

A.P.

of Prosthetics,

:.orcr,

Russie

Introduction In most cases crtificial feet used in pricticpl i:;e rs?roduce insufficiently 0 nw0ber of inportent functions of hurwn feet end in thie connection the Central Reseprch Institute of Prostheiica (GRIP) ABE developed en entilro?onorphic two-link foot approechinz by its functions to P netural foot. Lethods The principal idea inherent in F ne~u foot is breed on tEki,lg into considerations of specific requirmenta needed both for e c~lcaneen foot sectiod ( shock absorption of t heel-strike, strbility when belencing in the frontal plcne excluding the foot subluxation) end for a forefoot ( ed?ptetion to E rough supporting surface for account of resilient lateral end rotational movability, normelization of the body bclence in the frontal plane, F :w.turrl roll-over eppearsnce, potential energy storage et the resilient highly rigid elements during the roll-over the forefoot, en e~propriate push-off from the support). For the purpose of realization of these contrcdictory requirements needed for the ebove-mentioned foot sections there VICE performed their pivoted articulation. lo meet this denand in t!le foot area which coincides in e [email protected] foot with e lon@tudinal arch apex there was pieced a spherical joint admitting 3-D resilient movability of the forefoot in relation to the celoaneen section dorsal flexion - ~‘3 to and the ankle section connected with it* 6-8';pranstion - supination - up to 5-6' in each direction;‘rotation relative to a verticel o:is - up to 4-50 in each direction. The given location of the spherical joint contributes simultaneously to the increase of the foot springy properties that ellows to bear significant verticel 1oRds ( ixluding unforeseen ones) for account of f resilient foot flattening. In addition to the spherical joint there VPS introduced an ankle joint into the foot thet had permitted to prescribe the twolink foot to the patiente with verioui potterns of esit. Results Testings of the two-link feet in procesc 02 their exploitation 'oy the petients es ~11 er con;wretive bio..;ac::wical studies hclve proven the e:-istence of above-mentioned frxtionel advantages of n6ture.l feet. DiSCUSSiOn

THE H.Z. Dan&h’. Alberta University

EFFECT M. Hulliger,

OF CLINICAL CD.

Hospital’, Calgary. of Calgary. Alberta, Canada

Children’s

SPASTICITY

Mah. I. O‘Callaghan and Department RN 4Nl

ON GAIT and A. Wojctechowski

of Clinical

Neurosciences

In defining candidates for selective dorsal rhiwtomy we identify two groups of children based on their clinical neurological examination (1). Patients in group I have classical spasricity with velocity dependent satch responses. but children in group II assume the adducted flexed posture of spastic diplegia only on standing. We have been involved in developing quantitative methods to assess change in gut after selective dorsal rhizotomy (2). The purpose of this pilot study was to see whether we could momtor variability and change in overall gait patterns wnh this methodology. Methods Tbc kmematic gait data were subjected to principal component analysis (PCA) and several cocfftcients were calculated, which represent the scaling and rotation of principal component phase plots and which in turn provide estimates of the degree of deviation of pathological from normal global gait patterns. Results for one scaling coefficient 0) and one other coefficient related to rotation (Cb) are presented here. We also compared measures of gait speed, stride length. and cadence in 4 children with spastic diplegia tn each group. The 8 children were selected for rhclr ability to ambulate independently. ReSUIt.9 The children in group I had a mean calculated speed of 0.85 m/s. whereas group II speed was 0.71 m/s. 7his is a 20% difference. Group II exhibited faster cadences however. which mitigated the effects of a 38% shorter snide length. This result is easily explained on the basis of age and mean calculated stride length. Ca was least variable across SubJects in group II and less variable within subjects in group II. It was closest to the normal reference tn the older children who made up group I. Cb was dramatically variable for either group. and between individual step cycles.

The petient 0-w Lyuba of 7 years old using in above-knee prasthesis with a new foot since October 1995, tells enthusiasticrlly that her artificial leg seems to be her own le& ( it walks ES if it were aa elive one). The girl9 parents report Ebout thair daughter feelings: the foot is adepted precisely to an uneven surface, absorbs well the impacts and provides an easy rollover. These properties were absent in the preceding feet which she used earlier. References: " Prosthetic tile Joint", Int.Cl. A 61 F2/60. I. ;;U;No.I266538 2. Multiaxial Dynamic True ste Journal 1996, Vo E' .B. No.1.

Res onse Foot of %p esthetics p.llA.

end Ankle. The College and Orthotice, JPO.

Park Winter

Session Two ASSESSMENT OF AMBULATORY POTENTlAL IN CHILDREN WITH CEREBRAL PALSY J Ii Patrick FRCS, Consultant Orthopaedic Surgeon, Orthotic Research and Locomotor Assessment Unit (ORLAU), The Robert Jones and Agnes Hunt Orthopaedic nod District Hospital NNS Trust, OSWESTRY, Shropahire. SY 10 7AG

Introductron Clinical exammatmn of quadriplegic Cerebral Palsy chddren pre and post operaron has estabbshed muscle weakness as a potent cause of fadure of surgical treatment in some Recurrence of knee tlexion and hip adduction following hamstring and adductor releases happen If antagomst muscles are very weak pre-operatively leg at MFX Grade 3 or below) Stabibsmg muscle control of the hip Joint m smgle-leg stance IS suspect If hip abduction weakness is found chmcally. requring walkmg ald compensatton Synkinesis durmg quadriceps activity, again Implies poor control. and in the presence of tight knee flexors may well cause a tlexion moment at the knee unopposed by the weaker anterior antagomst

MaterlalandMethods Discussion Quadriplegic Type ‘A’ for 30 selectwe

Cerebral Palsy cases (patients wthout volitional m&s) motor

extra-pyramtdal tendmous agonist

and control

A prognoshc Independent

weakness test sitting

as a cause

of the effects by the age

Cerebral

Palsy

Muscle record the

strength muscle

presence

balance surgically

have been observed

the

lower

Oswestry

limb

the

include loss the presence

Gait

muscle

benefit

Laboramy

groups,

MRC of

scale use ‘equwocal‘ but

(or

IS tested

at the

of I,BVI~Y.

of success ‘9’ patients

same

acrwe muscles

resistance are then

Spasttctty unable

of of

of

for

as passive

IS inexact

Alternatwes

The wooerlv

latter corresponds active aeamst

not

in agontsts &ec@tates susfam optimal ,omt

to

failure)

rlinically

tune

.1I

any serious Antlgravtty walking

be

Sometmes jomt and musculoseldom IS much S~,.ZSS olaced won

is the observatton et al’) for these Type

m Cerebral Palsy IS vanable and actmn as either ‘present’. ‘absent’ with

which oflen

found to contmwx~dv

deformities

problems (Watt

enterrng main

of a contraction

Gait Clinic itmbs when

ditTicult!es in them,

_

of these

of these of2 years

patient

vobtwnal strength in the range testing 8s performed

at Oswestry in the lower

The Ia& have muittple problems as well as tower limbs. abnormal tone.

postural and can be corrected

deformity

muscle

Every

Type ‘5’ tn upper

signs.

examined actwitv

joint

are to

weakness akgnment

for

How

to or

,t

-

long

.-

in antagomsts standing

does

it take to ertnblish a repeatable Neil1 Thompson, Richard Baker Greenprrk Henlthcnre Trust, Belfnst

Introduction Studies

have been

cases

of

abductor

been seen performed

or

quadrtceps

An

dlustratwe on a I2 year

anti-gravllational

case IS demonstrated old quadrtplegic child

onis) tensor

Chnicallv. she was observed to walk fasciae iatae and gluteus medius) was

on the

MRC

It was abductor

recogmred weakness

A s~mdar

have

suggested

that

it can

Those gravity’: ~bmcal

quadrmle)iic m&e; exammauon

,he the

lomt

limited

abduction

of the

Htp the

hips

(to

abductor power were stronger.

adductors

the

further surgical release of the adducrors have caused a hip adductlon postwe again

presence

to grav~tatmnal

hmetlc operatwe

of weakness effect.

testmg), recurrence

Trendelenburg

stance abdtrctmn

IO* (in at 4

and

the

of the

be Part

766.773

we

‘lurch’

s#de adductmn range, may

cained

by the hip

body

was

cause

group

ofthe

care

pre-operntwe

CMT. Grace suil,vors

over

The adductors, rf unstretched No change in hip posture may

and

the

stance-

by a normal be expected

assessmenf

MGA 1989 wtth Cerebral

Early Palsy

prognosis Dev bled

adult

to this the

10 able-bodied

children

have

been

anelysed

m the gait

analysis

laboratory

at Musgrave

Recurrance

deformities.

transfer

an able-bodied

standard dew&n calculated for all [email protected]~ gait analysis at Musgrave Park (Joint angles. ankle and selected temper”-spatial parameters)

A smular laboratory protocols

m stance phase “antican be ldentlfied durutg of deformity (naked-eye,

welyht

for

Method

analysed standard

of the

1 I steps

performed,

ttghten

weakness groups) ebadeoce

may explam the III type ‘B’ cases

of rhe shonen

quadriceps

hamstrings

up to

Few studies have attempted to assess how long child. or have performed this asse%mxnt with used m modern clinical gait analysis

Park Hospital startmg at different points so that they strike the force plates a dS%rent number of steps after initiation of gait It is assumed that a cyclic pattern has been established by the tenth step and IO cycles form this step or greater are averaged and

m the presence of weakness in abductor power A plea is therefore be aware of th,s scenarm In cases of Type ‘8‘ quadrlpleglc Cerebral the acquxltmn of bate, muv+ strength and control following surgical

Watt IM, Robenson neonatal mtcnswe Vol31

#a

Cerebral Palsy patients with a delinate the h,p abductor, or knee extensor When alhed wth C&t Laboratory

adductor stwgerv for cbn,c,ans to the potemtnl for should

with

due

(eg

phase.

,n,ervent,on

/

occurs occur

and 1 dmwnsmnal madence or post

lex emphasnes walkmg hip aRer made Palsy

that the result. would inewtabiy

smtat~on wdl

in stance

with

w adduction-sczssortng found to be 5.

rake

couch testmg releases had

scale

ofcrouch

wdeo l,,gh

control weakness on Two previous adductor

cycle?

_ and

establish a repeatable gait pattern’. takes for an able-bodied or disabled data in the format most commonly Maw

gaii

for ambul~tio” R: Chdd Neural

of

the

to see at which step the deviation for established process was for ,outme are dwussed

conducted clinical

graphs stride

used moments Data

for each 10 stride

on a number appointments

in the standard and powers from earlier

of the vwiation

&disabled The results

parameters

dataset at pelvis, steps was falls

withm

children attending and wnplications for

the

for clinical hip. knee. then the

the gait

analysis