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Comparison of gait with and without shoes in children
168
Abstracts
! Gait & Posture
Resttlti All evaluated gait parameters showed M) signifwnt changes pre and post injection in bemiplegic patients (Group I). Evaluation 6 weeks post injection of dblegic patients (amur, II) shomd a significant i~pmvetnent in all the kinem& pammeters’of;he’ankle angle & sagittal plane: initial contact, max. dorsiflexion in stance and max. dorsiflexion in swing (pre inj. vs. 6 weeks post: p < 0.001). Clinical exambtation shows an improvement in range of motion of ankles and knees and questionnaire (by patents and physical therapists) contirms a benefit in gait in both groups. There is no statistically significant change in the kinematic parameters of hips and knees in the sag&al plane.
7 (1998)
144-190
l&a& At the hip, a minimal decrease in the extensor moment was observed during ted swing in WS gait. An increasein the flexor moment was noted at the knee fmm initial contact to single~limb supFmt while WS. lltere was M imxase in the plantartlexion tnmnent during terminal stance while WS. More power absorption at the ankle occurred at Al while WS. At A2 power gear&an occured earlier in BF gait (Fig. 2). More power generationwas noted at initial contact through the weight xceptawe and less absorption at K3 while WS (Fig. 3). m There WBSa significmt increase in stride length from BF fo WS (+I 1.7&m, p=O.O32). Despite this increase,velocity tined relatively constant due to a decrease in cadencewhile WS.
In both groups the velocity, caden% stride length and duration of stride did not show any significant impmvemcnts pre- and post-injection.
Dhmion In the literature only injections into the gastmcnemius muscles of hemi- and diplegic patients with different dosages are reported. Therefore the effects between both can not be distinguished. Our t&Its show& that there are different effects in hemi- and diplegic calf muscles which may be explained by the different pathologies. While there is only a minimal benefit in the data of group 1,group 11showed a significant improvement post injection. This can be explained by the different muscles, that are mainly responsible for the equinus which is in hemiplegic patients soleus and in diplegic patients the gastroc muscle. Supported by our findings it may be justified to do pre-injection EMG studies and inject the muscles accordingly.
SessionFourteen: Kinematics and Kinetics II Comparison ofGait With and Without Shoes in Children Donna Oeftineer, MS’. Physul Therapy students**, Ramona Hicks, Ph.D**, Chester Tylkowski, MD’; Sam Augsburger, MSME’ ‘Shriners Hospitals for Children, Lexington, Kentucky. 40502 “Unwersity of Kentucky, Division of Physical Therapy, Lexington, Kentucky Introduction Gait analysis is frequently used to evalute the effectiveness of orthoses. It has not been determined if changes in kinematic and temporal spatial data while wearing onhosis are further modified by the shoe. The purpose of this study was to determine if differences exist in kinematic, kinetic, andtemporal-spatial data with and without shoes in ablebodied children. The null hypothesis was that barefoot (BF) gait and gait while wearing shoes (WS) are not of the same population. Methodology Fourteen able-bodied children ages seven to ten with no know musculoskeletal or neurological disease participated in this study. A full bcdy gait analysis, including kinematic, kinetic and temgoml spatial datameasurements BF and WS was collected on each subject. All subjects wore similar athletic shoes. The data collection system was a Motion Analysis Corpaation HiRes ExpertVision system, including 6 HiRes Pulnix cameras and 2 AMTl forceplates. The Cleveland Clinic marker set was wed in conjunction with OnhoT& 2.5 to reduce the data Data was collected until three clean forceplate strikes for each side and for both conditions was achieved. One representative trial fmn each subject was chosen for analysis. Kinematic data was nommlized to 100% of the gait cycle and kinetic data was normalized to body we@. The two data groups were: shoes (n=l2) and BF (n=l4). Statistical comparisons were pafomted between each conditiw using a point by point paired t-test to check for regional differences with significance determined by p < 0.05. A standardt-test with significance set at p < 0.05 was used to analyze temporal-spatial data. Results Kinematics: There was a slight decreasein external mtstion of the foot while WS compmed to BF (Fig. la). A small decreasein knee flexion fmm initial cantact through the weiabt accwtance was seenin WS tit corntared to BF. At th+ ankle, there was a dew&in plr&flexion during weight-accept&, d&g termi~I double limb support and terminal swing. These change8could be attributable to a change in timbtg seen BSa phase shift in the WS curve. The aforementionedevents occurred later in WS gait than BF.
Discussion Due to the very small standard deviations of the data, minimal changes in the magnitude of the curves resulted in statistically sianiiicant differences, vet these channes do not appearto be clinically significant. On this basis we reject the null hypothesis. However, the changes in the temporal-spatial dataneed to be considered. The differences seen in the average tide length could possibly be explainedby the addedweipht of the shoe. An increase in distal t&asshad i pend&m-le&thening effect on the leg, resulting in increased inertia during swing phase and thus an increasein stride length and B decrease in cadence. The results tium this study aressimilar to those of Radtka et al., that found differences in temporal spatial data in chilhm wearing orthosis and shoes competed to BF The increase in stride length was the samefor both studies, suggesting that the changes seen in the orthotic study may beattributable to the shoes and as well as the orthasis. We believe this study establishesthat gait analysis in shoes alone is not necessary and that BF gait analysis is sufficient for clinical studies. However, it is impatant to keep in mind that temporal spatial changes seenwith the addition of orthotics may be partially due to the addition of the shoe. Future studies need to be undertaken to determine what role shws play in studies with shoes and ortboses on temporal spatial data. References Radtka. Set al Physical Therapy, 77:395-409, 1997
Successful and unsuccessful attempts to stand from sitting following traumatic head iojuty. Jack Cmsbie PhD, JeannieLim PT. Anne Moseley PT and Robert Herbert PT School of Physiotherapy. Faculty of Health Sciences, University of Sydney. Australia Introduction Standing up from sitting LSa common motor task of daily Iwing, and frequently the precursor of purposeful ambulation. Many studies have investigated the biomechamcs of standmg up. ptiicularly in healthy subjects. Studiesusing subjects with disabilities are less common, and m no case has there been a repan of trials in which the subject failed to successfully complete the task, yet an investigation of the failed attemptsmight provide the clinician wth a hasis upon which to prescribe treatment. Possiblereasons for failure might include such impediments as inadequatejoint rangeor the failure to generateadequatenet muscle moments at the hip. knee and ankle joints (Ada et al., 1992; Crosbie et al., 1997;Rcdosky et al, 1988) The purpose of this study was to compare successful and unsuccessful attempts to stand up in traumatically head-mnlured(THI) subjects with matched healthy subjects in the light of these variables. Methods Four THI subjects and four matched healthy subjects panlcipated m a three dimensmnal kmematic and kmetic analysis of standing up from sittmg. Subjectssat on a height-adjustable stool which incomomted four load cells. Their feet were placed m a standardizedposition on a par of floor-,&ted force platforms. Sea, he@,, was set at a level at which THI SUbJeCtS would exherience about a tifw percent success rate in performing the activity Each subject was wdeotaped attempting to stand up 20 times. Successful and unsuccessful attempts were categorized on data reduction
1
Abstracts
! Gait & Posture
Resttlti All evaluated gait parameters showed M) signifwnt changes pre and post injection in bemiplegic patients (Group I). Evaluation 6 weeks post injection of dblegic patients (amur, II) shomd a significant i~pmvetnent in all the kinem& pammeters’of;he’ankle angle & sagittal plane: initial contact, max. dorsiflexion in stance and max. dorsiflexion in swing (pre inj. vs. 6 weeks post: p < 0.001). Clinical exambtation shows an improvement in range of motion of ankles and knees and questionnaire (by patents and physical therapists) contirms a benefit in gait in both groups. There is no statistically significant change in the kinematic parameters of hips and knees in the sag&al plane.
7 (1998)
144-190
l&a& At the hip, a minimal decrease in the extensor moment was observed during ted swing in WS gait. An increasein the flexor moment was noted at the knee fmm initial contact to single~limb supFmt while WS. lltere was M imxase in the plantartlexion tnmnent during terminal stance while WS. More power absorption at the ankle occurred at Al while WS. At A2 power gear&an occured earlier in BF gait (Fig. 2). More power generationwas noted at initial contact through the weight xceptawe and less absorption at K3 while WS (Fig. 3). m There WBSa significmt increase in stride length from BF fo WS (+I 1.7&m, p=O.O32). Despite this increase,velocity tined relatively constant due to a decrease in cadencewhile WS.
In both groups the velocity, caden% stride length and duration of stride did not show any significant impmvemcnts pre- and post-injection.
Dhmion In the literature only injections into the gastmcnemius muscles of hemi- and diplegic patients with different dosages are reported. Therefore the effects between both can not be distinguished. Our t&Its show& that there are different effects in hemi- and diplegic calf muscles which may be explained by the different pathologies. While there is only a minimal benefit in the data of group 1,group 11showed a significant improvement post injection. This can be explained by the different muscles, that are mainly responsible for the equinus which is in hemiplegic patients soleus and in diplegic patients the gastroc muscle. Supported by our findings it may be justified to do pre-injection EMG studies and inject the muscles accordingly.
SessionFourteen: Kinematics and Kinetics II Comparison ofGait With and Without Shoes in Children Donna Oeftineer, MS’. Physul Therapy students**, Ramona Hicks, Ph.D**, Chester Tylkowski, MD’; Sam Augsburger, MSME’ ‘Shriners Hospitals for Children, Lexington, Kentucky. 40502 “Unwersity of Kentucky, Division of Physical Therapy, Lexington, Kentucky Introduction Gait analysis is frequently used to evalute the effectiveness of orthoses. It has not been determined if changes in kinematic and temporal spatial data while wearing onhosis are further modified by the shoe. The purpose of this study was to determine if differences exist in kinematic, kinetic, andtemporal-spatial data with and without shoes in ablebodied children. The null hypothesis was that barefoot (BF) gait and gait while wearing shoes (WS) are not of the same population. Methodology Fourteen able-bodied children ages seven to ten with no know musculoskeletal or neurological disease participated in this study. A full bcdy gait analysis, including kinematic, kinetic and temgoml spatial datameasurements BF and WS was collected on each subject. All subjects wore similar athletic shoes. The data collection system was a Motion Analysis Corpaation HiRes ExpertVision system, including 6 HiRes Pulnix cameras and 2 AMTl forceplates. The Cleveland Clinic marker set was wed in conjunction with OnhoT& 2.5 to reduce the data Data was collected until three clean forceplate strikes for each side and for both conditions was achieved. One representative trial fmn each subject was chosen for analysis. Kinematic data was nommlized to 100% of the gait cycle and kinetic data was normalized to body we@. The two data groups were: shoes (n=l2) and BF (n=l4). Statistical comparisons were pafomted between each conditiw using a point by point paired t-test to check for regional differences with significance determined by p < 0.05. A standardt-test with significance set at p < 0.05 was used to analyze temporal-spatial data. Results Kinematics: There was a slight decreasein external mtstion of the foot while WS compmed to BF (Fig. la). A small decreasein knee flexion fmm initial cantact through the weiabt accwtance was seenin WS tit corntared to BF. At th+ ankle, there was a dew&in plr&flexion during weight-accept&, d&g termi~I double limb support and terminal swing. These change8could be attributable to a change in timbtg seen BSa phase shift in the WS curve. The aforementionedevents occurred later in WS gait than BF.
Discussion Due to the very small standard deviations of the data, minimal changes in the magnitude of the curves resulted in statistically sianiiicant differences, vet these channes do not appearto be clinically significant. On this basis we reject the null hypothesis. However, the changes in the temporal-spatial dataneed to be considered. The differences seen in the average tide length could possibly be explainedby the addedweipht of the shoe. An increase in distal t&asshad i pend&m-le&thening effect on the leg, resulting in increased inertia during swing phase and thus an increasein stride length and B decrease in cadence. The results tium this study aressimilar to those of Radtka et al., that found differences in temporal spatial data in chilhm wearing orthosis and shoes competed to BF The increase in stride length was the samefor both studies, suggesting that the changes seen in the orthotic study may beattributable to the shoes and as well as the orthasis. We believe this study establishesthat gait analysis in shoes alone is not necessary and that BF gait analysis is sufficient for clinical studies. However, it is impatant to keep in mind that temporal spatial changes seenwith the addition of orthotics may be partially due to the addition of the shoe. Future studies need to be undertaken to determine what role shws play in studies with shoes and ortboses on temporal spatial data. References Radtka. Set al Physical Therapy, 77:395-409, 1997
Successful and unsuccessful attempts to stand from sitting following traumatic head iojuty. Jack Cmsbie PhD, JeannieLim PT. Anne Moseley PT and Robert Herbert PT School of Physiotherapy. Faculty of Health Sciences, University of Sydney. Australia Introduction Standing up from sitting LSa common motor task of daily Iwing, and frequently the precursor of purposeful ambulation. Many studies have investigated the biomechamcs of standmg up. ptiicularly in healthy subjects. Studiesusing subjects with disabilities are less common, and m no case has there been a repan of trials in which the subject failed to successfully complete the task, yet an investigation of the failed attemptsmight provide the clinician wth a hasis upon which to prescribe treatment. Possiblereasons for failure might include such impediments as inadequatejoint rangeor the failure to generateadequatenet muscle moments at the hip. knee and ankle joints (Ada et al., 1992; Crosbie et al., 1997;Rcdosky et al, 1988) The purpose of this study was to compare successful and unsuccessful attempts to stand up in traumatically head-mnlured(THI) subjects with matched healthy subjects in the light of these variables. Methods Four THI subjects and four matched healthy subjects panlcipated m a three dimensmnal kmematic and kmetic analysis of standing up from sittmg. Subjectssat on a height-adjustable stool which incomomted four load cells. Their feet were placed m a standardizedposition on a par of floor-,&ted force platforms. Sea, he@,, was set at a level at which THI SUbJeCtS would exherience about a tifw percent success rate in performing the activity Each subject was wdeotaped attempting to stand up 20 times. Successful and unsuccessful attempts were categorized on data reduction
1