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Foot and ankle adaptations during gait in children with ACL injury
Abstracts / Gait & Posture 42S (2015) S1–S90
ing to perform TAP surgery in feet with a pre-operative hindfoot misalignment, provided that the misalignment is corrected.
References [1] Wood, et al. J Bone Joint Surg 2008;91(B):69–103. [2] Doets, et al. Foot Ankle Int 2008;28(2):171–7. [3] Schacht, et al. Biometrics 2008;64(4):1110–6.
http://dx.doi.org/10.1016/j.gaitpost.2015.03.075 Foot and ankle adaptations during gait in children with ACL injury Monica E. Ursei 1,∗ , Marino Scandella 2 , Gorka Knorr 1 , Franck Accadbled 1 1
Service d’Orthopédie, Hôpital des Enfants, CHU Toulouse, France 2 Laboratoire d’analyse de la marche, Hôpital des Enfants, CHU Toulouse, France Main topics: Movement analysis in clinical practice; Clinical decision making processes Introduction: ACL injuries are common in adult population, resulting in knee instability, pain and increased risk of knee osteoarthritis. Several studies have demonstrated changes in gait pattern of subjects with this pathology. Once thought to be rare in paediatric population, ACL injury has received increased attention recently. ACL tears are becoming more frequent, as children are more involved in contact sports and better diagnostic techniques (such as MRI) are available. Few studies have examined changes in gait pattern of children with ACL injury and gait adaptations related to this pathology. The purpose of our study is to examine foot and ankle gait compensations in children with symptomatic ACL injury [1,2]. Materials and methods: 42 children (12 girls, 30 boys; mean age 13.4 years [range: 10–17]) with unilateral ACL injury were recruited from Children’s Hospital, Toulouse, France. All of them presented knee pain, different degrees of swelling and knee instability. Diagnosis was confirmed by MRI scan. All the patients with neurological or congenital musculoskeletal condition or previous knee surgery were excluded. Each patient had undergone gait analysis and data were collected using Vicon 460 motion system. We analysed ankle kinematic parameters and foot progression. Comparisons were made between ACL injury patients and the reference normal gait data of our gait laboratory. For gait data, several parameters were measured: ankle position at initial contact, mid stance (25% of gait cycle GC), pre-swing (60% GC) and mid swing (83% GC). Foot progression was measured in stance and in swing. Results: All the patients except one had plantar flexion of the ankle at initial contact (between 2 and 15◦ , mean 4.4◦ ). For 23 (54%) patients ankle dorsiflexion was diminished in mid stance (mean 3.8◦ ) compared to the reference value. Plantar flexion in pre-swing was increased (mean 19.3◦ ) in 38 (90%) patients. Ankle dorsiflexion was diminished in mid swing for 39 (92%) patients – mean 1.8◦ of plantar flexion. All the patients had increased external rotation of the foot both in stance (mean 11.2◦ ) and in swing (mean 16.8◦ ). Discussion and conclusion: During a gait cycle, children with ACL injury have modified ankle kinematics: plantar flexion at initial contact, diminished ankle dorsiflexion in stance and increased plantar flexion in pre-swing. All the patients walked with increased external rotation on the foot and decreased ankle dorsiflexion in swing. Modified kinematics seems to be an adaptation to avoid knee instability.
S41
References [1] Edward MW, Ashley M. Brower-anterior cruciate ligament injuries in the prepubescent and adolescent athlete. J Athl Train 2010;45(September–October (5)):509–12. [2] Tamires LT, et al. Compliant surface after ACL reconstruction and its effects on gait. Acta Sci 2013;35(July–December):237–42.
http://dx.doi.org/10.1016/j.gaitpost.2015.03.076 Uni- and bimanual goal-directed arm movement organization in children at 6–9 years: Effects of a preterm birth C. Dahlström ∗ , M. Nygård, E. Domellöf, A.-M. Johansson, L. Rönnqvist Department of Psychology, Umeå University, Umeå, Sweden Main topics: Analysis of clinical movement data; Motor control and motor learning Introduction and aim: Psychomotor deficits are more commonly reported among children born preterm (PT) than those born full-term (FT). Further, evidence exists for more covert motor problems in children born preterm at school age [1]. Such findings may be associated with a more immature spatio-temporal model of movements and lower cognitive functioning in children born PT than FT [2]. The main aim of this study was to investigate the effects of gestational age (GA) on uni- and bimanual goal-directed arm movement organization and on cognitive functioning in children at school age. Patients/materials and methods: Participants consisted of 88 children between 6 and 9 years of age (M = 7.7 years; 40 PT, 19 girls; 48 FT, 22 girls) without known developmental delays or deviations. Children born PT were divided into two subgroups: moderately PT (M-PT), 34–36 weeks’ gestation (GW), and very PT (V-PT), <34 GW. Movement kinematics was examined during performance of a goaldirected task, where the participants pushed three buttons in a sequential order in two different directions (vertical or horizontal) with either the right or left hand (unimanual) and with both hands simultaneously (bimanual). Movements were recorded by a 6-camera movement registration system (240 Hz, ProReflex) and the number of movement units (MUs) was derived from head, shoulders, elbow, and wrist movement velocity profiles. Cognitive function in terms of verbal IQ (VIQ) and full scale IQ (FSIQ) was measured by the Wechsler Intelligence Scale for Children, 4th edition (WISC-IV). Results: Overall, a significant difference between the groups regarding number of MUs and FSIQ was found. In general, children born V-PT showed more MUs compared with the FT and M-PT group. Regardless of group, a significant higher amount of MUs was found in the bimanual condition than in the unimanual, and during horizontal movement performance in comparison with vertical. Furthermore, GA was significant negatively correlated with number of MUs for right and left wrist and right elbow, and also with FSIQ. Discussion and conclusions: These findings suggest that lower GAs are associated with both more segmented goal-directed arm movements as well as with lower general cognitive ability. During the more demanding tasks, i.e., bimanual and horizontal movements, this association became particularly evident, where the children born V-PT exhibited the greatest difficulties. Thus, this indicate immature spatio-temporal movement organization as a long-lasting effect of risk factors associated with a preterm birth, specifically for children born V-PT, that may be related to lower cognitive function. Further, limitations in kinematic degrees of free-
ing to perform TAP surgery in feet with a pre-operative hindfoot misalignment, provided that the misalignment is corrected.
References [1] Wood, et al. J Bone Joint Surg 2008;91(B):69–103. [2] Doets, et al. Foot Ankle Int 2008;28(2):171–7. [3] Schacht, et al. Biometrics 2008;64(4):1110–6.
http://dx.doi.org/10.1016/j.gaitpost.2015.03.075 Foot and ankle adaptations during gait in children with ACL injury Monica E. Ursei 1,∗ , Marino Scandella 2 , Gorka Knorr 1 , Franck Accadbled 1 1
Service d’Orthopédie, Hôpital des Enfants, CHU Toulouse, France 2 Laboratoire d’analyse de la marche, Hôpital des Enfants, CHU Toulouse, France Main topics: Movement analysis in clinical practice; Clinical decision making processes Introduction: ACL injuries are common in adult population, resulting in knee instability, pain and increased risk of knee osteoarthritis. Several studies have demonstrated changes in gait pattern of subjects with this pathology. Once thought to be rare in paediatric population, ACL injury has received increased attention recently. ACL tears are becoming more frequent, as children are more involved in contact sports and better diagnostic techniques (such as MRI) are available. Few studies have examined changes in gait pattern of children with ACL injury and gait adaptations related to this pathology. The purpose of our study is to examine foot and ankle gait compensations in children with symptomatic ACL injury [1,2]. Materials and methods: 42 children (12 girls, 30 boys; mean age 13.4 years [range: 10–17]) with unilateral ACL injury were recruited from Children’s Hospital, Toulouse, France. All of them presented knee pain, different degrees of swelling and knee instability. Diagnosis was confirmed by MRI scan. All the patients with neurological or congenital musculoskeletal condition or previous knee surgery were excluded. Each patient had undergone gait analysis and data were collected using Vicon 460 motion system. We analysed ankle kinematic parameters and foot progression. Comparisons were made between ACL injury patients and the reference normal gait data of our gait laboratory. For gait data, several parameters were measured: ankle position at initial contact, mid stance (25% of gait cycle GC), pre-swing (60% GC) and mid swing (83% GC). Foot progression was measured in stance and in swing. Results: All the patients except one had plantar flexion of the ankle at initial contact (between 2 and 15◦ , mean 4.4◦ ). For 23 (54%) patients ankle dorsiflexion was diminished in mid stance (mean 3.8◦ ) compared to the reference value. Plantar flexion in pre-swing was increased (mean 19.3◦ ) in 38 (90%) patients. Ankle dorsiflexion was diminished in mid swing for 39 (92%) patients – mean 1.8◦ of plantar flexion. All the patients had increased external rotation of the foot both in stance (mean 11.2◦ ) and in swing (mean 16.8◦ ). Discussion and conclusion: During a gait cycle, children with ACL injury have modified ankle kinematics: plantar flexion at initial contact, diminished ankle dorsiflexion in stance and increased plantar flexion in pre-swing. All the patients walked with increased external rotation on the foot and decreased ankle dorsiflexion in swing. Modified kinematics seems to be an adaptation to avoid knee instability.
S41
References [1] Edward MW, Ashley M. Brower-anterior cruciate ligament injuries in the prepubescent and adolescent athlete. J Athl Train 2010;45(September–October (5)):509–12. [2] Tamires LT, et al. Compliant surface after ACL reconstruction and its effects on gait. Acta Sci 2013;35(July–December):237–42.
http://dx.doi.org/10.1016/j.gaitpost.2015.03.076 Uni- and bimanual goal-directed arm movement organization in children at 6–9 years: Effects of a preterm birth C. Dahlström ∗ , M. Nygård, E. Domellöf, A.-M. Johansson, L. Rönnqvist Department of Psychology, Umeå University, Umeå, Sweden Main topics: Analysis of clinical movement data; Motor control and motor learning Introduction and aim: Psychomotor deficits are more commonly reported among children born preterm (PT) than those born full-term (FT). Further, evidence exists for more covert motor problems in children born preterm at school age [1]. Such findings may be associated with a more immature spatio-temporal model of movements and lower cognitive functioning in children born PT than FT [2]. The main aim of this study was to investigate the effects of gestational age (GA) on uni- and bimanual goal-directed arm movement organization and on cognitive functioning in children at school age. Patients/materials and methods: Participants consisted of 88 children between 6 and 9 years of age (M = 7.7 years; 40 PT, 19 girls; 48 FT, 22 girls) without known developmental delays or deviations. Children born PT were divided into two subgroups: moderately PT (M-PT), 34–36 weeks’ gestation (GW), and very PT (V-PT), <34 GW. Movement kinematics was examined during performance of a goaldirected task, where the participants pushed three buttons in a sequential order in two different directions (vertical or horizontal) with either the right or left hand (unimanual) and with both hands simultaneously (bimanual). Movements were recorded by a 6-camera movement registration system (240 Hz, ProReflex) and the number of movement units (MUs) was derived from head, shoulders, elbow, and wrist movement velocity profiles. Cognitive function in terms of verbal IQ (VIQ) and full scale IQ (FSIQ) was measured by the Wechsler Intelligence Scale for Children, 4th edition (WISC-IV). Results: Overall, a significant difference between the groups regarding number of MUs and FSIQ was found. In general, children born V-PT showed more MUs compared with the FT and M-PT group. Regardless of group, a significant higher amount of MUs was found in the bimanual condition than in the unimanual, and during horizontal movement performance in comparison with vertical. Furthermore, GA was significant negatively correlated with number of MUs for right and left wrist and right elbow, and also with FSIQ. Discussion and conclusions: These findings suggest that lower GAs are associated with both more segmented goal-directed arm movements as well as with lower general cognitive ability. During the more demanding tasks, i.e., bimanual and horizontal movements, this association became particularly evident, where the children born V-PT exhibited the greatest difficulties. Thus, this indicate immature spatio-temporal movement organization as a long-lasting effect of risk factors associated with a preterm birth, specifically for children born V-PT, that may be related to lower cognitive function. Further, limitations in kinematic degrees of free-