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Gait analysis results of split tibialis posterior transfer
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Gait & Posture 1994; 2: NO 1
combined with analysis of limb segment position in the sagittal plane was used to identify gait patterns in 25 non-operated cerebral palsy spastic hemiplegic children. Gait analysis was performed using a Kistler force plate and Vicon motion analysis system. Five gait patterns were identified in single stance: (1) drop foot gait; (2) ‘fixed’ knee and ankle; (3) ‘fixed’ knee, ankle, and hip (triple flexion); (4) knee hyperextension with ankle dorsiflexion; (5) knee hyperextension with no ankle dorsiflexion. A hypothesis of the biomechanical cause of each pattern is presented and the role of surgery and orthotics in the management is discussed.
The energy cost of walking in spina bifida and cerebral palsy: a comparative study C M Du&v, I S Corr)), H K Graham, R A B Mollan
Royal Belfast hospital for Sick Children and Musgrave Park Hospital, Belfast Work already presented from the gait analysis laboratory at Musgrave Park Hospital has shown that the Cosmed K2 system represents a useful tool in the assessment of oxygen uptake in normal children, producing repeatable results consistent with those determined by others using less portable apparatus. It is known that handicapped people have a raised energy consumption for walking. Using the Cosmed system we have studied the oxygen consumption of walking in children with spina bifida (n = 20) and cerebral palsy (n = 12) between the ages of 4 and 14 years. The children were requested to walk at their own usual speed and the distance covered and time taken recorded; from this the speed of walking was calculated. We have found that the rate of oxygen consumption, expressed as ml-’ kg-’ min-’ is consistently and significantly lower in children with spina bifida (range Il.6 20.71 ml-l kg-’ m-l), regardless of the neurosegmental level, than in those with cerebral palsy (range 17.06 42.97 ml- I kg-l mmI) for age-matched children. However, the energy cost of walking, expressed as ml- ’ kg- I I, is comparable for children with cerebral palsy ringe 0.28-1.55 ml-l kg-’ m-l) and low neural-tube defects range (0.22-1.18 ml-l kg-l m-l). It is significantly higher for those with high (i.e. upper lumbar and thoracic) neural-tube defects (range 1.74-3.95 ml-l kg-’ m-l). Children with spina bifida have a reduced aerobic capacity by virtue of their reduced functioning muscle mass. This contributes to their relatively low rate of energy consumption in walking, particularly in those with higher lesions. Furthermore we suggest that children with spina bifida maintain a low rate of energy consumption by reducing their walking speeds (range 1.46-56.1 m-l minmI) but by doing so incur a higher energy cost of walking. This allows them to walk at similar levels of oxygen consumption to non-handicapped children but at greatly increased cost per metre walked. The walking speeds (range 7.8-60 m-l min-I)
and the functional muscle mass of those children with cerebral palsy is generally higher and this is reflected in their greatly increased oxygen consumption rate but more moderate increase in oxygen cost per metre.
Gait analysis results of split tibialis posterior transfer A Kennedy, T O’Brien, A Jenkinson
Gait Laboratory, Dublin 3
Central Remedial Clinic, Clontarf,
Fourteen children with spastic cerebral palsy underwent split tibialis posterior transfer with or without tendo achilles lengthening to correct a mobile equinovarus deformity. The surgical procedure entailed transferring the split portion of the tendon laterally into peroneus brevis. Preoperative and postoperative gait analysis using CODA 3 movement analyser was obtained in all cases. The system utilizes optical scanning techniques to track the motion of markers fixed on the patient. Videorecording with variable speed review was obtained simultaneously. Sagittal and transverse plane kinematics of the ankle and foot were studied and pre- and postoperative results compared. In the sagittal plane, results showed that split tibialis posterior transfer allows improved dorsiflexion in the swing phase of gait. Reduced plantarflexion at terminal stance may be attributable to the concomitant tendo achilles lengthening in the majority of cases. Measurement in the transverse plane was of the lateral angle of the foot to give an indication of the degree of intoeing and out-toeing. Postoperatively the mean value of the lateral angle of the foot was close to normal. The conclusions drawn were that split tibialis posterior transfer is useful in rebalancing on equinovarus foot. It allows improved dorsiflexion in the swing phase. Care should be taken when combining a split tibialis posterior transfer and a tendo achilles lengthening as plantarflexion at terminal stance may be significantly reduced. Normalizing the foot angle may reduce abnormal rotational forces on the leg and the procedure has a very positive cosmetic effect.
Further reading
Bleck EE. Orthopaedic Munagement in Cerehrul P&y. Philadelphia: J.B. Lippincott, 1989 DeLuca PA, The use of gait analysis and dynamic EMG in the assessment of the child with cerebral palsy. Hum Move Sci I99 I ; IO: 543-54 Gage JR. Gait analysis in cerebral palsy. Clin Dev Med 121 Mac Keith Press. Green NE, Griffin PP. Shaiavi R. Split posterior tibia1 tendon transfer in spastic cerebral palsy. J Bone Joint Surg 1983; 65-A(6)
King TE Jr, Kaufer H, Hensinger RN. Split posterior tibia1 tendon transfers in children with cerebral spastic paralysis and equinovarus. J Bone Joint Surg 1985; 67A(2): February
Gait & Posture 1994; 2: NO 1
combined with analysis of limb segment position in the sagittal plane was used to identify gait patterns in 25 non-operated cerebral palsy spastic hemiplegic children. Gait analysis was performed using a Kistler force plate and Vicon motion analysis system. Five gait patterns were identified in single stance: (1) drop foot gait; (2) ‘fixed’ knee and ankle; (3) ‘fixed’ knee, ankle, and hip (triple flexion); (4) knee hyperextension with ankle dorsiflexion; (5) knee hyperextension with no ankle dorsiflexion. A hypothesis of the biomechanical cause of each pattern is presented and the role of surgery and orthotics in the management is discussed.
The energy cost of walking in spina bifida and cerebral palsy: a comparative study C M Du&v, I S Corr)), H K Graham, R A B Mollan
Royal Belfast hospital for Sick Children and Musgrave Park Hospital, Belfast Work already presented from the gait analysis laboratory at Musgrave Park Hospital has shown that the Cosmed K2 system represents a useful tool in the assessment of oxygen uptake in normal children, producing repeatable results consistent with those determined by others using less portable apparatus. It is known that handicapped people have a raised energy consumption for walking. Using the Cosmed system we have studied the oxygen consumption of walking in children with spina bifida (n = 20) and cerebral palsy (n = 12) between the ages of 4 and 14 years. The children were requested to walk at their own usual speed and the distance covered and time taken recorded; from this the speed of walking was calculated. We have found that the rate of oxygen consumption, expressed as ml-’ kg-’ min-’ is consistently and significantly lower in children with spina bifida (range Il.6 20.71 ml-l kg-’ m-l), regardless of the neurosegmental level, than in those with cerebral palsy (range 17.06 42.97 ml- I kg-l mmI) for age-matched children. However, the energy cost of walking, expressed as ml- ’ kg- I I, is comparable for children with cerebral palsy ringe 0.28-1.55 ml-l kg-’ m-l) and low neural-tube defects range (0.22-1.18 ml-l kg-l m-l). It is significantly higher for those with high (i.e. upper lumbar and thoracic) neural-tube defects (range 1.74-3.95 ml-l kg-’ m-l). Children with spina bifida have a reduced aerobic capacity by virtue of their reduced functioning muscle mass. This contributes to their relatively low rate of energy consumption in walking, particularly in those with higher lesions. Furthermore we suggest that children with spina bifida maintain a low rate of energy consumption by reducing their walking speeds (range 1.46-56.1 m-l minmI) but by doing so incur a higher energy cost of walking. This allows them to walk at similar levels of oxygen consumption to non-handicapped children but at greatly increased cost per metre walked. The walking speeds (range 7.8-60 m-l min-I)
and the functional muscle mass of those children with cerebral palsy is generally higher and this is reflected in their greatly increased oxygen consumption rate but more moderate increase in oxygen cost per metre.
Gait analysis results of split tibialis posterior transfer A Kennedy, T O’Brien, A Jenkinson
Gait Laboratory, Dublin 3
Central Remedial Clinic, Clontarf,
Fourteen children with spastic cerebral palsy underwent split tibialis posterior transfer with or without tendo achilles lengthening to correct a mobile equinovarus deformity. The surgical procedure entailed transferring the split portion of the tendon laterally into peroneus brevis. Preoperative and postoperative gait analysis using CODA 3 movement analyser was obtained in all cases. The system utilizes optical scanning techniques to track the motion of markers fixed on the patient. Videorecording with variable speed review was obtained simultaneously. Sagittal and transverse plane kinematics of the ankle and foot were studied and pre- and postoperative results compared. In the sagittal plane, results showed that split tibialis posterior transfer allows improved dorsiflexion in the swing phase of gait. Reduced plantarflexion at terminal stance may be attributable to the concomitant tendo achilles lengthening in the majority of cases. Measurement in the transverse plane was of the lateral angle of the foot to give an indication of the degree of intoeing and out-toeing. Postoperatively the mean value of the lateral angle of the foot was close to normal. The conclusions drawn were that split tibialis posterior transfer is useful in rebalancing on equinovarus foot. It allows improved dorsiflexion in the swing phase. Care should be taken when combining a split tibialis posterior transfer and a tendo achilles lengthening as plantarflexion at terminal stance may be significantly reduced. Normalizing the foot angle may reduce abnormal rotational forces on the leg and the procedure has a very positive cosmetic effect.
Further reading
Bleck EE. Orthopaedic Munagement in Cerehrul P&y. Philadelphia: J.B. Lippincott, 1989 DeLuca PA, The use of gait analysis and dynamic EMG in the assessment of the child with cerebral palsy. Hum Move Sci I99 I ; IO: 543-54 Gage JR. Gait analysis in cerebral palsy. Clin Dev Med 121 Mac Keith Press. Green NE, Griffin PP. Shaiavi R. Split posterior tibia1 tendon transfer in spastic cerebral palsy. J Bone Joint Surg 1983; 65-A(6)
King TE Jr, Kaufer H, Hensinger RN. Split posterior tibia1 tendon transfers in children with cerebral spastic paralysis and equinovarus. J Bone Joint Surg 1985; 67A(2): February