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Gait problems in children and adolescents with Guillain–Barre syndrome. Preliminary results
Gait & Posture 49S (2016) 188
Contents lists available at ScienceDirect
Gait & Posture journal homepage: www.elsevier.com/locate/gaitpost
P48 presented in PS02: Poster teaser: Children (non-CP)
Gait problems in children and adolescents with Guillain–Barre syndrome. Preliminary results Anna Swiecicka, Ewa Szczerbik, Dorota Dunin-Wasowicz, Malgorzata Kalinowska, Malgorzata Syczewska * The Children’s Memorial Health Institute, Warszawa, Poland
Introduction: Guillain–Barre´ syndrome (GBS) is a rapid-onset disease caused by the immune system damaging the peripheral nervous system (myelin insulation). Symptoms usually comprise muscle weakness of legs and arms, pain, sometimes neck and respiratory muscles are also involved. Patients experience also changes in gait pattern. In most cases immunotherapy gives good results, and patients restore [1_TD$IF]with time muscle strength and their gait pattern is improved, although quite often they need rehabilitation treatment. Research question: The aim of the work was to assess the gait problems of GBS paediatric patients. If they have similar changes in the gait pattern a standard rehabilitation protocol can be designed in the future to help them faster regain better [2_TD$IF]functional status. Methods: Fourteen patients (10 boys, 4 girls) aged 2–15.5 years old who were treated in Dept. Neurology due to GBS were evaluated. Part of the clinical assessment was gait analysis, performed after the acute phase of the GBS was over. Gait analysis was performed using 12-cameraVICON MX system with Nexus, and surface Motion Lab EMG system. Six trials were recorded for all patients, data were processed using Polygon software. Spatiotemporal data were normalized to aged and sex reference data. Muscle strength was assessed clinically in all patients. Results: In all patients the gait speed and cadence were decreased, to 60%, and 74% respectively (median values for the group). Step length was decreased to 80%. While stance phase was slightly increased in these patients (107% of the normal value), the single stance was diminished (88%). Only 3 patients had proper pelvic tilt,[3_TD$IF] with no obliquity and rotation. Most patients had decreased hip range of motion in sagittal plane, and increased hip extension in stance phase. In patients with marked reduction of hip flexion in swing phase there was decreased activity of rectus femoris seen in EMG. Most patients demonstrated knee hyperextension in
* Corresponding author. E-mail address: [email protected] (M. Syczewska). http://dx.doi.org/10.1016/j.gaitpost.2016.07.242 0966-6362/
the stance phase and limited flexion in swing phase. The plantarflexion in swing phase was accompanied by decreased activity of tibialis anterior. All patients had decreased plantarflexion at the end of the stance phase. There were no differences between left and right side. The muscle strength was between 3+ and 4 in case of muscles around pelvis and 4 to 4+ in case of leg muscles. Discussion: Data from the literature show, that 65% of GBS patients do not restore their functional status from the past (i.e. before onset of GBS) [1]. Some data suggest, that young age and fast progression of GBS predispose for permanent motor deficits [2]. Therefore rehabilitation treatment should be introduced as soon as possible to facilitate their recovery. Our results show, that GBS patients exhibit marked changes of the gait pattern, although all of them were past the acute phase of the disease. These changes suggest muscular weakness (decreased hip range of motion, decreased plantarflexion at the end of the stance phase, and plantarflexion at the end of the swing phase), although in clinical evaluation the muscle strength seems sufficient for gait. Another possibility of such changed gait pattern is partial deprivation or dysfunction of the proprioception due to GBS. For this reason points the fact, that in GBS patients who were training sport before the onset of the illness the functional deficits were much smaller than in patients who were less active. The shortcoming of this study is low number of participants due to low number of patients suffering from GBS in young age. References [1] Davidson I, Wilson Ch, Walton T, et al. Physiotherapy and Guillain–Barre syndrome: results of a national survey. Physiotherapy 2009;95:157–63. [2] Vajsar J, Fehlings D, Stephrns D. Long-term outcome in children with Guillain– Barre syndrome. J. Pediatr. 2003;142:305–9.
Contents lists available at ScienceDirect
Gait & Posture journal homepage: www.elsevier.com/locate/gaitpost
P48 presented in PS02: Poster teaser: Children (non-CP)
Gait problems in children and adolescents with Guillain–Barre syndrome. Preliminary results Anna Swiecicka, Ewa Szczerbik, Dorota Dunin-Wasowicz, Malgorzata Kalinowska, Malgorzata Syczewska * The Children’s Memorial Health Institute, Warszawa, Poland
Introduction: Guillain–Barre´ syndrome (GBS) is a rapid-onset disease caused by the immune system damaging the peripheral nervous system (myelin insulation). Symptoms usually comprise muscle weakness of legs and arms, pain, sometimes neck and respiratory muscles are also involved. Patients experience also changes in gait pattern. In most cases immunotherapy gives good results, and patients restore [1_TD$IF]with time muscle strength and their gait pattern is improved, although quite often they need rehabilitation treatment. Research question: The aim of the work was to assess the gait problems of GBS paediatric patients. If they have similar changes in the gait pattern a standard rehabilitation protocol can be designed in the future to help them faster regain better [2_TD$IF]functional status. Methods: Fourteen patients (10 boys, 4 girls) aged 2–15.5 years old who were treated in Dept. Neurology due to GBS were evaluated. Part of the clinical assessment was gait analysis, performed after the acute phase of the GBS was over. Gait analysis was performed using 12-cameraVICON MX system with Nexus, and surface Motion Lab EMG system. Six trials were recorded for all patients, data were processed using Polygon software. Spatiotemporal data were normalized to aged and sex reference data. Muscle strength was assessed clinically in all patients. Results: In all patients the gait speed and cadence were decreased, to 60%, and 74% respectively (median values for the group). Step length was decreased to 80%. While stance phase was slightly increased in these patients (107% of the normal value), the single stance was diminished (88%). Only 3 patients had proper pelvic tilt,[3_TD$IF] with no obliquity and rotation. Most patients had decreased hip range of motion in sagittal plane, and increased hip extension in stance phase. In patients with marked reduction of hip flexion in swing phase there was decreased activity of rectus femoris seen in EMG. Most patients demonstrated knee hyperextension in
* Corresponding author. E-mail address: [email protected] (M. Syczewska). http://dx.doi.org/10.1016/j.gaitpost.2016.07.242 0966-6362/
the stance phase and limited flexion in swing phase. The plantarflexion in swing phase was accompanied by decreased activity of tibialis anterior. All patients had decreased plantarflexion at the end of the stance phase. There were no differences between left and right side. The muscle strength was between 3+ and 4 in case of muscles around pelvis and 4 to 4+ in case of leg muscles. Discussion: Data from the literature show, that 65% of GBS patients do not restore their functional status from the past (i.e. before onset of GBS) [1]. Some data suggest, that young age and fast progression of GBS predispose for permanent motor deficits [2]. Therefore rehabilitation treatment should be introduced as soon as possible to facilitate their recovery. Our results show, that GBS patients exhibit marked changes of the gait pattern, although all of them were past the acute phase of the disease. These changes suggest muscular weakness (decreased hip range of motion, decreased plantarflexion at the end of the stance phase, and plantarflexion at the end of the swing phase), although in clinical evaluation the muscle strength seems sufficient for gait. Another possibility of such changed gait pattern is partial deprivation or dysfunction of the proprioception due to GBS. For this reason points the fact, that in GBS patients who were training sport before the onset of the illness the functional deficits were much smaller than in patients who were less active. The shortcoming of this study is low number of participants due to low number of patients suffering from GBS in young age. References [1] Davidson I, Wilson Ch, Walton T, et al. Physiotherapy and Guillain–Barre syndrome: results of a national survey. Physiotherapy 2009;95:157–63. [2] Vajsar J, Fehlings D, Stephrns D. Long-term outcome in children with Guillain– Barre syndrome. J. Pediatr. 2003;142:305–9.