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Kinematic effects of sensorimotor timing training in children with diplegic cerebral palsy
S88
Abstracts / Gait & Posture 39S (2014) S1–S141
P04 Kinematic effects of sensorimotor timing training in children with diplegic cerebral palsy Anna-Maria Johansson 1,∗ , Erik Domellöf 1,2 , Louise Rönnqvist 1 1
Department of Psychology, Umeå University, Umeå, Sweden 2 Kolbäcken Child Rehabilitation Centre, Umeå, Sweden Introduction and aim: The objective of the present study was to explore the individual effects of sensorimotor timing training with the Interactive Metronome© (IM) in young individuals with spastic diplegic cerebral palsy (DCP). IM is a multi-modal integration training method where the goal is to synchronize rhythmic movement activation with a beat. To this end, error feedback is provided via auditory and visual cues. One previous case study has shown positive effects on upper-limb kinematics of IM training in children with hemiplegic CP [1]. However, there is a need for extended scientific evaluation of the effects of existing training methods for children with CP of various types and severity. In the present study 3D movement registration technique was used to objectively evaluate training effects on goal-directed upper-limb movements. Patients/materials and methods: Participants comprised three children with spastic DCP (two boys; one girl, age range: 12–16 years). The score on the Manual Ability Classification System was II, IV, and III and the Gross Motor Function Classification System score was III, IV, and IV for cases I–III, respectively. The spasticity severely affected arm function in cases II and III. All cases were diagnosed with intellectual disability and other comorbidities were diagnoses of autism, epilepsy, cortical visual impairment, strabismus, dysarthria, asthma and scoliosis. IM training consisted of a four week (12 sessions) individually customised program including bilateral and unilateral movements of the arms and hands. To establish short- and long-term effects, goaldirected upper-limb movements were examined by the use of a 6-camera optoelectronic recording system (240 Hz, ProReflex, Qualisys Inc.) at three time points, before and at two following occasions after the IM training (post-test I, one week after completed training; post-test II, six months after post-test I). The goal-directed evaluation task consisted of pushing three buttons in a sequential order in four different directions (extension–flexion; flexion–extension; adduction–abduction; abduction–adduction). The following parameters were derived from the wrist marker; movement duration (time needed to complete the task), segmentation of the movement trajectory (number of movement units), and 3D distance. Results: The intra- as well as the inter-individual variability of IM effects were large. Case I showed some improvement in timing ability with auditory error feedback at post-test I as measured by the IM equipment. Self-phased timing was not improved. Cases II and III showed no apparent improvement in timing ability. For case I, the 3D analyses of the movement trajectories during the evaluation task, showed great inconsistency with no systematic improvements at both post-test occasions. However, Case II and III improved significantly as characterized by decreased duration at post-test I. This improvement remained at post-test II. Further, the segmentations of the wrist movement trajectory in terms of the number of movement units significantly decreased at post-test I. This finding was also stable at post-test II. Few changes were detected on the 3D distance for either case. Discussion and conclusions: No substantial improvement was shown on timing ability for any of the cases, possibly due to task
constraints inflicted by the severity of the CP in these children. However, the training did result in faster and smoother movements for cases II and III. The effect appeared to mainly affect temporal aspects and remained at six month follow up. For these cases, the results suggest improved motor planning and control of goal-directed upper-limb actions. Case I showed no improvements, possibly due to the complexity of comorbidity including diagnoses of autism and intellectual disability. Thus, IM appears to be a feasible and promising method to improve movement control in some children diagnosed with severe types of CP. However, future studies should include outcome measures pertaining to attention as the IM encompasses high attentional demand.
Reference [1] Johansson A-M, Domellöf E, Rönnqvist L. Short- and long-term effects of synchronized metronome training in children with hemiplegic cerebral palsy: a two case study. Dev Neurorehabil 2012;15(2):160–9, http://dx.doi.org/10.3109/17518423.2011.635608.
http://dx.doi.org/10.1016/j.gaitpost.2014.04.121 P05 Functional results of patients with lower limb injures after polytrauma Z. Pavare 1,2,3,∗ , A. Smolovs 3 , R. Jakusonoka 1 , A. Jumtins 1 , T. Ananjeva 2,3 , A. Vetra 2 1 Department of Orthopedic Surgery, Riga Stradins University, Latvia 2 Rehabilitation Research Laboratory, Riga Stradins University, Latvia 3 National Rehabilitation Centre “Vaivari”, Jurmala, Latvia
Introduction and aim: The functional recovery is an important process for patients after trauma. Polytrauma is defined as a syndrome of multiple injuries of certain severity (Injury Severity Score (ISS) > 16) with consecutive systemic reactions which may lead to dysfunction of remote organs [1]. Since ISS does not provide unbiased information about the amount of work and resources that are required if a patient has serious multiple injuries in one of the ISS anatomic regions, particularly orthopaedic injuries, New Injury Severity Score (NISS) values were used to evaluate the severity of polytrauma injuries [2]. The purpose of this study is to analyze functional results of polytrauma patients with lower limb injury consequences. In order to assess the functional results of polytrauma patients with lower limb injuries a clinical examination and an instrumented 3-dimensional gait analysis (3DGA) were used. Patients/materials and methods: The study was conducted on 34 polytrauma patients (17 women and 17 men; age range 23–59, mean age 39 years) 12–41 months after the polytrauma, ISS 9–50, mean ISS value 20.5; NISS 17–50, mean NISS value 25.9. Clinical and 3DGA data were compared with healthy control group of 32 healthy volunteers (23 women and nine men; age range 19–65, mean age 35.9 years). 3DGA was performed using six Qualisys (Sweden) ProReflex MCU (240 Hz) cameras and the AMTI (USA) force plate. Results: The results of the study show that polytrauma patients had decreased range of motion and muscle strength in hip, knee, ankle and subtalar joint of the injured side (p < 0.05). In 3DGA an increased stance time, a pelvic anterior tilt, a decreased extension in the hip joint, a maximum flexion in the knee joint, a vertical load of ground reaction force (GRF), step length and cadence in the injured side were found (p < 0.05). Also
Abstracts / Gait & Posture 39S (2014) S1–S141
P04 Kinematic effects of sensorimotor timing training in children with diplegic cerebral palsy Anna-Maria Johansson 1,∗ , Erik Domellöf 1,2 , Louise Rönnqvist 1 1
Department of Psychology, Umeå University, Umeå, Sweden 2 Kolbäcken Child Rehabilitation Centre, Umeå, Sweden Introduction and aim: The objective of the present study was to explore the individual effects of sensorimotor timing training with the Interactive Metronome© (IM) in young individuals with spastic diplegic cerebral palsy (DCP). IM is a multi-modal integration training method where the goal is to synchronize rhythmic movement activation with a beat. To this end, error feedback is provided via auditory and visual cues. One previous case study has shown positive effects on upper-limb kinematics of IM training in children with hemiplegic CP [1]. However, there is a need for extended scientific evaluation of the effects of existing training methods for children with CP of various types and severity. In the present study 3D movement registration technique was used to objectively evaluate training effects on goal-directed upper-limb movements. Patients/materials and methods: Participants comprised three children with spastic DCP (two boys; one girl, age range: 12–16 years). The score on the Manual Ability Classification System was II, IV, and III and the Gross Motor Function Classification System score was III, IV, and IV for cases I–III, respectively. The spasticity severely affected arm function in cases II and III. All cases were diagnosed with intellectual disability and other comorbidities were diagnoses of autism, epilepsy, cortical visual impairment, strabismus, dysarthria, asthma and scoliosis. IM training consisted of a four week (12 sessions) individually customised program including bilateral and unilateral movements of the arms and hands. To establish short- and long-term effects, goaldirected upper-limb movements were examined by the use of a 6-camera optoelectronic recording system (240 Hz, ProReflex, Qualisys Inc.) at three time points, before and at two following occasions after the IM training (post-test I, one week after completed training; post-test II, six months after post-test I). The goal-directed evaluation task consisted of pushing three buttons in a sequential order in four different directions (extension–flexion; flexion–extension; adduction–abduction; abduction–adduction). The following parameters were derived from the wrist marker; movement duration (time needed to complete the task), segmentation of the movement trajectory (number of movement units), and 3D distance. Results: The intra- as well as the inter-individual variability of IM effects were large. Case I showed some improvement in timing ability with auditory error feedback at post-test I as measured by the IM equipment. Self-phased timing was not improved. Cases II and III showed no apparent improvement in timing ability. For case I, the 3D analyses of the movement trajectories during the evaluation task, showed great inconsistency with no systematic improvements at both post-test occasions. However, Case II and III improved significantly as characterized by decreased duration at post-test I. This improvement remained at post-test II. Further, the segmentations of the wrist movement trajectory in terms of the number of movement units significantly decreased at post-test I. This finding was also stable at post-test II. Few changes were detected on the 3D distance for either case. Discussion and conclusions: No substantial improvement was shown on timing ability for any of the cases, possibly due to task
constraints inflicted by the severity of the CP in these children. However, the training did result in faster and smoother movements for cases II and III. The effect appeared to mainly affect temporal aspects and remained at six month follow up. For these cases, the results suggest improved motor planning and control of goal-directed upper-limb actions. Case I showed no improvements, possibly due to the complexity of comorbidity including diagnoses of autism and intellectual disability. Thus, IM appears to be a feasible and promising method to improve movement control in some children diagnosed with severe types of CP. However, future studies should include outcome measures pertaining to attention as the IM encompasses high attentional demand.
Reference [1] Johansson A-M, Domellöf E, Rönnqvist L. Short- and long-term effects of synchronized metronome training in children with hemiplegic cerebral palsy: a two case study. Dev Neurorehabil 2012;15(2):160–9, http://dx.doi.org/10.3109/17518423.2011.635608.
http://dx.doi.org/10.1016/j.gaitpost.2014.04.121 P05 Functional results of patients with lower limb injures after polytrauma Z. Pavare 1,2,3,∗ , A. Smolovs 3 , R. Jakusonoka 1 , A. Jumtins 1 , T. Ananjeva 2,3 , A. Vetra 2 1 Department of Orthopedic Surgery, Riga Stradins University, Latvia 2 Rehabilitation Research Laboratory, Riga Stradins University, Latvia 3 National Rehabilitation Centre “Vaivari”, Jurmala, Latvia
Introduction and aim: The functional recovery is an important process for patients after trauma. Polytrauma is defined as a syndrome of multiple injuries of certain severity (Injury Severity Score (ISS) > 16) with consecutive systemic reactions which may lead to dysfunction of remote organs [1]. Since ISS does not provide unbiased information about the amount of work and resources that are required if a patient has serious multiple injuries in one of the ISS anatomic regions, particularly orthopaedic injuries, New Injury Severity Score (NISS) values were used to evaluate the severity of polytrauma injuries [2]. The purpose of this study is to analyze functional results of polytrauma patients with lower limb injury consequences. In order to assess the functional results of polytrauma patients with lower limb injuries a clinical examination and an instrumented 3-dimensional gait analysis (3DGA) were used. Patients/materials and methods: The study was conducted on 34 polytrauma patients (17 women and 17 men; age range 23–59, mean age 39 years) 12–41 months after the polytrauma, ISS 9–50, mean ISS value 20.5; NISS 17–50, mean NISS value 25.9. Clinical and 3DGA data were compared with healthy control group of 32 healthy volunteers (23 women and nine men; age range 19–65, mean age 35.9 years). 3DGA was performed using six Qualisys (Sweden) ProReflex MCU (240 Hz) cameras and the AMTI (USA) force plate. Results: The results of the study show that polytrauma patients had decreased range of motion and muscle strength in hip, knee, ankle and subtalar joint of the injured side (p < 0.05). In 3DGA an increased stance time, a pelvic anterior tilt, a decreased extension in the hip joint, a maximum flexion in the knee joint, a vertical load of ground reaction force (GRF), step length and cadence in the injured side were found (p < 0.05). Also