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Oxygen cost during walking in children with arthrogryposis
S22
ESMAC 2012 abstract / Gait & Posture 38 (2013) S1–S116
plantarflexion stiffness. This decrease in stiffness, however, could not be confirmed during gait by increased plantarflexion motion during the first ankle rocker (initial contact to foot flat) contact; plantarflexion motion during the first ankle rocker was found to be unchanged. However, the significantly less maximum ankle power absorption with the SSO versus the SO indicates less energy storage during dorsiflexion in the SSO carbon spring than in the SO. This may also have influenced the significantly lower ankle plantarflexion moment with the SSO versus the SO. All children in the study
groups and the C-group, with the highest in the C-group, and the lowest in AMC 1 (p = 0.009). Walking distance differed between the AMC groups and the C-group, with the shortest distance covered by AMC 1 (p = 0.009). Age group <12 years: There were no children using KAFO-L (AMC group 1). No significant differences were found between the AMC groups and the C-group neither in O2 cost, walking speed, nor in walking distance. O2 cost was higher in AMC 2 than in AMC 3 and the C-group. AMC 3 had higher walking speed and walked longer distance than AMC 2 and the C-group.
chose to continue wearing the SSO, and 8/9 parents reported that their child’s gait improved with the SSO.
O35
Discussion & conclusions: The highest O2 cost was found in children with AMC <12 years walking with KAFO-O or AFO, which may be explained by the heterogeneous representation in hip muscle strength among the children in this group. The children in AMC 1 who had similar good muscle strength in hip extensors but needed more extensive orthotic solutions (KAFO-L) and were totally dependent on orthoses to achieve walking ability, had similar O2 cost compared to the other AMC groups in the same age group. Slowing down the walking speed seems to be a strategy in some of the AMC groups, in particular in the children with KAFO-L.
Oxygen cost during walking in children with arthrogryposis
References
Reference [1] Bartonek Å, et 2007;49:615–20.
al.
Developmental
Medicine
and
Child
Neurology
http://dx.doi.org/10.1016/j.gaitpost.2013.07.047
Marie Eriksson, Li Villard, Åsa Bartonek Karolinska Institutet, Dept of Women’s and Children’s Health, Stockholm, Sweden Introduction: Arthrogryposis Multiplex Congenita (AMC) can be described as a complex condition characterized by deformed joints [1]. To compensate for lower extremity deformities and muscle weakness, orthoses are often used and different gait patterns in children with AMC have been identified [2]. The ambulatory activity level has been reported as lower in children with AMC compared to typical developed youth [3], however, no study on energy consumption has been found. The aim of this study was therefore to measure oxygen (O2) cost in children with AMC during walking. Patients/materials and methods: 21 children with AMC, 5.0–17.0 (median 12.8) years, and a control group (C) consisting of 24 age-matched children, 5.1–16.8 (median 12.2) years participated in the study. A Cosmed K4b2 (Cosmed, Italy) was used to measure O2 cost during walking at self-selected speed during 5 minutes of which the two last minutes were analysed. Children with AMC were divided into three groups based on orthoses use; AMC 1 using knee-ankle-foot orthoses with locked knee joints (KAFO-L), AMC 2 using ankle-foot orthoses (AFO) or KAFOs with open knee joints (KAFO-O) and AMC 3 using footwear. Nonparametric test was used to compare values between the AMC and control groups. Significant differences were determined at the p ≤ 0.05 level. Results: Data is presented in age groups <12 years and >12 years (Fig.) Age group >12 years: With respect to the entire study group, the lowest O2 cost (p < 0.000), the highest walking speed (p = 0.001), and the longest walking distance (p = 0.001) were seen in C-group >12 years. O2 cost was similar in the AMC groups but higher than in the C-group (p = 0.007). Walking speed differed between the AMC
[1] Hall, 1997. [2] Eriksson et al., 2010. [3] Dillon et al., 2009.
http://dx.doi.org/10.1016/j.gaitpost.2013.07.048 O36 Sit to stand movement supported by an active orthosis Julia Block 1 , Stefan Van Drongelen 1 , Daniel W.W. Heitzmann 1 , Roman Müller 2 , Markus Grün 3 , Sebastian I. Wolf 1 1 Heidelberg University Clinics, Department for Orthopedics and Trauma Surgery, Heidelberg, Germany 2 TU Darmstadt, Microtechnology Electromechanical Systems Lab, Darmstadt, Germany 3 TU Darmstadt, Department of Control Engineering and Mechatronics, Darmstadt, Germany
Introduction: An active knee orthosis has been developed for assisting the elderly in challenging ADL-tasks [1] like stair-climbing or sit-to-stand (STS). In contrast to approaches of exo-skeletal devices, this orthosis aims to amplify knee joint moment in the elderly with reduced muscle strength. Aim of this study was to test whether the user profits from the supportive function of the orthosis. A lower EMG-activation during STS was expected due to the supportiv external moment. Patients/materials and methods: One healthy subject was tested with a custom made pair of knee-ankle-foot-orthoses with an actuator attached to the right orthosis. Ten symmetric STS movements at self-selected velocity were performed with feet placed
ESMAC 2012 abstract / Gait & Posture 38 (2013) S1–S116
plantarflexion stiffness. This decrease in stiffness, however, could not be confirmed during gait by increased plantarflexion motion during the first ankle rocker (initial contact to foot flat) contact; plantarflexion motion during the first ankle rocker was found to be unchanged. However, the significantly less maximum ankle power absorption with the SSO versus the SO indicates less energy storage during dorsiflexion in the SSO carbon spring than in the SO. This may also have influenced the significantly lower ankle plantarflexion moment with the SSO versus the SO. All children in the study
groups and the C-group, with the highest in the C-group, and the lowest in AMC 1 (p = 0.009). Walking distance differed between the AMC groups and the C-group, with the shortest distance covered by AMC 1 (p = 0.009). Age group <12 years: There were no children using KAFO-L (AMC group 1). No significant differences were found between the AMC groups and the C-group neither in O2 cost, walking speed, nor in walking distance. O2 cost was higher in AMC 2 than in AMC 3 and the C-group. AMC 3 had higher walking speed and walked longer distance than AMC 2 and the C-group.
chose to continue wearing the SSO, and 8/9 parents reported that their child’s gait improved with the SSO.
O35
Discussion & conclusions: The highest O2 cost was found in children with AMC <12 years walking with KAFO-O or AFO, which may be explained by the heterogeneous representation in hip muscle strength among the children in this group. The children in AMC 1 who had similar good muscle strength in hip extensors but needed more extensive orthotic solutions (KAFO-L) and were totally dependent on orthoses to achieve walking ability, had similar O2 cost compared to the other AMC groups in the same age group. Slowing down the walking speed seems to be a strategy in some of the AMC groups, in particular in the children with KAFO-L.
Oxygen cost during walking in children with arthrogryposis
References
Reference [1] Bartonek Å, et 2007;49:615–20.
al.
Developmental
Medicine
and
Child
Neurology
http://dx.doi.org/10.1016/j.gaitpost.2013.07.047
Marie Eriksson, Li Villard, Åsa Bartonek Karolinska Institutet, Dept of Women’s and Children’s Health, Stockholm, Sweden Introduction: Arthrogryposis Multiplex Congenita (AMC) can be described as a complex condition characterized by deformed joints [1]. To compensate for lower extremity deformities and muscle weakness, orthoses are often used and different gait patterns in children with AMC have been identified [2]. The ambulatory activity level has been reported as lower in children with AMC compared to typical developed youth [3], however, no study on energy consumption has been found. The aim of this study was therefore to measure oxygen (O2) cost in children with AMC during walking. Patients/materials and methods: 21 children with AMC, 5.0–17.0 (median 12.8) years, and a control group (C) consisting of 24 age-matched children, 5.1–16.8 (median 12.2) years participated in the study. A Cosmed K4b2 (Cosmed, Italy) was used to measure O2 cost during walking at self-selected speed during 5 minutes of which the two last minutes were analysed. Children with AMC were divided into three groups based on orthoses use; AMC 1 using knee-ankle-foot orthoses with locked knee joints (KAFO-L), AMC 2 using ankle-foot orthoses (AFO) or KAFOs with open knee joints (KAFO-O) and AMC 3 using footwear. Nonparametric test was used to compare values between the AMC and control groups. Significant differences were determined at the p ≤ 0.05 level. Results: Data is presented in age groups <12 years and >12 years (Fig.) Age group >12 years: With respect to the entire study group, the lowest O2 cost (p < 0.000), the highest walking speed (p = 0.001), and the longest walking distance (p = 0.001) were seen in C-group >12 years. O2 cost was similar in the AMC groups but higher than in the C-group (p = 0.007). Walking speed differed between the AMC
[1] Hall, 1997. [2] Eriksson et al., 2010. [3] Dillon et al., 2009.
http://dx.doi.org/10.1016/j.gaitpost.2013.07.048 O36 Sit to stand movement supported by an active orthosis Julia Block 1 , Stefan Van Drongelen 1 , Daniel W.W. Heitzmann 1 , Roman Müller 2 , Markus Grün 3 , Sebastian I. Wolf 1 1 Heidelberg University Clinics, Department for Orthopedics and Trauma Surgery, Heidelberg, Germany 2 TU Darmstadt, Microtechnology Electromechanical Systems Lab, Darmstadt, Germany 3 TU Darmstadt, Department of Control Engineering and Mechatronics, Darmstadt, Germany
Introduction: An active knee orthosis has been developed for assisting the elderly in challenging ADL-tasks [1] like stair-climbing or sit-to-stand (STS). In contrast to approaches of exo-skeletal devices, this orthosis aims to amplify knee joint moment in the elderly with reduced muscle strength. Aim of this study was to test whether the user profits from the supportive function of the orthosis. A lower EMG-activation during STS was expected due to the supportiv external moment. Patients/materials and methods: One healthy subject was tested with a custom made pair of knee-ankle-foot-orthoses with an actuator attached to the right orthosis. Ten symmetric STS movements at self-selected velocity were performed with feet placed