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Pathological gait of patients with musculoskeletal injuries after polytrauma
Abstracts / Gait & Posture 36 (2012) S1–S101
SCP child, when the footplate was dorsal flexed by 19◦ , the angle between footplate and talo-calcaneus complex decreased by 7.5◦ (not shown). This relative plantar flexion of talo-calcaneus complex constitutes 39% of dorsal rotation of the footplate. For comparison, in the TD adult, when the footplate was dorsal flexed by 23◦ , the angle between footplate and talo-calcaneus complex decreased by 2◦ (i.e. 9% of dorsal rotation of the footplate, not shown).
Discussion and conclusion: X-ray imaging shows that during dynamometry measurements of foot and ankle of a child with SCP, compared to a TD adult, foot deformities, and especially the orientation of the calcaneus within the sagittal plane, gives a biased view on the relation between footsole and the TS length. In loaded conditions this foot deformity gets even more pronounced. These results are important to consider when TS function is concluded from footsole orientation, like in common gait analysis and physical examination. Disclosure: No significant relationships.
References
S85
Results: There is a correlation between the excursion of COP to the right or left side, and higher activity of TB on the homolateral side, within unexpected posterior platform translation (r = 0.76). Discussion and conclusion: Movements of the upper limbs during bipedal locomotion are induced by the pripriospinal neuronal linkage of the cervical and thoracolumbar spinal cord [3]. TB is active during a fast gait and is manifested through the extension
of the upper limb within the swing phase of ipsilateral lower limb [4]. To follow our results, TB is also active during postural reactions to prevent falls. Supposedly, the propriospinal circuits of the upper and lower limbs are also active in situations requiring balance. The findings showed postural asymmetries in healthy subjects during balance reactions due to the preferential positioning of their COP to the left or right side (independent of lower limb dominance). We conclude that the excursion of COP in the mediolateral direction during the translation of the platform is related to increased activity of homolateral TB. These results may assist in further understanding motor control mechanisms. Disclosure: No significant relationships. Acknowledgements: This research was supported by IGA UP FTK2011-11 “Interlimb coordination in lower limb amputees”.
[1] Bénard, et al. Clin Biomech 2010;25:802–8. [2] Tardieu, et al. Eur J Appl Physiol Occup Physiol 1977;37:153–61.
References doi:10.1016/j.gaitpost.2011.10.325 P54 Activity of musculus triceps brachii within posterior platform translation in healthy subjects B. Koláˇrová 1 , M. Janura 1 , P. Koláˇr 2,∗ , Z. Svoboda 1 , L. Hylmarová 2 1
Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Olomouc, Czech Republic 2 Department of Physiotherapy, Faculty of Health Sciences, Olomouc, Czech Republic
Introduction: Protective automatic reactions to unexpected displacements are multi-segmental [1]. One of the mechanisms to avoid falling on uneven surfaces is the involvement of the upper extremities [2]. The purpose of our study was to assess postural strategies in healthy subjects within unexcepted posterior platform translation in the standing position. The association between upper limb muscle activity (m. triceps brachii – TB) and center of pressure positioning (COP) in the mediolateral direction was evaluated. Patients/materials and methods: Postural reactivity to backward translation was assessed in eleven healthy subjects (age 50.9 ± 7.2 years, height 183.2 ± 6.3 cm, weight 84.8 ± 12.1 kg). Within the postural reaction to the translation simultaneously were measured both the position of COP (NeuroCom) of the whole body as well as the activity of TB by surface electromyography (Delsys). The relation between COP excursion in the mediolateral direction, and the difference in activity of the left and right TB was assessed by applying the Spearman rank correlation coefficient (Statistica, version 9.0).
[1] [2] [3] [4]
Deliagina TG, et al. J Physiol 2006;573:211–24. Troy KL, et al. J Biomech 2009;42(9):1339–44. Dietz V, Michel J. Ann N Y Acad Sci 2009;1164:97–103. Zehr EP, et al. J Neurophysiol 2007;98(3):1810–4.
doi:10.1016/j.gaitpost.2011.10.326 P55 Pathological gait of patients with musculoskeletal injuries after polytrauma R. Jakusonoka 1,∗ , Z. Gorbacova 3
Pavare 2 , A.
Jumtins 1 , T.
Ananjeva 2 , K.
1
Chair of Orthopaedic Surgery, Riga Stradins University, Riga, Latvia Rehabilitation Research Laboratory, Riga Stradins University, Riga, Latvia 3 Faculty of Medicine, Riga Stradins University, Riga, Latvia 2
Introduction: The functional result of polytrauma patients is important long term process. To assess the functional result of polytrauma patients with musculoskeletal injuries we used instrumented gait analysis. We analysed the gait changes of these patients in order of New Injury Severity Score (NISS). Patients/materials and methods: Retrospective analysis of 154 polytrauma patients with musculoskeletal injuries treated in two Riga hospitals during 2008–2010 year period was made. The New Injury Severity Score and Injury Severity Score values for these patients were calculated. The evaluation of functional recovery of 16 polytrauma patients with musculoskeletal injuries was performed in 4–13 months after polytrauma using instrumented gait
S86
Abstracts / Gait & Posture 36 (2012) S1–S101
analysis. We evaluated kinematic parameters (motions in pelvis and lower extremities joints in sagittal plane) of gait cycle. Results: 12 patients had increased anterior pelvic tilt, 3 patients had increased posterior pelvic tilt, 1 patient had asymmetric pelvic motion during gait cycle. 7 patients had limited extension in both hip joints, 3 patients had limited extension in hip joint of most seriously injured side, 1 patient had excessive extension in both hip joints, 5 patients had normal hip joint motion during gait cycle. 8 patients had persistent flexion in both knee joints, 3 patients had persistent flexion in knee joint of most seriously injured side, 2 patients had excessive extension of most seriously injured side, 3 patients had normal knee joint motion during gait cycle. 5 patients had limited dorsiflexion in ankle joint of most seriously injured side, 2 patients had limited plantar flexion in both ankle joints, 3 patients had limited plantar flexion of most seriously injured side, 6 patients had normal ankle joint motion during gait cycle. 13 patients had correlation of pathological changes of gait with NISS, 3 patients had not correlation between pathological changes of gait and NISS. Discussion and conclusion: Our study gives preliminary indication that the pathological changes of gait correlates with NISS in polytrauma patients with musculoskeletal injuries and possibility to identify primary and secondary functional changes which can not be diagnosed with clinical examination methods. Disclosure: No significant relationships. References [1] Perry J. Gait analysis. Normal and pathological function; 1992. p. 186–77. [2] Sutherland AG, et al. The New Injury Severity Score: better prediction of functional recovery after musculoskeletal injury. Value Health 2006;9(1):24–7. [3] Gebhard F, et al. Polytrauma-pathology and management principles. Langenbecks Arch Surg 2008;393:825–31.
doi:10.1016/j.gaitpost.2011.10.327 P56 Rectus femoris spasticity in patients with cerebral palsy D. Metaxiotis 1,3,∗ , V. Kouvelioti 2 , C. Milonas 3 , A. Kiriakidis 1 1
B’ Orthopaedic Clinic, Papageorgiou Hospital, Thessaloniki, Greece Gait Analysis Laboratory, ELEPAP, Thessaloniki, Greece 3 ELEPAP, Thessaloniki, Greece 2
Introduction: Foot clearance in swing phase is one of the basic prerequisites of normal gait. Aim of the study is the objective and dynamic documentation of the knee kinematics in ambulatory children with spastic cerebral palsy and the examination of possible causes of differences when compared to normals. Patients/materials and methods: 23 ambulatory patients with an average age of 10.8 years (6–17 years) with cerebral palsy, spastic diplegia where examined clinically including Duncan-Ely test. They were also examined with 3-D instrumented gait analysis. The Elite system with six cameras was used and the knee kinematics in the sagittal plane was recorded. Results: Almost all patients (21/23) had a positive Duncan-Ely test during clinical examination. The knee kinematics in the sagittal plane showed that in 28/46 knees the range of motion was decreased compared to normal values. In 41/46 knees there was a delayed maximum knee flexion in swing phase and in 22/46 knees the amplitude of the maximum knee flexion was decreased compared to normals. Patients with severe crouch or mild rectus spasticity had almost normal knee flexion. Discussion and conclusion: Patients with spastic cerebral palsy who are able to walk have an impaired foot clearance because of the pathological action of the rectus femoris. In our study the majority of the patients with clinically confirmed rectus spasticity had decreased timing and amplitude of max. knee flexion in swing. In
patients with severe co-contraction of the knee flexors and extensors the max. knee flexion was within normal range. Therefore max. knee flexion in swing should not be considered as a specific evaluation parameter in rectus femoris spasticity. Disclosure: No significant relationships.
References [1] Ounpuu S, et al. J Pediatr Orthop 1993. [2] Reinbolt JA, et al. J Biomech 2008.
doi:10.1016/j.gaitpost.2011.10.328 P57 Spasticity can be quantified during passive muscle stretch in an objective and repeatable way by integrating electrophysiological and biomechanical signals E. Aertbeliën 1 , L. Bar-On 2,∗ , H. Wambacq 1 , C. Huenaerts 2 , K. Lambrechts 3 , H. Bruyninckx 1 , B. Dan 4 , G. Molenaers 2 , K. Desloovere 2 1 Division of Production Engineering, Machine Design and Automation, Department of Mechanical Engineering, Faculty of Engineering, K.U. Leuven, Heverlee, Belgium 2 University Hospital Pellenberg, Laboratory for Clinical Motion Analysis, Pellenberg, Belgium 3 Department of Rehabilitation Sciences, K.U. Leuven, Heverlee, Belgium 4 Department of Neurology, University Children’s Hospital Queen Fabiola, Brussels, Belgium
Introduction: Current clinical measures of spasticity lack the accuracy and sensitivity that is needed to provide clinicians with quantitative data [1]. The aim of this study was to investigate the repeatability of a non-invasive, portable muscle tone measurement device which integrates signals to measure spasticity in the med. hamstrings (MEH) and gastrocnemius (GAS) in children with spastic cerebral palsy (CP). Patients/materials and methods: Nine children with spastic type of CP (age 5.3–16.1 years, GMFCS I–III, 6 hemi-, 3 di-, 1 quadraplegia) were tested on two occasions within a four week period. The MEH and GAS were tested in supine position by passively moving the knee or ankle joint through the full ROM during five seconds (V0), one second (V1) and as fast as possible (V2). Three repetitions were performed at each velocity with 7 s of rest between repetitions. Joint angles, angular velocity and acceleration were measured using inertial measurement units (IMUs). Reactive resistance was measured using a 6 DoF force transducer and muscle activity of the agonistic and antagonistic muscles using surface EMG (sEMG). Data was recorded with a custom-made Labview application (National instruments). EMG parameters were calculated at each velocity during a zone starting 200 ms prior to the time of maximum velocity and ending when 90% of the ROM was reached (Zmaxvel). To calculate the normalized average, the amount of sEMG (area under the rms EMG–time curve) was divided by the time and expressed as a percentage of maximum voluntary contraction (MVC). The following parameters were calculated (custom-made software Matlab® ): the average amount of sEMG, torque at pre-defined angles (10◦ dorsiflexion and 70◦ knee flexion) at each velocity, the difference in the average amounts of sEMG and in torque between V2 and V0. Within session repeatability was calculated with ICCw(1,1), based on single data; between session repeatability with ICCb(1,k), using averaged data [3]. The standard errors of measures and smallest detectible differences were calculated from one way ANOVA.
SCP child, when the footplate was dorsal flexed by 19◦ , the angle between footplate and talo-calcaneus complex decreased by 7.5◦ (not shown). This relative plantar flexion of talo-calcaneus complex constitutes 39% of dorsal rotation of the footplate. For comparison, in the TD adult, when the footplate was dorsal flexed by 23◦ , the angle between footplate and talo-calcaneus complex decreased by 2◦ (i.e. 9% of dorsal rotation of the footplate, not shown).
Discussion and conclusion: X-ray imaging shows that during dynamometry measurements of foot and ankle of a child with SCP, compared to a TD adult, foot deformities, and especially the orientation of the calcaneus within the sagittal plane, gives a biased view on the relation between footsole and the TS length. In loaded conditions this foot deformity gets even more pronounced. These results are important to consider when TS function is concluded from footsole orientation, like in common gait analysis and physical examination. Disclosure: No significant relationships.
References
S85
Results: There is a correlation between the excursion of COP to the right or left side, and higher activity of TB on the homolateral side, within unexpected posterior platform translation (r = 0.76). Discussion and conclusion: Movements of the upper limbs during bipedal locomotion are induced by the pripriospinal neuronal linkage of the cervical and thoracolumbar spinal cord [3]. TB is active during a fast gait and is manifested through the extension
of the upper limb within the swing phase of ipsilateral lower limb [4]. To follow our results, TB is also active during postural reactions to prevent falls. Supposedly, the propriospinal circuits of the upper and lower limbs are also active in situations requiring balance. The findings showed postural asymmetries in healthy subjects during balance reactions due to the preferential positioning of their COP to the left or right side (independent of lower limb dominance). We conclude that the excursion of COP in the mediolateral direction during the translation of the platform is related to increased activity of homolateral TB. These results may assist in further understanding motor control mechanisms. Disclosure: No significant relationships. Acknowledgements: This research was supported by IGA UP FTK2011-11 “Interlimb coordination in lower limb amputees”.
[1] Bénard, et al. Clin Biomech 2010;25:802–8. [2] Tardieu, et al. Eur J Appl Physiol Occup Physiol 1977;37:153–61.
References doi:10.1016/j.gaitpost.2011.10.325 P54 Activity of musculus triceps brachii within posterior platform translation in healthy subjects B. Koláˇrová 1 , M. Janura 1 , P. Koláˇr 2,∗ , Z. Svoboda 1 , L. Hylmarová 2 1
Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Olomouc, Czech Republic 2 Department of Physiotherapy, Faculty of Health Sciences, Olomouc, Czech Republic
Introduction: Protective automatic reactions to unexpected displacements are multi-segmental [1]. One of the mechanisms to avoid falling on uneven surfaces is the involvement of the upper extremities [2]. The purpose of our study was to assess postural strategies in healthy subjects within unexcepted posterior platform translation in the standing position. The association between upper limb muscle activity (m. triceps brachii – TB) and center of pressure positioning (COP) in the mediolateral direction was evaluated. Patients/materials and methods: Postural reactivity to backward translation was assessed in eleven healthy subjects (age 50.9 ± 7.2 years, height 183.2 ± 6.3 cm, weight 84.8 ± 12.1 kg). Within the postural reaction to the translation simultaneously were measured both the position of COP (NeuroCom) of the whole body as well as the activity of TB by surface electromyography (Delsys). The relation between COP excursion in the mediolateral direction, and the difference in activity of the left and right TB was assessed by applying the Spearman rank correlation coefficient (Statistica, version 9.0).
[1] [2] [3] [4]
Deliagina TG, et al. J Physiol 2006;573:211–24. Troy KL, et al. J Biomech 2009;42(9):1339–44. Dietz V, Michel J. Ann N Y Acad Sci 2009;1164:97–103. Zehr EP, et al. J Neurophysiol 2007;98(3):1810–4.
doi:10.1016/j.gaitpost.2011.10.326 P55 Pathological gait of patients with musculoskeletal injuries after polytrauma R. Jakusonoka 1,∗ , Z. Gorbacova 3
Pavare 2 , A.
Jumtins 1 , T.
Ananjeva 2 , K.
1
Chair of Orthopaedic Surgery, Riga Stradins University, Riga, Latvia Rehabilitation Research Laboratory, Riga Stradins University, Riga, Latvia 3 Faculty of Medicine, Riga Stradins University, Riga, Latvia 2
Introduction: The functional result of polytrauma patients is important long term process. To assess the functional result of polytrauma patients with musculoskeletal injuries we used instrumented gait analysis. We analysed the gait changes of these patients in order of New Injury Severity Score (NISS). Patients/materials and methods: Retrospective analysis of 154 polytrauma patients with musculoskeletal injuries treated in two Riga hospitals during 2008–2010 year period was made. The New Injury Severity Score and Injury Severity Score values for these patients were calculated. The evaluation of functional recovery of 16 polytrauma patients with musculoskeletal injuries was performed in 4–13 months after polytrauma using instrumented gait
S86
Abstracts / Gait & Posture 36 (2012) S1–S101
analysis. We evaluated kinematic parameters (motions in pelvis and lower extremities joints in sagittal plane) of gait cycle. Results: 12 patients had increased anterior pelvic tilt, 3 patients had increased posterior pelvic tilt, 1 patient had asymmetric pelvic motion during gait cycle. 7 patients had limited extension in both hip joints, 3 patients had limited extension in hip joint of most seriously injured side, 1 patient had excessive extension in both hip joints, 5 patients had normal hip joint motion during gait cycle. 8 patients had persistent flexion in both knee joints, 3 patients had persistent flexion in knee joint of most seriously injured side, 2 patients had excessive extension of most seriously injured side, 3 patients had normal knee joint motion during gait cycle. 5 patients had limited dorsiflexion in ankle joint of most seriously injured side, 2 patients had limited plantar flexion in both ankle joints, 3 patients had limited plantar flexion of most seriously injured side, 6 patients had normal ankle joint motion during gait cycle. 13 patients had correlation of pathological changes of gait with NISS, 3 patients had not correlation between pathological changes of gait and NISS. Discussion and conclusion: Our study gives preliminary indication that the pathological changes of gait correlates with NISS in polytrauma patients with musculoskeletal injuries and possibility to identify primary and secondary functional changes which can not be diagnosed with clinical examination methods. Disclosure: No significant relationships. References [1] Perry J. Gait analysis. Normal and pathological function; 1992. p. 186–77. [2] Sutherland AG, et al. The New Injury Severity Score: better prediction of functional recovery after musculoskeletal injury. Value Health 2006;9(1):24–7. [3] Gebhard F, et al. Polytrauma-pathology and management principles. Langenbecks Arch Surg 2008;393:825–31.
doi:10.1016/j.gaitpost.2011.10.327 P56 Rectus femoris spasticity in patients with cerebral palsy D. Metaxiotis 1,3,∗ , V. Kouvelioti 2 , C. Milonas 3 , A. Kiriakidis 1 1
B’ Orthopaedic Clinic, Papageorgiou Hospital, Thessaloniki, Greece Gait Analysis Laboratory, ELEPAP, Thessaloniki, Greece 3 ELEPAP, Thessaloniki, Greece 2
Introduction: Foot clearance in swing phase is one of the basic prerequisites of normal gait. Aim of the study is the objective and dynamic documentation of the knee kinematics in ambulatory children with spastic cerebral palsy and the examination of possible causes of differences when compared to normals. Patients/materials and methods: 23 ambulatory patients with an average age of 10.8 years (6–17 years) with cerebral palsy, spastic diplegia where examined clinically including Duncan-Ely test. They were also examined with 3-D instrumented gait analysis. The Elite system with six cameras was used and the knee kinematics in the sagittal plane was recorded. Results: Almost all patients (21/23) had a positive Duncan-Ely test during clinical examination. The knee kinematics in the sagittal plane showed that in 28/46 knees the range of motion was decreased compared to normal values. In 41/46 knees there was a delayed maximum knee flexion in swing phase and in 22/46 knees the amplitude of the maximum knee flexion was decreased compared to normals. Patients with severe crouch or mild rectus spasticity had almost normal knee flexion. Discussion and conclusion: Patients with spastic cerebral palsy who are able to walk have an impaired foot clearance because of the pathological action of the rectus femoris. In our study the majority of the patients with clinically confirmed rectus spasticity had decreased timing and amplitude of max. knee flexion in swing. In
patients with severe co-contraction of the knee flexors and extensors the max. knee flexion was within normal range. Therefore max. knee flexion in swing should not be considered as a specific evaluation parameter in rectus femoris spasticity. Disclosure: No significant relationships.
References [1] Ounpuu S, et al. J Pediatr Orthop 1993. [2] Reinbolt JA, et al. J Biomech 2008.
doi:10.1016/j.gaitpost.2011.10.328 P57 Spasticity can be quantified during passive muscle stretch in an objective and repeatable way by integrating electrophysiological and biomechanical signals E. Aertbeliën 1 , L. Bar-On 2,∗ , H. Wambacq 1 , C. Huenaerts 2 , K. Lambrechts 3 , H. Bruyninckx 1 , B. Dan 4 , G. Molenaers 2 , K. Desloovere 2 1 Division of Production Engineering, Machine Design and Automation, Department of Mechanical Engineering, Faculty of Engineering, K.U. Leuven, Heverlee, Belgium 2 University Hospital Pellenberg, Laboratory for Clinical Motion Analysis, Pellenberg, Belgium 3 Department of Rehabilitation Sciences, K.U. Leuven, Heverlee, Belgium 4 Department of Neurology, University Children’s Hospital Queen Fabiola, Brussels, Belgium
Introduction: Current clinical measures of spasticity lack the accuracy and sensitivity that is needed to provide clinicians with quantitative data [1]. The aim of this study was to investigate the repeatability of a non-invasive, portable muscle tone measurement device which integrates signals to measure spasticity in the med. hamstrings (MEH) and gastrocnemius (GAS) in children with spastic cerebral palsy (CP). Patients/materials and methods: Nine children with spastic type of CP (age 5.3–16.1 years, GMFCS I–III, 6 hemi-, 3 di-, 1 quadraplegia) were tested on two occasions within a four week period. The MEH and GAS were tested in supine position by passively moving the knee or ankle joint through the full ROM during five seconds (V0), one second (V1) and as fast as possible (V2). Three repetitions were performed at each velocity with 7 s of rest between repetitions. Joint angles, angular velocity and acceleration were measured using inertial measurement units (IMUs). Reactive resistance was measured using a 6 DoF force transducer and muscle activity of the agonistic and antagonistic muscles using surface EMG (sEMG). Data was recorded with a custom-made Labview application (National instruments). EMG parameters were calculated at each velocity during a zone starting 200 ms prior to the time of maximum velocity and ending when 90% of the ROM was reached (Zmaxvel). To calculate the normalized average, the amount of sEMG (area under the rms EMG–time curve) was divided by the time and expressed as a percentage of maximum voluntary contraction (MVC). The following parameters were calculated (custom-made software Matlab® ): the average amount of sEMG, torque at pre-defined angles (10◦ dorsiflexion and 70◦ knee flexion) at each velocity, the difference in the average amounts of sEMG and in torque between V2 and V0. Within session repeatability was calculated with ICCw(1,1), based on single data; between session repeatability with ICCb(1,k), using averaged data [3]. The standard errors of measures and smallest detectible differences were calculated from one way ANOVA.