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Variation in foot-ground force exchange by Gross Motor Function Classification System level in cerebral palsied children
Abstracts / Gait & Posture 42S (2015) S1–S27
S23
O34 Three-dimensional analysis of the shoulder motion in patients with massive irreparable cuff tears after latissimus dorsi tendon transfer (ltd) Carmela Conte 1,∗ , Mariano Serrao 2 , Giorgio Ippolito 2 , Chiara Iacovelli 1 , Pietro Caliandro 1,3 , Luca Padua 1,3 , Vincenzo De Cupis 2 1
Don Carlo Gnocchi Onlus Foundation, Italy Department of Medical and Surgical Sciences and Biotechnologies, University of Rome Polo Pontino, Latina, Italy 3 Institute of Neurology, Department Geriatrics, Neuroscience & Orthopedics, Catholic University, Policlinic A. Gemelli, Rome, Italy 2
Introduction: Latissimus dorsi tendon transfer (LTD) is a recent method for surgical treatment of massive irreparable posterosuperior cuff tears. However, it is unknown whether the shoulder kinematics are restored after LTD intervention. The aims of the present study was to quantitatively evaluate the effect of LTD on the shoulder kinematics. Methods: Nine patients with massive irreparable posterosuperior cuff tears (5 M, 4 F; mean age, 60 ± 4 years; range, 66–51 years) were recorded through a 3-D motion optoelectronic analysis system (BTS, Milan, Italy) before (T0) and at 3 (T1) and 6 (T2) months after LTD. We investigated ROM maximal shoulder flexion-extension, abduction-adduction and horizontal abductionadduction and the conic movements of the shoulder joint (area of intra- and extra-rotation normalized for the arm length) during standing posture. Thirteen markers were placed on anatomical landmarks in accordance with validated upper limb and trunk biomechanical model. Results: A significant effect of the LTD was observed on the shoulder kinematics (repeated measures ANOVA, all, p < 0.05). Posthoc analysis revealed a significant improvement of the shoulder motion at T2 compared to T0 for all motor tasks (flexion-extension: 176.9 ± 40.1◦ vs 150.5 ± 50.7◦ ; abduction-adduction: 101.5 ± 38.1◦ vs 110.1 ± 31.6◦ ; horizontal abduction-adduction: 79.4 ± 16.2◦ vs 87.3 ± 12.3◦ ; intra-rotation: 1.7 ± 0.9 vs 2.1 ± 0.8; extra-rotation: 1.6 ± 0.9 vs 2.1 ± 0.7). Discussion: Our study indicates that LTD is effective in the shoulder kinematics recovering. Three-dimensional motion analysis system is a useful tool to quantitatively evaluate the shoulder function massive irreparable posterosuperior cuff tears and the effect of surgical treatment. http://dx.doi.org/10.1016/j.gaitpost.2015.07.048 O35 Variation in foot-ground force exchange by Gross Motor Function Classification System level in cerebral palsied children Rita Neviani 1,∗ , Isabella Campanini 2 , Daniela Pandarese 1 , Andrea Merlo 2 1 Motion Analysis Laboratory LAMBDA, Santa Maria Nuova Hospital, Reggio Emilia, Italy 2 LAM – Motion Analysis Laboratory (Rehabilitation Department) AUSL Reggio Emilia, Italy
Introduction: Cerebral palsy (CP) is a neurological disorder typically associated with joint deformities (e.g. equinus foot) and gait disturbances (e.g. crouch gait) that can be assessed by three-dimensional gait analysis (GA). Several indices have been
Fig. 1. Box plot of BEQ, DLA and DPA in healthy, GMFCS1 and GMFCS2 group.
developed to summarize the overall gait performance [1]. Among the indices used in literature, the dynamic loading and propulsive abilities (DLA, DPA) [2] and the biomechanical efficiency quotient (BEQ) [3] can be quickly obtained by force plates and a by single marker placed on the sacrum, respectively. In this study we provided reference normal values for these indices and assessed their concurrent validity with the Gross Motor Function Classification System in sample of mildly compromised CP children (GCFMS levels I and II). Methods: This retrospective, consecutive cohort study was conducted on 21 children with diplegia (12 males, 9 females; mean age 12 y; GMFCS ranging between I and II) who were evaluated by GA. Data from an age-matched group of 26 typically developing children (15 males, 11 females; mean age 12y) were also analyzed. A set of summarizing indices was computed from GA data, including the height normalized walking speed, DLA, DPA and BEQ. Reference values from healthy children were obtained and compared to those of adults. Next, the dependency of indices values upon the level of impairment (healthy, GMFCS level I or GMFCS1 and GMFCS level II or GMFCS2 ) was assessed by the Kruskal–Wallis test and the Mann–Wilcoxon test for group comparisons. Results: Walking speed in healthy children was 86 (SD 11) %height/s. BEQ reference values were 1 (SD 0.2), in accordance with Kerrigan [3]. DLA and DPA in children were respectively 82 (SD 2) and 11 (SD 2) %BW, comparable to that of healthy adults [2]. Walking speed was reduced in PC children (p < 0.01), as expected, without significant differences between GMFCS groups. BEQ progressively increased from 1 in healthy children to 2.0 (SD 0.5) in the GMFCS1 group (p < 0.01) until 2.8 (SD 0.9) in the GMFCS2 group (p < 0.01). DLA in the GMFCS1 group was similar to that of controls (p = 0.30) and significantly lower in the GMFCS2 group (p < 0.01). DPA progressively decreased with the GMFCS levels and resulted significantly different both between healthy children and the GMFCS1 group (p < 0.01) and between the GMFCS1 and the GMFCS2 group (p < 0.01) (see Fig. 1). Discussion: The results of the study highlight that indices and walking speed of cerebral palsied children and adolescents, GMFCS levels I and II, differ from typically developing and from adults. Gait impairments are significantly different in biomechanical efficiency, dynamic loading and propulsive abilities between GMFCS1 and GMFCS2 group. We suppose that these indices can be used to assess the effectiveness of therapeutic intervention on gait efficiency and on the recovery of loading and propulsive abilities. Reference [1] Galli M, Cimolin V. Gait Posture 2014;39(4):1005–10. [2] Campanini I. et Merlo A. Gait & posture 2009;30:127–31. [3] Kerrigan DC, et al. Am J Phys Med Rehabil 1996;75(1):3–8.
http://dx.doi.org/10.1016/j.gaitpost.2015.07.049
S23
O34 Three-dimensional analysis of the shoulder motion in patients with massive irreparable cuff tears after latissimus dorsi tendon transfer (ltd) Carmela Conte 1,∗ , Mariano Serrao 2 , Giorgio Ippolito 2 , Chiara Iacovelli 1 , Pietro Caliandro 1,3 , Luca Padua 1,3 , Vincenzo De Cupis 2 1
Don Carlo Gnocchi Onlus Foundation, Italy Department of Medical and Surgical Sciences and Biotechnologies, University of Rome Polo Pontino, Latina, Italy 3 Institute of Neurology, Department Geriatrics, Neuroscience & Orthopedics, Catholic University, Policlinic A. Gemelli, Rome, Italy 2
Introduction: Latissimus dorsi tendon transfer (LTD) is a recent method for surgical treatment of massive irreparable posterosuperior cuff tears. However, it is unknown whether the shoulder kinematics are restored after LTD intervention. The aims of the present study was to quantitatively evaluate the effect of LTD on the shoulder kinematics. Methods: Nine patients with massive irreparable posterosuperior cuff tears (5 M, 4 F; mean age, 60 ± 4 years; range, 66–51 years) were recorded through a 3-D motion optoelectronic analysis system (BTS, Milan, Italy) before (T0) and at 3 (T1) and 6 (T2) months after LTD. We investigated ROM maximal shoulder flexion-extension, abduction-adduction and horizontal abductionadduction and the conic movements of the shoulder joint (area of intra- and extra-rotation normalized for the arm length) during standing posture. Thirteen markers were placed on anatomical landmarks in accordance with validated upper limb and trunk biomechanical model. Results: A significant effect of the LTD was observed on the shoulder kinematics (repeated measures ANOVA, all, p < 0.05). Posthoc analysis revealed a significant improvement of the shoulder motion at T2 compared to T0 for all motor tasks (flexion-extension: 176.9 ± 40.1◦ vs 150.5 ± 50.7◦ ; abduction-adduction: 101.5 ± 38.1◦ vs 110.1 ± 31.6◦ ; horizontal abduction-adduction: 79.4 ± 16.2◦ vs 87.3 ± 12.3◦ ; intra-rotation: 1.7 ± 0.9 vs 2.1 ± 0.8; extra-rotation: 1.6 ± 0.9 vs 2.1 ± 0.7). Discussion: Our study indicates that LTD is effective in the shoulder kinematics recovering. Three-dimensional motion analysis system is a useful tool to quantitatively evaluate the shoulder function massive irreparable posterosuperior cuff tears and the effect of surgical treatment. http://dx.doi.org/10.1016/j.gaitpost.2015.07.048 O35 Variation in foot-ground force exchange by Gross Motor Function Classification System level in cerebral palsied children Rita Neviani 1,∗ , Isabella Campanini 2 , Daniela Pandarese 1 , Andrea Merlo 2 1 Motion Analysis Laboratory LAMBDA, Santa Maria Nuova Hospital, Reggio Emilia, Italy 2 LAM – Motion Analysis Laboratory (Rehabilitation Department) AUSL Reggio Emilia, Italy
Introduction: Cerebral palsy (CP) is a neurological disorder typically associated with joint deformities (e.g. equinus foot) and gait disturbances (e.g. crouch gait) that can be assessed by three-dimensional gait analysis (GA). Several indices have been
Fig. 1. Box plot of BEQ, DLA and DPA in healthy, GMFCS1 and GMFCS2 group.
developed to summarize the overall gait performance [1]. Among the indices used in literature, the dynamic loading and propulsive abilities (DLA, DPA) [2] and the biomechanical efficiency quotient (BEQ) [3] can be quickly obtained by force plates and a by single marker placed on the sacrum, respectively. In this study we provided reference normal values for these indices and assessed their concurrent validity with the Gross Motor Function Classification System in sample of mildly compromised CP children (GCFMS levels I and II). Methods: This retrospective, consecutive cohort study was conducted on 21 children with diplegia (12 males, 9 females; mean age 12 y; GMFCS ranging between I and II) who were evaluated by GA. Data from an age-matched group of 26 typically developing children (15 males, 11 females; mean age 12y) were also analyzed. A set of summarizing indices was computed from GA data, including the height normalized walking speed, DLA, DPA and BEQ. Reference values from healthy children were obtained and compared to those of adults. Next, the dependency of indices values upon the level of impairment (healthy, GMFCS level I or GMFCS1 and GMFCS level II or GMFCS2 ) was assessed by the Kruskal–Wallis test and the Mann–Wilcoxon test for group comparisons. Results: Walking speed in healthy children was 86 (SD 11) %height/s. BEQ reference values were 1 (SD 0.2), in accordance with Kerrigan [3]. DLA and DPA in children were respectively 82 (SD 2) and 11 (SD 2) %BW, comparable to that of healthy adults [2]. Walking speed was reduced in PC children (p < 0.01), as expected, without significant differences between GMFCS groups. BEQ progressively increased from 1 in healthy children to 2.0 (SD 0.5) in the GMFCS1 group (p < 0.01) until 2.8 (SD 0.9) in the GMFCS2 group (p < 0.01). DLA in the GMFCS1 group was similar to that of controls (p = 0.30) and significantly lower in the GMFCS2 group (p < 0.01). DPA progressively decreased with the GMFCS levels and resulted significantly different both between healthy children and the GMFCS1 group (p < 0.01) and between the GMFCS1 and the GMFCS2 group (p < 0.01) (see Fig. 1). Discussion: The results of the study highlight that indices and walking speed of cerebral palsied children and adolescents, GMFCS levels I and II, differ from typically developing and from adults. Gait impairments are significantly different in biomechanical efficiency, dynamic loading and propulsive abilities between GMFCS1 and GMFCS2 group. We suppose that these indices can be used to assess the effectiveness of therapeutic intervention on gait efficiency and on the recovery of loading and propulsive abilities. Reference [1] Galli M, Cimolin V. Gait Posture 2014;39(4):1005–10. [2] Campanini I. et Merlo A. Gait & posture 2009;30:127–31. [3] Kerrigan DC, et al. Am J Phys Med Rehabil 1996;75(1):3–8.
http://dx.doi.org/10.1016/j.gaitpost.2015.07.049