To compare time-distance, kinematic, and kinetic gait parameters in patients with idiopathic Parkinson's disease (PD) off dopaminergic therapy with a group of healthy control subjects.
A ...group-comparison study.
Gait analysis laboratory.
Patients with PD (n=20) and healthy age-matched controls (n=20).
Not applicable.
Time-distance, kinematic, and kinetic gait variables.
PD patients walked slower with shorter stride-length, comparable cadence, and longer double support times. Kinematics showed a reduction of the range of motion in the hip, knee, and ankle joints. Maximum hip extension and the ankle plantar flexion were significantly reduced. Kinetic gait parameters showed reduced push-off ankle power and lift-off hip power generation. Strong correlations between these important body advancement mechanisms and the walking velocity were observed.
In addition to previously described dysfunctional kinematics, abnormal kinetic parameters play an important role in the characterization of gait in PD patients off therapy. Hence, these parameters could be used to document treatment effects of parkinsonian gait disorders.
Objective. To evaluate intrasubject repeatability of data obtained from computer-aided motion analysis in normal and spastic children.
Design. Prospective controlled study.
Background. Information ...from gait analysis is used in selecting therapeutic interventions for gait improvement in cerebral palsy. While there are several studies regarding repeatability of normal gait, there are no studies evaluating the repeatability of spastic gait.
Methods. Forty children (20 normal, 20 with diplegic type of cerebral palsy) were subjected to gait analysis. Kinematic, kinetic and time distance parameters obtained from gait analysis were studied for intrasubject variability within-day and between-day using statistical measures.
Results. Normal children had lower variability in time distance parameters than spastic children both within and between days. The repeatability of kinetics was better than those of kinematics, and values for normal children were better than those for spastic children. Within-day repeatability of kinematics and kinetics was better in normal children. Between-day repeatability of kinematics was better in normal children, while spastic children showed better repeatability for kinetics.
Conclusions. We found lower repeatability of gait analysis data in spastic children compared to normal children. Restricted joint range of motion due to spasticity in the group of cerebral palsy patients may be responsible for the lower repeatability of data. Some errors due to marker placement are inadvertent and contribute to the lower between-day repeatability.
Relevance
The results of this study should be of interest to clinicians who make therapeutic decisions in patients with cerebral palsy using gait analysis data, and for scientists studying normal and pathological gait.
Does home-based progressive resistance or high-intensity circuit training improve strength, function, activity, or participation in children with cerebral palsy (CP)?
This was the first study on ...high-intensity circuit training for children with CP. This study was conducted as a randomized prospective controlled pilot study.
Evaluation took place at the gait laboratory of the university hospital, training sessions were performed at home.
Children (N=22) with CP (average age: 12y, 10mo, 19 Gross Motor Function Classification System level I, 3 level II) were randomly assigned either to progressive resistance training (PRT) or high-intensity circuit training (HICT).
The PRT group trained with progressive overload, while the HICT group performed as many repetitions as possible within 30-second intervals (8wk, 3 times weekly in both groups).
Outcome measures stretched over all domains of the International Classification of Functioning, Disability and Health and included muscle strength, muscle power sprint test (MPST), timed stairs test (TST), 6-minute walking test, Gait Profile Score (GPS), timed Up and Go test (TUGT) and participation questionnaires.
Only the HICT group was able to improve strength. Furthermore, the HICT group scored better in the MPST, while PRT participants improved in the TST and TUGT. The HICT-group was able to show improvement in the subscores of the parent-reported participation questionnaire. Other measures of mobility or participation did not change.
Both programs improved function specific to intervention. However, only the HICT group showed significant strength and participation improvements. Compliance was decent in both groups, but the average training unit was shorter in the HICT group. Both exercise programs showed functional benefits, but HICT might be the preferable option for strengthening in highly functional children with CP.
This study evaluated the effects of medial hamstring lengthening on gait in patients with diplegic cerebral palsy. A group of patients who underwent medial hamstring lengthening and distal rectus ...transfer was compared to a group of patients who underwent intramuscular psoas lengthening as well. Patients who underwent a psoas lengthening showed an increased anterior pelvic tilt and a tendency towards genu recurvatum, features that could indicate postoperative hamstring weakness. These results underline the importance of medial hamstrings for pelvis and knee motion in the sagittal plane during walking. In additional the limitations of the popliteal angle as a clinical measure to evaluate hamstring length in the presence of hip flexor tightness are discussed.
•Randomized, prospective trial comparing surgical and Ponseti treatment in clubfoot.•Long-term follow-up of 10 years.•Morphology, functional outcomes, overall health, pain and ability to participate ...in daily activities were evaluated.•Foot kinematics was evaluated with Oxford foot model.•Ponseti is superior to surgery in long-term run.
Treatment of idiopathic clubfoot has shifted from extensive surgical release to conservative Ponseti method; however, randomized prospective trials to compare both methods are lacking. The goal of this study was to compare the long-term results of Ponseti method with those of surgery in terms of morphology, function, X-rays, overall health and gait.
In 2001, a single center, prospective, randomized, and controlled trial with a parallel design was started. Twenty-four feet of 15 patients were randomly assigned to two groups: 12 feet each to a Ponseti and surgical group. Mean follow-up was 10 years. International Clubfoot Study Group score (ICFSG), the Pediatric Outcomes Data Collection Instrument (PODCI) and the Functional Rating System (FRS) were used to compare morphology, functional, radiological and subjective outcomes, and the Oxford Foot Model (OFM) was used to evaluate foot kinematics.
No significant difference was seen between groups in the initial Pirani scores (p=0.618). Ponseti group had more favorable long-term outcomes according to the FRS (p=0.005), higher ICFSG, scores for morphology (p=0.021), function (p=0.005) and X-rays (p=0.02), and better parent reported functional status according to the PODCI (p=0.018). Surgically treated clubfeet were stiffer – ankle dynamic range of motion (p=0.015) and the maximal hindfoot dorsiflexion during gait were limited as measured by OFM (p=0.039). This was compensated by an increase in motion between the hindfoot and forefoot. Furthermore, these children had more difficulty playing sports and experienced more pain, which might have led to inferior results in the happiness domain of the PODCI.
These results suggest that the Ponseti method provides superior long-term outcomes for idiopathic clubfoot deformity.
Highlights • First study reporting on the long-term outcomes of children with unilateral CP treated with SEMLS. • Children with unilateral CP profit from SEMLS and maintain the benefits long term. • ...Fine-tuning surgeries are needed during the long-term follow-up. • The complication rate was low.
Aim
We investigated the long‐term efficacy and safety of multilevel surgery (MLS) in ambulatory children with bilateral spastic cerebral palsy (CP).
Method
Two hundred and thirty‐one children were ...evaluated at short term (1.1y, SD 0.4) and long term (9.1y, SD 3.0) follow‐up using clinical examination and gait analysis. MLS was investigated by studying changes in the Gait Profile Score (GPS) referenced to the minimally important clinical difference.
Results
Ambulatory children aged 10 years and 7 months (SD 2y 11mo) at MLS in Gross Motor Function Classification System levels I (19), II (144), and III (68) showed a decrease (improvement) in preoperative GPS from 16.3° (SD 4.8) to 11.3° (SD 3.2) at short‐term follow‐up, an improvement of 5°. At long‐term follow‐up, GPS was maintained at 11.4° (SD 3.1). Overall, 177 (76.6%) children maintained their improvement in GPS after 9 years.
Interpretation
Multilevel surgery is a safe and effective surgical intervention, which leads to a significant improvement in gait kinematics in children with bilateral spastic CP. This study improves our understanding of MLS in the long term and will help to inform families and children when planning for MLS.
What this paper adds
Largest study of multilevel surgery (MLS) for children with bilateral spastic cerebral palsy, with longest follow‐up.
MLS resulted in significant long‐term improvements in gait function.
Minor adverse events were common, while events requiring intervention were uncommon (4% of children).
Thirty‐nine per cent of children required additional surgery during follow‐up.
‘Single‐event multilevel surgery’ was changed to the more realistic term ‘multilevel surgery’.
Resumen
Evolución a largo plazo de la marcha después de una cirugía multinivel en niños con Parálisis Cerebral: estudio multicéntrico de cohorte
Objetivo
Investigamos la eficacia y seguridad a largo plazo de la cirugía multinivel (MLS) en niños deambuladores con Parálisis Cerebral Espástica Bilateral (BSCP).
Método
Doscientos treinta y un niños fueron evaluados a corto plazo (1,1 años, SD 0,4) y a largo plazo (9,1 años, SD 3,0) seguidos con evaluación clínica y análisis de marcha. MLS fue investigado evaluando los cambios en el Puntaje de Perfil de Marcha Gait Profile Score (GPS) referenciado a la diferencia clínica de mínima importancia.
Resultados
Niños deambuladores de 10 años y 7 meses de edad (DS 2 años 11 meses) con MLS en Gross Motor Function Classification System nivel I (19), II (144), y III (68) mostraron una disminución (mejora) en GPS preoperatorio desde 16.3° (DS 4.8) a 11.3° (DS 3.2) en el seguimiento a corto plazo, una mejoría del 5%. En el seguimiento a largo plazo, el GPS se mantuvo en en 11.4° (DS 3.1). Después de 9 años, 177 (76,6%) de los niños mantuvieron su mejoría en el GPS.
Conclusiones
La cirugía multinivel es una intervención quirúrgica segura y efectiva, la cual lleva a una mejoría significativa en la cinemática de la marcha en niños con BSCP. Este estudio mejora nuestra comprensión de las MLS en el largo plaza y ayudara a informar a las familias y a los niños cuando se planea una MLS.
Resumo
Desenvolvimento da marcha em longo prazo após cirurgia multinível em crianças com paralisia cerebral: um estudo multicêntrico de coorte
Objetivo
Nós investigamos a eficácia de longo termo e a segurança da cirurgia multinível (CMN) em crianças ambulatórias com paralisia cerebral bilateral espástica (PCBE).
Método
Duzentas e trinta e uma crianças foram avaliadas em acompanhamento de curto (1,1a, DP 0,4), e longo prazo (9,1 a, DP 3,0) usando exame clínico e análise de marcha. A CMN foi investigada usando as mudanças no Escore do Perfil da Marcha (EPM) com referência a difereça clínica minimamente importante.
Resultados
Crianças ambulatórias com idade de 10 anos e 7 meses (DP 2a11m) no momento da CMS e níveis de Classificação da Função Motora Grossa (GMFCS) I (19), II (144) e III (68) mostraram um decréscimo (melhora) no EPM pré‐operatório de 16,3° (DP 4,8) a 11,3° (DP 3,2) no acompanhamento de curto prazo, uma melhora de 5°. No acompanhamento de longo c prazo, o EPM foi mantido a 11,4° (DP 3,1). No geral, 177 (76,6%) crianças mantiveram a melhora no EPM após 9 anos.
Interpretação
A cirurgia multinível é uma intervenção cirúrtgica segura e efetiva, que leva a melhora significativa na cinemática da marcha em crianças com PCBE. Este estudo melhora nossa compreensão da CMN no longo prazo e ajudará a informar famílias no planejamento para CMN.
What this paper adds
Largest study of multilevel surgery (MLS) for children with bilateral spastic cerebral palsy, with longest follow‐up.
MLS resulted in significant long‐term improvements in gait function.
Minor adverse events were common, while events requiring intervention were uncommon (4% of children).
Thirty‐nine per cent of children required additional surgery during follow‐up.
‘Single‐event multilevel surgery’ was changed to the more realistic term ‘multilevel surgery’.
This article's has been translated into Spanish and Portuguese.
Follow the links from the to view the translations.
The purpose of this study was to evaluate hip and pelvis rotations in groups of hemiplegic and diplegic children before and after surgical correction of fixed internal rotation deformity of the hip. ...Twenty-two children with cerebral palsy (eight diplegia, 14 hemiplegia) having fixed internal rotation deformity at the hip were treated by multilevel surgery which included derotation osteotomy of the femur. Evaluation was done before and at a mean of 3.1 years after surgery using three-dimensional computerized gait analysis. Preoperatively, the patients in the hemiplegia group had a significantly greater compensatory external rotation of the pelvis than those in the diplegic group. Post-operatively there were no significant differences between the two groups. In the hemiplegia group the external rotation of the pelvis was corrected after correction of hip rotation by derotation osteotomy. Patients in the diplegia group showed significant improvements in the hip rotation with no significant change in the pelvis rotation after multilevel surgery.
Whereas the developed gut mucosal barrier prevents luminal bacteria from invading the host, bacterial translocation appears to be facilitated in the neonate. The aim of this study was to determine ...the extent to which bacteria spontaneously translocate from the gut to extraintestinal organs during the neonatal period and to relate translocation to the evolving intestinal flora in the rat. Newborn Sprague-Dawley rats suckled ad libitum and ate regular chow after weaning. A total of 167 rats were killed either immediately or at 1, 9, 14, 21, 26, or 42 days after delivery. Mesenteric lymph nodes (MLN), liver, heart blood, and the terminal ileal loop were harvested under sterile conditions and analyzed for aerobic and facultatively anaerobic bacteria by standard microbiologic procedures. Bacterial translocation to the MLN and liver began soon after birth and peaked during the second week. On day 14, translocation to any organ was present in 85% of rats. All cultures from the liver were sterile after day 26. By contrast, the fall in translocation to the MLN was incomplete, as 50% of pups still had positive MLN on day 42. Blood cultures were positive in three of the 167 rats. The intensity of translocation as determined by the number of organs infected significantly increased with the number of gram-negative enterics and gram-positive cocci in the gut and was negatively correlated with the percentage of lactobacilli from the total measured intestinal flora (P < 0.0001). In conclusion, bacterial translocation from the gut is a physiological and age-dependent phenomenon in the neonatal rat. Translocation appears to be facilitated when intestinal concentrations of gram-negative enterics and gram-positive cocci are high and when the concentration of lactobacilli is low.
The immature host is prone to the passage of bacteria across the gut mucosal barrier. Corticosteroids accelerate the maturation of the intestinal mucosa and alter the composition of the gut bacterial ...flora. The present study was performed to assess the effect of prenatal cortisone on bacterial translocation in the neonatal rat. Time-pregnant Sprague Dawley rats were randomized on the 19th day of gestation for intraperitoneal injection of either 20 mg/100 g body weight of hydrocortisone or saline. Rats delivered spontaneously and the offspring were suckled ad libitum by the dam. Rat pups (N = 82) were killed 1 or 9 days after delivery. Mesenteric lymph nodes, liver, heart blood, and the terminal ileal loop were excised and quantitatively analyzed for bacteria. After one day, the proportion of rats with positive translocation was not significantly different between the two treatment groups (saline 62%, cortisone 80%, P = NS). By day 9, translocation had increased in the saline group (P = 0.03 vs day 1), did not significantly change in the cortisone group, and was significantly lower in rats treated with cortisone compared with the saline control (saline 90%, cortisone 60%, P = 0.02). The decrease in bacterial translocation after treatment with cortisone was associated with significantly lower total bacterial counts in the ileum (P < 0.05). Cortisone did not reduce bacterial counts in extraintestinal organs with positive translocation. In conclusion, prenatal treatment with cortisone reduces the incidence of spontaneous bacterial translocation from the intestine but not the concentration of translocated bacteria in extraintestinal organs of 9-day-old rats. Cortisone-induced changes of the intestinal microflora may have contributed to the reduction in translocation frequency.
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