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- Bartonek, A., et al.
(författare)
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The influence of spasticity in the lower limb muscles on gait pattern in children with sacral to mid-lumbar myelomeningocele : a gait analysis study
- 2005
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Ingår i: Gait & Posture. - : Elsevier BV. - 0966-6362 .- 1879-2219. ; 22:1, s. 10-25
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Tidskriftsartikel (refereegranskat)abstract
- Gait analysis and recording of standing position were performed in 38 ambulatory children with myelomeningocele. Thirty-four were independent ambulators and four required a walking aid. All subjects were assigned one of four muscle function groups based on muscle strength. They were also divided into subgroups based on the distinction between flaccid and spastic paresis in the lower limb joints. A comparison was made between the gait pattern of the children with spasticity and that of the children with flaccid paresis in each muscle function group. Spasticity in only the ankle joint muscles influenced the subject's gait and standing position compared to the subgroups with a flaccid paresis. Even larger deviations in gait and standing position were observed when spasticity occurred in muscles at the knee and hip joints. When setting ambulatory goals the presence of additional neurological symptoms such as spasticity and inadequate balance should be taken into consideration.
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| 5. |
- Gutierrez-Farewik, Elena M., et al.
(författare)
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Centre of mass motion during gait in persons with myelomeningocele
- 2003
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Ingår i: Gait & Posture. - 0966-6362 .- 1879-2219. ; 18:2, s. 37-46
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Tidskriftsartikel (refereegranskat)abstract
- The movement of the centre of mass in the vertical and lateral directions during gait in children with myelomeningocele was analyzed. The children were classified into five groups depending on the successive paresis of lower limb muscle groups and compared to a control group. In the groups with. dorsi- and plantarflexor weakness, the excursions increased and an anterior trend in the centre of mass was observed. In the groups with additional abductor paresis, the lateral excursion was highest and the vertical excursion low due to increased transverse and frontal motion and reduced sagittal motion. With further paresis of the hip extensors, the centre of mass was more posteriorly positioned due to compensatory trunk extension. Improved understanding of individual children's solutions to their muscle paresis can be obtained by visualizing the centre of mass relative to the pelvis. Centre of mass analyses in myelomeningocele offer an important complement to standard gait analysis.
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| 6. |
- Gutierrez-Farewik, Elena M., et al.
(författare)
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Characteristic gait kinematics in persons with lumbosacral myelomeningocele
- 2003
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Ingår i: Gait & Posture. - 0966-6362 .- 1879-2219. ; 18:3, s. 170-177
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Tidskriftsartikel (refereegranskat)abstract
- Thirty self-ambulatory children with mid-lumbar to low-sacral myelomeningocele who walked without aids and 21 control children were evaluated by three-dimensional gait analysis. Characteristic kinematic patterns and parameters in the trunk, pelvis, hip, knee and ankle were analyzed with respect to groups with successive weakness of the ankle plantarflexor, ankle dorsiflexor, hip abductor, hip extensor and knee flexor muscles. Extensive weakness of the plantarflexors resulted in kinematic alterations in the trunk, pelvis, hip and knee and in all three planes seen as knee flexion, anterior pelvic tilt and trunk and pelvic rotation. Additional extensive weakness of the dorsiflexors made little difference in the walking strategy. Large kinematic alterations in all planes were observed where there was a large extent of additional weakness of the hip abductor but strength remaining in the hip extensors. In this group, gait was characterized by large lateral sway of the trunk, rotation of the trunk and pelvis, pelvic hike and increased extension of the knees. In the group with total poresis hip extensors but yet some knee flexion, gait was similar to the previous group but there was less sagittal plane movement greates and posterior trunk tilt. Gait analysis provides an understanding of the compensatory strategies employed in these patients. Clinical management can be directed towards stabilizing the lower extremities and accommodating large upper body motion to preserve this method of self-ambulation even in children who have considerable hip extensor and abductor weakness.
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| 10. |
- Tedroff, K., et al.
(författare)
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Botulinumtoxin A treatment in toddlers with cerebral palsy
- 2010
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 99:8, s. 1156-1162
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Tidskriftsartikel (refereegranskat)abstract
- Aims: In this study the aim was to evaluate the effect of botulinum toxin A (BoNT-A) treatment on muscle tone, contracture development and gait pattern in young children with cerebral palsy (CP). Method: Fifteen children with spastic CP (mean age = 16 months) were included in a randomized control study. All received a daily stretching programme and children in the BoNT-A group additionally received two injections, 6 months apart in the gastrocnemius muscle. Outcomes were assessed at baseline, and after 1 and 3.5 years. A 3D gait-analysis was performed at 5 years of age. Results: Plantarflexor muscle tone in the BoNT-A group was significantly reduced after 3.5 years, while the muscle tone at the ankle and knee in the control group remained unchanged. The change-score in knee-flexion muscle tone between the groups was significantly different after 3.5 years. The knee joint ROM was significantly increased at 1 year in the BoNT-A group but reduced at the knee and ankle joints in the control group after 3.5 years. No group differences were found for gait analysis, GMFM-66 or PEDI. Conclusion: Early treatment of BoNT-A in children with spastic CP may decrease muscle tone and decelerate contracture development after 3.5 years. The effect on gait development remains inconclusive.
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