| 1. |
- Broström, Eva W., et al.
(författare)
-
Gait in children with achondroplasia – a cross-sectional study on joint kinematics and kinetics
- 2022
-
Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 23:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Children with achondroplasia have extreme short stature due to short limbs, as well as several other clinical features that may affect their gait. The purpose of this cross-sectional study was to provide a detailed description of gait in children with achondroplasia compared to age-matched controls. Methods: Between the years 2007 and 2010, 16 children with achondroplasia [mean age 9.6 years (range 5–16; six female)] with no previous history of orthopaedic lower limb surgery and 19 age-matched controls conducted three-dimensional (3D) gait analysis at one occasion. The gait analysis rendered pelvis and lower limb joint kinematics and kinetics, and time and distance data. Descriptive statistics, independent samples t-tests, and Fisher’s exact test were used to describe the cohort including gait data and participant characteristics. Results: Children with achondroplasia had kinematic gait pattern deviations in all three planes, especially in the sagittal plane, when compared to the control group. Peak anterior pelvic tilt and peak ankle dorsiflexion were found to be increased. Increased knee flexion was noted at initial contact and again at terminal stance. During stance, children with achondroplasia had a higher peak hip abduction angle and a higher peak knee varus angle in the frontal plane. In the sagittal plane, kinetic gait pattern deviations were found at the hip, knee, and ankle, consistent with a flexion pattern. Compared to the control group, children with achondroplasia walked with reduced walking speed and step length, and increased cadence. There was no difference in walking speed when leg length was taken into account. Normalised step length and normalised cadence, on the other hand, were found to be increased in children with achondroplasia. Conclusions: The observed gait characteristics in children with achondroplasia are related to anatomical attributes and strategies to increase step length, and hence walking speed.
|
|
| 2. |
- Gralén, Katarina, et al.
(författare)
-
Clinical practice of BOTOX® treatment for overactive bladder syndrome in Sweden : an assessment of resource use and external validity
- 2017
-
Ingår i: Scandinavian Journal of Urology. - : Medical Journals Sweden AB. - 2168-1805 .- 2168-1813.
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: The objective of this study was to assess the resource use of treating overactive bladder (OAB) patients in real-world clinical practice and to evaluate whether there is external validity in the treatment of OAB in clinical practice. Materials and methods: The study included 55 patients suffering from OAB and treated with BOTOX® at two Swedish clinics. The study was conducted as an anonymized retrospective chart review study. Results: The estimated yearly direct cost of BOTOX treatment was €902. The mean age of patients in the study was 60 years, and 85% were women. The severity of OAB before BOTOX treatment, given by the mean number of daily leakages, equalled 4.8. The median interval between treatments was 210 days. Conclusions: Patient characteristics in the real world were similar to those in the clinical trials, showing a high degree of external validity. Treatment intervals were longer in the real world than in clinical trials, indicating that treatment cost could be lower when patients are treated as observed in real-world clinical practice.
|
|
| 3. |
- Johansson, Gudrun M., et al.
(författare)
-
Assessment of arm movements during gait in stroke : the Arm Posture Score
- 2014
-
Ingår i: Gait & Posture. - : Elsevier BV. - 0966-6362 .- 1879-2219. ; 40:4, s. 549-555
-
Tidskriftsartikel (refereegranskat)abstract
- The purpose of the study was to apply the Arm Posture Score (APS) to a stroke population, since comprehensive measures to quantify arm swing in the affected and non-affected arms during gait are lacking. A further aim was to investigate how gait speed and upper limb function estimated by clinical measures are related to the APS in the stroke group. The APS is the summarized root mean square deviation (RMSD) from normal, based on kinematics. Four arm movements (sagittal and frontal planes) as well as six arm movements (incorporating transversal plane) were included in the calculation of APS, referred to as APS4 and APS6, respectively. The study population consisted of 25 persons with stroke and 25 age- and gender-matched controls. The APS measures were significantly different between the affected and non-affected arms, as well as between the affected arm and the non-dominant arm of the controls (p≤0.001). Spasticity significantly influenced both APS measures, while speed only had a significant effect on the APS4. The APS measures correlated significantly to clinical measures of upper limb function. Both APS measures seem to be useful indices to quantify and discriminate between impaired and normal arm swing during gait after stroke. The variability of rotational arm movements needs to be studied further before considering the additional value of the APS6 over the APS4. When interpreting the APS, complementary kinematics should be taken into account, as the single value of the APS gives no information about the direction of the deviation.
|
|
| 4. |
- Klets, Olesya, et al.
(författare)
-
Comparison between a subject-specific and a scaled generic musculoskeletal model of the lower extremities in a subject with unilateral cerebral palsy
- 2011
-
Ingår i: Clinical Biomechanics. - 0268-0033 .- 1879-1271.
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- The purpose of this paper was to develop methods to build a subject-specific musculoskeletal model of the lower extremities based on MRIs of a subject with unilateral CP, and to determine whether a scaled generic musculoskeletal model is accurate enough to characterize MTLs and MALs of 70 muscles in both lower limbs during gait in a subject with unilateral cerebral palsy. We found, that the generic models produced accurate values for changes in MTL during gait for almost all muscles, except adductor longus, adductor magnus, adductor brevis, quadratus femoris, pectineus, extensor digitorum longus, soleus, lateral gastrocnemius, and medial gastrocnemius. MALs computed from the scaled generic model, however, differed considerably from those computed from the subject-specific model. Upon comparison of hip, knee and ankle MALs in affected and non-affected sides of the lower extremities, the scaled generic model generally failed to identify level arm dysfunction in the subject with unilateral CP
|
|
| 5. |
|
|
| 6. |
- Lööf, Elin, et al.
(författare)
-
A cohort study of 59 children, focusing on foot involvement and the contralateral foot
- 2016
-
Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 87:5, s. 522-528
-
Tidskriftsartikel (refereegranskat)abstract
- Background and purpose — Idiopathic clubfoot can be bilateral or unilateral; however, most studies of gait have assessed clubfoot cases as one uniform group. The contralateral foot in children with unilateral clubfoot has shown deviations in pedobarographic measurements, but it is seldom included in studies of gait. We evaluated gait in children with idiopathic clubfoot, concentrating on foot involvement. Patients and methods — Three-dimensional gait analyses of 59 children, mean age 5.4 years, with bilateral (n = 30) or unilateral (n = 29) idiopathic clubfoot were stratified into groups of bilateral, unilateral, or contralateral feet. Age-matched controls (n = 28) were evaluated for comparison. Gait assessment included: (1) discrete kinematic and kinetic parameters, and (2) gait deviation index for kinematics (GDI) and kinetics (GDI-k). Results — No differences in gait were found between bilateral and unilateral idiopathic clubfoot, but both groups deviated when compared to controls. Compared to control feet, contralateral feet showed no deviations in discrete gait parameters, but discrepancies were evident in relation to unilateral clubfoot, causing gait asymmetries in children with unilateral involvement. However, all groups deviated significantly from control feet according to GDI and GDI-k. Interpretation — Bilateral and unilateral idiopathic clubfoot cases show the same persistent deviations in gait, mainly regarding reduced plantarflexion. Nevertheless, knowledge of foot involvement is important as children with unilateral clubfoot show gait asymmetries, which might give an impression of poorer deviations. The results of GDI/GDI-k indicate global gait adaptations of the contralateral foot, so the foot should preferably not be used as a reference for gait.
|
|
| 7. |
- Lööf, Elin, et al.
(författare)
-
Neurodevelopmental difficulties in children with idiopathic clubfoot
- 2019
-
Ingår i: Developmental Medicine and Child Neurology. - : Wiley. - 0012-1622 .- 1469-8749. ; 61:1, s. 98-104
-
Tidskriftsartikel (refereegranskat)abstract
- Aim: To evaluate neurodevelopmental difficulties in children with idiopathic clubfoot. Method: A cross-sectional study of 106 children (29 females, 77 males; aged 8–10y) with idiopathic clubfoot and 109 age-, sex-, and residential area-parallelized children from the general population. Neurodevelopmental difficulties were assessed using the parent-report Five to Fifteen (FTF) questionnaire. Group differences were analysed for FTF domains, subdomains, and items. The 90th centile cut-off of the general population on FTF and the parent-based disease-specific instrument (DSI) were used to evaluate clinical relevance of neurodevelopmental symptoms in idiopathic clubfoot. Results: Modest group differences were found for several FTF domains (motor skills, perception, and language) and subdomains (gross and fine motor skills, relation in space, comprehensive and expressive language skills). Thirty-one per cent of the children with idiopathic clubfoot scored in the clinically significant range on 2 or more FTF domains. DSI scores were lower in this subgroup. Interpretation: Findings indicate a moderate and selective increase of neurodevelopmental difficulties in children with idiopathic clubfoot as a whole, especially in the areas of motor skills, perception, and language. Idiopathic clubfoot with marked neurodevelopmental symptoms are associated with less satisfaction of the clubfoot treatment. Our results recommend awareness of neurodevelopmental difficulties in the assessment and treatment of idiopathic clubfoot. What this paper adds: A substantial minority of children with idiopathic clubfoot show neurodevelopmental difficulties. Children with idiopathic clubfoot might present additional difficulties in motor skills, perception, and language. Children with idiopathic clubfoot and marked neurodevelopmental symptoms show poorer parent-reported clubfoot treatment satisfaction. Neurodevelopmental difficulties should be considered in clinical practice of idiopathic clubfoot.
|
|
| 8. |
- Naili, Josefine E, et al.
(författare)
-
Deficits in functional performance and gait one year after total knee arthroplasty despite improved self-reported function
- 2017
-
Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer. - 0942-2056 .- 1433-7347. ; 25:11, s. 3378-3386
-
Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The current literature lacks sufficient information about improvements in gait patterns and function after total knee arthroplasty (TKA) and whether patients return to full function. This study evaluated change in gait, performance-based function, and self-reported function 1 year after TKA in patients with symptomatic knee osteoarthritis and how these aspects interrelate.METHODS: A total of 28 patients (64 % female) with knee osteoarthritis, with a mean age of 66 (±7) years, and 25 age- and gender-matched controls participated in this prospective cohort study. Three-dimensional gait analysis generated comprehensive measures of kinematic and kinetic gait deviations, respectively. Participants completed the Five Times Sit-to-Stand (5STS) test, and the self-reported questionnaire Knee Injury and Osteoarthritis Outcome Score (KOOS), at baseline prior to surgery and 1 year after TKA.RESULTS: Kinetic gait deviations of both the operated and non-operated limb persisted in patients with knee osteoarthritis at 1 year after surgery, while kinematic gait patterns were comparable to controls. Performance on the 5STS and KOOS scores in patients with knee osteoarthritis improved significantly 1 year after surgery (effect size 0.5-1.5), but did not reach the level of controls. Ten patients with knee osteoarthritis (36 %) exceeded the minimally detectable change on the 5STS.CONCLUSION: Measures of overall gait patterns and the 5STS revealed improvements in function 1 year after TKA, but were not restored to the level of healthy controls. Based on change in 5STS performance, we identified patients with substantial improvements in gait patterns. Self-reported measures of function could not detect differences between patients improving in 5STS performance and those who did not. These findings highlight the use of the 5STS in clinical practice since improvement on this test seems to follow the reduction in gait pattern deviations.LEVEL OF EVIDENCE: II.
|
|
| 9. |
- Naili, Josefine E., et al.
(författare)
-
Improved knee biomechanics among patients reporting a good outcome in knee-related quality of life one year after total knee arthroplasty
- 2017
-
Ingår i: BMC Musculoskeletal Disorders. - : BioMed Central. - 1471-2474. ; 18
-
Tidskriftsartikel (refereegranskat)abstract
- Background: It is not well understood why one in five patients report poor outcomes following knee arthroplasty. This study evaluated changes in knee biomechanics, and perceived pain among patients reporting either a good or a poor outcome in knee-related quality of life after total knee arthroplasty.Methods: Twenty-eight patients (mean age 66 (SD 7) years) were included in this prospective study. Within one month of knee arthroplasty and one year after surgery, patients underwent three-dimensional (3D) gait analysis, completed the Knee Injury and Osteoarthritis Outcome Score (KOOS), and rated perceived pain using a visual analogue scale. A "good outcome" was defined as a change greater than the minimally detectable change in the KOOS knee-related quality of life, and a "poor outcome" was defined as change below the minimally detectable change. Nineteen patients (68%) were classified as having a good outcome. Groups were analyzed separately and knee biomechanics were compared using a two-way repeated measures ANOVA. Differences in pain between groups were evaluated using Mann Whitney U test.Results: Patients classified as having a good outcome improved significantly in most knee gait biomechanical outcomes including increased knee flexion-extension range, reduced peak varus angle, increased peak flexion moment, and reduced peak valgus moment. The good outcome group also displayed a significant increase in walking speed, a reduction (normalization) of stance phase duration (% of gait cycle) and increased passive knee extension. Whereas, the only change in knee biomechanics, one year after surgery, for patients classified as having a poor outcome was a significant reduction in peak varus angle. No differences in pain postoperatively were found between groups.Conclusion: Patients reporting a good outcome in knee-related quality of life improved in knee biomechanics during gait, while patients reporting a poor outcome, despite similar reduction in pain, remained unchanged in knee biomechanics one year after total knee arthroplasty. With regards to surgeon-controlled biomechanical factors, surgery may most successfully address frontal plane knee alignment. However, achieving a good outcome in patient-reported knee-related quality of life may be related to dynamic improvements in the sagittal plane.
|
|
| 10. |
- Riad, Jacques, et al.
(författare)
-
Are Muscle Volume Differences Related to Concentric Muscle Work During Walking in Spastic Hemiplegic Cerebral Palsy?
- 2012
-
Ingår i: Clinical Orthopaedics and Related Research. - : Ovid Technologies (Wolters Kluwer Health). - 0009-921X .- 1528-1132. ; 470:5, s. 1278-1285
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Individuals with spastic hemiplegic cerebral palsy are typically high functioning and walk without assistive devices. The involved limb is usually smaller and shorter, although it is not clear whether the difference in muscle volume has an impact on walking capacity. Questions/purposes: We determined the volume of muscles important for propulsion and related that volume to concentric muscle work during walking on the hemiplegic and noninvolved sides in patients with cerebral palsy. Patients and Methods: We studied 46 patients (mean age, 17.6 years; range, 13-24 years) with spastic hemiplegic cerebral palsy. We assessed muscle volume using MRI and concentric muscle work in the sagittal plane from the hip, knee, and ankle using three-dimensional gait analysis. Patients were classified by Winters' criteria to assess the involvement of cerebral palsy and movement pattern during walking. Results: On the hemiplegic side, muscles were smaller, except for the gracilis muscle, and concentric muscle work from the ankle plantar flexors, knee extensors, and hip flexors and extensors was lower compared to the noninvolved side. Hip extensor work was higher on the hemiplegic and the noninvolved sides compared to a control group of 14 subjects without cerebral palsy. Hemiplegic to noninvolved volume ratios correlated with work ratios (r = 0.40-0.66). The Winters classification and previous calf muscle surgery predicted work ratios. Conclusions: Our observations of smaller muscles on the hemiplegic side and changes in muscle work on both sides can help us distinguish between primary deviations that may potentially be treatable and compensatory mechanisms that should not be treated.
|
|
