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EN
The aim of this study was to evaluate how wearing one or two orthoses influence the gait parameters in children with hemiplegia. Four children with hemiplegic cerebral palsy participated in the study. Patients were from 3 to 7 years old; one girl and three boys; one patient with right side hemiplegia, three patients with left side hemiplegia. Patients underwent the VICON MX system gait analysis three times (sessions): one with bare feet, the other two with shoes and orthoses: one with orthoses used unilaterally on palsied limb, one with orthoses used bilaterally. The following gait parameters were analyzed: velocity, cadence, pelvis tilt, range of pelvic movement in sagittal plane, separately for affected and non-affected side: step length, stance time (as a percentage of the gait cycle), range of hip movement in sagittal plane, knee flexion at initial contact, maximum knee flexion in swing phase. Results of the study showed which and how many gait parameters changed while wearing one in comparison with two orthoses. The results did not give a clear indication which condition is better: wearing one or two orthoses, however they suggest that when the orthotic devices are considered for patients with hemiplegic cerebral palsy, the objective, instrumented gait analysis can be used to take the best decision whether one or two orthoses should be prescribed.
EN
The aim of the research was to determine the energy changes during the gait cycle for a group of healthy children and a group of patients with cerebral palsy, and to compare the value of energy expenditure (EE) with the determined values of the Gillette Gait Index (GGI) and the Gait Deviation Index (GDI). Methods: The study group consisted of 56 children with regular gait and 56 patients with diagnosed cerebral palsy (CP). The gait kinematics was determined by BTS Smart System. Based on the identified position of the body mass, the following parameters were determined: the potential energy, kinetic energy, and total energy. The values were standardized to 100% of the gait cycle. The values of the Gillette Gait Index (GGI) and the Gait Deviation Index (GDI) were calculated using the authors’ own software. Results: Values of potential, kinematic and mechanical energy changes and mean values of total energy (energy expenditure – EE) were calculated for a reference group and for patients with CP. The obtained results were standardized in relation to the body mass and stride length. Furthermore, the values of the Gillette Gait Index (GGI) and the Gait Deviation Index (GDI) were calculated. Statistical analysis of the obtained results was performed. The Spearman rank correlation coefficient was defined between the calculated GGI and GDI values and energy expenditure EE. Conclusions: Values of energy expenditure changes can be used as an objective comparative tool for gait results concerning children with various neurological and orthopaedic dysfunctions.
EN
Purpose: The aim of the present study was to evaluate the influence of modified morphological parameters of the muscle model and excitation pattern on the results of musculoskeletal system numerical simulation in a cerebral palsy patient. Methods: The modelling of the musculoskeletal system was performed in the AnyBody Modelling System. The standard model (MoCap) was subjected to modifications consisting of changes in morphological parameters and excitation patterns of selected muscles. The research was conducted with the use of data of a 14-year-old cerebral palsy patient. Results: A reduction of morphological parameters (variant MI) caused a decrease in the value of active force generated by the muscle with changed geometry, and as a consequence the changes in active force generated by other muscles. A simulation of the abnormal excitation pattern (MII variant) resulted in the muscle’s additional activity during its lengthening. The simultaneous modification of the muscle morphology and excitation pattern (MIII variant) points to the interdependence of both types of muscle model changes. A significant increase in the value of the reaction force in the hip joint was observed as a consequence of modification of the hip abductor activity. Conclusions: The morphological parameters and the excitation pattern of modelled muscles have a significant influence on the results of numerical simulation of the musculoskeletal system functioning.
EN
The aim of this study was the electromyographic analysis of the erector spinae muscle, using the Noraxon Tele Myo DTS equipment. It’s used to test the neuromuscular function, during physical activity. It allows for detailed localization of the pathological changes in the muscle tissue. It can be also helpful to define the functional disorders of the muscular system in children with cerebral palsy. For the purpose of the study, a six-year-old girl with this disease was examined, one of the types of EMG - surface electromyography being used. The problem which is of primary importance in children with cerebral palsy is a widely understood damage of the musculoskeletal system. The test was performed in five starting positions, with the electrodes placed on the lumbar spine. As a result of the analysis, a motor skills disorder, asymmetry of muscle tension and dystonia was diagnosed. Dystonia may be the result of other disease, characteristic to children with cerebral palsy – scoliosis.
PL
Celem niniejszej pracy była analiza elektromiograficzna mięśnia prostownika grzbietu, przy użyciu aparatu Noraxon Tele Myo DTS. Jest ona wykorzystywana do badania funkcji nerwowo – mięśniowych w trakcie aktywności fizycznej. Pozwala na szczegółowe lokalizowanie zmian patologicznych w tkance mięśniowej. Może być stosowana do określania zaburzeń czynnościowych w układzie mięśniowym u dzieci z mózgowym porażeniem dziecięcym. W badaniu udział wzięła sześcioletnia dziewczynka z tym schorzeniem. W tym przypadku posłużono się jednym z rodzajów EMG – elektromiografią powierzchniową. Problemem mającym pierwszoplanowe znaczenie u dzieci z tą chorobą jest szeroko pojęte uszkodzenie narządu ruchu. Test przeprowadzono w pięciu pozycjach wyjściowych, z elektrodami umieszczonymi w odcinku lędźwiowym kręgosłupa. Na skutek wykonanych analiz odnotowano nieprawidłowości w koordynacji ruchowej, asymetrię w napięciu mięśniowym, a także zespół dystoniczny. Dystonia może być efektem występowania innego schorzenia, charakterystycznego dla dzieci z mózgowym porażeniem dziecięcym – skoliozy.
EN
Purpose: One of the aims of the treatment in ambulant cerebral palsy (CP) patients is improvement of gait. Level of gait pathology is assessed by instrumented gait analysis, including surface electromyography. The aim of this study was to investigate the relation of the abnormality level of the gait and the co-contraction of the agonist-antagonist muscles, and relation between symmetry left /right leg in gait and symmetry of muscular activity. Methods: Fifty one patients with Cerebral Palsy underwent clinical assessment and instrumented gait analysis, including surface electromyography. Signals were bilaterally collected from rectus femoris, medial and lateral hamstrings, tibialis anterior, lateral gastrocnemius and gluteus maximus. In older children additionally signals from soleus and lateral vastus were recorded. Sixteen gait variables were selected to calculate Gillette Gait Index, separately for left and right leg. From the envelopes the series of cross-correlation coefficients were calculated. Results: Weak correlations were found between averaged agonist-antagonist correlation coefficient and Gillette Gait Index. Differences between hemiparetic less-involved legs, hemiparetic spastic legs, and diplegic legs were found for co-contraction of rectus femoris and biceps femoris and for averaged agonist-antagonist co-contraction. The differences between hemiparetic and diplegic groups were found for some muscle correlation coefficients. Conclusions: The results obtained in this study show, that the activity pattern of the leg muscles is specific for a given patient, and the dependence of the kinematics pathology on the abnormal activation pattern is not a direct one.
6
Content available remote Thermograpic study of upper extremities in patients with cerebral palsy
EN
Trophic disorders like reduced skin blood circulation are well-known epiphenomenon of cerebral palsy (CP). They can influence quality of life and can lead to skin damages and, as a consequence, to decubitus. Therefore, it is important to analyse temperature regulation in patients with CP. Thermal imaging camera FLIR BCAM SD was used to study the dependency of skin blood circulation in upper extremities of patients with CP on hand dominance, hand force and hand volume. The hand force was evaluated using a conventional dynamometer. The hand volume was measured with a volumeter. A cold stress test for hands was applied in 22 patients with CP and 6 healthy subjects. The warming up process after the test was recorded with the thermal camera. It was confirmed that the hands of patients warm up slower comparing to healthy persons. The patients’ working hands warm up faster than non-working ones. A slight correlation was established between the hand grip force of the working hands and their warm up time. No correlation was found between the warming up time and the volume of the hand. The results confirm our assumption that there is a connection of peripheral blood circulation to upper limb motor functions.
PL
Wyznaczenie obciążeń układu szkieletowo-mięśniowego może wspomagać diagnostykę narządu ruchu oraz być pomocne w procesie doboru metod leczenia i śledzenia jego postępów. Obecne na rynku metody pomiarowe uniemożliwiają dokonania bezpośrednich i nieinwazyjnych pomiarów obciążeń układu szkieletowo-mięśniowego. W artykule przedstawiona została metodyka identyfikacji sił mięśniowych pacjenta z mózgowym porażeniem, przy wykorzystaniu środowiska AnyBody. Otrzymane wyniki wybranych sił mięśni zestawiono z wynikami otrzymanymi dla grupy pacjentów o chodzie prawidłowym oraz poddano analizie. Wskazano zależności pomiędzy zaburzeniami kinematyki chodu, a niewłaściwym funkcjonowaniem aparatu mięśniowego kończyn dolnych.
EN
Determination of musculoskeletal system load may assist in diagnosis of locomotor system and help for choosing method of treatment. The aim of the survey was to analyze the musculoskeletal system load during gait in patients with cerebral palsy. The paper presents a method for identification of muscle strength using simulation software AnyBody Modeling System. The results of muscle strength for patient with cerebral palsy were compared to the results for patients with normal gait.
EN
The pathological gait of children with cerebral palsy involves higher mechanical work, which limits their ability to function properly in society. Mechanical work is directly related to walking speed and, although a number of studies have been carried out in this field, few of them analysed the effect of the speed. The study aimed to develop standards for mechanical work during gait of children with cerebral palsy depending on the walking speed. The study covered 18 children with cerebral palsy and 14 healthy children. The BTS Smart software and the author's software were used to evaluate mechanical work, kinetic, potential and rotational energy connected with motion of the children body during walk. Compared to healthy subjects, mechanical work in children with cerebral palsy increases with the degree of disability. It can be expressed as a linear function of walking speed and shows strong and statistically significant correlations with walking gait. A negative statistically significant correlation between the degree of disability and walking speed can be observed. The highest contribution to the total mechanical energy during gait is from mechanical energy of the feet. Instantaneous value of rotational energy is 700 times lower than the instantaneous mechanical energy. An increase in walking speed causes the increase in the effect of the index of kinetic energy on total mechanical work. The method described can provide an objective supplementation for doctors and physical therapists to perform a simple and immediate diagnosis without much technical knowledge.
PL
Celem pracy była ocena stabilności ciała i jej mechanicznej kontroli przy staniu swobodnym na boso i staniu w ortozach kończyn dolnych u dzieci z mózgowym porażeniem dziecięcym. Badaniami objęto 40 dzieci z mózgowym porażeniem dziecięcym (MPDz) - pacjentów Mazowieckiego Centrum Neuropsychiartii w Zagórzu koło Warszawy. Grupę badawczą podzielono na dwie podgrupy ze względu na postać kliniczną MPDz: 20 osób z niedowładem połowiczym i 20 osób z niedowładem obustronnym. Wiek badanych mieścił się w przedziale 2-15 lat. Do oceny stabilności ciała i jej mechanicznej kontroli wykorzystano metodę stabilograficzną przy użyciu sprzętu AMTI NetForce OR6-7-1000. Pomiar równowagi przeprowadzono w dwóch pozycjach: stojącej swobodnie na boso i stojącej swobodnie w ortozach kończyn dolnych. Wyniki badań wskazują, że do poprawy stabilności ciała w pozycji stojącej po założeniu ortoz kończyn dolnych dochodzi w obu grupach badawczych, co objawia się zmniejszeniem wartości parametrów stabilograficznych. Istotne zmiany wykazano jedynie w grupie dzieci z niedowładem połowiczym, w zakresie: przemieszczenia COP lewo-prawo, średniej prędkości oraz długości całkowitej stabilogramu.
EN
The aim of the work was the evaluation of differences in the postural stability and its mechanical control between free bare feet standing position and standing position in lower limbs’ orthoses of children suffering from cerebral palsy. The examination included 40 children with cerebral palsy from Mazowieckie Centre of Neuropsychiatry in Zagórze, near Warsaw. The research group was divided into two subgroups: 20 persons with hemiparesis and 20 with diparesis. The examined children were aged between 2-15. The examination of body stability and its mechanical control was carried on with the help of the stabilographic method by means of AMTI NetForce OR6-7-1000 equipment. Balance was measured in these two tests: free standing, bare feet and standing with orthotics of lower limbs. An improvement in terms of lowering the values of stabilographic parameters of the body stability in both research groups after using lower limbs’ orthotics, was stated. Significant changes were observed only in the group of children with hemiparesis in the range of: left-right COP movement, mean speed and length of stabilogram.
EN
Gait analysis is an objective tool for the clinical assessment of locomotor activity in children with cerebral palsy (CP). Correct diagnosis and properly planned rehabilitation are necessary for enhanced motor functions in persons suffering from cerebral palsy. Orthoses, orthopedic operations, medications and physiotherapy are the most common treatments. However, there is still a lack of objective methods for assessing motor behavior and monitoring the progress of recovery. The aim of the study was to use the ground reaction force patterns generated during walking to create the Integral Method (IM), which could become an objective tool that could supplement the functional classification of CP children based on the Gross Motor Function Classification System (GMFCS). A total of 15 healthy children and 34 children with CP who walk independently participated in the study. A Kistler force plate and GRFintegral software were used. Of the 34 measurements based on the IM for CP children, 17 matched the level assigned by the GMFCS, 2 children were assigned a higher level, and 15 were assigned a lower level. Pearson’s correlation coefficient between the IM and the GMFCS was moderate (r = 0.61, p ≤ 0.01). Asymmetry was found in 11 cases. The IM supplements the GMFCS and is an objective and quantitative assessment of motor abilities. The method allows for the detection of asymmetry, diagnosis of the improvement of gait pattern and assessment of foot support technique. With the appropriate software, the IM provides pediatricians, neurologists, orthopedists, surgeons and physiotherapists with a simple and fast way to assess gait.
EN
The cerebral palsy symptoms are, among others, balance and gait disorders. The goal of this study was to assess balance capabilities in children with spastic diplegic cerebral palsy rehabilitated using Lokomat active orthosis. The experimental group included children with cerebral palsy, aged 6–14 years, independent standing, level II-III according to GMFCS classification. The cohort was randomly divided into two groups. The balance was assessed on a stabilometric platform. The experimental group was administered a rehabilitation program with the use of Lokomat active orthosis. Statistically significant improvement of balance was found in the experimental group; however, in the control group the improvement was also visible, but not on the statistically significant level. While comparing the results of both groups, significantly bigger improvement was achieved by the children from the experimental group. Lokomat active orthosis is one of the newest devices applied in the rehabilitation. The study shows that training with active orthosis can have positive influence on the balance improvement in children with CP and that further analysis of the impact of such training on locomotive functions is needed.
12
Content available remote Computerized analysis and modelling of patients with deformities of lower limbs
EN
The purpose of this paper was to model the human gait of typical subjects and patients with such deformities of lower limbs as: spastic diplegia cerebral palsy and spina bifida occulta. Model coefficients will lead to the development of a better computer system to support clinical decision-making in human gait in terms of assessment, diagnosis, and classificatio,mnn. Human gait was evaluated by using Motion Analysis System in the Syncrude Center for Motion and Balance in Edmonton. Kinetics data were used for the mathematical modelling based on regression function. The difference between the model coefficients of the patients with the deformities of lower limbs and typical subjects were analysed. There is shown that the model coefficients are different in each group. The modelling can help to define gait pathology and treatment for a large number of patients.
13
EN
The action of three functional rockers, namely the heel, ankle and forefoot rocker, assist the progression of the leg over the supporting foot. The purpose of this case series was to analyze the occurrence of foot rockers during gait in three children with cerebral palsy (CP) who had undergone the tendo-Achilles lengthening (TAL), procedure followed by a clinic- or home-based intervention and in one child with CP without history of surgery. Self-selected gait was video-recorded in a laboratory during six testing sessions at half-year intervals rendering a 3 year period of observation. One child had pre- and post-surgical gait data and the other two had post surgical data only. Sagittal plane knee angular velocity, as well as foot to ground positions, and foot rocker occurrence were analyzed. In a child with history of CP, and without history of surgery, mean angular velocities of the 1st, 2nd and 3rd foot rocker were 3.7, 0.57 and 6.67 rad/s, respectively, and the step length and cadence were normal. In children who underwent TAL the 1st and 2nd rocker was absent, as the initial contact of the foot with the ground was either with foot-flat or forefoot. The mean velocity of the 3rd rocker in children who underwent TAL was lower by approximately 50–80% than that of the nonsurgical case. Furthermore, the characteristic pattern of the knee joint to foot–floor position during gait was not observed in these cases. Foot rocker analysis identified children with abnormal gait characteristics. Following surgery these gait characteristics remained abnormal.
14
Content available remote Foot kinematics in gait of children with cerebral palsy (CP)
EN
Cerebral palsy (CP) is a developmental disorder of motor, psychological and emotional functions. Its most typical symptom is a walking disorder. The aim of this study was to analyze children's walking abilities based on basic kinematic parameters. In this research, the analysis of a three-dimensional kinematical movement is used to record the right and left parts of the child's body. The walking skills of two CP children are described. For locomotion analysis, the angular displacements in the right and left knees and ankles and foot distortion in both support and swing phases of the walk were chosen. The kinematic parameters can be helpful in the diagnosis and allow physiotherapists to suggest what exercise program should be develop in order to improve the habit of walking.
EN
Mechanical factors have a strong influence on the development of the musculoskeletal system. Muscle forces are one of the most important sources of the loadings acting on the bone elements and any disturbances in their activity can lead to severe pathology. Cerebral palsy is an example of such a situation and hip joint deformity, leading to its dislocation, is one of the most serious complications accompanied with muscle spasticity. The aim of the study is to perform an analysis of the stress and strain in hip joint of the children with the imbalance in muscle forces due to adductors spasticity (overactivity). Finite element model has been developed based on anatomical data obtained from computer tomography. The results of numerical simulations show an increase in stress and strain occurring in the femoral head and acetabulum as well as some relocation of its concentration zone in the medial direction.
EN
The aim of this study was to investigate the symmetry of gait kinematics in CP children who supplement traditional rehabilitation with excercises on BABS saddle. Two video cameras were used to record the left and right side of the body in sagittal plane while walking. Four to six strides were recorded and analyzed. To calculate the kinematic parameters SIMI MOTION was used. In this paper the walking symmetry of four CP children was decribed. They represented different abilities of walking: child 1/MJ and 10/ST walked independently, 6/SM needed somebody supporting him with two hands and 02/MR walked using support of an assistive mobility device. Children walking indepedently showed better symmetry than those needing assistance. This was seen especiall in step time, hip, knee and ankle linear (2D) displacement.
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