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How does applying of one or two orthoses influence gait parameters of children with hemiplegia?

Boryczka-Trefler Anna, Syczewska Małgorzata, Stępowska Jolanta

Acta of Bioengineering and Biomechanics

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2019

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Vol. 21, no. 2

95--100

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.

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Motor functions assessment method based on energy changes in gait cycle

Michnik R., Nowakowska K., Jurkojč J., Jochymczyk-Woźniak K., Kopyta I.

Acta of Bioengineering and Biomechanics

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2017

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Vol. 19, no. 4

63--75

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.

3

Influence of modified muscle morphology and activity pattern on the results of musculoskeletal system modelling in cerebral palsy patient

Ogrodnik J., Piszczatowski Sz.

Acta of Bioengineering and Biomechanics

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2017

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Vol. 19, no. 3

63--75

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.

4

Are electromyographic patterns during gait related to abnormality level of the gait in patients with spastic cerebral palsy?

Syczewska M., Święcicka A.

Acta of Bioengineering and Biomechanics

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2016

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Vol. 18, no. 3

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.

5

Index of Mechanical Work in Gait of Children with Cerebral Palsy

Dziuba A. K., Tylkowska M., Jaroszczuk S.

Acta of Bioengineering and Biomechanics

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2014

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Vol. 16, no. 3

77--87

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.

6

Integral method (IM) as a quantitative and objective method to supplement the GMFCS classification of gait in children with cerebral palsy (CP)

Dziuba A., Bober T., Kobel-Buys K., Stempień M.

Acta of Bioengineering and Biomechanics

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2013

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Vol. 15, no. 2

105--111

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.

7

Computerized analysis and modelling of patients with deformities of lower limbs

Pauk J.

Acta of Bioengineering and Biomechanics

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2009

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Vol. 11, nr 1

47-51

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.

8

Gait characteristics following Achilles tendon elongation: the foot rocker perspective

Bober T., Dziuba A., Kobel-Buys K., Kulig K.

Acta of Bioengineering and Biomechanics

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2008

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Vol. 10, nr 1

37-42

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.

9

Foot kinematics in gait of children with cerebral palsy (CP)

Dziuba A., Szpala A.

Acta of Bioengineering and Biomechanics

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2008

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Vol. 10, nr 4

3-6

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.

10

The symmetry of walk in Cerebral Palsy (CP) children

Dziuba A.

Zeszyty Naukowe Katedry Mechaniki Stosowanej / Politechnika Śląska

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2006

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z. 26

93-98

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.

11

Elektropneumatyczny przyrząd do wspomagania oddechu

Niegoda J., Zieliński M.

Zeszyty Naukowe Politechniki Świętokrzyskiej. Elektryka

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2000

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Z. 39

263-268

PL

W artykule pokrótce scharakteryzowano objawy i przyczyny dziecięcego porażenia mózgowego. Wymieniono metody i przyrządy do terapii poprzez wspomaganie oddechu. Zostały opisany układ pneumatyczny i elektryczny urządzenia do wspomagania oddechu.