No abstract

We undertook this study to determine if subclinical postural control mechanisms were abnormal in idiopathic scoliosis. Ninety-one female patients and fifty-seven age-matched female controls were examined. We used a force plate ataxiometer to quantitate postural sway in the standing position and recorded the displacement and acceleration of the center of pressure during static stance and under perturbation with eyes opened and closed. A joystick-controlled video system was used to measure reaction time and eye-hand motor coordination. The scoliosis group demonstrated significantly less sway during two of the eight standing balance conditions and on the remaining balance tests there was a similar trend, albeit nonsignificant. The reaction time for the scoliosis group was also significantly slower, but the accuracy was not significantly worse. We noted no statistical differences between progressive and nonprogressive or between braced and unbraced patients. The subgroup of patients whose curves progressed despite bracing had a tendency to demonstrate greater stability on all standing tests. They also exhibited faster reaction times and less error in eye-hand coordination than other patient groups. No correlation existed between severity of curve and test performance. We found no indication of deficient balance in idiopathic scoliosis, and the tests could not predict curve progression.

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Dynamic electromyography (EMG) of the lower-limb muscles has been proposed as an objective diagnostic tool to assist the surgeon in choosing appropriate surgery for correction of paralytic deformities (Perry and Hoffer 1979, Bennet et al. 1982, Barto et al. 1984). Those papers have described the abnormalities in phasic timing of the muscles tested while the patient walked, and related the prolonged and mal-timed electrical signals to the paralytic foot deformities. All the authors based their recommendations for corrective surgery on the dynamic EMGs. Barto and colleagues performed the EMG and clinical examinations independently and made separate recommendations: in three out of four cases the surgical recommendations were not in agreement with the EMG findings. In the cases that had surgery, the operation almost always was based on the EMG rather than the clinical findings, and resulted in satisfactory correction of the foot deformity in most cases.We have had a motion analysis laboratory for 10 years, in which gait EMG during muscle activity is transmitted by telemetry and real-time data output. In this study we have reviewed the EMG studies of leg muscles tested preoperatively, the surgical procedures performed and the follow-up results. We recognize the difficulty in determining the value of EMG gait studies when the surgeon's decisions are based on both clinical and laboratory findings, but in this study we have attempted to assess the positive and negative value of the dynamic EMGS in choosing the appropriate surgical procedure for correcting paralytic foot deformities. MaterialBetween 1980 and 1982 we selected 21 patients who had 23 gait EMG 3 examinations for pre-operative evaluation of paralytic deformities of the foot and who had a minimum follow-up period of one to six years; mean 3.6, median 3.8 years). Of the 21 patients, 17 had cerebral palsy (16 spastic, one athetoid); the remaining four patients were one each with myelomeningocele, Marfan syndrome, congenital talipes equinovarus and spastic paraplegia due to an arrested neuroblastoma of the spinal cord. N tri m 3 rn 0; m 2 one year after surgical correction (range c $ : 2 3 2 8 % .2: 0 , u