A Descriptive Study of Lower Limb Torsional Kinematic Profiles in Children With Spastic Diplegia

Simon, Anne-Laure; Ilharreborde, Brice; Mégrot, Fabrice; Mallet, Cindy; Azarpira, Reza; Mazda, Keyvan; Presedo, Ana; Penneçot, Georges-François

doi:10.1097/bpo.0000000000000331

Cited by 20 publications

(8 citation statements)

References 26 publications

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“…For example, observed frequencies of excessive pelvic or hip rotation or in/outtoeing were markedly lower than the frequencies reported in previous studies (Wren et al, 2005; O'Sullivan et al, 2007; de Morais Filho et al, 2009; Simon et al, 2015). However, the definition of what constitutes excessive rotation across studies varies substantially.…”

Section: Discussioncontrasting

confidence: 56%

Prevalence of Joint Gait Patterns Defined by a Delphi Consensus Study Is Related to Gross Motor Function, Topographical Classification, Weakness, and Spasticity, in Children with Cerebral Palsy

Nieuwenhuys

Papageorgiou

Schless

et al. 2017

Front. Hum. Neurosci.

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During a Delphi consensus study, a new joint gait classification system was developed for children with cerebral palsy (CP). This system, whose reliability and content validity have previously been established, identified 49 distinct joint patterns. The present study aims to provide a first insight toward the construct validity and clinical relevance of this classification system. The retrospective sample of convenience consisted of 286 patients with spastic CP (3–18 years old, GMFCS levels I–III, 166 with bilateral CP). Kinematic and kinetic trials from three-dimensional gait analysis were classified according to the definitions of the Delphi study, and one classified trial was randomly selected for each included limb (n = 446). Muscle weakness and spasticity were assessed for different muscle groups acting around the hip, knee, and ankle. Subsequently, Pearson Chi square tests, Cramer's V, and adjusted standardized residuals were calculated to explore the strength and direction of the associations between the joint patterns, and the different patient-specific characteristics (i.e., age, GMFCS level, and topographical classification) or clinical symptoms (muscle weakness and spasticity). Patient-specific characteristics showed several significant associations with the patterns of different joints, but the strength of most identified associations was weak. Apart from the knee during stance phase and the pelvis in the sagittal plane, the results systematically showed that the patterns with “minor gait deviations” were the most frequently observed. These minor deviations were found significantly more often in limbs with a lower level of spasticity and good muscle strength. Several other pathological joint patterns were moderately associated with weakness or spasticity, including but not limited to “outtoeing” for weakness and “intoeing” for spasticity. For the joints in the sagittal plane, significantly stronger associations were found with muscle weakness and spasticity, possibly because most of the evaluated muscles in this study mainly perform sagittal plane motions. Remarkably, the hip patterns in the coronal plane did not associate significantly with any of the investigated variables. Although further validation is warranted, this study contributes to the construct validity of the joint patterns of the Delphi consensus study, by demonstrating their ability to distinguish between clinically relevant subgroups in CP.

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Section: Discussioncontrasting

confidence: 56%

Prevalence of Joint Gait Patterns Defined by a Delphi Consensus Study Is Related to Gross Motor Function, Topographical Classification, Weakness, and Spasticity, in Children with Cerebral Palsy

Nieuwenhuys

Papageorgiou

Schless

et al. 2017

Front. Hum. Neurosci.

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“…Spastic diplegia manifests as high and constant “tightness” or “stiffness” in the muscles of the lower extremities, usually on the legs, hips, and pelvis. The abnormally high muscle tone that results creates lifelong difficulty with all voluntary and passive movement in the legs, such as ankle rotational anomalies, identified as the most frequent cause of lower limb torsional deviations followed by pelvic malalignment (Simon et al, 2015 ). The consequence of this impairment is shorter strides and difficulties performing rapid changes of direction, which explains the lower scores in both CODA tests.…”

Section: Discussionmentioning

confidence: 99%

Change of Direction Ability Performance in Cerebral Palsy Football Players According to Functional Profiles

et al. 2016

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The aims of the present study were to evaluate the validity and reliability of the two different change of direction ability (CODA) tests in elite football players with cerebral palsy (CP) and to analyse the differences in performance of this ability between current functional classes (FT) and controls. The sample consisted of 96 international cerebral palsy football players (FPCP) and 37 football players. Participants were divided into four different groups according to the International Federation of Cerebral Palsy Football (IFCPF) classes and a control group (CG): FT5 (n = 8); FT6 (n = 12); FT7 (n = 62); FT8 (n = 14); and CG (n = 37). The reproducibility of Modified Agility Test (MAT) and Illinois Agility Test (IAT) (ICC = 0.82–0.95, SEM = 2.5–5.8%) showed excellent to good values. In two CODA tests, CG performed faster scores compared with FPCP classes (p < 0.01, d = 1.76–3.26). In IAT, FT8 class comparisons regarding the other classes were: FT5 (p = 0.047, d = 1.05), FT6 (p = 0.055, d = 1.19), and FT7 (p = 0.396, d = 0.56). With regard to MAT, FT8 class was also compared with FT5 (p = 0.006, d = 1.30), FT6 (p = 0.061, d = 0.93), and FT7 (p = 0.033, d = 1.01). No significant differences have been found between FT5, FT6, and FT7 classes. According to these results, IAT and MAT could be useful and reliable and valid tests to analyse CODA in FPCP. Each test (IAT and MAT) could be applied considering the cut point that classifiers need to make a decision about the FT8 class and the other FT classes (FT5, FT6, and FT7).

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“…26 , 27 , [114][115][116][117][118] Data-driven models have identified unique kinematic deviations associated with torsional malalignment (femoral and/or tibial increased torsion), as well as atypical patterns at the knee and foot. 29,30,32,65,77,[119][120][121][122][123][124][125][126][127][128][129][130] Numerous models used 3D-IGA to quantify nuances of those patterns and their relationship(s) to other gait deviations at the trunk, pelvis, hip, knee, foot and ankle, and even the upper extremities. 69,72,73,75,76,116,[131][132][133][134][135][136][137][138][139][140][141][142][143][144][145][146][147][148]…”

Section: Supporting Evidence and Clinical Interpretationmentioning

confidence: 99%

Three-Dimensional Instrumented Gait Analysis for Children With Cerebral Palsy: An Evidence-Based Clinical Practice Guideline

States,

Salem,

Krzak

et al. 2024

Pediatric Physical Therapy

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Background: Children with cerebral palsy (CP) who walk have complex gait patterns and deviations often requiring physical therapy (PT)/medical/surgical interventions. Walking in children with CP can be assessed with 3-dimensional instrumented gait analysis (3D-IGA) providing kinematics (joint angles), kinetics (joint moments/powers), and muscle activity. Purpose: This clinical practice guideline provides PTs, physicians, and associated clinicians involved in the care of children with CP, with 7 action statements on when and how 3D-IGA can inform clinical assessments and potential interventions. It links the action statement grades with specific levels of evidence based on a critical appraisal of the literature. Conclusions: This clinical practice guideline addresses 3D-IGA’s utility to inform surgical and non-surgical interventions, to identify gait deviations among segments/joints and planes and to evaluate the effectiveness of interventions. Best practice statements provide guidance for clinicians about the preferred characteristics of 3D-IGA laboratories including instrumentation, staffing, and reporting practices. Video Abstract: Supplemental digital content available at http://links.lww.com/PPT/A524.

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A Descriptive Study of Lower Limb Torsional Kinematic Profiles in Children With Spastic Diplegia

Abstract: Level IV.

Cited by 20 publications

References 26 publications

Prevalence of Joint Gait Patterns Defined by a Delphi Consensus Study Is Related to Gross Motor Function, Topographical Classification, Weakness, and Spasticity, in Children with Cerebral Palsy

Prevalence of Joint Gait Patterns Defined by a Delphi Consensus Study Is Related to Gross Motor Function, Topographical Classification, Weakness, and Spasticity, in Children with Cerebral Palsy

Change of Direction Ability Performance in Cerebral Palsy Football Players According to Functional Profiles

Three-Dimensional Instrumented Gait Analysis for Children With Cerebral Palsy: An Evidence-Based Clinical Practice Guideline

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