Relationship between ankle function and walking ability for children and young adults with cerebral palsy: A systematic review of deficits and targeted interventions

Conner, Benjamin C.; Remec, Nushka M.; Michaels, Cassidy M.; Wallace, Chase W.; Andrisevic, Emily; Lerner, Zachary F.

doi:10.1016/j.gaitpost.2021.10.024

Cited by 17 publications

(19 citation statements)

References 127 publications

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“…GDI has previously been reported to be a reliable measure and was used in many studies (23,26,(36)(37)(38) for assessing the similarities of the pathological gait to a desired trajectory, e.g., a dataset of 166 TDs (35). By including 15 kinematic measures from all three joints, GDI is an inclusive kinematic measure and can capture this interdependency, and thereby, the lower extremity kinematics changes, more thoroughly when compared with joint-by-joint analysis.…”

Section: Discussionmentioning

confidence: 99%

Case report: The gait deviation index may predict neurotherapeutic effects of FES-assisted gait training in children with cerebral palsy

Behboodi

Sansare

Zahradka

et al. 2023

Front. Rehabil. Sci.

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BackgroundChildren with cerebral palsy (CP) show progressive loss of ambulatory function characterized by kinematic deviations at the hip, knee, and ankle. Functional electrical stimulation (FES) can lead to more typical lower limb kinematics during walking by eliciting appropriately timed muscle contractions. FES-assisted walking interventions have shown mixed to positive results in improving lower limb kinematics through immediate correction of gait during the application of FES, or long-term, persisting effects of non-FES-assisted gait improvements following multi-week FES-assisted gait training, at the absence of stimulation, i.e., neurotherapeutic effects. It is unknown, however, if children with CP will demonstrate a neurotherapeutic response following FES-assisted gait training because of the CP population's heterogeneity in gait deviations and responses to FES. Identifying the neurotherapeutic responders is, therefore, important to optimize the training interventions to those that have higher probability of benefiting from the intervention.ObjectiveThe purpose of this case study was to investigate the relationship between immediate and neurotherapeutic effects of FES-assisted walking to identify responders to a FES-assisted gait training protocol.MethodsThe primary outcome was Gait Deviation Index (GDI) and secondary outcome was root mean squared error (RMSE) of the lower extremity joint angles in the sagittal plane between participants with CP and a typically developing (TD) dataset. Potential indicators were defined as immediate improvements from baseline during FES-assisted walking followed by neurotherapeutic improvements at the end of training.Case descriptionGait analysis of two adolescent female participants with spastic diplegia (Gross Motor Function Classification System level II and III) was conducted at the start and end of a 12-week FES-assisted treadmill training protocol. Participant 1 had scissoring crouch gait, while participant 2 had jump gait.OutcomesThe GDI showed both immediate (presence of FES) and neurotherapeutic (absence of FES after training period) improvements from baseline in our two participants. Joint angle RMSE showed mixed trends between immediate and neurotherapeutic changes from baseline. The GDI warrants investigation in a larger sample to determine if it can be used to identify responders to FES-assisted gait training.

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Section: Discussionmentioning

confidence: 99%

Case report: The gait deviation index may predict neurotherapeutic effects of FES-assisted gait training in children with cerebral palsy

Behboodi

Sansare

Zahradka

et al. 2023

Front. Rehabil. Sci.

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“…Cerebral palsy (CP), a pediatric onset movement disorder characterized by slow and inefficient gait patterns [1] , is often associated with poor neuromuscular control at the ankle joint [2] , [3] . These pathological gait patterns create a significant barrier to physical activity, which is likely detrimental to healthy childhood development [4] .…”

Section: Introductionmentioning

confidence: 99%

Ankle Exoskeleton Assistance Increases Six-Minute Walk Test Performance in Cerebral Palsy

Conner¹,

Orekhov²,

Lerner³

2021

IEEE Open J. Eng. Med. Biol.

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Objective: To determine the effects of providing battery-powered ankle dorsiflexor and plantar flexor exoskeleton assistance on six-minute walk test performance and efficiency in children and young adults with cerebral palsy by comparing distance walked under exoskeleton assisted (Assisted) and no device (Shod) walking conditions, and explore the acclimation rate to maximal walking with ankle exoskeleton assistance. Results: Six-minute walk test performance significantly improved under the final Assisted condition test compared to the Shod condition (42 ± 27 m, p = 0.02), surpassing the minimum clinically important difference range for children and young adults with CP. There was no difference in walking efficiency (-0.06 ± 0.1, p = 0.3). Participants had an average acclimation rate of 19.6 m per session. Conclusions: Powered ankle assistance can significantly improve six-minute walk test performance in individuals with mild-to-moderate gait impairment from CP, supporting the use of this intervention to improve functional mobility and walking capacity in this patient population.INDEX TERMS Ankle assistance, cerebral palsy, exoskeleton, six-minute walk test IMPACT STATEMENT Battery-powered ankle assistance can increase six-minute walk test distance for individuals with CP past the minimum clinically important difference without negatively affecting energetic efficiency compared to device-free walking.

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“…The improvement of walking ability is considered one of the primary goals to allow for a more active and independent lifestyle in CP [2,7]. In conjunction with other medical, surgical, and therapeutic interventions, assistive devices are essential in the management of gait and mobility of these patients [7][8][9].…”

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confidence: 99%

“…Due to the role of the ankle joint in gait [7] and the greater muscle dysfunction of distal lower-extremity muscles in CP [10,11], ankle-foot orthoses (AFOs) are the foremost used type of assistive devices [7][8][9][12][13][14][15]. Technological advances over the last decades have resulted in the development of AFO designs for CP , which are typically prescribed depending on (1) the pathological gait pattern and (2) the functional capacities (level of the Gross Motor Function Classification System, GMFCS) of the child [8,9].…”

mentioning

confidence: 99%

“…This, together with their poor adaptability to challenging mobility tasks and ground variations encountered during daily-life [7,25], make them (still) ineffective solutions to be employed in all varieties of everyday activities [12,23]. An emerging trend to address the shortcomings of pervious AFO designs is the design of untethered robot-assisted AFOs [26,27].…”

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confidence: 99%

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Perspectives on assistive technology for improving gait performance of children with Cerebral Palsy in daily-life: requirements,needs and wishes

Bayón

Hoorn

Barrientos

et al. 2022

Preprint

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Background: Ankle-foot orthoses (AFOs) are extensively used as a primary management method to assist walking and ambulation of children with Cerebral Palsy (CP). However, there are certain barriers that hinder their prescription and as well as their use as a mobility device in all kinds of daily-life activities. This research attempts to further understand the existing limitations of current AFOs to promote a better personalization of new design solutions.Methods: Stakeholder (professionals in CP and end-users with CP) perspectives on AFO technology were collected by two online surveys. Respondents evaluated the limitations of current assistive solutions and assessment methods, provided their expectations towards a new AFO design, and analyzed importance of different design features and metrics to enrich the gait performance of these patients in daily-life. Quantitative responses were rated and compared with respect to their perceived importance. Qualitative responses were classified into themes by using content analysis. Results: 130 survey responses from ten countries were analyzed, 94 from professionals and 36 from end-users with CP. The most highly rated design features by both stakeholder groups were the comfort and the ease of putting on and taking off the assistive device. In general, professionals preferred new features to enrich the independence of the patient by improving gait at functional levels. Responses from end-users also considered their social acceptance and participation. Health-care professionals reported a lack of confidence concerning decision-making about AFO prescription. The relation between the type of assistance required to each pathological gait was not straightforward, and they agreed that more information about patients’ day-today walking performance would be beneficial. Conclusion: This research emphasizes the importance of developing new approaches to assess and treat CP gait in daily-life situations. The stakeholders’ needs and criteria reported here may serve as insights for the design of future assistive devices and for the follow-up care of these patients.

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Relationship between ankle function and walking ability for children and young adults with cerebral palsy: A systematic review of deficits and targeted interventions

Cited by 17 publications

References 127 publications

Case report: The gait deviation index may predict neurotherapeutic effects of FES-assisted gait training in children with cerebral palsy

Case report: The gait deviation index may predict neurotherapeutic effects of FES-assisted gait training in children with cerebral palsy

Ankle Exoskeleton Assistance Increases Six-Minute Walk Test Performance in Cerebral Palsy

Perspectives on assistive technology for improving gait performance of children with Cerebral Palsy in daily-life: requirements,needs and wishes

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