Status of surface electromyography assessment as part of clinical gait analysis in the management of patients with cerebral palsy - Outcomes of a Delphi process.

Background: The assessment of gait disorders in patients with neuromotor conditions, such as cerebral palsy (CP), has been a focus of clinical and research attention, with electromyography (EMG) offering a nuanced understanding of neurological and neuromuscular disorders. However, the interpretation of EMG data in the context of gait analysis remains challenging due to the complexity of neuromotor dynamics and variability in assessment methodologies.

Research Question: To which consensus can we get in a group of experts in the fields of neurological and neuromuscular disorders, biomechanics, and clinical gait analysis to establish standardized protocols and a common language for the measurement and analysis of EMG data in gait disorders, particularly in people living with CP?

Methods: A three-round Delphi process was conducted from February to September 2023 to gather opinions of 53 experts on the use of surface EMG data during gait in the context of CP.

A Velocity Stretch Reflex Threshold Based on Muscle-Tendon Unit Peak Acceleration to Detect Possible Occurrences of Spasticity during Gait in Children with Cerebral Palsy.

Spasticity might affect gait in children with cerebral palsy. Quantifying its occurrence during locomotion is challenging. One approach is to determine kinematic stretch reflex thresholds, usually on the velocity, during passive assessment and to search for their exceedance during gait.

Common modelling assumptions affect the joint moments measured during passive joint mobilizations.

Joint resistance to passive mobilization has already been estimated in-vivo in several studies by measuring the applied forces and moments while manipulating the joint. Nevertheless, in most of the studies, simplified modelling approaches are used to calculate this joint resistance. The impact of these simplifications is still unknown.

A procedure and model for the identification of uni- and biarticular structures passive contribution to inter-segmental dynamics.

Inter-segmental moments come from muscles contractions, but also from passive moments, resulting from the resistance of the periarticular structures. To quantify the passive contribution of uni- and biarticular structures during gait, we propose an innovative procedure and model. 12 typically developed (TD) children and 17 with cerebral palsy (CP) participated in a passive testing protocol.

Effect of an augmented reality active video game for gait training in children with cerebral palsy following single-event multilevel surgery: protocol for a randomised controlled trial.

Introduction: In paediatric rehabilitation, fun and motivation are also critical keys to successful therapy. A variety of interventions have shown positive effects, high level of interest, compliance and engagement with active video game (AVG).This seems to be an interesting approach for the postoperative gait rehabilitation of children with cerebral palsy (CP).

Visual Feedback in Augmented Reality to Walk at Predefined Speed Cross-Sectional Study Including Children With Cerebral Palsy.

In an augmented reality environment, the range of possible real-time visual feedback is extensive. This study aimed to compare the impact of six scenarios in augmented reality combining four visual feedback characteristics on achieving a target walking speed. The six scenarios have been developed for Microsoft Hololens augmented reality headset.

Rehabilitation After Single-Event Multilevel Surgery for Children and Young Adults With Cerebral Palsy: A Systematic Review.

This review sought to describe and analyze published protocols for rehabilitation after single-event multilevel surgery for people with cerebral palsy, to identify their differences and limits, and to introduce a common step-by-step framework for future descriptions and assessments of postoperative rehabilitation protocols.The MEDLINE, Embase, CINAHL, and the Cochrane Library databases were searched. Inclusion criteria were as follows: (1) single-event multilevel surgery, (2) full-text reports published after 1985, and (3) articles with a method section describing the rehabilitation protocol.

Clinical gait analysis and physical examination don't correlate with physical activity of children with cerebral palsy. Cross-sectional study.

Gait analysis and physical clinical measures are usually performed in children with cerebral palsy to help the surgeons make therapeutic decision. However, the level of physical activity in daily life is not systematically assessed. The aim of this cross sectional study was to examine the correlations between: three-dimensional gait analysis kinematic and spatiotemporal parameters, clinical measures and physical activity.

Contribution of passive moments to inter-segmental moments during gait: A systematic review.

Inter-segmental moments computed by inverse dynamic during gait come from active moments, due to muscle contraction, but also from passive moments, resulting from the resistance of the periarticular structures to their deformation. The evaluation of the proportion of the inter-segmental moments that can be attributed to passive moments has led to divergent results. Thus, the purpose of this study was to systematically search and synthesize the evidence of the contribution of passive moments to inter-segmental moments during healthy and pathological gait.

Validity of Hololens Augmented Reality Head Mounted Display for Measuring Gait Parameters in Healthy Adults and Children with Cerebral Palsy.

Serious games are a promising approach to improve gait rehabilitation for people with gait disorders. Combined with wearable augmented reality headset, serious games for gait rehabilitation in a clinical setting can be envisaged, allowing to evolve in a real environment and provide fun and feedback to enhance patient's motivation. This requires a method to obtain accurate information on the spatiotemporal gait parameters of the playing patient.

A Classification and Calibration Procedure for Gesture Specific Home-Based Therapy Exercise in Young People With Cerebral Palsy.

Movement-based video games can provide engaging practice for repetitive therapeutic gestures towards improving manual ability in youth with cerebral palsy (CP). However, home-based gesture calibration and classification is needed to personalize therapy and ensure an optimal challenge point. Nineteen youth with CP controlled a video game during a 4-week home-based intervention using therapeutic hand gestures detected via electromyography and inertial sensors.

A biofeedback-enhanced therapeutic exercise video game intervention for young people with cerebral palsy: A randomized single-case experimental design feasibility study.

Importance/background: Movement-controlled video games have potential to promote home-based practice of therapy activities. The success of therapy gaming interventions depends on the quality of the technology used and the presence of effective support structures.

Aim: This study assesses the feasibility of a novel intervention that combines a co-created gaming technology integrating evidence-based biofeedback and solution-focused coaching (SFC) strategies to support therapy engagement and efficacy at home.

Kinematics after unilateral femoral derotation osteotomy in children with diplegic cerebral palsy.

Introduction: Femoral derotation osteotomy (FDO) is a treatment option in children and adolescents with cerebral palsy who have transverse plane deviations in their lower limbs. When the transverse kinematic deviations are asymmetric, the osteotomy indication can be unilateral.

Hypothesis: Unilateral FDO has a kinematic effect on ipsilateral transverse plane deviations along with those of the pelvis and contralateral side.

Telepsychiatry for Children and Adolescents: A Review of the PROMETTED Project.

Background: Telemedicine for children and adolescents is a public health topic, and since 2009 in France, the legal framework defines practical modalities. Some children with Attention Deficit with or without Hyperactivity Disorder, social anxiety, or Autism Spectrum Disorder (ASD) can be easily engaged within a teleconsultation model. Literature suggests new opportunities to facilitate the care process for the ASD person and his family: diagnosis with the use of validated instruments and parental accompaniment.

Predicting postoperative gait in cerebral palsy.

In this work, postoperative lower limb kinematics are predicted with respect to preoperative kinematics, physical examination and surgery data. Data of 115 children with cerebral palsy that have undergone single-event multilevel surgery were considered. Preoperative data dimension was reduced utilizing principal component analysis.

Dual-tasking postural control in patients with right brain damage.

The control of dual-tasking effects is a daily challenge in stroke neurorehabilitation. It maybe one of the reasons why there is poor functional prognosis after a stroke in the right hemisphere, which plays a dominant role in posture control. The purpose of this study was to explore cognitive motor interference in right brain-lesioned and healthy subjects maintaining a standing position while performing three different tasks: a control task, a simple attentional task and a complex attentional task.

Self-adjusting, isostatic exoskeleton for the human knee joint.

A knee-joint exoskeleton design that can apply programmable torques to the articulation and that self-adjusts to its physiological movements is described. Self-adjustment means that the articular torque is automatically produced around the rotational axis of the joint. The requirements are first discussed and the conditions under which the system tracks the spatial relative movements of the limbs are given.

Rectus femoris transfer and musculo-skeletal modeling: effect of surgical treatment on gait and on rectus femoris kinematics.

Spasticity of the rectus femoris (RF) is one of the possible causes of stiff knee gait (SKG) in cerebral palsy. Musculoskeletal studies have shown that in SKG, length and speed of the RF are affected. No evaluation had been made to quantify the modifications of those parameters after surgery.

Proximal femoral osteotomy in neurologic pediatric hips using the locking compression plate.

Background: Proximal femoral osteotomy (PFO) is a widely performed reconstructive surgery in pediatric patients with diagnosis of neurologic abnormalities. Many implants have been used for the fixation of these osteotomies. These devices have been evolved to provide stable fixation.

The convex wrapping algorithm: a method for identifying muscle paths using the underlying bone mesh.

Associating musculoskeletal models to motion analysis data enables the determination of the muscular lengths, lengthening rates and moment arms of the muscles during the studied movement. Therefore, those models must be anatomically personalized and able to identify realistic muscular paths. Different kinds of algorithms exist to achieve this last issue, such as the wired models and the finite elements ones.

Foot contact event detection using kinematic data in cerebral palsy children and normal adults gait.

Initial contact (IC) and toe off (TO) times are essential measurements in the analysis of temporal gait parameters, especially in cerebral palsy (CP) gait analysis. A new gait event detection algorithm, called the high pass algorithm (HPA) has been developed and is discussed in this paper. Kinematics of markers on the heel and metatarsal are used.

Comparison of the SCoRE and HA methods for locating in vivo the glenohumeral joint centre.

A recent paper has described a new functional method, the symmetrical centre of rotation (SCoRE), for locating joint centre position [Ehrig, R.M., Taylor, W.