Muscle capacity to accelerate the body during gait varies with foot position in cerebral palsy.

Background: Children with cerebral palsy (CP) often have altered gait patterns compared to their typically developing peers. These gait patterns are characterized based on sagittal plane kinematic deviations; however, many children with CP also walk with altered transverse plane kinematics.

Research Question: How do both altered skeletal alignment and kinematic deviations affect muscles' capacity to accelerate the body during gait?

Methods: A three-dimensional gait analysis was completed for 18 children with spastic CP (12.

Evaluation of a method to scale muscle strength for gait simulations of children with cerebral palsy.

Cerebral palsy (CP) is a neurological disorder that results in life-long mobility impairments. Musculoskeletal models used to investigate mobility deficits for children with CP often lack subject-specific characteristics such as altered muscle strength, despite a high prevalence of muscle weakness in this population. We hypothesized that incorporating subject-specific strength scaling within musculoskeletal models of children with CP would improve accuracy of muscle excitation predictions in walking simulations.

Strength Training Effects on Muscle Forces and Contributions to Whole-Body Movement in Cerebral Palsy.

Strength training is often prescribed for children with cerebral palsy (CP); however, links between strength gains and mobility are unclear. Nine children (age 14 ± 3 years; GMFCS I-III) with spastic CP completed a 6-week strength-training program. Musculoskeletal gait simulations were generated for four children to assess training effects on muscle forces and function.

Changes in lower extremity strength may be related to the walking speed improvements in children with cerebral palsy after gait training.

Background: Cerebral palsy (CP) has a high probability of resulting in lower extremity strength and walking deficits. Numerous studies have shown that gait training has the potential to improve the walking abilities of these children; however, the factors governing these improvements are unknown.

Aims: This study aimed to evaluate the relationship between change in lower extremity strength, walking speed and endurance of children with CP following gait training.

Changes in Mobility and Muscle Function of Children with Cerebral Palsy after Gait Training: A Pilot Study.

The goal of this pilot study was to characterize the effects of gait training on the capacity of muscles to produce body accelerations and relate these changes to mobility improvements seen in children with cerebral palsy (CP). Five children (14 years ± 3 y; GMFCS I-II) with spastic diplegic CP participated in a 6-week gait training program. Changes in 10-m fast-as-possible walking speed and 6-minute walking endurance were used to assess changes in mobility.

Standing Programs to Promote Hip Flexibility in Children With Spastic Diplegic Cerebral Palsy.

Purpose: To investigate the effects of a standing program on the range of motion (ROM) of hip abduction in children with spastic diplegic cerebral palsy.

Methods: The participants were 13 children, Gross Motor Functional Classification System level III, who received physical therapy and a daily standing program using a custom-fabricated stander from 12 to 14 months of age to the age of 5 years. Hip abduction ROM was goniometrically assessed at baseline and at 5 years.

Overground body-weight-supported gait training for children and youth with neuromuscular impairments.

The aim of this investigation was to determine if body-weight-supported (BWS) overground gait training has the potential to improve the walking abilities of children and youth with childhood onset motor impairments and intellectual disabilities. Eight participants (mean age of 16.3 years) completed 12 weeks of BWS overground gait training that was performed two times a week.

Motor control of the lower extremity musculature in children with cerebral palsy.

The aim of this investigation was to quantify the differences in torque steadiness and variability of the muscular control in children with cerebral palsy (CP) and typically developing (TD) children. Fifteen children with CP (age=14.2±0.

Coactivation of lower leg muscles during body weight-supported treadmill walking decreases with age in adolescents.

The kinematics of children's walking are nearly adult-like by about age 3-4 years, but metabolic efficiency of walking does not reach adult values until late in adolescence or early adulthood, perhaps due to higher coactivation of agonist/antagonist muscle pairs in adolescents. Additionally, it is unknown how use of a body weight-supported treadmill device affects coactivation, but because unloading will alter the activity of anti-gravity muscles, it was hypothesized that muscle coactivation will be altered as well. Muscle coactivation during treadmill walking was evaluated for adolescents (ages 10 to 17 years, M = 13.

Influence of lower body pressure support on the walking patterns of healthy children and adults.

The purpose of this investigation was to evaluate the effect of a lower body positive pressure support system on the joint kinematics and activity of the lower extremity antigravity musculature of adults and children during walking. Adults (age = 25 ± 4 years) and children (age = 13 ± 2 years) walked at a preferred speed and a speed that was based on the Froude number, while 0-80% of their body weight was supported. Electrogoniometers were used to monitor knee and ankle joint kinematics.

Evaluation of lower body positive pressure supported treadmill training for children with cerebral palsy.

Purpose: To examine the feasibility of using lower body positive pressure supported (LBPPS) treadmill training to improve the walking abilities, balance and lower extremity strength of children with cerebral palsy (CP).

Methods: Nine children with CP (GMFCS II-IV) participated in LBPPS treadmill training 2 days per week for 6 weeks. Pre and post training measures of preferred walking speed, spatiotemporal kinematics, lower extremity strength, and the BESTest were used to assess potential improvements from LBPPS treadmill training.

Sensory information utilization and time delays characterize motor developmental pathology in infant sitting postural control.

Sitting is one of the first developmental milestones that an infant achieves. Thus measurements of sitting posture present an opportunity to assess sensorimotor development at a young age. Sitting postural sway data were collected using a force plate, and the data were used to train a neural network controller of a model of sitting posture.

Body weight supported treadmill training improves the regularity of the stepping kinematics in children with cerebral palsy.

Objective: To examine if body weight supported treadmill training (BWSTT) improves the regularity of stepping kinematics in children with cerebral palsy (CP).

Methods: Twelve children with CP who had Gross Motor Function Classification Scores that ranged from II-IV participated in 12 weeks of body weight supported treadmill training that was performed 2 days a week. The primary outcome measure was the regularity of the stepping kinematics, which was assessed with Fourier analysis methods.

Approximate entropy used to assess sitting postural sway of infants with developmental delay.

Infant sitting postural sway provides a window into motor development at an early age. The approximate entropy, a measure of randomness, in the postural sway was used to assess developmental delay, as occurs in cerebral palsy. Parameters used for the calculation of approximate entropy were investigated, and approximate entropy of postural sway in early sitting was found to be lower for infants with developmental delay in the anterior-posterior axis, but not in the medial-lateral axis.

Mechanical work performed by the legs of children with spastic diplegic cerebral palsy.

The purpose of this investigation was to evaluate the work performed on the center of mass by the legs of children with cerebral palsy. 10 children that were diagnosed as having cerebral palsy with spastic diplegia (Age=9.1+/-2 years), and 10 healthy children with no walking disabilities participated (Age=9.

Nonlinear detrended fluctuation analysis of sitting center-of-pressure data as an early measure of motor development pathology in infants.

Upright sitting is one of the first motor skills an infant learns, and thus sitting postural control provides an early window into the infant's motor development. Early identification of infants with motor developmental delay, such as infants with cerebral palsy, allows for early therapeutic intervention by physical therapists. Early intervention is thought to produce better outcomes, due to greater neural plasticity in younger infants.

Use of information entropy measures of sitting postural sway to quantify developmental delay in infants.

Background: By quantifying the information entropy of postural sway data, the complexity of the postural movement of different populations can be assessed, giving insight into pathologic motor control functioning.

Methods: In this study, developmental delay of motor control function in infants was assessed by analysis of sitting postural sway data acquired from force plate center of pressure measurements. Two types of entropy measures were used: symbolic entropy, including a new asymmetric symbolic entropy measure, and approximate entropy, a more widely used entropy measure.

Pre- and post-operative gait analysis for evaluation of neck pain in chronic whiplash.

Introduction: Chronic neck pain after whiplash is notoriously refractory to conservative treatment, and positive radiological findings to explain the symptoms are scarce. The apparent disproportionality between subjective complaints and objective findings is significant for the planning of treatment, impairment ratings, and judicial questions on causation. However, failure to identify a symptom's focal origin with routine imaging studies does not invalidate the symptom per se.

Reliability of center of pressure measures for assessing the development of sitting postural control.

Objectives: To determine the reliability of linear and nonlinear tools, including intrasession and intersession reliability, when used to analyze the center of pressure (COP) time series during the development of infant sitting postural control.

Design: Longitudinal study.

Setting: University hospital laboratory.

Nonlinear analysis of sitting postural sway indicates developmental delay in infants.

Background: Upright sitting is one of the first developmental motor milestones achieved by infants, and sitting postural sway provides a window into the developing motor control system. A variety of posture sway measures can be used, but the optimal measures for infant development have not been identified.

Methods: We have collected sitting postural sway data from two groups of infants, one with typical development (n=33), and one with delayed development and either diagnosed with or at risk for cerebral palsy (n=26), when the infants had developed to the point where they could just maintain sitting for about 10s.

Factors affecting functional reach scores in youth with typical development.

Purpose: Functional Reach Test scores were examined for the effects of traditional and alternate methods and subject characteristics.

Methods: Eighty subjects aged 7 to 16 years were tested. Effects of measurement method (from finger-to-finger or from toe-to-finger) and style of reach (1 or 2 arms) were investigated.

Development of upper body coordination during sitting in typically developing infants.

Our goal was to determine how the actions of the thorax and the pelvis are organized and coordinated to achieve independent sitting posture in typically developing infants. The participants were 10 typically developing infants who were evaluated longitudinally from first onset of sitting until sitting independence. Each infant underwent nine testing sessions.

Bone health knowledge, self-efficacy, and behaviors in adolescent females.

Purpose: To determine whether an educational program about osteoporosis will improve knowledge and confidence about osteoporosis prevention, self-efficacy, and self-reported bone-health lifestyle behaviors in adolescent girls.

Methods: Tests of knowledge, self-efficacy, calcium intake, and physical activity were compared before and after an osteoporosis educational in-service program. The differential effects of intervention, an osteoporosis in-service program versus no intervention, were determined using 2 x 2 analyses of variance.

Program evaluation of physical therapy as an early intervention and related service in special education.

Purpose: The primary purpose of this study was to develop a database method for documenting achievement of Individualized Education Plan/Individualized Family Service Plan objectives in a practical and cost-effective manner that could be easily replicated in other school systems.

Method: This study was conducted in a public school district in a Midwest metropolitan area in which 18 pediatric physical therapists provided services. A database method for documenting achievement of Individualized Education Plan/Individualized Family Service Plan objectives was used.

Methods to improve the reliability of the functional reach test in children and adolescents with typical development.

Purpose: Test-retest reliability of the Functional Reach Test was examined in children with typical development by comparing standard and alternate methods.

Methods: Eighty subjects ages seven to 16 years were tested and 69 retested for four methods of Functional Reach Test (ie, one-arm finger-to-finger, two-arm finger-to-finger, one-arm toe-to-finger, and two-arm toe-to-finger). Intraclass correlation coefficients and limits of agreement were calculated.