Understanding the complexity of decision-making for mothers of young children with ambulatory cerebral palsy: A qualitative phenomenological study.

Aim: To investigate non-clinical factors that affect health-related decision-making in mothers with young ambulatory children living with cerebral palsy (CP).

Method: Guided by phenomenology, we asked parents to describe early experiences of raising a young ambulatory child living with CP. Conversations were audio-recorded, transcribed, coded, and analysed using a qualitative inductive approach.

The effect of thoraco-lumbo-sacral orthosis wear time and clinical risk factors on curve progression for individuals with adolescent idiopathic scoliosis.

Background Context: The effectiveness of bracing with a thoraco-lumbo-sacral orthosis (TLSO) for adolescent idiopathic scoliosis (AIS) has been studied extensively, with a growing body of evidence supporting TLSO use. In this study we examine the effect of wear time and other important causal factors affecting curve progression and develop a risk model that can be applied to individual patients and is based on important casual factors.

Purpose: Understand the impact of TLSO wear time and other risk factors in order to guide optimal treatment.

The long-term effects of aggressive spasticity reducing treatment, including selective dorsal rhizotomy, on joint kinematic outcomes of persons with cerebral palsy.

Background: Selective dorsal rhizotomy (SDR) creates a large and permanent reduction of spasticity for children with cerebral palsy (CP). Previous SDR outcomes studies have generally lacked appropriate control groups, had limited sample sizes, or reported short-term follow-up, limiting evidence for improvement in long-term gait function.

Research Question: Does aggressive spasticity management for individuals with CP improve long-term gait kinematics (discrete joint kinematics) compared to a control group of individuals with CP with minimal spasticity management?

Methods: This study was a secondary analysis - focused on joint-level kinematics - of a previous study evaluating the long-term outcomes of SDR.

Factor analysis of the Gait Outcomes Assessment List's goal questions: A new method to measure goal prioritization in ambulatory individuals with cerebral palsy.

Aim: To evaluate the factor structure of the 49 goal prioritization questions of the Gait Outcome Assessment List (GOAL).

Method: This was a retrospective review of 622 consecutive individuals diagnosed with cerebral palsy (median = 11 years 2 months, SD = 6 years 0 months, 370 male), who underwent a routine clinical gait analysis at a specialty center and completed the validated GOAL. To assess dimensionality, we performed exploratory and confirmatory factor analyses on the goal ratings of its 49 gait-related items.

Medial Gastrocnemius Muscle Properties of Children With Cerebral Palsy After Different Tone Treatments: A Pilot Study.

Objective: Spasticity in children with cerebral palsy can be managed by a spectrum of approaches, from conservative therapy, to temporary botulinum toxin A injections, to permanent transection of sensory nerves with a selective dorsal rhizotomy. This pilot study investigated whether these three tone management approaches are associated with histological and biochemical properties of the medial gastrocnemius.

Design: A convenience sample of children with cerebral palsy undergoing gastrocnemius lengthening surgery was enrolled.

American Society of Biomechanics Clinical Biomechanics Award 2021: Redistribution of muscle-tendon work in children with cerebral palsy who walk in crouch.

Background: Previous study showed the triceps surae exhibits spring-like behavior about the ankle during walking in children with cerebral palsy. Thus, the work generated by the triceps surae is diminished relative to typically developing children. This study investigated whether the quadriceps offset the lack of triceps surae work production in children with cerebral palsy who walk in crouch.

Interobserver reliability of biplanar radiography is unaffected by clinical factors relevant to individuals at risk of pathological lower limb torsion.

Background: Assessments of lower limb torsion are ubiquitous in clinical gait analysis practice as pathologic lower limb rotational deformity may contribute to gait abnormalities, anterior knee pain, as well as other debilitating conditions. Understandably, the overall utility of any torsional assessment is dependent on the measurement method's intrinsic accuracy, precision, and robustness to clinical interference factors. Recently, biplanar radiography (BPR) measurements of torsion have been shown to be both accurate and precise, but the robustness of BPR to potential interference factors is unknown.

Distal femoral extension osteotomy and patellar tendon advancement or shortening in ambulatory children with cerebral palsy: A modified Delphi consensus study and literature review.

Purpose: In children with cerebral palsy, flexion deformities of the knee can be treated with a distal femoral extension osteotomy combined with either patellar tendon advancement or patellar tendon shortening. The purpose of this study was to establish a consensus through expert orthopedic opinion, using a modified Delphi process to describe the surgical indications for distal femoral extension osteotomy and patellar tendon advancement/patellar tendon shortening. A literature review was also conducted to summarize the recent literature on distal femoral extension osteotomy and patellar tendon shortening/patellar tendon advancement.

Assessment of foot alignment and function for ambulatory children with cerebral palsy: Results of a modified Delphi technique consensus study.

Purpose: The purpose of this study was to establish consensus for the assessment of foot alignment and function in ambulatory children with cerebral palsy, using expert surgeon's opinion through a modified Delphi technique.

Methods: The panel used a five-level Likert-type scale to record agreement or disagreement with 33 statements regarding the assessment of foot alignment and function. Consensus was defined as at least 80% of responses being in the highest or lowest of two of the five Likert-type ratings.

Anterior distal femoral hemiepiphysiodesis in children with cerebral palsy: Establishing surgical indications and techniques using the modified Delphi method and literature review.

Purpose: The purpose of this study was to develop consensus for the surgical indications of anterior distal femur hemiepiphysiodesis in children with cerebral palsy using expert surgeon opinion through a modified Delphi technique.

Methods: The panel used a 5-level Likert-type scale to record agreement or disagreement with 27 statements regarding anterior distal femur hemiepiphysiodesis. Consensus was defined as at least 80% of responses being in the highest or lowest 2 of the Likert-type ratings.

Finding consensus for hamstring surgery in ambulatory children with cerebral palsy using the Delphi method.

Purpose: There is marked variation in indications and techniques for hamstring surgery in children with cerebral palsy. There is particular uncertainty regarding the indications for hamstring transfer compared to traditional hamstring lengthening. The purpose of this study was for an international panel of experts to use the Delphi method to establish consensus indications for hamstring surgery in ambulatory children with cerebral palsy.

Quantifying alignment bias during the fabrication and fitting of ankle-foot orthoses: A single center study.

Background: The sagittal plane alignment of ankle-foot orthoses (AFO) and AFO footwear combinations (AFO-FC) has been shown to influence gait outcomes. As such, clinicians often target a particular alignment during the fabricating and fitting of an AFO to maximize outcomes.

Research Question: How does the alignment of an AFO change during the fabrication and fitting process with respect to the intended, benchmark sagittal plane alignment identified by the consulting orthotist?

Study Design: Prospective METHODS: The assessment of AFO alignment was performed using a convenience sample of 125 custom molded AFOs from 68 individuals fabricated at our center (57 bilateral AFOs, 11 unilateral AFOs).

Presence and predictors of pain after orthopedic surgery and associated orthopedic outcomes in children with cerebral palsy.

While children with cerebral palsy (CP) may undergo 8-22 orthopedic surgeries in their lifetime, little is known about the associated pain. We aimed to assess the pain presence before and one year after lower extremity orthopedic surgery, predictors of pain presence at follow-up, and the association between pain and orthopedic outcomes related to surgery. This retrospective study included 86 children with CP (M age = 10.

Atypical triceps surae force and work patterns underlying gait in children with cerebral palsy.

The purpose of this study was to quantitatively assess Achilles tendon mechanical behavior during gait in children with cerebral palsy (CP). We used a newly designed noninvasive sensor to measure Achilles tendon force in 11 children with CP (4F, 8-16 years old) and 15 typically developing children (controls) (9F, 8-17 years old) during overground walking. Mechanical work loop plots (force-displacement plots) were generated by combining muscle-tendon kinetics, kinematics, and EMG activity to evaluate the Achilles tendon work generated about the ankle.

Long-term effects of spasticity treatment, including selective dorsal rhizotomy, for individuals with cerebral palsy.

Aim: To understand the long-term effects of comprehensive spasticity treatment, including selective dorsal rhizotomy (SDR), on individuals with spastic cerebral palsy.

Method: This was a pre-registered, multicenter, retrospectively matched cohort study. Children were matched on age range and spasticity at baseline.

Alternative methods for measuring ankle-foot orthosis alignment in clinical care.

Background: Changes in gait due to an ankle foot orthosis (AFO) have been shown to be impacted by the sagittal plane alignment of the AFO, but there is variability in practice and lack of consensus as to how this alignment should be measured. The neutral angle is a measure of AFO alignment that has the potential to be used by various specialties that prescribe, provide, and analyze AFOs. Currently, a lack of validated measurement methods prevents the neutral angle from being used in various clinical settings.

Distal rectus femoris surgery in children with cerebral palsy: results of a Delphi consensus project.

Purpose: The purpose of this study was for an international panel of experts to establish consensus indications for distal rectus femoris surgery in children with cerebral palsy (CP) using a modified Delphi method.

Methods: The panel used a five-level Likert scale to record agreement or disagreement with 33 statements regarding distal rectus femoris surgery. The panel responded to statements regarding general characteristics, clinical indications, computerized gait data, intraoperative techniques and outcome measures.

Indications for gastrocsoleus lengthening in ambulatory children with cerebral palsy: a Delphi consensus study.

Purpose: Equinus is the most common deformity in cerebral palsy (CP) and gastrocsoleus lengthening (GSL) is the most commonly performed surgery to improve gait and function in ambulatory children with CP. Substantial variation exists in the indications for GSL and surgical technique. The purpose of this study was to review surgical anatomy and biomechanics of the gastrocsoleus and to utilize expert orthopaedic opinion through a Delphi technique to establish consensus for surgical indications for GSL in ambulatory children with CP.

Comparing short-term outcomes between conus medullaris and cauda equina surgical techniques of selective dorsal rhizotomy.

Aim: To compare short-term outcomes between conus medullaris (conus) and cauda equina (cauda) selective dorsal rhizotomy (SDR) techniques in children with spastic cerebral palsy.

Method: This was a retrospective review of SDR at a single center from 2013 to 2017. Gait and functional outcome measures were assessed at no more than 18 months pre-SDR (baseline) and 8 to 36 months post-SDR (follow-up).

Association of Knee Pain and Crouch Gait in Individuals With Cerebral Palsy.

Background: Crouch gait (ie, excessive knee flexion) is commonly seen in patients with cerebral palsy (CP) and has been inconsistently linked with knee pain. The definitive cause of knee pain is unknown, but may result from increased joint forces due to crouch gait kinematics. Our purpose was to determine whether knee pain is positively associated with knee flexion in gait among a large sample of ambulatory individuals with CP.

What's New in the Orthopaedic Treatment of Ambulatory Children With Cerebral Palsy Using Gait Analysis.

Background: Limb deformities in ambulatory children with cerebral palsy (CP) are common. The natural history of lower extremity deformities is variable and the impact on gait is managed with many treatment modalities. Effective interventions must consider the underlying pathophysiology, patient-specific goals, and incorporate objective outcome assessment.

Establishing surgical indications for hamstring lengthening and femoral derotational osteotomy in ambulatory children with cerebral palsy.

Purpose: Surgical procedures, such as medial hamstring lengthening (MHL) and femoral derotational osteotomy (FDO), can improve the gait of children with cerebral palsy (CP); however, substantial variation exists in the factors that influence the decision to perform surgery. The purpose of this study was to use expert surgeon opinion through a Delphi technique to establish consensus for indications in ambulatory children with CP.

Methods: A 15-member panel, all established experts with at least nine years' experience in the surgical management of children with CP, was created (mean of 20.