Demonstrating the utility of Instrumented Gait Analysis in the treatment of children with cerebral palsy.

Background: Instrumented gait analysis (IGA) has been around for a long time but has never been shown to be useful for improving patient outcomes. In this study we demonstrate the potential utility of IGA by showing that machine learning models are better able to estimate treatment outcomes when they include both IGA and clinical (CLI) features compared to when they include CLI features alone.

Design: We carried out a retrospective analysis of data from ambulatory children diagnosed with cerebral palsy who were seen at least twice at our gait analysis center.

Delayed Diagnosis of Complete Achilles Tendon Rupture in a Teenage Athlete: A Case Report of Nonoperative Treatment.

Case: A 19-year-old female athlete experienced calf pain during sport. A complete Achilles tendon rupture was diagnosed 4 weeks after injury. Ultrasound revealed discontinuity of the Achilles tendon with 2.

Ankle proprioception in children with cerebral palsy.

Purpose: There is no established clinical standard to evaluate ankle proprioception in children with cerebral palsy (CP). This study compared ankle position sense of children with CP to age-matched children who are typically developing (TD).

Methods: Children aged 6-17 years participated (15 CP, 58 TD).

Reliability of the Gait Outcomes Assessment List questionnaire.

Aim: To report the test-retest reliability of the parent version of the Gait Outcomes Assessment List (GOAL) questionnaire for item, domain, total score, and goal importance in children with cerebral palsy (CP) functioning in Gross Motor Function Classification System (GMFCS) levels I to III.

Method: The GOAL questionnaire was completed twice, 3 to 31 days apart, in a prospective cohort study of 112 caregivers of children aged 4 to 17 years with CP (40% unilateral; GMFCS level I = 53; II = 35; III = 24; 76 males). All had an outpatient visit over a 1-year period.

A model for understanding the causes and consequences of walking impairments.

Walking is an important skill with positive impacts on health, function, and well-being. Many disorders impair walking and its positive impacts through a variety of complex and interrelated mechanisms. Any attempt to understand walking impairments, or the effects of interventions intended to treat these impairments, must respect this complexity.

Variability in lower extremity motor function in spina bifida only partially associated with spinal motor level.

Purpose: Previous studies have found motor function to correlate with spinal motor level and, accordingly, individuals with spina bifida are frequently categorized clinically in this manner. The aim of the current study was to describe how lower extremity functions including strength, selective motor control, and mirror movements vary by motor level in children and young adults with spina bifida.

Methods: A single center, retrospective, cross-sectional, descriptive study using data collected in the National Spina Bifida Patient Registry and by a gait laboratory was performed.

Causal factors affecting gross motor function in children diagnosed with cerebral palsy.

Background: Cerebral palsy (CP) is a complex neuromuscular condition that may negatively influence gross motor function. Children diagnosed with CP often exhibit spasticity, weakness, reduced motor control, contracture, and bony malalignment. Despite many previous association studies, the causal impact of these impairments on motor function is unknown.

Short-term causal effects of common treatments in ambulatory children and young adults with cerebral palsy: three machine learning estimates.

Orthopedic and neurological impairments (e.g., muscle contractures, spasticity) are often treated in children and young adults with cerebral palsy (CP).

Blood pressure in adults with cerebral palsy: a systematic review and meta-analysis of individual participant data.

Objectives: This systematic review and meta-analysis was designed to determine the overall mean blood pressure and prevalence of hypertension among a representative sample of adults living with cerebral palsy by combining individual participant data. Additional objectives included estimating variations between subgroups and investigating potential risk factors for hypertension.

Methods: Potential datasets were identified by literature searches for studies published between January 2000 and November 2017 and by experts in the field.

The importance of a consistent workflow to estimate muscle-tendon lengths based on joint angles from the conventional gait model.

Background: Musculoskeletal models enable us to estimate muscle-tendon length, which has been shown to improve clinical decision-making and outcomes in children with cerebral palsy. Most clinical gait analysis services, however, do not include muscle-tendon length estimation in their clinical routine. This is due, in part, to a lack of knowledge and trust in the musculoskeletal models, and to the complexity involved in the workflow to obtain the muscle-tendon length.

A patella marker to improve hip and knee kinematics for models with functionally defined joint axes.

Background: The clinical utility of motion capture modeling relies on the accurate tracking of segment motions. Soft tissue artefact presents a particular challenge for modeling hip rotation, knee rotation, and knee varus-valgus motions. The integration of a patella marker has been shown to significantly improve hip rotation tracking for models that utilize anatomical definitions of joint axes (e.

Perceived Limitations of Walking in Individuals With Cerebral Palsy.

Objective: Impairments associated with cerebral palsy (CP) can affect gait quality and limit activity and participation. The purpose of this study was to quantify (1) which of 6 factors (pain, weakness, endurance, mental ability, safety concerns, balance) were perceived to limit walking ability the most in individuals with CP and (2) whether age or Gross Motor Function Classification System (GMFCS) level is related to that perception.

Methods: This cross-sectional study queried data from a gait laboratory database.

Synergies analysis produces consistent results between motion analysis laboratories.

Aim: The dynamic motor control index during walking (walk-DMC) is a scaled measure of motor control derived from electromyographic analysis of the lower extremity during gait. Walk-DMC has been shown to be related to patient outcomes and there has been an increasing interest from motion analysis centers regarding using this metric in their own practice. However, the methods for computing the index reported in the literature are not consistent.

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).

Rectus femoris transfer in children with cerebral palsy: comparing a propensity score-matched observational study to a randomized controlled trial.

Aim: To test whether an observational study employing propensity score matching could accurately estimate the causal treatment effects of rectus femoris transfer (RFT) as part of single-event multilevel surgery (SEMLS) in ambulatory children with cerebral palsy.

Method: We used a large clinical database to derive a propensity score for treatment assignment (SEMLS±RFT) and used this score to generate a matched patient cohort. We compared the causal treatment effects estimated from this matched cohort with a previously published randomized controlled trial (RCT).

Deep neural networks enable quantitative movement analysis using single-camera videos.

Many neurological and musculoskeletal diseases impair movement, which limits people's function and social participation. Quantitative assessment of motion is critical to medical decision-making but is currently possible only with expensive motion capture systems and highly trained personnel. Here, we present a method for predicting clinically relevant motion parameters from an ordinary video of a patient.

Pre-operative gastrocnemius lengths in gait predict outcomes following gastrocnemius lengthening surgery in children with cerebral palsy.

Equinus deformity is one of the most common gait deformities in children with cerebral palsy. We examined whether estimates of gastrocnemius length in gait could identify limbs likely to have short-term and long-term improvements in ankle kinematics following gastrocnemius lengthening surgery to correct equinus. We retrospectively analyzed data of 891 limbs that underwent a single-event multi-level surgery (SEMLS), and categorized outcomes based on the normalcy of ankle kinematics.

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.

Muscle Synergy Constraints Do Not Improve Estimates of Muscle Activity From Static Optimization During Gait for Unimpaired Children or Children With Cerebral Palsy.

Neuromusculoskeletal simulation provides a promising platform to inform the design of assistive devices or inform rehabilitation. For these applications, a simulation must be able to accurately represent the person of interest, such as an individual with a neurologic injury. If a simulation fails to predict how an individual recruits and coordinates their muscles during movement, it will have limited utility for informing design or rehabilitation.

Self-reported physical function is associated with walking speed in adults with cerebral palsy.

Purpose: To understand the relationship of walking speed to self-reported pain, fatigue, and physical function in adults with CP.

Methods: Design: Cross-sectional study.

Setting: Accredited clinical motion analysis laboratory in a regional children's hospital.

Comparing the effects of two spasticity management strategies on the long-term outcomes of individuals with bilateral spastic cerebral palsy: a multicentre cohort study protocol.

Introduction: Spasticity is one of the primary pathologies associated with cerebral palsy (CP), yet no definitive evidence exists to guide the appropriate level of spasticity management for an individual. Spasticity management strategies often differ by center. On one end of this strategy spectrum is a highly-interventional approach, characterized by treatments such as a selective dorsal rhizotomy (SDR), intrathecal baclofen pump (ITB), and anti-spasticity injections and medications.

Anterior Guided Growth of the Distal Femur for Knee Flexion Contracture: Clinical, Radiographic, and Motion Analysis Results.

Background: Fixed knee flexion deformity is common in children with neuromuscular disorders. Anterior guided growth (AGG) of the distal femur can achieve gradual correction in patients who are skeletally immature. Little outcome data are available on this procedure.

Estimating the effect size of surgery to improve walking in children with cerebral palsy from retrospective observational clinical data.

Single-event multilevel surgery (SEMLS) is a standard treatment approach aimed at improving gait for patients with cerebral palsy, but the effect of this approach compared to natural progression without surgical intervention is unclear. In this study, we used retrospective patient history, physical exam, and three-dimensional gait analysis data from 2,333 limbs to build regression models estimating the effect of SEMLS on gait, while controlling for expected natural progression. Post-hoc classifications using the regression model results identified which limbs would exhibit gait within two standard deviations of typical gait at the follow-up visit with or without a SEMLS with 73% and 77% accuracy, respectively.