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ABSTRACT: The purpose of this study was to characterize the manner in which net joint moments and non-muscular forces generate, absorb, and transfer mechanical energy during walking in able-bodied children. Standard gait data from seven healthy subjects between 6 and 17 years of age were combined with a dynamic model of the whole body to perform a power analysis based on induced acceleration techniques. These data were used to determine how each moment and force generates energy to, absorbs energy from, and transfers energy among the major body segments. The joint moments were found to induce transfers of mechanical energy between body segments that generally exceeded the magnitudes of energy generation and absorption. The amount of energy transferred by gravitational and velocity-dependent forces was considerably less than for the joint moments. The hip and ankle joint moments had relatively simple power patterns that tended to oppose each other, particularly over the stance phase. The knee joint moment had a more complex power pattern that appeared distinct from the hip and ankle moments. The general patterns of mechanical energy flow were similar to previous reports in adults. The approach described in this paper should provide a useful complement to standard clinical gait analysis procedures.
Medical Engineering & Physics 08/2012; · 1.62 Impact Factor
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Robert J Palisano,
Margo Orlin,
Lisa A Chiarello,
Donna Oeffinger,
Marcy Polansky,
Jill Maggs,
George Gorton,
Anita Bagley, Chester Tylkowski,
Lawrence Vogel,
Mark Abel,
Richard Stevenson
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ABSTRACT: To test a model of determinants of intensity of participation in leisure and recreational activities by youth with cerebral palsy (CP).
Prospective cohort study.
Children's hospitals (N=7).
Youth with CP (N=205; age, 13-21y) and their parents. The sample included 107 (57.2%) males and 26 (12.7%) to 57 (27.8%) youth in each of the 5 levels of the Gross Motor Function Classification System (GMFCS).
Not applicable.
Youth completed the Children's Assessment of Participation and Enjoyment by means of an interview. Parents completed the Pediatric Outcomes Data Collection Instrument, Family Environment Scale, Coping Inventory, Measure of Processes of Care, a demographic questionnaire, and a services questionnaire.
Structural equation modeling was used to test the model. Fit statistics indicate good model fit. The model explains 35% of the variance in intensity of participation. Path coefficients (P ≤ .05) indicate that higher physical ability, higher enjoyment, younger age, female sex, and higher family activity orientation are associated with higher intensity of participation. GMFCS level and caregiver education have indirect effects on intensity of participation. The path between services and intensity of participation was not significant.
Participation by youth with CP is influenced by multiple factors. The influence of physical activity supports the importance of activity accommodations and assistive technology for youth who are not capable of improving physical ability. Knowledge of family activity orientation is important for identifying opportunities for participation. The unexplained variance suggests that the model should include other determinants, such as physical accessibility and availability of transportation and community leisure and recreational activities.
Archives of physical medicine and rehabilitation 09/2011; 92(9):1468-76. · 2.18 Impact Factor
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ABSTRACT: To describe the self-concept of adults with cerebral palsy (CP).
Cross-sectional design included the Tennessee Self-Concept Scale, version 2 (TSCS:2), Functional Independence Measure (FIM™), Beck Depression Index II (BDI®-II), Craig Hospital Inventory of Environmental Factors (CHIEF), Diener's Satisfaction with Life Scale (SWLS), Gross Motor Functional Classification System (GMFCS) levels and demographic questions.
One hundred and two people with CP (52 females, mean age=26) participated. Thirty-eight participants had unreliable answers as indicated by validity scales and were excluded from the analysis. Ten participants had high self-concept; 41 had average self-concept and 13 had low total self-concept. Self-concept had a fair and inverse association with the BDI-II (Pearson's r= -0.3, p<0.01) and a moderate and direct association with the SWLS (Pearson's r=0.4, p<0.001). Self-concept was not associated with GMFCS level or FIM score. Family and Personal sub-domain scores were lowest sub-domain scores for people with low self-concept (p<0.01).
The majority of the participants in this sample had a healthy self-concept; and self-concept was not associated with severity of CP, but with lack of depression and life satisfaction. Results suggest the need for family centred care into adulthood.
Disability and Rehabilitation 01/2011; 33(10):855-61. · 1.50 Impact Factor
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ABSTRACT: The aim of this study was to generate growth curves for ambulatory children and adolescents with cerebral palsy (CP) using tibial lengths and to determine if they differed according to sex or Gross Motor Function Classification System (GMFCS) level.
Growth data were studied from a cohort of 750 participants (442 males, 308 females [1199 visits]; mean age 10 y 9 mo, SD 3 y 4 mo, range 4-21 y) with CP (hemiplegia, n=163; diplegia, n=573; triplegia, n=11; quadriplegia n=2; GMFCS levels I-III), and 165 typically developing children (96 males, 115 females; [211 visits]) mean age 10 y 9 mo, SD 4 y 2 mo, range 4-19 y). Tibial length measurements calculated from data collected during routine gait analyses were validated using anthropometric tibial length measurements and were used to generate growth curves for males and females classified as GMFCS level I, II, or III. Growth was compared in participants of different sexes and GMFCS levels using the median curves.
Growth curves for males and females (GMFCS levels I-III) with estimate lines for 3rd, 10th, 25th, 50th, 75th, 90th, and 97th centiles were generated. Mean tibial length was greater in males than in females in all GMFCS levels. Tibial lengths were shorter in participants classified as GMFCS level III than in those classified as GMFCS level I or II.
To our knowledge this is the first large-scale investigation of bone growth in ambulatory children and adolescents with CP. The large sample made it possible to generate growth curves and to provide insight into growth trends. The study findings serve as a basis for analysis of the relationships between growth, function, and treatment outcomes.
Developmental Medicine & Child Neurology 09/2010; 52(9):e195-201. · 2.92 Impact Factor
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ABSTRACT: Lower-extremity musculotendinous surgery is standard treatment for ambulatory children with deformities such as joint contractures and bony torsions resulting from cerebral palsy (CP). However, evidence of efficacy is limited to retrospective, uncontrolled studies with small sample sizes focusing on gait variables and clinical examination measures. The aim of this study was to prospectively examine whether lower-extremity musculotendinous surgery in ambulatory children with CP improves impairments and function measured by gait and clinical outcome tools beyond changes found in a concurrent matched control group.
Seventy-five children with spastic CP (Gross Motor Function Classification System levels I to III, age 4 to 18 y) that underwent surgery to improve gait were individually matched on the basis of sex, Gross Motor Function Classification System level, and CP subtype to a nonsurgical cohort, minimizing differences in age and Gross Motor Function Measure Dimension E. At baseline and at least 12 months after baseline or surgery, participants completed gait analysis and Gross Motor Function Measure, and parents completed outcome questionnaires. Mean changes at follow-up were compared using analysis of covariance adjusted for baseline differences.
Surgery ranged from single-level soft tissue release to multilevel bony and/or soft tissue procedures. At follow-up, after correcting for baseline differences, Gillette Gait Index, Pediatric Outcomes Data Collection Instrument Expectations, and Pediatric Quality of Life Inventory (PedsQL) Physical Functioning improved significantly for the surgical group compared with the nonsurgical group, which showed minimal change.
On the basis of a matched concurrent data set, there was significant improvement in function after 1 year for a surgical group compared with a nonsurgical group as measured by the Gillette Gait Index, with few significant changes noted in outcome measures. Changes over 1 year are minimal in the nonsurgical group, supporting the possibility of ethically performing a randomized controlled trial using nonsurgical controls.
Therapeutic level 2. Prospective comparative study.
Journal of pediatric orthopedics 12/2009; 29(8):903-9. · 1.23 Impact Factor
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ABSTRACT: Treatment of Legg-Calvé-Perthes disease (LCPD) may improve if new knowledge can be obtained regarding how articular cartilage changes shape during the course of this disorder. A new technique is presented showing how analyses of magnetic resonance images can be used to quantify the three-dimensional changes in the femoral and acetabular articulating cartilage surfaces of children with LCPD. Ten male subjects (8 +/- 1 years) with unilateral LCPD were enrolled in this IRB approved study. Sets of magnetic resonance images of both hips were obtained at three different times. Three-dimensional virtual models of the cartilage were created from these images, and mathematical spheres were fit to the articulating surfaces. Five parameters (size, shape deformity (sphericity error), radial growth rate, joint fit, and joint incongruity) were used to quantify cartilage surface shape. Data were analyzed by using a linear mixed-model. Joint incongruity, i.e., the distance between the centers of the femoral and acetabular spheres, was slightly more than 2.5 times larger (p = 0.001) in LCPD hips than the contralateral normal hips. Cartilage shape deformity was 65% larger in hips with LCPD than in normal hips. Growth rates of the femoral head and the opposing acetabular surface showed that distortion of the femoral surface occurred first and the opposing acetabular surface followed. Mean radial difference (acetabular surface radius minus femoral surface radius) in LCPD hips was less than half (p < 0.01) the value of normal hips. Interobserver variability was approximately 10% of the value attributable to LCPD. This is the first known report presenting a technique that quantifies the three-dimensional size, deformity, growth, fit. and incongruity of the femoral and acetabular articulating cartilaginous surfaces of LCPD and contralateral normal hips. The data obtained support the use of this technique and provide pilot data for a future clinical study of LCPD. Objective assessment of cartilage shape enabled by this technique may aid future diagnoses, enable monitoring of three-dimensional femoral and acetabular remodeling, and permit quantitative assessment of treatment efficacy.
Journal of Orthopaedic Research 05/2009; 27(8):981-8. · 2.81 Impact Factor
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ABSTRACT: Traditional use of the Pediatric Outcomes Data Collection Instrument (PODCI) assumes that all items have the same structure, are measuring the intended constructs, and assess the right levels of function to show change after orthopaedic or neurological intervention. Item response theory (IRT) methods can statistically account for inherent differences in PODCI item characteristics and thus reveal attributes of the measure important to effectiveness research. Our study uses IRT methods to determine whether PODCI items fit the projected dimensional structure of the PODCI, assess function on each dimension at the right level for a population of ambulatory children with cerebral palsy (CP), and reveal changes after intervention in this population.
Proxy-reported PODCI questionnaires for 570 ambulatory children with CP were randomly divided into 2 groups for model creation and model testing using exploratory and then confirmatory factor analysis. The resulting model was compared with the projected dimensional structure, tested for fit of individual items, and examined for gaps and ceiling effects. Response changes at 1 year were compared between those with (n = 91) and without (n = 284) surgical intervention using paired t tests.
Factor analysis reduced the projected dimensions from 5 to 4 for this population, resulting in dimensions for mobility, upper extremity function (UEF), comfort and general health, and self-worth. All but 3 items fit their respective dimensions; ceiling effects were noted in 3 dimensions. Responses showed changes in the comfort and general health, mobility, and UEF dimensions in those who had surgery; in those children who did not have surgery, only the UEF responses changed.
The PODCI can show change after intervention when data are analyzed using IRT methods. Ceiling effects in 3 dimensions may limit the amount of change the PODCI can show in a population of ambulatory children with CP.
Level II. This was a retrospective investigation of a diagnostic tool, the PODCI, using a randomized cross-sectional design for model development, and a case-control design to assess sensitivity to change.
Journal of Pediatric Orthopaedics 04/2008; 28(2):192-8. · 1.16 Impact Factor
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Douglas Barnes,
Judith L Linton,
Elroy Sullivan,
Anita Bagley,
Donna Oeffinger,
Mark Abel,
Diane Damiano,
George Gorton,
Diane Nicholson,
Mark Romness,
Sarah Rogers, Chester Tylkowski
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ABSTRACT: The Pediatric Outcomes Data Collection Instrument (PODCI) was developed in 1994 as a patient-based tool for use across a broad age range and wide array of musculoskeletal disorders, including children with cerebral palsy (CP). The purpose of this study was to establish means and SDs of the Parent PODCI measures by age groups and Gross Motor Function Classification System (GMFCS) levels for ambulatory children with CP.
This instrument was one of several studied in a prospective, multicenter project of ambulatory patients with CP between the aged 4 and 18 years and GMFCS levels I through III. Participants included 338 boys and 221 girls at a mean age of 11.1 years, with 370 diplegic, 162 hemiplegic, and 27 quadriplegic. Both baseline and follow-up data sets of the completed Parent PODCI responses were statistically analyzed.
Age was identified as a significant predictor of the PODCI measures of Upper Extremity Function, Transfers and Basic Mobility, Global Function, and Happiness With Physical Condition. Gross Motor Function Classification System levels was a significant predictor of Transfers and Basic Mobility, Sports and Physical Function, and Global Function. Pattern of involvement, sex, and prior orthopaedic surgery were not statistically significant predictors for any of the Parent PODCI measures. Mean and SD scores were calculated for age groups stratified by GMFCS levels. Analysis of the follow-up data set validated the findings derived from the baseline data. Linear regression equations were derived, with age as a continuous variable and GMFCS levels as a categorical variable, to be used for Parent PODCI predicted scores.
The results of this study provide clinicians and researchers with a set of Parent PODCI values for comparison to age- and severity-matched populations of ambulatory patients with CP.
Journal of Pediatric Orthopaedics 12/2007; 28(1):97-102. · 1.16 Impact Factor
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Elroy Sullivan,
Douglas Barnes,
Judith L Linton,
Janine Calmes,
Diane Damiano,
Donna Oeffinger,
Mark Abel,
Anita Bagley,
George Gorton,
Diane Nicholson,
Sarah Rogers, Chester Tylkowski
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ABSTRACT: In ambulatory children with cerebral palsy (CP), practitioners often examine outcomes using measures related to functions necessary for daily life. The Gross Motor Function Measure (GMFM) Dimensions D and E, Pediatric Outcomes Data Collection Instrument (PODCI) Parent and Child versions, Gillette Functional Assessment Questionnaire (FAQ) Walking subscale, Functional Independence Measure for Children (WeeFIM), Pediatric Quality of Life Inventory (PedsQL), temporal-spatial gait parameters, and O(2) cost during ambulation were selected for study. Cross-sectional data were collected in a prospective multicenter study of 562 participants with CP (339 males, 223 females), between 4 and 18 years of age (mean age 11y 1mo). There were 240 classified as Gross Motor Function Classification System Level I, 196 as Level II, and 126 as Level III. The tools that had the best interrelationships and underlying constructs predominately measured changes in physical function. These included portions of the FAQ, Parent PODCI, WeeFIM, and GMFM. GMFM Dimensions D and E exhibited a very strong relationship. Temporal-spatial gait parameters and O2 cost measures represented a different construct of physical function. The Child PODCI reports and both the Parent and Child PedsQL reports did not relate well to other measures, suggesting a pattern of answers not related to question content. The Parent PODCI, the FAQ Walking subscale, and GMFM Dimension E were found to be an appropriate minimum set of instruments for assessment of functional outcomes in patients with ambulatory CP.
Developmental Medicine & Child Neurology 06/2007; 49(5):338-44. · 2.92 Impact Factor
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ABSTRACT: This prospective study compared the test-retest reliability of thirteen variables calculated from the pendulum test in able-bodied children to those of children diagnosed with cerebral palsy. Ten healthy children and 10 children with a primary diagnosis of cerebral palsy (CP) (mean age 13 years) participated in the study. Data were collected using a three-dimensional motion analysis system on two separate occasions 73+/-28 days apart. The between day reliability ICC scores of all variables were moderate to very high (0.60-0.98) for children with CP and high to very high (0.71-0.98) for able-bodied children. The children with CP demonstrated slower maximum angular velocity compared to the able-bodied children (202 degrees /s versus 293 degrees /s, p<0.01). The time to maximum angular velocity occurred sooner for children with CP compared to able-bodied children (0.22s versus 0.34s, p<0.001). For some children with CP, the knee motions demonstrated were not oscillations of decreasing magnitude. Therefore the integrals of knee motion in each plane were calculated. For both groups of subjects the largest integrals of motion were in the sagittal plane (knee flexion/extension). The able-bodied subject's integrals were twice as large compared to subjects diagnosed with CP (p<0.01). High test-retest reliability of the variables suggests that the pendulum test provides an objective and reliable method to assess quadriceps spasticity in children with cerebral palsy.
Gait & Posture 06/2007; 26(1):97-105. · 2.12 Impact Factor
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ABSTRACT: The purpose of this study is to determine the effect on hip rotation of hamstring lengthening as measured by preoperative and postoperative motion analysis. Thirty-eight patients/76 hips in children with cerebral palsy spastic diplegia were retrospectively reviewed using presurgical and postsurgical gait analysis. Physical examination and gait analysis showed an increase in knee extension and decreased popliteal angles postoperatively. Kinematic analysis showed an increase in knee extension and decreased hip internal rotation throughout the gait cycle postoperatively as well. No difference was seen between those with internal and external rotation pattern at the hip preoperatively. As a group, the patients did not improve enough to change from internal to external rotation at the hip, suggesting that children with cerebral palsy spastic diplegia with significant internal rotation gait should have other surgical options besides hamstring lengthening when internal rotation gait of the hip is to be treated.
Journal of Pediatric Orthopaedics 04/2007; 27(2):142-6. · 1.16 Impact Factor
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Donna Oeffinger,
George Gorton,
Anita Bagley,
Diane Nicholson,
Douglas Barnes,
Janine Calmes,
Mark Abel,
Diane Damiano,
Richard Kryscio,
Sarah Rogers, Chester Tylkowski
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ABSTRACT: This prospective cross-sectional multicenter study assessed the relationships between Gross Motor Function Classification System (GMFCS) level and scores on outcome tools used in pediatric orthopedics. Five hundred and sixty-two participants with cerebral palsy (CP; 339 males, 223 females; age range 4-18y, mean age 11y 1mo [SD 3y 7mo]; 400 with diplegia, 162 with hemiplegia; GMFCS Levels I-III;) completed the study. The Functional Assessment Questionnaire (FAQ), Gross Motor Function Measure (GMFM) Dimensions D and E, Pediatric Quality of Life Inventory (PedsQL), the Pediatric Outcomes Data Collection Instrument (PODCI), Pediatric Functional Independence Measure (WeeFIM), temporal-spatial gait parameters, and O(2) cost were collected during one session. Descriptive characteristics are reported by GMFCS level clinicians can use for comparison with individual children. Tools with a direct relationship between outcome scores and GMFCS levels were the PODCI Parent and Child Global Function, Transfers & Basic Mobility, and Sports and Physical Function; PODCI Parent Upper Extremity Function; WeeFIM Self-care and Mobility; FAQ Question 1; GMFM Dimensions D and E; GMFM-66; O(2) cost; and temporal-spatial gait parameters. Child report scores differed significantly higher than Parent scores for six of eight PODCI subscales and three of four PedsQL dimensions. Children classified into different GMFCS levels function differently.
Developmental Medicine & Child Neurology 03/2007; 49(3):172-80. · 2.92 Impact Factor
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Anita M Bagley,
George Gorton,
Donna Oeffinger,
Douglas Barnes,
Janine Calmes,
Diane Nicholson,
Diane Damiano,
Mark Abel,
Richard Kryscio,
Sarah Rogers, Chester Tylkowski
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ABSTRACT: Discriminatory ability of several pediatric outcome tools was assessed relative to Gross Motor Function Classification System (GMFCS) level in patients with cerebral palsy. Five hundred and sixty-two patients (400 with diplegia, 162 with hemiplegia; 339 males, 223 females; age range 4-18y, mean 11y 1mo [SD 3y 7mo]), classified as GMFCS Levels I to III, participated in this prospective multicenter, cross-sectional study. All tools were completed by parents and participants when appropriate. Effect size indices (ESIs) for parametric variables and odds ratios for non-parametric data quantified the magnitude of differences across GMFCS levels. Binary logistic regression models determined discrimination, and receiver operating characteristic curves addressed sensitivity and specificity. Between Levels I and II, the most discriminatory tools were Gross Motor Function Measure (GMFM-66), velocity, and WeeFIM Mobility. Between Levels II and III, the most discriminatory tools were GMFM Dimension E, Pediatric Functional Independence Measure (WeeFIM) Self-Care and Mobility, cadence, and Gillette Functional Assessment Questionnaire Question 1. Large ESIs were noted for Parent and Child reports of Pediatric Outcomes Data Collection Instrument (PODCI) Sports & Physical Function, Parent report of PODCI Global Function, GMFM Dimension E, and GMFM-66 across all GMFCS level comparisons. The least discriminatory tools were the Quality of Life and cognition measures; however, these are important in comprehensive assessments of treatment effects.
Developmental Medicine & Child Neurology 03/2007; 49(3):181-6. · 2.92 Impact Factor
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Anita M Bagley PhD,
SHC George Gorton BS,
SHC Donna Oeffinger PhD,
Douglas Barnes MD,
SHC Janine Calmes MS PT,
SHC Diane Nicholson PhD PT,
Diane Damiano PhD PT,
Mark Abel MD,
Richard Kryscio PhD,
Sarah Rogers MPH, SHC Chester Tylkowski MD
[show abstract]
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ABSTRACT: Discriminatory ability of several pediatric outcome tools was assessed relative to Gross Motor Function Classification System (GMFCS) level in patients with cerebral palsy. Five hundred and sixty-two patients (400 with diplegia, 162 with hemiplegia; 339 males, 223 females; age range 4-18y, mean 11y 1mo [SD 3y 7mo]), classified as GMFCS Levels I to III, participated in this prospective multicenter, cross-sectional study. All tools were completed by parents and participants when appropriate. Effect size indices (ESIs) for parametric variables and odds ratios for non-parametric data quantified the magnitude of differences across GMFCS levels. Binary logistic regression models determined discrimination, and receiver operating characteristic curves addressed sensitivity and specificity. Between Levels I and II, the most discriminatory tools were Gross Motor Function Measure (GMFM-66), velocity, and WeeFIM Mobility. Between Levels II and III, the most discriminatory tools were GMFM Dimension E, Pediatric Functional Independence Measure (WeeFIM) Self-Care and Mobility, cadence, and Gillette Functional Assessment Questionnaire Question 1. Large ESIs were noted for Parent and Child reports of Pediatric Outcomes Data Collection Instrument (PODCI) Sports & Physical Function, Parent report of PODCI Global Function, GMFM Dimension E, and GMFM-66 across all GMFCS level comparisons. The least discriminatory tools were the Quality of Life and cognition measures; however, these are important in comprehensive assessments of treatment effects.
Developmental Medicine & Child Neurology 02/2007; 49(3):181 - 186. · 2.92 Impact Factor
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Diane Damiano,
Mark Abel,
Mark Romness,
Donna Oeffinger, Chester Tylkowski,
George Gorton,
Anita Bagley,
Diane Nicholson,
Douglas Barnes,
Janine Calmes,
Richard Kryscio,
Sarah Rogers
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ABSTRACT: The goal was to compare children with hemiplegia with those with diplegia within Gross Motor Functional Classification System (GMFCS) levels using multiple validated outcome tools. Specifically, we proposed that children with hemiplegia would have better gait and gross motor function within levels while upper extremity function would be poorer. Data were collected on 422 ambulatory children with cerebral palsy: 261 with diplegia and 161 with hemiplegia, across seven centers. Those with hemiplegia in each level performed significantly and consistently better on gait or lower extremity function and poorer on upper extremity and school function than those with diplegia. In GMFCS Level II, the group with hemiplegia walked faster (p = 0.017), scored 6.6 points higher on Dimension E of the Gross Motor Function Measure (p = 0.017), 6.7 points lower on Upper Extremity subscale of the Pediatric Outcomes Data Collection Instrument, and 9.1 points lower on WeeFIM self-care (p = 0.002). Basing motor prognosis on GMFCS level alone may underestimate lower extremity skills of children with hemiplegia, and overestimate those of children with diplegia.
Developmental Medicine & Child Neurology 11/2006; 48(10):797-803. · 2.92 Impact Factor
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Diane Damiano PhD,
Mark Abel MD,
Mark Romness MD,
Donna Oeffinger PhD, Chester Tylkowski MD,
George Gorton BS,
Anita Bagley PhD,
Diane Nicholson PhD PT,
Douglas Barnes MD,
Janine Calmes MS PT,
Richard Kryscio PhD,
Sarah Rogers MPH
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ABSTRACT: The goal was to compare children with hemiplegia with those with diplegia within Gross Motor Functional Classification System (GMFCS) levels using multiple validated outcome tools. Specifically, we proposed that children with hemiplegia would have better gait and gross motor function within levels while upper extremity function would be poorer. Data were collected on 422 ambulatory children with cerebral palsy: 261 with diplegia and 161 with hemiplegia, across seven centers. Those with hemiplegia in each level performed significantly and consistently better on gait or lower extremity function and poorer on upper extremity and school function than those with diplegia. In GMFCS Level II, the group with hemiplegia walked faster (p=0.017), scored 6.6 points higher on Dimension E of the Gross Motor Function Measure (p=0.017), 6.7 points lower on Upper Extremity subscale of the Pediatric Outcomes Data Collection Instrument, and 9.1 points lower on WeeFIM self-care (p=0.002). Basing motor prognosis on GMFCS level alone may underestimate lower extremity skills of children with hemiplegia, and overestimate those of children with diplegia.
Developmental Medicine & Child Neurology 09/2006; 48(10):797 - 803. · 2.92 Impact Factor
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ABSTRACT: Knowledge of hind foot bone motion is important for understanding gait as well as various foot pathologies, but the three-dimensional (3D) motion of these bones remains incompletely understood. The purpose of this study was to quantify the motion of the talus, calcaneus, navicular, and cuboid in normal adult feet during open chain quasi-static uniplanar plantar flexion motion. Magnetic resonance images of the right feet of six normal young adult males were taken from which 3D virtual models were made of each hind foot bone. The 3D motion of these models was analyzed. Each hind foot bone rotated in the same plane about half as much as the foot (mean 0.54 degrees of bone rotation per degree of foot motion, range 0.40-0.73 degrees per degree of foot motion as measured relative to the fixed tibia). Talar motion was primarily uniaxial, but the calcaneus, navicular, and cuboid bones exhibited biplanar (sometimes triplanar) translation in addition to biaxial rotation. Net translational motions of these bones averaged 0.39 mm of bone translation per degree of foot motion (range 0.06-0.62 mm per degree of foot motion). These data reflect the functional anatomy of the foot, extend the findings of prior studies, provide a standard for comparison to patients with congenital or acquired foot deformities, and establish an objective reference for quantitatively assessing the efficacy of various hind foot therapies.
Journal of Biomechanics 02/2006; 39(4):726-33. · 2.43 Impact Factor
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ABSTRACT: The purpose of this study was to determine the effect clinically prescribed ankle-foot orthoses (AFOs) have on the temporal-spatial parameters of gait, as compared with barefoot walking in children with cerebral palsy. A retrospective chart review of data collected between 1995 and 1999 in our motion analysis laboratory was performed. A retrospective chart review of 700 patients revealed 115 patients (mean age 9 years) who had a primary diagnosis of CP (diplegia n=97, hemiplegia n=18). All were wearing clinically prescribed hinged or solid AFOs at the time of undergoing a three dimensional gait analysis. In line with our standard clinical practice, data for both conditions (braced and barefoot walking) were collected the same day by the same examiner. Statistical analyses indicated the temporal and spatial gait parameters of velocity, stride length, step length, and single limb stance were significantly increased (p<0.001) with the use of AFOs versus barefoot walking. Cadence was the only parameter found to not be statistically different.
Developmental Medicine & Child Neurology 04/2002; 44(4):227-32. · 2.92 Impact Factor
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ABSTRACT: Despite the inability of radiographic measurements to quantify the 3-dimensional (3D) shape and size of the hindfoot bones affected by the clubfoot pathology, radiographs continue to be used to evaluate treatment efficacy. Advancements in imaging and image analysis allow new quantitative insights to be obtained into bone shape and size. Therefore, this study sought to quantify and compare the 3D size, shape, and articulating surface morphology of the tibia, talus, calcaneus, navicular, and cuboid bones in the adolescent surgically treated unilateral clubfoot and the contralateral normal foot. Anatomic measurements were obtained by geometrically modeling 3D reconstructed magnetic resonance images of the hindfoot tarsals in the feet of 7 adolescents (mean age, 13.0+/-2.8 years). The results showed that the tarsal bones in the surgically treated clubfoot were smaller in volume (20%-36%) and smaller in surface area (16%-28%) than those in the contralateral normal foot. Correspondingly, the size and shape of the articulating surfaces of these bones in the surgically treated clubfoot were also smaller and flatter than those in the contralateral normal foot. Specifically, the mean talar articular surface area was 25% to 40% smaller, the mean talar-tibiotalar articular surface length was 26% smaller, the mean tibiotalar articular surface length difference was 78% smaller, and the mean navicular "flattening index" was 86% larger in the surgically treated clubfoot. These data offer an objective standard that will advance the knowledge of the clubfoot pathology and aid treatment efficacy evaluation.
Journal of Pediatric Orthopaedics 26(3):329-35. · 1.16 Impact Factor
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ABSTRACT: Advances in imaging and computerized analyses have enabled three-dimensional bone motion in the treated clubfoot to be measured precisely. Three-dimensional translations and rotations of the talus, calcaneus, navicular, and cuboid of surgically treated clubfeet were less in magnitude and sometimes different in direction (or without motion in a specific plane) compared with the contralateral normal feet. Surgical techniques used for clubfoot treatment do not restore normal hindfoot bone motion when examined with high-resolution magnetic resonance imaging, computer reconstruction, and image analysis techniques. These data advance the knowledge of hindfoot bone motion and establish a new and quantitative objective.
Journal of Pediatric Orthopaedics 25(5):630-4. · 1.16 Impact Factor
