modulation ability of automatic postural response in individuals with spastic diplegic cerebral...
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ESMAC 2012 abstract / Gait & Posture 38 (2013) S1S116 S67
mentation of these results in calculations for the sake of accuracy.Furtherworkwill entail quantication of segmental parameters forthe foot and the thigh.
 Ganley KJ, Powers CM. Clinical Biomechanics 2004;19. Rao G, Amarantini D, Favier D. Journal of Biomechanics 2005;39:8. Zonta MB, et al. Revista Paulista de Pediatria 2009;27:4. Niiler TA, Riad J. GCMAS 2012.
Improvement of hemiplegic patients gaitpattern over 8-month period afterplantarexors fasciotomy: A case study
Mari Alvela1,2, Margot Pintson1,2, KadriEnglas1,2, Ulle Kruus1,2, Priit Eelmae1,2,3
1 Haapsalu Neurological Rehabilitation Centre,Clinical Gait Lab, Haapsalu, Estonia2 Centre of Excellence in Health Promotion andRehabilitation, Haapsalu, Estonia3 University of Tartu, Institute of Exercise Biologyand Physiotherapy, Haapsalu, Estonia
Introduction: Clinical gait analysis (CGA) was conducted onan 8-year old female patient with spastic right hemiplegia (cere-bral palsy, CP). The main problem of the patient is extremely tightAchilles tendon. Achilles tendon lengthening was done in earlychildhood, with no positive results. In addition, pre-fasciotomy leglength discrepancy was 2.5 cm, resulting with posture problems.CGA was conducted pre-operatively, one month, four months andeight months following fasciotomy. The rst two analyses weremade barefoot, the last analysis was done with footwear, with cor-rection for leg length discrepancy. After the surgery, the patientreceived three intensive rehabilitation periods, each lasted twoweeks. In addition she had 20 robot-assisted treadmill training ses-sions and home exercises. The aim of this paper is to describe thechanges of gait pattern over time after plantarexors fasciotomy ofhemiplegic patient.
Patients/materials and methods: 3D Vicon Gait Analysis Sys-tem (8 Vicon MX-T20 cameras, two Basler cameras) and two AMTIdynamographic platforms were used to capture the data. Mark-ers were placed according to Davis model. Before the gait analysisphysiotherapeutic assessmentwas carried out. All assessments andgait data collection was carried out within one day by two physio-therapists. Data was captured with Vicon Nexus 1.7.1 software andpresented for interpretationwith Vicon Polygon 3.5.1 software. Forinterpretation three good gait trials were selected.
Results: Before the surgery, there was a severe plantarex-ion (over 25) at initial contact on the right side. Plantarexionlasted throughout the whole gait cycle, with no active dorsiex-ion in swing phase. Push-off values for the right ankle were closeto zero. One month post-op analysis showed great improvement ofankle dorsi-plantarexionmovement. Initial contactwas stillmadewith ankle in plantarexion, but the range was less than 10. Thegraph has moved close to zero-line, with drop-foot in the swingphase. The pattern on ankle power graph is close to normal, but val-ues are minimal. 8-month post-op analysis showed improvementfrom mid-stance to toe-off; the patient has achieved 2nd and 3rdrocker. Initial contact is still made with ankle in plantarexion anddrop-foot continues because there is no active dorsiexion. Push-off values on the ankle power graph have increased up to about 1/3of estimated values.
Discussion and conclusions: The fasciotomy has been effec-tive for improving the gait pattern of hemiplegic patient. Positionof the right foot improved greatly. There was a great difference inthe ankle joint position at the initial contact pre and post-op, butalmost no change occurred during 1-month and 8-month follow-up studies due to no active dorsiexion. Furthermore, drop-footin the swing phase retained. Because of no further improvementin swing-phase and initial contact, AFO was recommended to sup-port the dorsiexion of right ankle. The push-off values increasedconstantly. The fasciotomy showed good results in improving gaitpattern an CGA is a good tool to describe and evaluate the efcacyof chosen intervention.
Modulation ability of automatic posturalresponse in individuals with spastic diplegiccerebral palsy
Etsuko Mori1, Hidehito Tomita1, Akira Kanai1,Yoshiki Fukaya2, Daisuke Kawaguchi1, AkiyoshiWatanabe3
1 Toyohashi SOZO University, Graduate School ofHealth Sciences, Toyohashi, Japan2 Aichi Prefectural Hospital and Rehabilitation Centerfor Disabled Children, Dai-ni Aoitorigakuen, Okazaki,Japan3 Koseikai Akaiwaso, Toyohashi, Japan
Introduction: Roncesvalles et al.  examined automatic pos-tural response to support surface translation in individuals withspastic diplegic cerebral palsy (SDCP) and reported that individualswith SDCP appear to have difculty modulating postural muscleactivity to t changes in the velocity and amplitude of the trans-lation. Since this study only recorded lower leg muscle activity, itis unclear whether individuals with SDCP have the ability to mod-ulate thigh and trunk muscle activity. The present study aimed toexamine this possibility by recording postural muscle activity inthe trunk and lower limbs during platform perturbations.
Patients/materials and methods: In this study, participantswere 7 individuals with SDCP (SDCP group, 2 females and 5 males,1424 years of age) and 7 age- and gender-matched individualswithout disability (control group). All participants in the SDCPgroup were rated as level II on the Gross Motor Function Clas-sication System. Participants stood on a platform that movedtransiently in the backward direction. The perturbations were con-ducted under two different conditions (easy: 4 cm at 15 cm/s;difcult: 8 cm at 25 cm/s). Surface electromyogramswere recordedfrom the rectus abdominis, erector spinae (ES), rectus femoris,medial hamstring (MH), tibialis anterior, and gastrocnemius (GcM)muscles. The center of pressure in the anteroposterior direction(CoPy) during the perturbation was also recorded.
Results: The onset latency of GcM was signicantly later in theSDCP group than in the control group, although no signicant dif-ferences were found in ES or MH between the two groups. In bothgroups, response amplitudes in ES,MH, andGcMwere signicantlylarger in the difcult condition than in the easy condition. Althoughthe degree of modulation in GcM was signicantly smaller in theSDCP group than in the control group, no signicant differenceswere found in the degree of modulation in ES or MH between thetwo groups. In both perturbation conditions, the peak CoPy dis-placement after the perturbation was signicantly larger in theSDCP group than in the control group.
Discussion and conclusions: This is the rst study to demon-strate that individuals with SDCP appear to have the ability to
S68 ESMAC 2012 abstract / Gait & Posture 38 (2013) S1S116
modulate tight and trunk muscle activity to t task conditions.However, the degree of modulation in the SDCP group was not asmuch as in the control group, and the peak CoPy displacement waslarger in the SDCP group. These results suggest that an increase intight and trunk muscle activity is insufcient to compensate for adelayedonset latencyof lower legmuscleactivityanda lackofmod-ulationof lower legmuscle activity, resulting in a largerdisturbanceof postural equilibrium.
 Roncesvalles MN, Woollacott MW, Burtner PA. Neural factors underlyingreduced postural adaptability in children with cerebral palsy. Neuroreport2002;13:240710.
Prediction of site of botulinum toxin multilevelbased on gait parameters: A pilot study
Irene Pulido-Valdeolivas1, David Gmez-Andrs1,Aitor Cinza1, Gabriel Liano1, LorenaMartn-Romn1, Javier Lpez2, Samuel IgnacioPascual-Pascual1, Estrella Rausell 1
1 Trastornos del Desarrollo y MaduracinNeurolgica, IdiPaz, Universidad Autnoma deMadrid, Spain2 Hospital Universitario Infanta Sofa, Rehabilitacin,S.S. de los Reyes, Madrid, Spain
Introduction: Multilevel injection of botulinum toxin type A(MIBT) is a frequent treatment for spasticity in cerebral palsy (CP).
The planning of muscles to be injected is based on clinical parame-ters. Neither common pre-treatment studies nor standard decisionprotocols exist. The objective of this study is to determine the inu-ence of pre-treatment gait pattern in injection planning in orderto assess the potential role of instrumental gait analysis in MBTIdecision-making.
Patients/materials and methods: 17 school-aged childrenaffected by spastic CP with predominant affection of lower limbs(GMFCS I-III, MACS I-II, CFCS I) who were going to be injected wereselected. The 16 left and the 16 right kinematic parameters usedto calculate Gillette Gait Index were measured in each child beforeinjection. Their values were expressed in Z-score according to areference dataset of normal school-aged children. Muscles to beinjectedweredeterminedbyclinical expertisewithout informationprovided by gait analysis. Random forests were trained by usingGMFCS and the 32 gait parameters as independent variables. Good-ness of t of each onewas estimated by the area under ROC and theinuence of each dependent variable in each model was estimatedby mean percentage of decrease in model accuracy when variableis out of the bag.
Results:Our predictivemodel onlywas better than randomnessin left and right rectus femoris muscles and left and right ham-strings. The following gure is a heat map that shows importanceof each dependent variable in each muscle model. The greener thesquare, the more positive the importance, which means that val-ues of that variable are more related with decision-making in thatparticular muscle.
Discussion and conclusions: Small sample size and the limitednumber of gait parameters tha