1st Joint ESMAC-GCMAS Meeting - Análise de Marcha

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Table 1. Subject demographics Group Age pre N (post #1) Follow-up time (post #1) - 185 - N (post #2) Follow-up time (post #2) S1 6.8 (2.3) 28 1.1 (0.3) 7 3.6 (0.6) S2 5.5 (1.3) 69 1.2 (0.7) 20 3.5 (0.5) Key: mean (standard deviation), all times in years. Discussion This study showed that response of subjects to L1-S1 and L1-S2 SDR surgery was equivalent for a specific set of kinematic and spasticity outcome measures. There has been significant controversy over whether S2 rootlets should be included in SDR surgery. Supporting S2 inclusion was Lang’s study showing that sparing S2 left residual plantarflexor spasticity. Opposing S2 inclusion was Molenaers’ study showing that including S2 promoted crouch gait. This study appears to contradict both of those prior studies. The data analyzed here shows equivalent outcomes, between S1 and S2 surgeries, for both plantarflexor spasticity and selected kinematic variables. The explanation for this seems to lie in clinical principles underlying the surgical technique as applied here. For the majority of subjects, rootlets demonstrating pathological electrophysiology were sectioned while rootlets with appropriate response were spared (n.b. some subjects did have S2 rootlets spared for a variety of reasons not directly related to electrophysiological response). Clearly the question of including vs. sparing S2 rootlets remains unresolved. Further analysis into long(er) term outcomes, including foot-related outcomes, is warranted. Maximum Dorsiflexion [deg] Knee Flexion @ Initial Contact [deg] 15 10 5 0 -5 45 40 35 30 25 20 15 10 5 0 typical pre pst #1 pst #2 typical pre pst #1 pst #2 Minimum Hip Flexion [deg] Minimum Knee Flexion [deg] 10 5 0 -5 20 15 10 5 0 typical pre pst #1 pst #2 typical References 1.Lang FF et al., Neurosurgery, 34:847-853 2.Molenaers G, et al., 13 th ESMAC, Warsaw, 2004. 3. Schwartz et al. 14 th ESMAC, Barcelona, 2005 pre pst #1 pst #2 Pelvic Tilt [deg] 25 20 15 10 5 0 pre pst #1 pst #2 S1 S2 typical Figure 1. Mean and 95% confidence interval for kinematic outcome measures are shown. No significant interactions were found. The trends that appear (minimum hip flexion and knee flexion and maximum dorsiflexion) favor the S2 group. Disconcertingly, mean pelvic tilt showed a deteriorating trend in both groups and both intervals.
O-57 DYNAMIC FUNCTION AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IS RELATED TO GRAFT CHOICE Webster Kate Dr, Feller Julian Assoc. Prof., Joanne Wittwer Ms. Musculoskeletal Research Centre and Gait CCRE, La Trobe University, Melbourne Australia Summary/Conclusions In this study clear differences were observed in the knee kinematic and kinetic profiles between patients who had undergone hamstring or patellar tendon anterior cruciate ligament (ACL) reconstruction. Patients with patellar tendon grafts demonstrated reduced external knee flexion moments whereas patients with hamstring grafts demonstrated reduced external knee extension moments. These results suggest that there are graft-specific differences in knee biomechanics after ACL reconstruction that appear to relate to the donor site. Introduction ACL reconstruction is a common procedure. However, debate continues as to whether the patellar tendon (PT) or the hamstring tendon (HS) graft is preferable. A number of studies have examined the effect of ACL reconstruction on joint kinematic and kinetic patterns during gait. These have shown that although there is a tendency towards gait normalization after the reconstructive procedure, altered moments about the knee in the flexion-extension axis still persist [1-4]. It has been suggested that abnormal gait pattens might have implications for the long term development of pathologic knee conditions [4, 5]. However, in the majority of these studies, only patients who had received a PT graft were examined. Therefore, the purpose of this study was to investigate biomechanical differences associated with the use of both HS and PT grafts during walking and also during higher impact activities that involved single limb landing. Statement of Clinical Significance As both hamstring and patellar tendon grafts are used for ACL reconstruction, it is clinically relevant to understand the biomechanical differences in knee function associated with each graft. The reduced knee flexion angles and moments we observed in the patellar tendon patients may place this group at greater risk of developing degenerative joint changes. Methods Two experiments were conducted. In experiment 1, the gait patterns of 17 PT patients, 17 HS patients and 17 controls matched for activity were compared. In experiment 2, single-limb landing patterns for vertical and horizontal hops were compared between 17 PT patients, 17 HS and 12 control subjects. ACL patients were tested 9 to 12 months following surgery. For both experiments a 3-dimensional motion analysis and force plate system was used to determine sagittal plane kinematics and kinetics of the lower limb. Results In experiment 1 (walking) there were significant differences in the moments about the operated knee that related to graft type. The PT patients had a reduced external knee flexion moment at mid stance whilst the HS patients had a reduced external extension moment at terminal stance. Experiment 2 (landing) results for both the horizontal and vertical hops also showed a reduction in the external flexion moment about the operated knee for the PT group compared to the nonoperated side, the control subjects and the operated side of the HS patients, but no differences compared with the operated side of the HS group. In the PT group the maximum knee flexion angle in the operated limb was also reduced compared to the non operated limb for both horizontal and vertical hops. During landing from a horizontal hop the external knee flexor moment was the predominant moment for the control group but not for patient groups. For the vertical hop the ankle dorsiflexion moment predominated in all subject groups. The patient - 186 -
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O-01 KNEE EXTENSION AT TERMINAL SWI
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O-02 THE MODIFIED TARDIEU IN STANDI
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O-03 COORDINATION BETWEEN PELVIS, T
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O-04 CAN GAIT ANALYSIS GUIDE MANAGE
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O-05 DISTAL FEMORAL EXTENTSION OSTE
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O-06 THE EFFECT OF SHOES ON GAIT IN
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O-07 CORRELATIONS BETWEEN CLINICAL
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O-08 DOUBLE CALIBRATION VS GLOBAL O
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O-09 THE SYMMETRICAL AXIS OF ROTATI
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O-10 FEASIBILITY OF A NEW -JOINT CO
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O-11 A SINGLE GAIT CYCLE AS MEASURE
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O-12 IMPROVED TRACKING OF HIP ROTAT
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O-13 PROTOCOL CHANGES CAN IMPROVE T
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O-14 ALTERNATIVE METHODS FOR MEASUR
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O-15 OVERLAY PROJECTION OF 3D GAIT
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O-16 RELATIONSHIP BETWEEN THE ANTHR
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O-17 COMPARING THE RELIABILITY OF V
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O-18 3D HIP AND PELVIC GAIT PATTERN
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O-19 RELIABILITY AND VALIDITY OF AN
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O-20 HOW ACCURATE IS THE ESTIMATION
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O-21 IMPACT OF WHEELCHAIR PROPULSIO
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O-22 TOWARDS A NEW PROTOCOL FOR MOT
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O-23 KINEMATIC ANALYSIS OF UPPER LI
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O-24 KINEMATIC UPPER LIMB ANALYSIS
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O-25 3D KINEMATICS OF UPPER EXTREMI
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O-26 CLINICALLY SIGNIFICANT SHOULDE
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O-27 OBJECTIVE IDENTIFCATION OF GAI
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- 110 - O-28 NORMALCY GAIT INDEX AN
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O-29 GILLETTE GAIT INDEX IS CONSIST
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O-30 GAITABASE: NEW APPROACH TO CLI
Page 61 and 62: O-31 A MODIFIED GAIT CLASSIFICATION
Page 63 and 64: O-32 QUANTIFICATION OF KINEMATIC ME
Page 65 and 66: O-33 EXTRINSIC AND INTRINSIC VARIAT
Page 67 and 68: O-34 PAIRED OUTCOME ASSESSMENT OF A
Page 69 and 70: O-35 ENERGY EXPENDITURE DURING OVER
Page 71 and 72: O-36 HIGH FAILURE RATES WHEN AVOIDI
Page 73 and 74: O-37 SUBJECT SPECIFIC HIP GEOMETRY
Page 75 and 76: O-38 BIOMECHANICAL AND METABOLIC PE
Page 77 and 78: O-39 BIOMECHANICS OF GAIT IN CHARCO
Page 79 and 80: O-40 SAGITTAL PLANE LOWER EXTREMITY
Page 81 and 82: O-41 AN EXPLORATION OF THE FUNCTION
Page 83 and 84: O-42 DYNAMIC SIMULATIONS OF SLOW, F
Page 85 and 86: O-43 AUTOMATIC IDENTIFICATION OF MU
Page 87 and 88: O-44 DYNAMIC MEASUREMENT OF GASTROC
Page 89 and 90: O-45 ASSESSING THE REGULATORY ACTIV
Page 91 and 92: O-46 ABNORMAL EMG-ACTIVITY IN PATHO
Page 93 and 94: O-47 AVERAGED EMG PROFILES IN RUNNI
Page 95 and 96: O-48 TRACKING DYNAMIC FOOT PRESSURE
Page 97 and 98: O-49 THE INFLUENCE OF FOOTWEAR SOLE
Page 99 and 100: O-50 GAIT ANALYSIS IN CHILDREN TREA
Page 101 and 102: O-51 A COMPARISON OF METHODS FOR US
Page 103 and 104: O-52 BIOMECHANICAL OPTIMIZATION OF
Page 105 and 106: O-53 EFFECT OF SENSORY-THRESHOLD EL
Page 107 and 108: O-54 THE IMPACT OF SINGLE EVENT MUL
Page 109 and 110: O-55 COMPREHENSIVE GAIT ANALYSIS OU
Page 111: O-56 THE EFFECT OF INCLUDING S2 ROO
Page 115 and 116: O-58 RECOVERY OF MUSCLE STRENGTH FO
Page 117 and 118: O-59 AUDITORY-PACED WALKING FOLLOWI
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1st Joint ESMAC-GCMAS Meeting - Análise de Marcha

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