1st Joint ESMAC-GCMAS Meeting - Análise de Marcha

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equinus in terminal swing (SW) was noted for 13 of 38 sides and consistent with dorsiflexor weakness. Variations in the degree of dorsiflexion in ST were due to variations in ankle plantar flexor strength and/or presence of plantar flexor contracture. The mean peak ankle plantar flexor moment 0.91±0.36 N.m/kg (normal = 1.2±0.2 N.m/kg) and power 2.23±0.54 W/kg (normal = 3.3±1.0 W/kg) were significantly less than normal consistent with ankle plantar flexor weakness noted in 32 of 38 ankles. a) b) c) d) Figure 1. Comparison of sagittal plane ankle kinematic and kinetic patterns for representative individuals with CMT. The most common pattern a) normal ankle dorsiflexion in SW and delayed and increased peak dorsiflexion in terminal ST - 13 sides, b) normal ankle dorsiflexion in SW and delayed but normal peak dorsiflexion in ST - 10 sides, c) excessive ankle plantar flexion in ST and increased and delayed peak dorsiflexion in ST - 6 sides and d) excessive plantar flexion in ST and SW - 4 sides. Discussion Gait analysis data indicate that persons with CMT demonstrate a variety of functional presentations. Gait patterns were not age related which highlights the variable penetrance of this genetic disorder. Although the textbook description reports a foot drop due to anterior tibialis weakness, a significant number of our patients presented with plantar flexor weakness and associated prolonged dorsiflexion or delayed heel rise with an absence of foot drop. Gait analysis data that demonstrates ankle plantar flexor weakness may be the first and most common functional sign that CMT may be present. The above findings would not support the naming of this disease as a peroneal nerve palsy and indicate that treatment strategies need to be specific to the actual functional deficits, which are unique to each patient. References [1] Davis RB, (1996), Human Motion Analysis: Current Applications and Future Directions, 17-42. [2] Õunpuu S, (1991), J Pediatric Orthopaedics, 11, 341-349. - 139 -
O-40 SAGITTAL PLANE LOWER EXTREMITY KINEMATICS IN CHILDREN WITH HEREDITARY SPASTIC PARAPLEGIA Nichols, Molly, MPT 1 , Dorociak, Robin, BS 1 , and Aiona, Michael, MD 1 1 Shriners Hospitals for Children, Portland, Oregon, United States Summary/conclusions Children with Hereditary Spastic Paraplegia (HSP) demonstrate one of four sagittal plane gait patterns distinct from children with spastic diplegic cerebral palsy as revealed by computerized gait analysis of the lower extremities. Further analysis with additional subjects and upper extremity kinematics will substantiate these patterns. Introduction Hereditary Spastic Paraplegia refers to a group of more than 30 inherited neurologic disorders in which the predominant characteristic is lower extremity spasticity resulting in an atypical gait pattern [1]. Since the first clinical descriptions of HSP by Strümpell in 1880, few studies have been published describing the gait patterns of HSP [2] and to date minimal kinematic information exists for the pediatric population. Statement of clinical significance Defining sagittal plane gait patterns specific to children with HSP will allow the clinician to differentiate between this population and children with spastic diplegic cerebral palsy, better directing diagnosis and treatment. The use of computerized gait analysis for children with HSP reveals patterns that cannot be distinguished by visual gait inspection. Methods A retrospective chart review was performed for 18 patients (10 female, 8 male; mean age 12.7 yrs, range 3.9 to 18.7 yrs) with HSP who underwent routine clinical gait analysis. The diagnosis of HSP was confirmed by family history (14 patients) or clinically confirmed by a neurologist (4 patients). Patients included were independent ambulators without orthoses or prior surgical intervention. Computerized gait analysis was performed using a VICON motion system. Patient gait trials were processed using Vicon Clinical Manager. One representative trial for each of the right and left sides was chosen for analysis. Because it was noted that the patients had symmetric patterns, a representative side was chosen for illustration. Utilizing the gait classification system described by Rodda [3], six clinicians experienced in gait analysis attempted to classify the HSP patients into the diplegic gait patterns. As 11/18 HSP patients did not fit into any of these categories, the purpose of this study was to determine whether patterns specific to HSP could be differentiated. Results Sagittal plane kinematic profiles of HSP patients grouped into four patterns where the primary differences were at the knee and pelvis (fig.1). Ankle position did not present as a distinguishing characteristic. Group A consists of 6 patients (2 female, 4 male) with a mean age of 11.4 ± 2.7 yrs and is characterized by an exaggerated double-bump pattern at the pelvis and a triple-bump pattern at the knee (an additional flexion peak in late stance). Group B includes 4 patients (all female, mean age 5.4 ± 2.2 yrs) with primary characteristics of increased peak knee flexion in loading and swing as well as knee hyperextension in midstance. Group C consists of 4 patients (1 female, 3 male) with a mean age of 17.7 ± 1.0 yrs. This group has a moderate double bump pelvic pattern in anterior tilt, hip flexion in terminal stance, a crouched/stiff knee pattern and peak ankle dorsiflexion near norms. Group D includes 4 patients (3 female, 1 male) with a mean age of 17.0 ± 2.4 yrs. This group is the mildest pattern with a slight double-bump pelvic pattern, hip extension to neutral in terminal stance and knee - 140 -
Page 1 and 2:
O-01 KNEE EXTENSION AT TERMINAL SWI
Page 3 and 4:
O-02 THE MODIFIED TARDIEU IN STANDI
Page 5 and 6:
O-03 COORDINATION BETWEEN PELVIS, T
Page 7 and 8:
O-04 CAN GAIT ANALYSIS GUIDE MANAGE
Page 9 and 10:
O-05 DISTAL FEMORAL EXTENTSION OSTE
Page 11 and 12:
O-06 THE EFFECT OF SHOES ON GAIT IN
Page 13 and 14:
O-07 CORRELATIONS BETWEEN CLINICAL
Page 15 and 16:
O-08 DOUBLE CALIBRATION VS GLOBAL O
Page 17 and 18:
O-09 THE SYMMETRICAL AXIS OF ROTATI
Page 19 and 20:
O-10 FEASIBILITY OF A NEW -JOINT CO
Page 21 and 22:
O-11 A SINGLE GAIT CYCLE AS MEASURE
Page 23 and 24:
O-12 IMPROVED TRACKING OF HIP ROTAT
Page 25 and 26:
O-13 PROTOCOL CHANGES CAN IMPROVE T
Page 27 and 28: O-14 ALTERNATIVE METHODS FOR MEASUR
Page 29 and 30: O-15 OVERLAY PROJECTION OF 3D GAIT
Page 31 and 32: O-16 RELATIONSHIP BETWEEN THE ANTHR
Page 33 and 34: O-17 COMPARING THE RELIABILITY OF V
Page 35 and 36: O-18 3D HIP AND PELVIC GAIT PATTERN
Page 37 and 38: O-19 RELIABILITY AND VALIDITY OF AN
Page 39 and 40: O-20 HOW ACCURATE IS THE ESTIMATION
Page 41 and 42: O-21 IMPACT OF WHEELCHAIR PROPULSIO
Page 43 and 44: O-22 TOWARDS A NEW PROTOCOL FOR MOT
Page 45 and 46: O-23 KINEMATIC ANALYSIS OF UPPER LI
Page 47 and 48: O-24 KINEMATIC UPPER LIMB ANALYSIS
Page 49 and 50: O-25 3D KINEMATICS OF UPPER EXTREMI
Page 51 and 52: O-26 CLINICALLY SIGNIFICANT SHOULDE
Page 53 and 54: O-27 OBJECTIVE IDENTIFCATION OF GAI
Page 55 and 56: - 110 - O-28 NORMALCY GAIT INDEX AN
Page 57 and 58: O-29 GILLETTE GAIT INDEX IS CONSIST
Page 59 and 60: 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: O-39 BIOMECHANICS OF GAIT IN CHARCO
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 and 112: O-56 THE EFFECT OF INCLUDING S2 ROO
Page 113 and 114: O-57 DYNAMIC FUNCTION AFTER ANTERIO
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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