Background: There are many treatments for idiopathic toe-walking, including casts with or without... more Background: There are many treatments for idiopathic toe-walking, including casts with or without injection of botulinum toxin A. Combined treatment with casts and botulinum toxin A has become more common even though there have been few studies of its efficacy and safety problems. Our aims were to conduct a randomized controlled trial to test the hypotheses that combined treatment with casts and botulinum toxin A is more effective than casts alone in reducing toewalking by patients five to fifteen years of age, and that the treatment effect correlates with the extent of coexisting neuropsychiatric problems. Methods: All patients who had been consecutively admitted to the pediatric orthopaedics department of our institution because of idiopathic toe-walking between November 2005 and April 2010 were considered for inclusion in the study. Forty-seven children constituted the study population. The children were randomized to undergo four weeks of treatment with below-the-knee casts either as the sole intervention or to undergo the cast treatment one to two weeks after receiving injections of botulinum toxin A into the calves. Before treatment and three and twelve months after cast removal, all children underwent three-dimensional (3-D) gait analysis. The severity of the idiopathic toe-walking was classified on the basis of the gait analysis, and the parents rated the time that their child spent on his/her toes during barefoot walking. Passive hip, knee, and ankle motion as well as ankle dorsiflexor strength were measured. Before treatment, all children were evaluated with a screening questionnaire for neuropsychiatric problems. Results: No differences were found in any outcome parameter between the groups before treatment or at three or twelve months after cast removal. Several gait-analysis parameters, passive ankle motion, and ankle dorsiflexor strength were improved at both three and twelve months in both groups, even though many children still demonstrated some degree of toe-walking. The treatment outcomes were not correlated with coexisting neuropsychiatric problems. Conclusion: Adding botulinum toxin-A injections prior to cast treatment for idiopathic toe-walking does not improve the outcome of cast-only treatment. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Rapid head rotation is a major cause of brain damage in automobile crashes and falls. This report... more Rapid head rotation is a major cause of brain damage in automobile crashes and falls. This report details a new model for rotational acceleration about the center of mass of the rabbit head. This allows the study of brain injury without translational acceleration of the head. Impact from a pneumatic cylinder was transferred to the skull surface to cause a half-sine peak acceleration of 2.1 3 10 5 rad/s 2 and 0.96-ms pulse duration. Extensive subarachnoid hemorrhages and small focal bleed-ings were observed in the brain tissue. A pronounced reactive astrogliosis was found 8–14 days after trauma, both as networks around the focal hemorrhages and more diffusely in several brain regions. Astrocytosis was prominent in the gray matter of the cerebral cortex, layers II–V, and in the granule cell layer and around the axons of the pyramidal neurons in the hippocampus. The nuclei of cranial nerves, such as the hypoglossal and facial nerves, also showed intense astrocytosis. The new model allows study of brain injuries from head rotation in the absence of translational influences .
Background: Arthrogryposis Multiplex Congenita (AMC) is a heterogeneous condition characterized b... more Background: Arthrogryposis Multiplex Congenita (AMC) is a heterogeneous condition characterized by multiple joint contractures at birth. Greater movements in the trunk and pelvis during walking have been observed in children with AMC using orthoses compared to those wearing only shoes. This study investigated gait dynamics in children with AMC and identified compensatory mechanisms that accommodate walking.
Abstract
Purpose Lower limb contractures and muscle weakness
are common in children with arthrogr... more Abstract Purpose Lower limb contractures and muscle weakness are common in children with arthrogryposis multiplex congenita (AMC). To enhance or facilitate ambulation, orthoses may be used. The aim of this study was to describe gait pattern among individuals wearing their habitual orthotic devices. Methods Fifteen children with AMC, mean age 12.4 (4.3) years, with some lower limb involvement underwent 3-D gait analysis. Three groups were defined based on orthosis use; Group 1 used knee–ankle–foot orthoses with locked knee joints, Group 2 used ankle–foot orthoses or knee– ankle–foot orthoses with open knee joints and Group 3 used no orthoses. Results The greatest trunk and pelvis movements in all planes and the greatest hip abduction were observed in Group 1, compared to Groups 2 and 3, as well as to the gait laboratory control group. Maximum hip extension was similar in Groups 1 and 2, but in Group 3, there was less hip extension and large deviations from the control data. Lower cadence and walking speed were observed in Group 1 than in Groups 2 and 3. The step length was similar in all groups and also with respect to the gait laboratory reference values. Conclusions Children with AMC were subdivided according to orthoses use. Kinematic data as recorded with 3-D gait analysis showed differences among the groups in trunk, pelvis and knee kinematics, and in cadence and walking speed. The step length was similar in all groups and to the gait laboratory reference values, which may be attributable to good hip extension strength in all participants. Keywords Motion analysis AMC Amyoplasia Ambulation
Background: There are many treatments for idiopathic toe-walking, including casts with or without... more Background: There are many treatments for idiopathic toe-walking, including casts with or without injection of botulinum toxin A. Combined treatment with casts and botulinum toxin A has become more common even though there have been few studies of its efficacy and safety problems. Our aims were to conduct a randomized controlled trial to test the hypotheses that combined treatment with casts and botulinum toxin A is more effective than casts alone in reducing toewalking by patients five to fifteen years of age, and that the treatment effect correlates with the extent of coexisting neuropsychiatric problems. Methods: All patients who had been consecutively admitted to the pediatric orthopaedics department of our institution because of idiopathic toe-walking between November 2005 and April 2010 were considered for inclusion in the study. Forty-seven children constituted the study population. The children were randomized to undergo four weeks of treatment with below-the-knee casts either as the sole intervention or to undergo the cast treatment one to two weeks after receiving injections of botulinum toxin A into the calves. Before treatment and three and twelve months after cast removal, all children underwent three-dimensional (3-D) gait analysis. The severity of the idiopathic toe-walking was classified on the basis of the gait analysis, and the parents rated the time that their child spent on his/her toes during barefoot walking. Passive hip, knee, and ankle motion as well as ankle dorsiflexor strength were measured. Before treatment, all children were evaluated with a screening questionnaire for neuropsychiatric problems. Results: No differences were found in any outcome parameter between the groups before treatment or at three or twelve months after cast removal. Several gait-analysis parameters, passive ankle motion, and ankle dorsiflexor strength were improved at both three and twelve months in both groups, even though many children still demonstrated some degree of toe-walking. The treatment outcomes were not correlated with coexisting neuropsychiatric problems. Conclusion: Adding botulinum toxin-A injections prior to cast treatment for idiopathic toe-walking does not improve the outcome of cast-only treatment. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Rapid head rotation is a major cause of brain damage in automobile crashes and falls. This report... more Rapid head rotation is a major cause of brain damage in automobile crashes and falls. This report details a new model for rotational acceleration about the center of mass of the rabbit head. This allows the study of brain injury without translational acceleration of the head. Impact from a pneumatic cylinder was transferred to the skull surface to cause a half-sine peak acceleration of 2.1 3 10 5 rad/s 2 and 0.96-ms pulse duration. Extensive subarachnoid hemorrhages and small focal bleed-ings were observed in the brain tissue. A pronounced reactive astrogliosis was found 8–14 days after trauma, both as networks around the focal hemorrhages and more diffusely in several brain regions. Astrocytosis was prominent in the gray matter of the cerebral cortex, layers II–V, and in the granule cell layer and around the axons of the pyramidal neurons in the hippocampus. The nuclei of cranial nerves, such as the hypoglossal and facial nerves, also showed intense astrocytosis. The new model allows study of brain injuries from head rotation in the absence of translational influences .
Background: Arthrogryposis Multiplex Congenita (AMC) is a heterogeneous condition characterized b... more Background: Arthrogryposis Multiplex Congenita (AMC) is a heterogeneous condition characterized by multiple joint contractures at birth. Greater movements in the trunk and pelvis during walking have been observed in children with AMC using orthoses compared to those wearing only shoes. This study investigated gait dynamics in children with AMC and identified compensatory mechanisms that accommodate walking.
Abstract
Purpose Lower limb contractures and muscle weakness
are common in children with arthrogr... more Abstract Purpose Lower limb contractures and muscle weakness are common in children with arthrogryposis multiplex congenita (AMC). To enhance or facilitate ambulation, orthoses may be used. The aim of this study was to describe gait pattern among individuals wearing their habitual orthotic devices. Methods Fifteen children with AMC, mean age 12.4 (4.3) years, with some lower limb involvement underwent 3-D gait analysis. Three groups were defined based on orthosis use; Group 1 used knee–ankle–foot orthoses with locked knee joints, Group 2 used ankle–foot orthoses or knee– ankle–foot orthoses with open knee joints and Group 3 used no orthoses. Results The greatest trunk and pelvis movements in all planes and the greatest hip abduction were observed in Group 1, compared to Groups 2 and 3, as well as to the gait laboratory control group. Maximum hip extension was similar in Groups 1 and 2, but in Group 3, there was less hip extension and large deviations from the control data. Lower cadence and walking speed were observed in Group 1 than in Groups 2 and 3. The step length was similar in all groups and also with respect to the gait laboratory reference values. Conclusions Children with AMC were subdivided according to orthoses use. Kinematic data as recorded with 3-D gait analysis showed differences among the groups in trunk, pelvis and knee kinematics, and in cadence and walking speed. The step length was similar in all groups and to the gait laboratory reference values, which may be attributable to good hip extension strength in all participants. Keywords Motion analysis AMC Amyoplasia Ambulation
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Papers by Elena M Gutierrez-Farewik
toxin A. Combined treatment with casts and botulinum toxin A has become more common even though there have been
few studies of its efficacy and safety problems. Our aims were to conduct a randomized controlled trial to test the
hypotheses that combined treatment with casts and botulinum toxin A is more effective than casts alone in reducing toewalking
by patients five to fifteen years of age, and that the treatment effect correlates with the extent of coexisting
neuropsychiatric problems.
Methods: All patients who had been consecutively admitted to the pediatric orthopaedics department of our institution
because of idiopathic toe-walking between November 2005 and April 2010 were considered for inclusion in the study.
Forty-seven children constituted the study population. The children were randomized to undergo four weeks of treatment
with below-the-knee casts either as the sole intervention or to undergo the cast treatment one to two weeks after receiving
injections of botulinum toxin A into the calves. Before treatment and three and twelve months after cast removal, all
children underwent three-dimensional (3-D) gait analysis. The severity of the idiopathic toe-walking was classified on the
basis of the gait analysis, and the parents rated the time that their child spent on his/her toes during barefoot walking.
Passive hip, knee, and ankle motion as well as ankle dorsiflexor strength were measured. Before treatment, all children
were evaluated with a screening questionnaire for neuropsychiatric problems.
Results: No differences were found in any outcome parameter between the groups before treatment or at three or twelve
months after cast removal. Several gait-analysis parameters, passive ankle motion, and ankle dorsiflexor strength were
improved at both three and twelve months in both groups, even though many children still demonstrated some degree of
toe-walking. The treatment outcomes were not correlated with coexisting neuropsychiatric problems.
Conclusion: Adding botulinum toxin-A injections prior to cast treatment for idiopathic toe-walking does not improve the
outcome of cast-only treatment.
Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Purpose Lower limb contractures and muscle weakness
are common in children with arthrogryposis multiplex
congenita (AMC). To enhance or facilitate ambulation,
orthoses may be used. The aim of this study was to describe
gait pattern among individuals wearing their habitual
orthotic devices.
Methods Fifteen children with AMC, mean age 12.4 (4.3)
years, with some lower limb involvement underwent 3-D
gait analysis. Three groups were defined based on orthosis
use; Group 1 used knee–ankle–foot orthoses with locked
knee joints, Group 2 used ankle–foot orthoses or knee–
ankle–foot orthoses with open knee joints and Group 3
used no orthoses.
Results The greatest trunk and pelvis movements in all
planes and the greatest hip abduction were observed in
Group 1, compared to Groups 2 and 3, as well as to the gait
laboratory control group. Maximum hip extension was
similar in Groups 1 and 2, but in Group 3, there was less
hip extension and large deviations from the control data.
Lower cadence and walking speed were observed in Group
1 than in Groups 2 and 3. The step length was similar in all
groups and also with respect to the gait laboratory reference
values.
Conclusions Children with AMC were subdivided
according to orthoses use. Kinematic data as recorded with
3-D gait analysis showed differences among the groups in
trunk, pelvis and knee kinematics, and in cadence and
walking speed. The step length was similar in all groups
and to the gait laboratory reference values, which may
be attributable to good hip extension strength in all
participants.
Keywords Motion analysis AMC Amyoplasia
Ambulation
toxin A. Combined treatment with casts and botulinum toxin A has become more common even though there have been
few studies of its efficacy and safety problems. Our aims were to conduct a randomized controlled trial to test the
hypotheses that combined treatment with casts and botulinum toxin A is more effective than casts alone in reducing toewalking
by patients five to fifteen years of age, and that the treatment effect correlates with the extent of coexisting
neuropsychiatric problems.
Methods: All patients who had been consecutively admitted to the pediatric orthopaedics department of our institution
because of idiopathic toe-walking between November 2005 and April 2010 were considered for inclusion in the study.
Forty-seven children constituted the study population. The children were randomized to undergo four weeks of treatment
with below-the-knee casts either as the sole intervention or to undergo the cast treatment one to two weeks after receiving
injections of botulinum toxin A into the calves. Before treatment and three and twelve months after cast removal, all
children underwent three-dimensional (3-D) gait analysis. The severity of the idiopathic toe-walking was classified on the
basis of the gait analysis, and the parents rated the time that their child spent on his/her toes during barefoot walking.
Passive hip, knee, and ankle motion as well as ankle dorsiflexor strength were measured. Before treatment, all children
were evaluated with a screening questionnaire for neuropsychiatric problems.
Results: No differences were found in any outcome parameter between the groups before treatment or at three or twelve
months after cast removal. Several gait-analysis parameters, passive ankle motion, and ankle dorsiflexor strength were
improved at both three and twelve months in both groups, even though many children still demonstrated some degree of
toe-walking. The treatment outcomes were not correlated with coexisting neuropsychiatric problems.
Conclusion: Adding botulinum toxin-A injections prior to cast treatment for idiopathic toe-walking does not improve the
outcome of cast-only treatment.
Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Purpose Lower limb contractures and muscle weakness
are common in children with arthrogryposis multiplex
congenita (AMC). To enhance or facilitate ambulation,
orthoses may be used. The aim of this study was to describe
gait pattern among individuals wearing their habitual
orthotic devices.
Methods Fifteen children with AMC, mean age 12.4 (4.3)
years, with some lower limb involvement underwent 3-D
gait analysis. Three groups were defined based on orthosis
use; Group 1 used knee–ankle–foot orthoses with locked
knee joints, Group 2 used ankle–foot orthoses or knee–
ankle–foot orthoses with open knee joints and Group 3
used no orthoses.
Results The greatest trunk and pelvis movements in all
planes and the greatest hip abduction were observed in
Group 1, compared to Groups 2 and 3, as well as to the gait
laboratory control group. Maximum hip extension was
similar in Groups 1 and 2, but in Group 3, there was less
hip extension and large deviations from the control data.
Lower cadence and walking speed were observed in Group
1 than in Groups 2 and 3. The step length was similar in all
groups and also with respect to the gait laboratory reference
values.
Conclusions Children with AMC were subdivided
according to orthoses use. Kinematic data as recorded with
3-D gait analysis showed differences among the groups in
trunk, pelvis and knee kinematics, and in cadence and
walking speed. The step length was similar in all groups
and to the gait laboratory reference values, which may
be attributable to good hip extension strength in all
participants.
Keywords Motion analysis AMC Amyoplasia
Ambulation