Sergio T Fonseca

The atypical walking pattern in children with spastic cerebral palsy is assumed to involve kinematic and morphological adaptations that allow them to move. The purpose of this study was to explore how the requirements of the task and the energy-generating and energy-conserving capabilities of children with cerebral palsy relate to kinematic and mechanical energy patterns of walking. Six children with hemiplegic cerebral palsy and a matched group of typically developing children participated in the study. Kinematic data were collected at 5 different walking speeds. Vertical stiffness, mechanical energy parameters, and landing angle were measured during the stance phase. The affected side of the children with cerebral palsy showed greater vertical stiffness, a greater ratio of kinetic forward energy to potential energy, and a smaller landing angle when compared with those of the nonaffected lower extremity and with those of typically developing children. Previous research has shown th...

An experiment was conducted in which volume of used oxygen per stride time and the total segmental changes in kinetic energy generated per stride time, DeltaEk s-1, of 11 participants were determined on Day 1 for 7 treadmill running speeds. Gait transition speeds were determined on Day 2. Running metabolism and transition speed were predicted from the Day 1 mechanics of running expressed in Speed x DeltaEk s-1 coordinates. Predictions followed from the relation between 2 generalized quality ratios Qmetab, and Qmech, with numerator DeltaEk s-1. In Qmetab, the denominator was the volume of used oxygen per stride time; in Qmech, the denominator was the absolute regression constant from the linear dependency of DeltaEk s-1 on speed.

Patellofemoral pain syndrome (PFPS) is characterized by anterior knee pain, which may limit the performance of functional activities. The influence of hip joint motion on the development of this syndrome has already been documented in the literature. In this regard, studies have investigated the effectiveness of hip muscle strengthening in patients with PFPS. The aims of this systematic review were (1) to summarize the literature related to the effects of hip muscle strengthening on pain intensity, muscle strength, and function in individuals with PFPS and (2) to evaluate the methodological quality of the selected studies. A search for randomized controlled clinical trials was conducted using the following databases: Google Scholar, MEDLINE, PEDro, LILACS, and SciELO. The selected studies had to distinguish the effects of hip muscle strengthening in a group of patients with PFPS, as compared to non-intervention or other kinds of intervention, and had to investigate the following out...

The objective of this study was to provide normative data of frontal plane patellar alignment according to McConnell and Arno angles, verify the association between theses angles and identify the presence of patellar rotation in different sports. Cross-sectional. Nine participants (18 knees) were assessed in a preliminary study to verify the intra and inter-examiner reliabilities of the patellar alignment measures. In the main study, 230 volleyball, basketball, gymnastics and soccer athletes (460 knees) were evaluated in order to obtain normative data of patellar alignment. Frontal plane patellar alignment (McConnell and Arno angles) measured in standing position by means of photogrammetry. The standardized method demonstrated intra and inter-examiner reliability coefficients varying from .85 to .98. The mean McConnell and Arno angles were 2.05° (±5.9) and 2.89° (±7.57), respectively. A low association was observed (r = .189, p < .0001) between these angles. There was a difference in distribution of medial and lateral rotations, according to the McConnell angle, between different sports (p < .014). The proposed procedure for measuring patellar alignment according to McConnell and Arno angles proved to be highly reliable. This made possible the establishment of normative data in a large sample of healthy athletes.

The objective of this study was to test the feasibility of a treatment programme based on the elements of constraint-induced movement therapy (CIMT) to encourage use of the affected arm of a child with obstetric brachial plexus injury (OBP), as well as to document clinical changes observed with this intervention. A 2-year-old female child with Erb's palsy had 14 weeks of daily home-based treatment with 30-minute sessions planned according to the principles of CIMT. The child was assessed every 2 weeks with the Toddler Arm Use Test. Test scores throughout the intervention period demonstrated improvements in quality of movement, amount of use and willingness to use the affected extremity. The child's mother reported improved ability to perform bimanual activities at home. The results suggest that treatment based on CIMT principles has potential to promote functional gains for children with OBP. Experimental studies should test the effects of this kind of intervention for child...

ABSTRACT BACKGROUND: Botulinum toxin A (BTA) is commonly used to treat children with cerebral palsy (CP). However, the variables measured before BTA application and associated with motor function and independent mobility, known as predictors of functional outcomes, have not been well defined. OBJECTIVE: To identify clinical predictors of gains in functional motor skills and independence of mobility among children with CP, three and six months after BTA application. METHODS: This was a convenience sample of children with spastic CP (n=35). Measurements of quantitative gains in motor skills and independence of mobility were taken three and six months after BTA application. These outcomes were observed through repeated applications of two functional tests: GMFM (Gross Motor Function Measure) and PEDI (Pediatric Evaluation of Disability Inventory). These tests evaluated gross motor function while sitting or standing and during transitions between these postures, and also during dynamic activities such as walking, running and jumping, along with the children's independence in mobility tasks. The independent variables included the children's characteristics such as age, severity, topographic diagnosis, neuromuscular-skeletal parameters (range of motion and spasticity), gait quality and performance in the functional tests before BTA. RESULTS: Four predictive models were developed (R2 between 0.58 and 0.83; p<0.05) through the use of CART analysis: two at three months and two at six months after BTA application. The results indicated that children with better gait quality, smaller repertoire of functional motor skills, less independence of locomotion and age below four years and six months before BTA presented greater gains in motor skills and independence in mobility. CONCLUSION: The results identified significant clinical parameters that can predict functional outcomes of BTA applications among children with CP.

The objective of this study was to verify whether proprioception is affected in individuals with ACL-deficient knees and good functional and muscular performances. Eleven subjects with ACL injury and 11 controls participated in the study. Functional performance was assessed using the Cincinnati Knee Rating System (CKRS), hop index, and figure-eight ratio. An isokinetic test was done to evaluate muscular performance. Proprioception was evaluated through position, sense and threshold tests. Analyses of variance were used for data analysis. The injured subjects scored significantly lower in the CKRS (p = 0.001). No statistically significant differences were found in the hop index, in the figure-eight ratio, or in peak torque. There were no statistically significant differences in proprioception bettween groups and between legs. These results indicated that the individuals evaluated in this study with ACL injury and good functional and muscular performance did not have proprioceptive deficits, suggesting that the ligament mechanoreceptors, in some cases, might not contribute relevantly to proprioception.

Skeletal muscles adapt their length and stiffness according to the functional demands to which they are regularly submitted. The modification of muscle stiffness and length induced by resistance training can alter joint stiffness and, theoretically, change joint resting position. Thirty subjects, randomly assigned to two groups, were submitted to a resistance training of the elbow flexor muscles of the non-dominant arm. This training was performed in the inner range in group 1 and throughout the complete range of motion in group 2. The dominant arm of each subject was considered the control. A biomechanical model of a hybrid mass-spring pendulum was used to estimate the elbow joint stiffness and the elbow resting position was assessed using a standard goniometer. There was a significant increase in joint stiffness of the experimental arm after complete range of motion training, which was not observed after the training performed in inner range. The resting position of the experimental arm was modified to a significantly greater flexion angle in both groups. No change was observed after resistance training in the control arm. The results showed that modifications in joint stiffness seem to depend on the volume of work imposed to skeletal muscles. In addition, both models of resistance training changed, through different mechanisms, the elbow joint resting position. These findings suggest that posture and joint stability may be modified by specific strengthening protocols.