An evaluation of gait disturbances in children undergoing rehabilitation for cerebral palsy

Janusz Nowotny, Krzysztof Czupryna, Jacek Sołtys

Janusz Nowotny, Krzysztof Czupryna, Jacek Sołtys – An evaluation of gait disturbances in children undergoing rehabilitation for cerebral palsy. Fizjoterapia Polska 2003; 3(2); 189-196

Abstract
Cerebral palsy (CP) belongs to the group of dysfunctions in which impairment of the gait function is a constant element. The goal in rehabilitation is to steer the process of compensation in such a way that the gait pattern produces a minimum of disturbances and limitations in locomotion. Objective evaluation is essential for purposes of planning rehabilitation and monitoring outcome. Since the evaluation of gait can be parameterized, the authors have presenting methods for making such an evaluation, concentrating on two types of tests. The possibility of evaluating gate symmetry is presented, based on the use of the Parotec® system, along with evaluation based on analysis of particular gate markers, using the Zebris system. Certain practical remarks are given in the conclusion, essential for planning and managing the course of rehabilitation for children with cerebral palsy.

Key words:
Cerebral Palsy, evaluation of gait disturbances, rehabilitation

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Some possibilities for alleviating gait disturbances in children undergoing rehabilitation for cerebral palsy, in the light of baropedographic tests: a preliminary report

Janusz Nowotny, Krzysztof Czupryna, Jerzy Pietruszewski, Małgorzata Matyja

Janusz Nowotny, Krzysztof Czupryna, Jerzy Pietruszewski, Małgorzata Matyja – Some possibilities for alleviating gait disturbances in children undergoing rehabilitation for cerebral palsy, in the light of baropedographic tests: a preliminary report. Fizjoterapia Polska 2003; 3(3); 217-223

Abstract

Background. A pathological gait stereotype often occurs in children with cerebral palsy. The effort is made during rehabilitation to alleviate some of the symptoms, but this requires a precise survey of the component factors involved in the abnormal gait pattern that can be remedied. Atypical methods are sometimes used in rehabilitation, and their suitability also needs objective verification. Material and methods. Our study presents the possibilities for objective gait evaluation using baropedographic tests based on the Parotec® system. The possibilities of improving gait symmetry are also presented, using the example of children undergoing rehabilitation for cerebral palsy who have also been receiving botulin injections or the so-called inhibitive plaster casts. Results and Conclusions. These additional therapeutic devices facilitate further treatment and have a positive impact on improving the symmetry of gait in these children. We also found that this testing can be a valuable source of information for the therapist, pointing out which parameters of abnormal gait should be focused on during further rehabilitation.

Key words:
Cerebral Palsy, evaluation of gait disturbances, botulin, inhibitive plaster casts
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Comparison of motoric activity of American and Polish children with cerebral palsy during rehabilitation

Iwona Kasior-Szerszeń, Wanda Stryła

Iwona Kasior-Szerszeń, Wanda Stryła – Comparison of motoric activity of American and Polish children with cerebral palsy during rehabilitation. Fizjoterapia Polska 2006; 6(1); 7-12

Abstract

Background. Common features of cerebral palsy in children are movement and posture disorders. The most disturbed sphere is motorics. Movement disorders include spastic limb paresis, unvoluntary movements, coordination and balance disturbances. The aim of this report was to compare motor efficiency concerning manual and locomotive functions as well as life activities in Polish and American children. Material and methods. Study material involved 100 Polish children and 107 children from USA. Survey method was used. Results. The results were compared with respect to locomotor and manual functions in Polish and American children. Statistically significant differences were obtained. Conclusions. 1. The level of disability was higher in American children than in Polish children. 2. Manual and locomotive functions in American children were more limited. 3. Everyday child care concerning basic life activities leads to chronic fatigue, frustration, depression and in consequence to disturbances in normal family life.

Key words:
cerebral palsy, rehabilitation, motoric activity
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Vertical positioning advantages in children with cerebral palsy

Stanisław Faliszewski, Ewa Kamińska, Marzena Wiernicka, Wanda Stryła

Stanisław Faliszewski, Ewa Kamińska, Marzena Wiernicka, Wanda Stryła – Vertical positioning advantages in children with cerebral palsy. Fizjoterapia Polska 2006; 6(2); 167-171

Abstract

A primary aim of this paper is an introduction of the concrete arguments to physiotherapists, physicians, parents and other pro-fessionals who deal with rehabilitation of children with cerebral palsy, about the importance and the necessity of application into practice vertical positioning method based on the age of a child, not on the achievements of gross motor activity, at any stage of a physical therapy process. Two basic types of vertical positioning method may be distinguished depending on the condition of a patient: the passive and the active vertical positioning method. The difficulty in the active vertical positioning method, that is in the ability of taking up the standing position unaided, opposing the force of gravity, is the major rehabilitation problem of children suffering from cerebral palsy. It is manifested by the inability to take up the standing position unaided at all or the delay in it in the proportion to the vertical positioning standard (about the 16th month of a lifetime) and it results in many disadvantageous changes mentioned in this article. The passive vertical positioning with the help of vertical positioners seems to be the only alternative in this situation. The passive vertical positioning method is above all, the overcoming of incorrect postural-motor patterns in children. The vertical positioning method enables the suppression of intensified spastic tension. The passive vertical positioning facilitates the performance of different ADL, e. g. eating, doing homework, reading, the use of a computer, and has an influence on the course of physiological processes. The Neurodevelopment Treatment method acknowledges it to be a priority while using techniques of the stimulation during the physical therapy process. The only contraindication to the passive vertical positioning can be the prolonged reluctance of a child to such form of taking up the standing position. The advantages connected with vertical positioning by use of vertical positioning table of children with cerebral palsy (passive method) are considered from the sensomotor, psychological, physiological and anatomical points of view and ability to regain particular motor functions. Disadvantageous effects of a short and long-time immobilisation at horizontal position as result of hypokinesis and hypogravity are taken into account as well. The results of the reaserch carried out on people remaining in a recumbent position shortly or prolongedly in consequence of diseases and injuries as well as on healthy people, prove that bed rest cause essential disadvantageous physiological changes.

Key words:
vertical positioning, cerebral palsy, hypogravia, hypodynamia
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Postoperative three-dimensional gait analysis in a child with cerebral palsy – ankle and knee joint kinematics

Wiesław Chwała, Dorota Pamuła

Wiesław Chwała, Dorota Pamuła – Postoperative three-dimensional gait analysis in a child with cerebral palsy – ankle and knee joint kinematics. Fizjoterapia Polska 2006; 6(4); 322-327

Abstract
The aim of this study was to assess ankle joint kinematics in a child with hemiplegic cerebral palsy after multiple soft tissue surgery. Gait analysis was performed using a video-based 3-dimensional gait analysis system (VICON). The gait of the child differed significantly at ankle and knee joints from that seen in a normal population. The stance phase was prolonged in both lower extremities. At the ankle significant differences were found in preswing, initial contact, loading response and terminal swing. Gait analysis demonstrated increased dorsiflexion, especially at preswing, most likely due to the prior surgery. The stance length was prolonged (by over 10%). At the knee significant differences were found in preswing, initial contact, loading response and terminal swing. The hemiparetic leg commonly presents as a functional shortening of two muscles: the rectus femoris and the tibialis anterior during the GC and little concentric action of the gastrocnemius muscle in preswing. The observed changes in muscle length confirm inadequate extension of the knee and increased dorsiflexion during stance.

Key words:
three-dimensional gait analysis, cerebral palsy, ankle and knee joints

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The efficacy of treatment with botulinum toxin type A in children with dynamic contractures of lower limbs in the management of cerebral palsy

Małgorzata Malinowska-Matuszewska, Małgorzata Kulesa, Antoni Czupryna

Małgorzata Malinowska-Matuszewska, Małgorzata Kulesa, Antoni Czupryna – The efficacy of treatment with botulinum toxin type A in children with dynamic contractures of lower limbs in the management of cerebral palsy. Fizjoterapia Polska 2007; 7(1); 38-44

Abstract

Background. The efficacy of botulinum toxin type A (BTX-A) in the management of cerebral palsy was determined in the lower limb. Material and methods. The study was carried out on 51 children with cerebral palsy aged 2-17 years (mean age 8 years and 6 months). The patients were undergoing treatment with BTX-A to reduce spasticity and alleviate dynamic contractures. Between one and four target muscles were selected according to functional goals (improving the gait pattern, increasing the range of motion at joints) and biomechanical assessments and were injected at multiple sites with BTX-A. The patients were evaluated at baseline and at 3 and 12 weeks post-injection. Parameters evaluated comprised Joint Range of Motion (ROM), Modified Ashworth Scale (MAS), Modified Physician Rating Scale (MPRS), Gross Motor Function Measure (GMFM) and Global Clinical Impression (GCI). Patterns of gait were monitored by VHS registration. Results. The statistical tests showed a significant (one degree) improvement over baseline at 3 weeks after the first injection (p<0.05) in MAS, MPRS, and GCI. A deterioration of MPRS and joint range of motion was observed at 12 weeks after the first dose and before the second dose (p<0.01). Two patients started to walk without mobility devices after the BTX-A treatment. The outcomes were worse in the five patients who did not perform the required rehabilitation programme after the BTX-A treatment. Conclusions. The use of BTX-A is indicated in children with diplegia and spastic hemiplegia to improve locomotor ability, and in tetraplegic children to facilitate nursing care and enable the patients to assume a standing position.

Słowa kluczowe:
spasticity, cerebral palsy, botulinum toxin type A (BTX-A), lower limbs
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Postural consequences of muscle tone disorders in children with cerebral palsy (hemiparesis)

Andrzej Szopa, Małgorzata Domagalska, Krzysztof Czupryna, Maciej Płaszewski

Andrzej Szopa, Małgorzata Domagalska, Krzysztof Czupryna, Maciej Płaszewski – Postural consequences of muscle tone disorders in children with cerebral palsy (hemiparesis). Fizjoterapia Polska 2007; 7(3); 241-249

Abstract
Background. The spontaneous adjustment of abnormal muscle tone in CP children leads to abnormal postural and motor patterns development. The aim of this work was to recognize and define some of compensatory postural patterns in CP children. Material and methods. The group of 18 children with hemiplegia, aged 5-14, were taken into the examination. The objective measurement of they postural patterns while standing, kneeling (of one and both legs) and sitting was done with a help of photogrammetry. In the same time using baroresistive platform a force distribution on the support base were measured. Results. In case of standing position two kinds of postural patterns were observed — the progravitational pattern and the anti-gravitational pattern. In every children with progravitional pattern lateral spine curvature were observed. Their values were significantly higher than similar in antigravitational pattern. In standing on one leg and half kneeing the arrangement of postural parameters were the same. In sitting in children with progravitional type mutual arrangement of shoulders and pelvis line was changed to parallel and in children with antygravitional type overloaded side changed to opposite. Conclusions. 1. The postural patterns through hemiparetic children are habitual and have differentiated character according to character of paresis. 2. Development of postural patterns is predictable, it is possible to steer the compensation during the treatment.
Key words:
cerebral palsy, compensatory antigravity mechanisms, postural patterns
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Differences in knee movement while walking in children with cerebral palsy (CP)

Alicja Dziuba, Krystyna Kobel-Buys

Alicja Dziuba, Krystyna Kobel-Buys – Differences in knee movement while walking in children with cerebral palsy (CP). Fizjoterapia Polska 2007; 7(4); 447-454

Abstract
Background. Cerebral palsy (CP) affects many children, with about 50,000 CP patients living currently in Poland. The most frequent manifestation of CP is a gait disorder attributable to both neurological and developmental factors. The aim of this study is to analyze children’s walking abilities using basic gait parameters and trace changes of these parameters during rehabilitation.Material and methods. This paper presents the results of two-dimensional gait analysis using two cameras positioned perpendicular to the direction of the child’s walk and recording at 50 Hz the movement of the right and left side of the body in the sagittal plane. The paper describes the walking skills of three CP boys born in 2000 (3/JK/02, 8/SA/02 and 20/BM/03) who were able to walk with help. The locomotion analysis was based on change over time of angular displacements in the right and left knee in the support and swing phases of gait. Results. The analysis showed that child 3/JK/02 had the best knee movement pattern, as suggested by the approximation of mean angular displacements in selected points in the swing and stance phases to those established for normal children. Child 8/SA/02 displayed greater deterioration of the gait pattern, as the knee movement pattern differed more considerably from that of a healthy child. The knee movement of child 20/MB/03 improved very little. Conclusion. The type of kinematic analysis conducted in this study is of diagnostic significance, helping to identify an improvement or deterioration of gait in children undergoing rehabilitation, and can aid the physician or physiotherapist in selecting exercises addressing specific elements of the gait pattern in order to effect lasting improvements.
Key words:
cerebral palsy, gait analysis, knee movement
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The use of botulinum toxin in clinical practice

Olga Wolska, Wojciech Kiebzak, Wiesław Tomaszewski, Ireneusz Kowalski, Mariusz Majewski, Józef Szarek, Katarzyna Zaborowska-Sapeta

Olga Wolska, Wojciech Kiebzak, Wiesław Tomaszewski, Ireneusz Kowalski, Mariusz Majewski, Józef Szarek, Katarzyna Zaborowska-Sapeta – The use of botulinum toxin in clinical practice. Fizjoterapia Polska 2008; 8(2); 105-114

Abstract
Botulinum toxin is increasingly used in clinical practice as a basic or adjunctive agent in many fields modern medicine. In the field of rehabilitation of the musculoskeletal system, the introduction of botulinum toxin has opened new unexpected therapeutic avenues. This method broadens the possibilities for therapeutic intervention of doctors and physiotherapists, for whom complete recovery or improvement of the patient’s overall physical capacity is the measure of success. Because of its effectiveness and high safety for the patient, it is considered to be a modern and promising medicinal agent. The possibility of applying botulinum toxin selectively and, at the same time, precisely makes for a good clinical effect, while an appropriate pharmacological safety margin is also maintained. Although the range of indications is broad, it is in the treatment of spasticity of particular muscle groups who received the treatment as quickly as possible. Absolute contraindications include: myasthenia gravis, myasthenic syndrome, blood coagulability disorders. The most serious relative contraindications are pregnancy and breast-feeding. Intensive clinical research as well as numerous scientific meetings are making it possible for the method to gain more popularity and also to the clinical experience. Current standards of botulinum toxin use have been elaborated and published by an interdisciplinary group of experts. These standards are guidelines for practicing physicians. The author’s experience and available literature have served to present a state-of-the-art review of the use of botulinum toxin in clinical practice.
Key words:
spasticity, botulinum toxin, cerebral palsy
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Postural problems of children with CP based on hemiparesis

Małgorzata Domagalska, Krzysztof Czupryna, Andrzej Szopa, Janusz Nowotny

Małgorzata Domagalska, Krzysztof Czupryna, Andrzej Szopa, Janusz Nowotny – Postural problems of children with CP based on hemiparesis. Fizjoterapia Polska 2008; 8(3); 253-259

Abstract
Background. Injury to the immature brain leads to impaired development of the antigravity mechanism. The adoption of progressively higher body positions is only possible due to compensatory mechanisms. The aim of the study was to diagnose postural disorders in children with CP with respect to the adopted compensatory mechanisms. Material and methods. Eighteen children with advanced hemiparesis, aged from 5 to 14, took part in the study. Objective posturometric measurements were taken while the patients maintained a standing position without assistance. Photogrammetric measurements was used to evaluate the spatial arrangement of individual body segments, with pressure forces on the support base being assessed simultaneously using a baroresistive platform. Results. Patients demonstrated two types of postural patterns: a progravity pattern and an antigravity pattern, which differed mainly in terms of the patient habitually overloading or unloading one of the lower limbs, changing the position of the centre of gravity projection on the support base and a characteristic relation of the shoulder and pelvic lines. Conclusions. The nature of postural disorders in CP children depends on the anti- or progravitational nature of the paresis. The development of postural disorders in CP children is predictable and should therefore be taken into account from the very beginning of rehabilitation
Key words:
cerebral palsy, compensatory antigravity mechanism, postural problems
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