48 results on '"de Coulon A"'
Search Results
2. Are Clinical Impairments Related to Kinematic Gait Variability in Children and Young Adults With Cerebral Palsy?
- Author
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Anne Tabard-Fougère, Dionys Rutz, Annie Pouliot-Laforte, Geraldo De Coulon, Christopher J. Newman, Stéphane Armand, and Jennifer Wegrzyk
- Subjects
cerebral palsy ,gait ,variability ,kinematic ,clinical impairments ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Intrinsic gait variability (GV), i.e., fluctuations in the regularity of gait patterns between repetitive cycles, is inherent to the sensorimotor system and influenced by factors such as age and pathology. Increased GV is associated with gait impairments in individuals with cerebral palsy (CP) and has been mainly studied based on spatiotemporal parameters. The present study aimed to describe kinematic GV in young people with CP and its associations with clinical impairments [i.e., passive range of motion (pROM), muscle weakness, reduced selective motor control (selectivity), and spasticity]. This retrospective study included 177 participants with CP (age range 5–25 years; Gross Motor Function Classification System I-III) representing 289 clinical gait analyses [n = 172 for unilateral CP (uCP) vs. 117 for bilateral CP (bCP)]. As variability metrics, Root Mean Square Deviation (RMSD) for nine lower-limb kinematic parameters and Gait Standard Deviation (GaitSD) – as composite score of the kinematic parameters – were computed for the affected (unilateral = uCP) and most affected side (bilateral = bCP), respectively, as defined by clinical scores. GaitSD was then computed for the non/less-affected side for between leg comparisons. Uni- and multivariate linear regressions were subsequently performed on GaitSD of the affected/most affected side with all clinical impairments (composite scores) as independent variables. Highest RMSD were found in the transverse plane (hip, pelvis), for distal joints in the sagittal plane (knee, ankle) and for foot progression. GaitSD was not different between uCP and bCP (affected/most affected side) but higher in the non-affected vs. affected side in uCP. GaitSD was associated with age (p < 0.001), gait deviation index (GDI) (p < 0.05), muscle weakness (p < 0.001), selectivity (p < 0.05), and pROM (p < 0.001). After adjustment for age and GDI, GaitSD remained associated with muscle weakness (uCP: p = 0.003, bCP: p < 0.001) and selectivity (bCP: p = 0.024). Kinematic GV can be expressed as global indicator of variability (GaitSD) in young people with CP given the strong correlation of RMSD for lower-limb kinematic parameters. In terms of asymmetry, increased variability of the non-affected vs. affected side may indicate contralateral compensation mechanisms in uCP. Notably muscle weakness (uCP, bCP) and selectivity (bCP) – but not spasticity – were associated with GaitSD. Further studies need to explore the clinical relevance of kinematic GV in CP to support the interpretation of clinical gait analyses and therapeutic decision-making.
- Published
- 2022
- Full Text
- View/download PDF
3. Walking Speed of Children and Adolescents With Cerebral Palsy: Laboratory Versus Daily Life
- Author
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Lena Carcreff, Corinna N. Gerber, Anisoara Paraschiv-Ionescu, Geraldo De Coulon, Kamiar Aminian, Christopher J. Newman, and Stéphane Armand
- Subjects
cerebral palsy ,typical development ,capacity ,performance ,inertial sensors ,walking speed ,Biotechnology ,TP248.13-248.65 - Abstract
The purpose of this pilot study was to compare walking speed, an important component of gait, in the laboratory and daily life, in young individuals with cerebral palsy (CP) and with typical development (TD), and to quantify to what extent gait observed in clinical settings compares to gait in real life. Fifteen children, adolescents and young adults with CP (6 GMFCS I, 2 GMFCS II, and 7 GMFCS III) and 14 with TD were included. They wore 4 synchronized inertial sensors on their shanks and thighs while walking at their spontaneous self-selected speed in the laboratory, and then during 2 week-days and 1 weekend day in their daily environment. Walking speed was computed from shank angular velocity signals using a validated algorithm. The median of the speed distributions in the laboratory and daily life were compared at the group and individual levels using Wilcoxon tests and Spearman’s correlation coefficients. The corresponding percentile of daily life speed equivalent to the speed in the laboratory was computed and observed at the group level. Daily-life walking speed was significantly lower compared to the laboratory for the CP group (0.91 [0.58–1.23] m/s vs 1.07 [0.73–1.28] m/s, p = 0.015), but not for TD (1.29 [1.24–1.40] m/s vs 1.29 [1.20–1.40] m/s, p = 0.715). Median speeds correlated highly in CP (p < 0.001, rho = 0.89), but not in TD. In children with CP, 60% of the daily life walking activity was at a slower speed than in-laboratory (corresponding percentile = 60). On the contrary, almost 60% of the daily life activity of TD was at a faster speed than in-laboratory (corresponding percentile = 42.5). Nevertheless, highly heterogeneous behaviors were observed within both populations and within subgroups of GMFCS level. At the group level, children with CP tend to under-perform during natural walking as compared to walking in a clinical environment. The heterogeneous behaviors at the individual level indicate that real-life gait performance cannot be directly inferred from in-laboratory capacity. This emphasizes the importance of completing clinical gait analysis with data from daily life, to better understand the overall function of children with CP.
- Published
- 2020
- Full Text
- View/download PDF
4. Assessment of gait quality and efficiency after undergoing a single-event multilevel surgery in children with cerebral palsy presenting an intoeing gait pattern
- Author
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Gabriel Moisan, Alice Bonnefoy-Mazure, Géraldo De Coulon, Anne Tabard-Fougère, Stéphane Armand, and Katia Turcot
- Subjects
Treatment Outcome ,Cerebral Palsy ,Pediatrics, Perinatology and Child Health ,Humans ,Neurology (clinical) ,General Medicine ,Child ,Gait ,Gait Disorders, Neurologic ,Biomechanical Phenomena ,Retrospective Studies - Abstract
The biomechanical impact of undergoing a single-event multilevel surgery (SEMLS) for children with cerebral palsy (CP) presenting an intoeing gait pattern has been widely documented. However, past studies mostly focused on gait quality rather than efficiency. Thus, there is a need to determine the impact of undergoing a SEMLS on gait quality and efficiency in children with CP presenting an intoeing gait pattern.Data from 16 children with CP presenting an intoeing gait pattern who underwent a SEMLS were retrospectively selected. Gait kinematics was quantified before (baseline) and at least 1 year after the surgery (follow-up). Gait quality was investigated with the Gait Profile Score (GPS), hip internal rotation angle and foot progression angle (FPA). Gait efficiency was analysed using clinically accessible variables, namely the normalised gait speed and medio-lateral and vertical centre of mass excursions (COMp). Dependent variables were compared between sessions with paired t-tests.At the follow-up, children with CP exhibited a more outward FPA and GPS as well as a decreased hip internal rotation angle. No changes in normalised gait speed and vertical COMp excursion were observed, and medio-lateral COMp excursion was slightly decreased.Children with CP presenting an intoeing gait pattern who underwent a SEMLS exhibited an increased gait quality, but gait efficiency was only minimally improved at the follow-up compared to baseline. Further studies are needed to identify contributors of gait efficiency in children with CP, and the best treatment modalities to optimise both their gait quality and efficiency.
- Published
- 2022
5. Results and complications of percutaneous pelvic osteotomy and intertrochanteric varus shortening osteotomy in 54 consecutively operated GMFCS level IV and V cerebral palsy patients
- Author
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Canavese, Federico, Marengo, Lorenza, and de Coulon, Geraldo
- Published
- 2017
- Full Text
- View/download PDF
6. What can we learn from the relationship between gait deviations and clinical impairments when comparing two databases?
- Author
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Annie Pouliot-Laforte, Louise Iterbeke, Anne Tabard-Fougère, Alice Bonnefoy-Mazure, Geraldo De Coulon, Kaat Desloovere, and Stéphane Armand
- Subjects
Adolescent ,Cerebral Palsy ,Rehabilitation ,Biophysics ,Clinical examination ,Biomechanical Phenomena ,Joint motions ,Muscle Spasticity ,Humans ,Cerebral palsy ,Orthopedics and Sports Medicine ,Gait analysis ,Child ,Gait Analysis ,Gait ,Retrospective Studies - Abstract
BACKGROUND: Several previous studies have tried to determine the relationship between gait and clinical impairments in children with Cerebral Palsy (CP). The heterogeneity of the population and the methodology used could explain the discrepancy within the results. Recently, Papageorgiou et al. (2019) used a Statistical Parametric Mapping (SPM) analysis to investigate this relationship, allowing to test across the kinematic waveforms parameters. RESEARCH QUESTION: Are we able to replicate the results of Papageorgiou et al. (2019) on a population of children with CP from another center? METHODS: Retrospectively, youth with spastic unilateral (uCP) or bilateral (bCP) CP (3-18 years of age) who underwent a clinical gait analysis at the Geneva University Hospitals (HUG) were screened. Following Papageorgiou et al. 2019, the same inclusion and exclusion criteria as well as the same methodology were applied. Mann-Whitney-U test was used to compare the impairments score between the two centers. A Student T-Test using SPM was applied to compare the kinematic waveforms from the two centers. A canonical correlation analysis using SPM was realized to assess the relationship between clinical impairments and the combined sagittal motion of the pelvis, hip, knee and ankle. RESULTS AND SIGNIFICANCE: A total of 211 patients were included with 131 uCP (10 [8-14] years old) and 80 bCP (11 [7-14] years old). The distribution of the Gross Motor Function Classification System levels and the proportion of previous treatment differs between centers. In both CP groups, significant differences were observed in the composite score and lower limb kinematics, reflecting less impaired patients with CP at HUG compared to Papagergiou et al. (2019). While similar associations between spasticity and kinematic were observed in both centers, the association with muscle weakness, selectivity, and range of motion differed. ispartof: GAIT & POSTURE vol:98 pages:261-265 ispartof: location:England status: published
- Published
- 2022
7. A 10.5-year follow-up of walking with unilateral spastic cerebral palsy.
- Author
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Bonnefoy-Mazure, Alice, De Coulon, Geraldo, Lascombes, Pierre, Bregou, Aline, and Armand, Stéphane
- Subjects
- *
CEREBRAL palsy , *PEARSON correlation (Statistics) , *WALKING speed , *GAIT in humans - Abstract
Purpose: The purpose of this study was to describe gait evolution in patients with unilateral spastic cerebral palsy (USCP) using modified Gait Profile Score (mGPS without hip rotation), Gait Variable Score (GVS), walking speed, and the observed effects of single-level surgery (SLS) after 10 years. Methods: Fifty-two patients with USCP (Gross Motor Function Classification System I) and data from two Clinical Gait Analyses (CGAs) were included. The evolution of patients' mGPS, GVS, and walking speed were calculated. Two "no surgery" and "single-level surgery" patient categories were analyzed. Paired t -tests were used to compare the data between CGAs and as a function of treatment category. Pearson's correlations were used to examine relationships between baseline values and evolutions in mGPS and walking speed. Results: Mean ages (SD) at first and last CGAs were 9.3 (3.2) and 19.7 (6.0) years old, respectively, with an average follow-up of 10.5 (5.6) years. Mean mGPS for the patients' affected side was significantly lower at the last CGA for the full cohort: baseline = 8.5° (2.1) versus follow-up = 7.2° (1.6), effect size = 0.73, p < 0.001. Significant improvements in mGPS and GVS for ankle and foot progression were found for the SLS group. The mGPS change and mGPS at baseline (r = −0.79, p < 0.001) were negatively correlated. Conclusions: SLS patients demonstrated a positive long-term change in gait pattern over time. The group that had undergone surgery had worse gait scores at baseline than the group that had not, but the SLS group's last CGA scores were relatively closer to those of the "no surgery" group. Level of evidence: This was a retrospective comparative therapeutic study (level III). [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
8. Self‐perceived gait quality in young adults with cerebral palsy
- Author
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Alice Bonnefoy-Mazure, Stéphane Armand, and Geraldo De Coulon
- Subjects
Adult ,Male ,030506 rehabilitation ,medicine.medical_specialty ,Adolescent ,genetic structures ,Visual analogue scale ,media_common.quotation_subject ,Severity of Illness Index ,Cerebral palsy ,Diagnostic Self Evaluation ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Gait (human) ,Physical medicine and rehabilitation ,Developmental Neuroscience ,Quality of life ,Perception ,medicine ,Humans ,Gait Disorders, Neurologic ,media_common ,ddc:618 ,ddc:617 ,Cerebral Palsy ,Gross Motor Function Classification System ,medicine.disease ,Walking Speed ,Preferred walking speed ,Gait analysis ,Pediatrics, Perinatology and Child Health ,Exercise Test ,Female ,Neurology (clinical) ,0305 other medical science ,Psychology ,human activities ,030217 neurology & neurosurgery - Abstract
AIM To explore how patients with cerebral palsy (CP) perceive their gait and evaluate associations between subjective gait perception and: objective gait parameters, endurance, pain, and fatigue. METHOD Sixty-two patients (21 females and 41 males; mean [SD] age 20y [5y 1mo], range 15-29y) performed a clinical gait analysis. Self-selected walking speed, Gait Profile Score, and Gait Variable Score were calculated. Subjective gait perception was assessed with a visual analogue scale using the question: 'On a scale from 0 (worst) to 10 (optimal), how would you describe your walking today?'. A 6-minute walk test (6MWT) measured endurance; the 36-Item Short Form Health Survey (SF-36) evaluated quality of life. T-tests, Pearson correlations, and univariate and multiple linear regression models were used to compare and find associations between the data. RESULTS Overall mean (SD) subjective gait perception was 7.5 (1.8) and was significantly higher for patients in Gross Motor Function Classification System (GMFCS) level I (7.9 [1.5]) than for patients in GMFCS levels II and III (5.9 [2.0]). Positive correlations were found between subjective gait perception and gait scores, walking speed, 6MWT distance, and SF-36 score. Only walking speed was a significant predictor of subjective gait perception. INTERPRETATION Subjective gait perception was influenced by GMFCS level and linked partially with the walking speed. The gait quality did not explain subjective gait perception. It is important to combine subjective and objective gait scores to develop personalized therapeutic goals. WHAT THIS PAPER ADDS Subjective gait perception is influenced by the physical impairment levels of patients with cerebral palsy. Subjective gait perception and objective gait scores are associated. Walking speed is the only predictor of gait perception.
- Published
- 2020
9. Comparison of gait characteristics between clinical and daily life settings in children with cerebral palsy
- Author
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Corinna N. Gerber, Stéphane Armand, Geraldo De Coulon, Lena Carcreff, Christopher J. Newman, Kamiar Aminian, and Anisoara Paraschiv-Ionescu
- Subjects
Male ,030506 rehabilitation ,Wilcoxon signed-rank test ,deviation index ,lcsh:Medicine ,0302 clinical medicine ,Gait (human) ,Activities of Daily Living ,older-adults ,adolescents ,physical-activity ,Child ,lcsh:Science ,gross motor function ,Gait ,ddc:618 ,Multidisciplinary ,ddc:617 ,ambulatory system ,Female ,walking activity ,Gait Analysis ,0305 other medical science ,performance ,medicine.medical_specialty ,Adolescent ,Case-Control Studies ,Cerebral Palsy/physiopathology ,Cross-Sectional Studies ,Gait/physiology ,Humans ,Walking Speed ,Young Adult ,Qualitative evidence ,Clinical settings ,Paediatric research ,Article ,Cerebral palsy ,scale ,03 medical and health sciences ,Physical medicine and rehabilitation ,medicine ,patterns ,business.industry ,Cerebral Palsy ,lcsh:R ,Translational research ,medicine.disease ,lcsh:Q ,business ,human activities ,030217 neurology & neurosurgery - Abstract
Gait assessments in standardized settings, as part of the clinical follow-up of children with cerebral palsy (CP), may not represent gait in daily life. This study aimed at comparing gait characteristics in laboratory and real life settings on the basis of multiple parameters in children with CP and with typical development (TD). Fifteen children with CP and 14 with TD wore 5 inertial sensors (chest, thighs and shanks) during in-laboratory gait assessments and during 3 days of daily life. Sixteen parameters belonging to 8 distinct domains were computed from the angular velocities and/or accelerations. Each parameter measured in the laboratory was compared to the same parameter measured in daily life for walking bouts defined by a travelled distance similar to the laboratory, using Wilcoxon paired tests and Spearman’s correlations. Most gait characteristics differed between both environments in both groups. Numerous high correlations were found between laboratory and daily life gait parameters for the CP group, whereas fewer correlations were found in the TD group. These results demonstrated that children with CP perform better in clinical settings. Such quantitative evidence may enhance clinicians’ understanding of the gap between capacity and performance in children with CP and improve their decision-making.
- Published
- 2020
10. Are Clinical Impairments Related to Kinematic Gait Variability in Children and Young Adults With Cerebral Palsy?
- Author
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Anne, Tabard-Fougère, Dionys, Rutz, Annie, Pouliot-Laforte, Geraldo, De Coulon, Christopher J, Newman, Stéphane, Armand, and Jennifer, Wegrzyk
- Subjects
Behavioral Neuroscience ,Psychiatry and Mental health ,Neuropsychology and Physiological Psychology ,Neurology ,cerebral palsy ,clinical impairments ,gait ,kinematic ,variability ,Biological Psychiatry - Abstract
Intrinsic gait variability (GV), i.e., fluctuations in the regularity of gait patterns between repetitive cycles, is inherent to the sensorimotor system and influenced by factors such as age and pathology. Increased GV is associated with gait impairments in individuals with cerebral palsy (CP) and has been mainly studied based on spatiotemporal parameters. The present study aimed to describe kinematic GV in young people with CP and its associations with clinical impairments [i.e., passive range of motion (pROM), muscle weakness, reduced selective motor control (selectivity), and spasticity]. This retrospective study included 177 participants with CP (age range 5-25 years; Gross Motor Function Classification System I-III) representing 289 clinical gait analyses [n = 172 for unilateral CP (uCP) vs. 117 for bilateral CP (bCP)]. As variability metrics, Root Mean Square Deviation (RMSD) for nine lower-limb kinematic parameters and Gait Standard Deviation (GaitSD) - as composite score of the kinematic parameters - were computed for the affected (unilateral = uCP) and most affected side (bilateral = bCP), respectively, as defined by clinical scores. GaitSD was then computed for the non/less-affected side for between leg comparisons. Uni- and multivariate linear regressions were subsequently performed on GaitSD of the affected/most affected side with all clinical impairments (composite scores) as independent variables. Highest RMSD were found in the transverse plane (hip, pelvis), for distal joints in the sagittal plane (knee, ankle) and for foot progression. GaitSD was not different between uCP and bCP (affected/most affected side) but higher in the non-affected vs. affected side in uCP. GaitSD was associated with age (p < 0.001), gait deviation index (GDI) (p < 0.05), muscle weakness (p < 0.001), selectivity (p < 0.05), and pROM (p < 0.001). After adjustment for age and GDI, GaitSD remained associated with muscle weakness (uCP: p = 0.003, bCP: p < 0.001) and selectivity (bCP: p = 0.024). Kinematic GV can be expressed as global indicator of variability (GaitSD) in young people with CP given the strong correlation of RMSD for lower-limb kinematic parameters. In terms of asymmetry, increased variability of the non-affected vs. affected side may indicate contralateral compensation mechanisms in uCP. Notably muscle weakness (uCP, bCP) and selectivity (bCP) - but not spasticity - were associated with GaitSD. Further studies need to explore the clinical relevance of kinematic GV in CP to support the interpretation of clinical gait analyses and therapeutic decision-making.
- Published
- 2022
11. Complications of intrathecal baclofen pump treatment in children with spastic cerebral palsy. A comparative analysis of patients weighing over or under 20 kg at the time of implantation
- Author
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Anne Tabard-Fougère, Christina Steiger, Federico Canavese, and Geraldo De Coulon
- Subjects
Male ,Baclofen ,Group B ,Spastic cerebral palsy ,Spastic ,medicine ,Humans ,Orthopedics and Sports Medicine ,Child ,Injections, Spinal ,Retrospective Studies ,ddc:618 ,Muscle Relaxants, Central ,business.industry ,Cerebral Palsy ,Incidence (epidemiology) ,Gross Motor Function Classification System ,Pump ,medicine.disease ,Weight ,Intrathecal baclofen ,Muscle Spasticity ,Anesthesia ,Pediatrics, Perinatology and Child Health ,Cerebral palsy ,Lioresal ,Spasticity ,business - Abstract
Objective The purpose of this study was to investigate the incidence of complications in pediatric spastic cerebral palsy (CP) patients weighing less than 20 kg at the time of intrathecal baclofen (ITB) pump implantation and to compare it with spastic CP patients heavier than 20 kg. Material and methods Twenty-seven patients with spastic CP (14 males) treated with ITB implantation at our institution between January 2002 and January 2018 were retrospectively reviewed. Eight of the 27 patients had a bodyweight below 20 kg (group A) and 19 had weight above 20 kg (group B). Results Group A had a significantly more important proportion of patients with the Gross Motor Function Classification System V compared to group B (88 vs. 42%). The median follow-up was respectively 2.5 (1.8-4.6) and 4.6 (1.9-10.0) years in groups A and B. Median age at the time of ITB implantation was 7.4 (2.8-12.8) and 13.7 (6.5-16.8) years in groups A and B (P = 0.002). The proportion of patients with complications or reoperation was NS between groups A and B (P > 0.05). No postoperative infections were recorded in any of the groups. During follow-up, five patients died (63%) in group A and three (16%) in group B (P = 0.049) within 3.8 years on average after ITB implantation. Conclusions ITB therapy in spastic CP patients weighing less than 20 kg seems to be as well tolerated and effective as it is in heavier (>20 kg) pediatric patients.
- Published
- 2022
12. What is the Best Configuration of Wearable Sensors to Measure Spatiotemporal Gait Parameters in Children with Cerebral Palsy?
- Author
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Lena Carcreff, Corinna N. Gerber, Anisoara Paraschiv-Ionescu, Geraldo De Coulon, Christopher J. Newman, Stéphane Armand, and Kamiar Aminian
- Subjects
cerebral palsy ,gait ,inertial sensors ,gait events ,spatiotemporal parameters ,Chemical technology ,TP1-1185 - Abstract
Wearable inertial devices have recently been used to evaluate spatiotemporal parameters of gait in daily life situations. Given the heterogeneity of gait patterns in children with cerebral palsy (CP), the sensor placement and analysis algorithm may influence the validity of the results. This study aimed at comparing the spatiotemporal measurement performances of three wearable configurations defined by different sensor positioning on the lower limbs: (1) shanks and thighs, (2) shanks, and (3) feet. The three configurations were selected based on their potential to be used in daily life for children with CP and typically developing (TD) controls. For each configuration, dedicated gait analysis algorithms were used to detect gait events and compute spatiotemporal parameters. Fifteen children with CP and 11 TD controls were included. Accuracy, precision, and agreement of the three configurations were determined in comparison with an optoelectronic system as a reference. The three configurations were comparable for the evaluation of TD children and children with a low level of disability (CP-GMFCS I) whereas the shank-and-thigh-based configuration was more robust regarding children with a higher level of disability (CP-GMFCS II–III).
- Published
- 2018
- Full Text
- View/download PDF
13. What can we learn from the relationship between gait and clinical impairments in children with cerebral palsy when comparing databases?
- Author
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Stéphane Armand, Alice Bonnefoy-Mazure, L. Iterbeke, A. Pouliot Laforte, Anne Tabard-Fougère, and G. De Coulon
- Subjects
medicine.medical_specialty ,Physical medicine and rehabilitation ,Gait (human) ,business.industry ,Rehabilitation ,Biophysics ,Medicine ,Orthopedics and Sports Medicine ,business ,medicine.disease ,Cerebral palsy - Published
- 2021
14. MRI changes in calf muscles of two children with cerebral palsy following Botulinum Toxin Type A injections: a preliminary report
- Author
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Federico Canavese, Geraldo De Coulon, Stéphane Armand, Alice Bonnefoy-Mazure, and Laura Merlini
- Subjects
Male ,Placebo ,Injections, Intramuscular ,Cerebral palsy ,Muscle tone ,Spastic cerebral palsy ,Spastic ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Botulinum Toxins, Type A ,Child ,Muscle, Skeletal ,Muscle contracture ,Leg ,business.industry ,Cerebral Palsy ,medicine.disease ,Magnetic Resonance Imaging ,medicine.anatomical_structure ,Treatment Outcome ,Neuromuscular Agents ,Muscle Spasticity ,Anesthesia ,Pediatrics, Perinatology and Child Health ,Ambulatory ,business ,Botulinum toxin type - Abstract
Intramuscular injections of Botulinum Toxin Type A (BoNT-A) in children with spastic cerebral palsy (CP) have been introduced in clinical practice with the aim of reducing muscle tone, preventing muscle contractures and, ultimately, improving function. The aim of this study was to evaluate prospectively the MRI changes in the calf muscles, gastrocnemius (GN) and soleus (S) of two children with unilateral spastic CP (US-CP), prior and more than 1-year following BoNT-A injections. Two male patients with US-CP were injected at the level of the GN and S muscles. Patients underwent a first lower extremity MRI prior to the first BoNT-A injection at the level of GN and S muscles of the affected side. A second MRI was perfomed 34 and 22 months after the index procedure, respectively. Both legs were investigated together symmetrically, to allow a precise comparison between muscles and structures. The MRI protocol included three sequences: axial-T2 weighted tse, SPACE and axial-T1 weighted. We found that BoNT-A injected GN and S muscles had increased signal intensity on the MRI performed 22 and 34 months after index procedure, when compared to the contralateral, not placebo injected (NaCl) leg. To the best of our knowledge, no previous studies have investigated the changes induced in muscle structures in ambulatory children with US-CP managed by BoNT-A injections. Level of evidence: II.
- Published
- 2020
15. Walking Speed of Children and Adolescents With Cerebral Palsy: Laboratory Versus Daily Life
- Author
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Christopher J. Newman, Stéphane Armand, Geraldo De Coulon, Corinna N. Gerber, Lena Carcreff, Kamiar Aminian, and Anisoara Paraschiv-Ionescu
- Subjects
0301 basic medicine ,Percentile ,Performance ,02 engineering and technology ,Walking speed ,Correlation ,gait deviation index ,physical-activity ,gross motor function ,Group level ,Original Research ,ddc:617 ,capability ,typical development ,Bioengineering and Biotechnology ,capacity ,cerebral palsy ,inertial sensors ,performance ,walking speed ,021001 nanoscience & nanotechnology ,ambulatory system ,Typical development ,0210 nano-technology ,Biotechnology ,medicine.medical_specialty ,Histology ,lcsh:Biotechnology ,Biomedical Engineering ,Bioengineering ,Inertial sensors ,Cerebral palsy ,clinical gait ,03 medical and health sciences ,Physical medicine and rehabilitation ,lcsh:TP248.13-248.65 ,medicine ,parameters ,Capacity ,business.industry ,medicine.disease ,Individual level ,Gait ,Preferred walking speed ,030104 developmental biology ,Gait analysis ,parkinsons-disease ,business - Abstract
The purpose of this pilot study was to compare walking speed, an important component of gait, in the laboratory and daily life, in young individuals with cerebral palsy (CP) and with typical development (TD), and to quantify to what extent gait observed in clinical settings compares to gait in real life. Fifteen children, adolescents and young adults with CP (6 GMFCS I, 2 GMFCS II, and 7 GMFCS III) and 14 with TD were included. They wore 4 synchronized inertial sensors on their shanks and thighs while walking at their spontaneous self-selected speed in the laboratory, and then during 2 week-days and 1 weekend day in their daily environment. Walking speed was computed from shank angular velocity signals using a validated algorithm. The median of the speed distributions in the laboratory and daily life were compared at the group and individual levels using Wilcoxon tests and Spearman's correlation coefficients. The corresponding percentile of daily life speed equivalent to the speed in the laboratory was computed and observed at the group level. Daily-life walking speed was significantly lower compared to the laboratory for the CP group (0.91 [0.58-1.23] m/s vs 1.07 [0.73-1.28] m/s, p = 0.015), but not for TD (1.29 [1.24-1.40] m/s vs 1.29 [1.20-1.40] m/s, p = 0.715). Median speeds correlated highly in CP (p < 0.001, rho = 0.89), but not in TD. In children with CP, 60% of the daily life walking activity was at a slower speed than in-laboratory (corresponding percentile = 60). On the contrary, almost 60% of the daily life activity of TD was at a faster speed than in-laboratory (corresponding percentile = 42.5). Nevertheless, highly heterogeneous behaviors were observed within both populations and within subgroups of GMFCS level. At the group level, children with CP tend to under-perform during natural walking as compared to walking in a clinical environment. The heterogeneous behaviors at the individual level indicate that real-life gait performance cannot be directly inferred from in-laboratory capacity. This emphasizes the importance of completing clinical gait analysis with data from daily life, to better understand the overall function of children with CP.
- Published
- 2020
16. Are Clinical Impairments Related to Kinematic Gait Variability in Children and Young Adults With Cerebral Palsy?
- Author
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Tabard-Fougère, Anne, Rutz, Dionys, Pouliot-Laforte, Annie, De Coulon, Geraldo, Newman, Christopher J., Armand, Stéphane, and Wegrzyk, Jennifer
- Subjects
YOUNG adults ,CEREBRAL palsy ,GAIT in humans ,RANGE of motion of joints ,LARGE-scale brain networks - Abstract
Intrinsic gait variability (GV), i.e., fluctuations in the regularity of gait patterns between repetitive cycles, is inherent to the sensorimotor system and influenced by factors such as age and pathology. Increased GV is associated with gait impairments in individuals with cerebral palsy (CP) and has been mainly studied based on spatiotemporal parameters. The present study aimed to describe kinematic GV in young people with CP and its associations with clinical impairments [i.e., passive range of motion (pROM), muscle weakness, reduced selective motor control (selectivity), and spasticity]. This retrospective study included 177 participants with CP (age range 5–25 years; Gross Motor Function Classification System I-III) representing 289 clinical gait analyses [ n = 172 for unilateral CP (uCP) vs. 117 for bilateral CP (bCP)]. As variability metrics, Root Mean Square Deviation (RMSD) for nine lower-limb kinematic parameters and Gait Standard Deviation (GaitSD) – as composite score of the kinematic parameters – were computed for the affected (unilateral = uCP) and most affected side (bilateral = bCP), respectively, as defined by clinical scores. GaitSD was then computed for the non/less-affected side for between leg comparisons. Uni- and multivariate linear regressions were subsequently performed on GaitSD of the affected/most affected side with all clinical impairments (composite scores) as independent variables. Highest RMSD were found in the transverse plane (hip, pelvis), for distal joints in the sagittal plane (knee, ankle) and for foot progression. GaitSD was not different between uCP and bCP (affected/most affected side) but higher in the non-affected vs. affected side in uCP. GaitSD was associated with age (p < 0.001), gait deviation index (GDI) (p < 0.05), muscle weakness (p < 0.001), selectivity (p < 0.05), and pROM (p < 0.001). After adjustment for age and GDI, GaitSD remained associated with muscle weakness (uCP: p = 0.003, bCP: p < 0.001) and selectivity (bCP: p = 0.024). Kinematic GV can be expressed as global indicator of variability (GaitSD) in young people with CP given the strong correlation of RMSD for lower-limb kinematic parameters. In terms of asymmetry, increased variability of the non-affected vs. affected side may indicate contralateral compensation mechanisms in uCP. Notably muscle weakness (uCP, bCP) and selectivity (bCP) – but not spasticity – were associated with GaitSD. Further studies need to explore the clinical relevance of kinematic GV in CP to support the interpretation of clinical gait analyses and therapeutic decision-making. [ABSTRACT FROM AUTHOR]
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- 2022
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17. Feasibility and reliability of using an exoskeleton to emulate muscle contractures during walking
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Michael Attias, Alice Bonnefoy-Mazure, G. De Coulon, Laurence Chèze, Stéphane Armand, Haute Ecole Spécialisée de Suisse Occidentale (HES-SO), Laboratoire de Cinésiologie, Willy Taillard Hopital Cantonal, Université de Genève (UNIGE), Pediatric Orthopaedic Service, Department of Child and Adolescent, Geneva University Hospitals and Geneva University, Laboratoire de Biomécanique et Mécanique des Chocs (LBMC UMR T9406), Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Université de Lyon-Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux (IFSTTAR)
- Subjects
Male ,030506 rehabilitation ,Kinematics ,Walking ,Quadriceps Muscle ,Tendons ,0302 clinical medicine ,Activities of Daily Living ,Orthopedics and Sports Medicine ,EXOSKELETON ,Gait ,Reliability (statistics) ,ddc:618 ,ddc:617 ,Rehabilitation ,CINEMATIQUE ,MUSCLE ,Exoskeleton Device ,Biomechanical Phenomena ,Stroke ,Lower Extremity ,SIMULATION ,Female ,medicine.symptom ,0305 other medical science ,Adult ,medicine.medical_specialty ,Contracture ,Adolescent ,Biophysics ,Cerebral palsy ,03 medical and health sciences ,Young Adult ,medicine ,Humans ,KINEMATICS ,[PHYS.MECA.BIOM]Physics [physics]/Mechanics [physics]/Biomechanics [physics.med-ph] ,Muscle, Skeletal ,Gait Disorders, Neurologic ,Muscle contracture ,business.industry ,Cerebral Palsy ,Reproducibility of Results ,medicine.disease ,Exoskeleton ,EMULATION ,Gait analysis ,Physical therapy ,Feasibility Studies ,business ,human activities ,030217 neurology & neurosurgery ,Hamstring - Abstract
Contracture is a permanent shortening of the muscle-tendon-ligament complex that limits joint mobility. Contracture is involved in many diseases (cerebral palsy, stroke, etc.) and can impair walking and other activities of daily living. The purpose of this study was to quantify the reliability of an exoskeleton designed to emulate lower limb muscle contractures unilaterally and bilaterally during walking. An exoskeleton was built according to the following design criteria: adjustable to different morphologies; respect of the principal lines of muscular actions; placement of reflective markers on anatomical landmarks; and the ability to replicate the contractures of eight muscles of the lower limb unilaterally and bilaterally (psoas, rectus femoris, hamstring, hip adductors, gastrocnemius, soleus, tibialis posterior, and peroneus). Sixteen combinations of contractures were emulated on the unilateral and bilateral muscles of nine healthy participants. Two sessions of gait analysis were performed at weekly intervals to assess the reliability of the emulated contractures. Discrete variables were extracted from the kinematics to analyse the reliability. The exoskeleton did not affect normal walking when contractures were not emulated. Kinematic reliability varied from poor to excellent depending on the targeted muscle. Reliability was good for the bilateral and unilateral gastrocnemius, soleus, and tibialis posterior as well as the bilateral hamstring and unilateral hip adductors. The exoskeleton can be used to replicate contracture on healthy participants. The exoskeleton will allow us to differentiate primary and compensatory effects of muscle contractures on gait kinematics.
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- 2016
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18. What is the Best Configuration of Wearable Sensors to Measure Spatiotemporal Gait Parameters in Children with Cerebral Palsy?
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Kamiar Aminian, Geraldo De Coulon, Anisoara Paraschiv-Ionescu, Christopher J. Newman, Stéphane Armand, Corinna N. Gerber, and Lena Carcreff
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030506 rehabilitation ,medicine.medical_specialty ,Biomechanical Phenomena ,Cerebral Palsy ,Child ,Foot ,Gait ,Gait Disorders, Neurologic ,Humans ,Wearable Electronic Devices ,cerebral palsy ,gait ,gait events ,inertial sensors ,spatiotemporal parameters ,Computer science ,Wearable computer ,lcsh:Chemical technology ,Biochemistry ,Article ,Analytical Chemistry ,Cerebral palsy ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,Inertial measurement unit ,medicine ,lcsh:TP1-1185 ,Electrical and Electronic Engineering ,Instrumentation ,Measure (data warehouse) ,ddc:618 ,ddc:617 ,medicine.disease ,Atomic and Molecular Physics, and Optics ,Gait analysis ,0305 other medical science ,030217 neurology & neurosurgery - Abstract
Wearable inertial devices have recently been used to evaluate spatiotemporal parameters of gait in daily life situations. Given the heterogeneity of gait patterns in children with cerebral palsy (CP), the sensor placement and analysis algorithm may influence the validity of the results. This study aimed at comparing the spatiotemporal measurement performances of three wearable configurations defined by different sensor positioning on the lower limbs: (1) shanks and thighs, (2) shanks, and (3) feet. The three configurations were selected based on their potential to be used in daily life for children with CP and typically developing (TD) controls. For each configuration, dedicated gait analysis algorithms were used to detect gait events and compute spatiotemporal parameters. Fifteen children with CP and 11 TD controls were included. Accuracy, precision, and agreement of the three configurations were determined in comparison with an optoelectronic system as a reference. The three configurations were comparable for the evaluation of TD children and children with a low level of disability (CP-GMFCS I) whereas the shank-and-thigh-based configuration was more robust regarding children with a higher level of disability (CP-GMFCS II-III).
- Published
- 2017
19. Plantar flexor muscle weakness and fatigue in spastic cerebral palsy patients
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Sarah Regina Dias da Silva, Geraldo De Coulon, Stéphane Armand, Daria Neyroud, Bengt Kayser, Nicola A. Maffiuletti, and Nicolas Place
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,M wave ,Voluntary activation ,Isometric exercise ,Calf muscles ,Cerebral palsy ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,Spastic cerebral palsy ,Isometric Contraction ,Developmental and Educational Psychology ,medicine ,Humans ,Young adult ,Muscle, Skeletal ,Leg ,Muscle Weakness ,ddc:618 ,Muscle fatigue ,ddc:617 ,Electromyography ,Foot ,Cerebral Palsy ,Muscle weakness ,030229 sport sciences ,medicine.disease ,Clinical Psychology ,Institutional repository ,Muscle twitch ,Case-Control Studies ,Muscle Fatigue ,Physical therapy ,Etiology ,Female ,medicine.symptom ,Psychology ,030217 neurology & neurosurgery ,Maximal voluntary force - Abstract
Patients with cerebral palsy develop an important muscle weakness which might affect the aetiology and extent of exercise-induced neuromuscular fatigue.This study evaluated the aetiology and extent of plantar flexor neuromuscular fatigue in patients with cerebral palsy.Ten patients with cerebral palsy and 10 age- and sex-matched healthy individuals (∼20 years old, 6 females) performed four 30-s maximal isometric plantar flexions interspaced by a resting period of 2-3s to elicit a resting twitch. Maximal voluntary contraction force, voluntary activation level and peak twitch were quantified before and immediately after the fatiguing task.Before fatigue, patients with cerebral palsy were weaker than healthy individuals (341±134N vs. 858±151N, p0.05) and presented lower voluntary activation (73±19% vs. 90±9%, p0.05) and peak twitch (100±28N vs. 199±33N, p0.05). Maximal voluntary contraction force was not significantly reduced in patients with cerebral palsy following the fatiguing task (-10±23%, p0.05), whereas it decreased by 30±12% (p0.05) in healthy individuals.Plantar flexor muscles of patients with cerebral palsy were weaker than their healthy peers but showed greater fatigue resistance.Cerebral palsy is a widely defined pathology that is known to result in muscle weakness. The extent and origin of muscle weakness were the topic of several previous investigations; however some discrepant results were reported in the literature regarding how it might affect the development of exercise-induced neuromuscular fatigue. Importantly, most of the studies interested in the assessment of fatigue in patients with cerebral palsy did so with general questionnaires and reported increased levels of fatigue. Yet, exercise-induced neuromuscular fatigue was quantified in just a few studies and it was found that young patients with cerebral palsy might be more fatigue resistant that their peers. Thus, it appears that (i) conflicting results exist regarding objectively-evaluated fatigue in patients with cerebral palsy and (ii) the mechanisms underlying this muscle fatigue - in comparison to those of healthy peers - remain poorly understood. The present study adds important knowledge to the field as it shows that when young adults with cerebral palsy perform sustained maximal isometric plantar flexions, they appear less fatigable than healthy peers. This difference can be ascribed to a better preservation of the neural drive to the muscle. We suggest that the inability to drive their muscles maximally accounts for the lower extent of exercise-induced neuromuscular fatigue in patients with cerebral palsy.
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- 2017
20. Percutaneous pelvic osteotomy in non-ambulatory cerebral palsy patients
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G. De Coulon and Federico Canavese
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Male ,Dysplasia ,medicine.medical_specialty ,Percutaneous ,Adolescent ,Cerebral palsy ,Blood loss ,medicine ,Dislocation ,Hip Dislocation ,Humans ,In patient ,Orthopedics and Sports Medicine ,Child ,Pelvic Bones ,Hip ,Surgical approach ,ddc:618 ,business.industry ,Cerebral Palsy ,medicine.disease ,Osteotomy ,Surgery ,Radiography ,Acetabular angle ,Percutaneous pelvic osteotomy ,Female ,Non ambulatory ,Radiology ,business ,Pelvic osteotomy ,Follow-Up Studies - Abstract
The aim of this study was to describe the surgical technique of and indications for percutaneous pelvic osteotomy in patients with severe cerebral palsy. Forty non-ambulatory children and adolescents (47 hips) were consecutively treated with percutaneous pelvic osteotomy. The mean preoperative Reimers’ migration percentage improved from 66.2% to 4.9% at the final follow-up. The mean preoperative acetabular angle (AA) improved from 32.4° to 13.2° at last follow-up. Percutaneous pelvic osteotomy is a less invasive surgical approach and appears to be a valid option with similar outcomes to standard techniques.This method results in less muscle stripping and blood loss and a shorter operating time.
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- 2014
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21. Results and complications of percutaneous pelvic osteotomy and intertrochanteric varus shortening osteotomy in 54 consecutively operated GMFCS level IV and V cerebral palsy patients
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Lorenza Marengo, Geraldo De Coulon, and Federico Canavese
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Male ,Percutaneous ,Avascular necrosis ,Severity of Illness Index ,Cohort Studies ,0302 clinical medicine ,Postoperative Complications ,Medicine ,Hip Dislocation ,Orthopedics and Sports Medicine ,Range of Motion, Articular ,Child ,Pain Measurement ,030222 orthopedics ,ddc:618 ,Osteotomy ,medicine.anatomical_structure ,Treatment Outcome ,Child, Preschool ,Female ,medicine.symptom ,Range of Motion ,medicine.medical_specialty ,Adolescent ,Risk Assessment ,Postoperative Care/methods ,Cerebral palsy ,03 medical and health sciences ,Femoral head ,Minimally Invasive Surgical Procedures/adverse effects/methods ,Deformity ,Hip Dislocation/diagnostic imaging/surgery ,Humans ,Minimally Invasive Surgical Procedures ,Preschool ,Pelvis ,Retrospective Studies ,Postoperative Care ,Postoperative Complications/epidemiology/physiopathology ,business.industry ,Cerebral Palsy ,medicine.disease ,Surgery ,body regions ,Hip subluxation ,Osteotomy/adverse effects/methods ,Cerebral Palsy/diagnosis/surgery ,business ,Spastic quadriplegia ,030217 neurology & neurosurgery ,Articular/physiology ,Follow-Up Studies - Abstract
This retrospective study evaluated mid-to-long-term outcome of a minimally invasive percutaneous pelvic osteotomy (PPO) approach combined with varus derotational shortening osteotomy (VDRSO) and soft tissue release in children with severe CP. A retrospective review was performed of all patients presenting with a diagnosis of CP with hip subluxation or dislocation treated surgically by simultaneous soft tissue release, VDRSO, and PPO between 2002 and 2015. Eligible patients included those with a diagnosis of spastic quadriplegia or CP GMFCS level IV or V with unilateral or bilateral hip subluxation or dislocation and surgical treatment of the deformity by simultaneous soft tissue release, VDRSO and PPO. All anterior–posterior (AP) radiographs of the pelvis were reviewed and Reimers migration percentage (MP) and acetabular angle (AA) were measured. In total, 54 children and adolescents (34 boys, 20 girls) with CP GMFCS level IV and V were treated during study period: 38 (70.4%) classified GMFCS level IV and 16 (29.6%) classified GMFCS level V. A total of 64 consecutive hips underwent simultaneous PPO associated with VDRSO. Overall, at the time of chart and radiograph review, mean age was 9.1 ± 3.3 years (range 4–16.5) and mean follow-up was 43.9 ± 19.5 months (range 3–72). Mean migration percentage improved from 66.8 ± 19.8% (range 33–100) preoperatively to 8.1 ± 16.5% (range 0–70) at last follow-up. Mean acetabular angle improved from 32.7° ± 7.1° (range 20–50) preoperatively to 14° ± 6.7° (range 0–27) at last follow-up. Only one case of bone graft dislodgment was observed. We did not observe any cases of avascular necrosis of the femoral head. All operated hips were pain free at the time of last follow-up. PPO through a less invasive surgical approach offers a valuable alternative to standard techniques as it gives similar outcome but with less muscle stripping and less time in surgery. III.
- Published
- 2016
22. Self-perceived gait quality in young adults with cerebral palsy.
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Bonnefoy‐Mazure, Alice, De Coulon, Geraldo, Armand, Stephane, and Bonnefoy-Mazure, Alice
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- *
CEREBRAL palsy , *YOUNG adults , *WALKING speed , *PEOPLE with cerebral palsy , *DIAGNOSIS of neurological disorders , *SELF diagnosis , *EXERCISE tests , *RESEARCH , *NEUROLOGICAL disorders , *RESEARCH methodology , *EVALUATION research , *MEDICAL cooperation , *HEALTH surveys , *SEVERITY of illness index , *GAIT disorders , *COMPARATIVE studies , *RESEARCH funding , *QUESTIONNAIRES , *DISEASE complications - Abstract
Aim: To explore how patients with cerebral palsy (CP) perceive their gait and evaluate associations between subjective gait perception and: objective gait parameters, endurance, pain, and fatigue.Method: Sixty-two patients (21 females and 41 males; mean [SD] age 20y [5y 1mo], range 15-29y) performed a clinical gait analysis. Self-selected walking speed, Gait Profile Score, and Gait Variable Score were calculated. Subjective gait perception was assessed with a visual analogue scale using the question: 'On a scale from 0 (worst) to 10 (optimal), how would you describe your walking today?'. A 6-minute walk test (6MWT) measured endurance; the 36-Item Short Form Health Survey (SF-36) evaluated quality of life. T-tests, Pearson correlations, and univariate and multiple linear regression models were used to compare and find associations between the data.Results: Overall mean (SD) subjective gait perception was 7.5 (1.8) and was significantly higher for patients in Gross Motor Function Classification System (GMFCS) level I (7.9 [1.5]) than for patients in GMFCS levels II and III (5.9 [2.0]). Positive correlations were found between subjective gait perception and gait scores, walking speed, 6MWT distance, and SF-36 score. Only walking speed was a significant predictor of subjective gait perception.Interpretation: Subjective gait perception was influenced by GMFCS level and linked partially with the walking speed. The gait quality did not explain subjective gait perception. It is important to combine subjective and objective gait scores to develop personalized therapeutic goals.What This Paper Adds: Subjective gait perception is influenced by the physical impairment levels of patients with cerebral palsy. Subjective gait perception and objective gait scores are associated. Walking speed is the only predictor of gait perception. [ABSTRACT FROM AUTHOR]- Published
- 2020
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23. Comparison of gait characteristics between clinical and daily life settings in children with cerebral palsy.
- Author
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Carcreff, Lena, Gerber, Corinna N., Paraschiv-Ionescu, Anisoara, De Coulon, Geraldo, Newman, Christopher J., Aminian, Kamiar, and Armand, Stéphane
- Subjects
CEREBRAL palsy ,EVERYDAY life ,DECISION making ,MOVEMENT disorders ,QUESTIONNAIRES - Abstract
Gait assessments in standardized settings, as part of the clinical follow-up of children with cerebral palsy (CP), may not represent gait in daily life. This study aimed at comparing gait characteristics in laboratory and real life settings on the basis of multiple parameters in children with CP and with typical development (TD). Fifteen children with CP and 14 with TD wore 5 inertial sensors (chest, thighs and shanks) during in-laboratory gait assessments and during 3 days of daily life. Sixteen parameters belonging to 8 distinct domains were computed from the angular velocities and/or accelerations. Each parameter measured in the laboratory was compared to the same parameter measured in daily life for walking bouts defined by a travelled distance similar to the laboratory, using Wilcoxon paired tests and Spearman's correlations. Most gait characteristics differed between both environments in both groups. Numerous high correlations were found between laboratory and daily life gait parameters for the CP group, whereas fewer correlations were found in the TD group. These results demonstrated that children with CP perform better in clinical settings. Such quantitative evidence may enhance clinicians' understanding of the gap between capacity and performance in children with CP and improve their decision-making. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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24. Are clinical parameters sufficient to model gait patterns in patients with cerebral palsy using a multilinear approach?
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Geraldo De Coulon, Vincent Pomero, Alice Bonnefoy-Mazure, Yoshisama Sagawa, Stéphane Armand, Pierre Lascombes, Laboratoire de Cinésiologie, Willy Taillard Hopital Cantonal, Université de Genève = University of Geneva (UNIGE), Institut des Sciences du Mouvement Etienne Jules Marey (ISM), Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Pediatric Orthopaedic Service, Department of Child and Adolescent, Geneva University Hospitals and Geneva University, Université de Genève (UNIGE), and Centre National de la Recherche Scientifique (CNRS)-Aix Marseille Université (AMU)
- Subjects
Male ,Knee Joint ,[SDV]Life Sciences [q-bio] ,0302 clinical medicine ,Range of Motion, Articular ,Child ,Gait ,ddc:618 ,ddc:617 ,General Medicine ,Computer Science Applications ,medicine.anatomical_structure ,Muscle Spasticity ,Child, Preschool ,Female ,medicine.symptom ,Range of motion ,Adult ,musculoskeletal diseases ,medicine.medical_specialty ,Multilinear map ,Adolescent ,Biomedical Engineering ,Bioengineering ,Cerebral palsy ,Young Adult ,03 medical and health sciences ,Physical medicine and rehabilitation ,medicine ,Humans ,Knee ,Muscle Strength ,Spasticity ,Retrospective Studies ,Hip ,business.industry ,Cerebral Palsy ,030229 sport sciences ,Models, Theoretical ,medicine.disease ,Sagittal plane ,Human-Computer Interaction ,Gait analysis ,Linear Models ,Physical therapy ,Ankle ,business ,Ankle Joint ,030217 neurology & neurosurgery - Abstract
International audience; The aim of this study was to evaluate whether clinical parameters are sufficient using, a multilinear regression model, to reproduce the sagittal plane joint angles (hip, knee, and ankle) in cerebral palsy gait. A total of 154 patients were included. The two legs were considered (308 observations). Thirty-six clinical parameters were used as regressors (range of motion, muscle strength, and spasticity of the lower). From the clinical gait analysis, the joint angles of the sagittal plane were selected. Results showed that clinical parameter does not provide sufficient information to recover joint angles and/or that the multilinear regression model is not an appropriate solution.
- Published
- 2016
25. Spastic hip dysplasia in severe cerebral palsy: Review from the literature
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De Coulon, Geraldo
- Subjects
Cerebral Palsy ,Pain ,Spasticity ,Hip dysplasia - Abstract
Cerebral palsy is a neurodevelopmental condition that could be secondary to hypoxic–ischaemic brain injury during the perinatal period of development or congenital anomalies. Cerebral palsy is the most frequent cause of physical disability in development countries. These patients have motor impairment and also a high rate of mental health problems. Their motor impairments developed unbalanced hip contractures that can lead to silent hip dislocation. The incidence of this complication can be very high, from 15% to 60% (1). There is a relationship with the degree of physical disability and hip dislocation (2). Non-walking patients have a high chance to develop this deformity. The pathogenesis of the progressive hip subluxation from the acetabulum is related to muscular imbalance around the hip. They usually have strong adductors and flexors and unbalanced weak abductors and extensors. The natural history of the hip dislocation can develop pain, contractures and difficulties with hygiene. Surveillance programmes in cerebral palsy patients can help in detecting at-risk patients for hip dislocation, and early recognition enables early appropriate interventions. The surveillance should be performed with regular radiographic hip examination; because physical examination alone is not a reliable method to mesure hip dislocation . Most physicians agree that preventing hip dislocation is a good way to prevent future problems with hip pain and contracture, providing benefits to the family, caregivers and patient (2). Surgical and rehabilitative approaches, such as soft tissue lengthening and proximal femoral and pelvic osteotomies, can help to maintain hip reduce into the acetabulum. The rationale of this review is to evaluate recent literature for current trends in the surveillance and treatment of spastic hip problems in patients with cerebral palsy.
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- 2016
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26. Assessment of the spatiotemporal gait parameters of children with cerebral palsy in daily-life settings: comparison between wearable systems using different sensor location
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Christopher J. Newman, Corinna N. Gerber, Anisoara Ionescu, Stéphane Armand, Kamiar Aminian, Geraldo De Coulon, and Lena Carcreff
- Subjects
medicine.medical_specialty ,Physical medicine and rehabilitation ,Gait (human) ,business.industry ,Rehabilitation ,Biophysics ,Physical therapy ,Medicine ,Orthopedics and Sports Medicine ,Wearable systems ,business ,medicine.disease ,Cerebral palsy - Published
- 2017
27. Trunk movements during gait in cerebral palsy
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Alice Bonnefoy-Mazure, Michael Attias, Geraldo De Coulon, Pierre Lascombes, Stéphane Armand, Mathieu Lempereur, Laboratoire de Cinésiologie, Willy Taillard Hopital Cantonal, Université de Genève (UNIGE), CHRU Brest - Service de médecine physique et de réadaptation (CHU Brest - Service de médecine physique ), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Service de Chirurgie d’Orthopédie Pédiatrique [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Division of Paediatrics Orthopaedic [Geneva], Geneva University Hospital (HUG), Développement, Adaptation et Handicap. Régulations cardio-respiratoires et de la motricité (DevAH), and Université de Lorraine (UL)
- Subjects
Male ,030506 rehabilitation ,medicine.medical_specialty ,Adolescent ,Movement ,Biophysics ,Hemiplegia ,Diplegia ,Cerebral palsy ,Clinical gait analysis ,03 medical and health sciences ,0302 clinical medicine ,Gait (human) ,Physical medicine and rehabilitation ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Child ,Gait ,Gait Disorders, Neurologic ,Retrospective Studies ,ddc:618 ,ddc:617 ,business.industry ,Cerebral Palsy ,Torso ,Gross Motor Function Classification System ,Thorax ,medicine.disease ,Trunk ,Spine ,Biomechanical Phenomena ,body regions ,Preferred walking speed ,Trunk movements ,Gait analysis ,Physical therapy ,Female ,0305 other medical science ,business ,Range of motion ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology ,030217 neurology & neurosurgery - Abstract
Background Lower limb deficits have been widely studied during gait in cerebral palsy, deficits in upper body have received little attention. The purpose of this research was to describe the characteristics of trunk movement of cerebral palsy children in terms of type of deficits (diplegia/hemiplegia) and gross motor function classification system (1, 2 or 3). Methods Data from 92 cerebral palsy children, which corresponds to 141 clinical gait analysis, were retrospectively selected. Kinematic parameters of trunk were extracted from thorax and spine angles in the sagittal, transverse and coronal planes. The range of motion and the mean positions over the gait cycle were analysed. Intra-group differences between the children with diplegia or hemiplegia, gross motor function classification systems 1 to 3 and typically developing participants were analysed with Kruskal–Wallis tests and post hoc tests. Pearson correlation coefficients between the gait profile score normalised walking speed and kinematic parameters of the thorax were assessed. Findings The results revealed: 1) the range of motion of the thorax and spine exhibited more significant differences between groups than the mean positions; 2) greater levels of impairment were associated with higher thorax range of motion, and 3) the children with diplegia and gross motor function classification system 3 exhibited a greater range of motion for all planes with the exception of spine rotation. Interpretation This study confirmed that greater levels of impairment in cerebral palsy are associated with greater thorax range of motion during gait. The thorax plays an important role during gait in cerebral palsy.
- Published
- 2015
28. Gait evolution in a family with hereditary spastic paraplegia
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Stéphane Armand, Pierre Lascombes, Geraldo De Coulon, Katia Turcot, Alice Bonnefoy-Mazure, Laboratoire de Cinésiologie, Willy Taillard Hopital Cantonal, Université de Genève (UNIGE), Service de Chirurgie d’Orthopédie Pédiatrique [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Division of Paediatrics Orthopaedic [Geneva], Geneva University Hospital (HUG), Développement, Adaptation et Handicap. Régulations cardio-respiratoires et de la motricité (DevAH), and Université de Lorraine (UL)
- Subjects
Male ,Aging ,Longitudinal study ,Gait deviation ,Statistical difference ,Hereditary spastic paraplegia ,Disease ,Walking ,Neuropsychological Tests ,Gene mutation ,Disability Evaluation ,Medicine ,Age of Onset ,Child ,Gait ,ddc:618 ,ddc:617 ,General Medicine ,musculoskeletal system ,Child, Preschool ,Disease Progression ,Female ,musculoskeletal diseases ,medicine.medical_specialty ,congenital, hereditary, and neonatal diseases and abnormalities ,Adolescent ,Evolution ,Cerebral palsy ,Young Adult ,Physical medicine and rehabilitation ,Humans ,Family ,Mobility Limitation ,Gait Disorders, Neurologic ,Spastic Paraplegia, Hereditary ,business.industry ,Infant ,medicine.disease ,nervous system diseases ,body regions ,Pediatrics, Perinatology and Child Health ,Neurology (clinical) ,business ,human activities ,Psychomotor Performance ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology ,Follow-Up Studies - Abstract
International audience; BACKGROUND:Evolution; Gait; Hereditary spastic paraplegia; Longitudinal study; WalkingThe degree of disability in patients with hereditary spastic paraplegia has been reported variable even in members of the same family (same gene mutation). Moreover, it has been established that patients with hereditary spastic paraplegia should be treated differently from cerebral palsy patients due to the progressive nature of this disease. However, the gait evolution of hereditary spastic paraplegia showing onset symptoms at an early age has been described as stable. Therefore, this study aims to evaluate the walking ability and the influence of treatments on gait evolution in a family with hereditary spastic paraplegia.METHODS:Clinical gait analyses were performed in six hereditary spastic paraplegia patients from the same family with a follow-up of 4-15 years.RESULTS:Based on the gait deviation index, results showed a large variation of walking ability in these patients and no statistical difference between the first and last examination. In fact, three patients have improved their gait (from childhood to adolescence) whereas three patients worsened their gait.CONCLUSIONS:Gait alterations in a family with hereditary spastic paraplegia are heterogeneous. Gait evolution in hereditary spastic paraplegia with early symptoms had a tendency to improve gait until adolescence with adapted treatments and to decline in the adulthood.
- Published
- 2015
29. Identification of gait patterns in individuals with cerebral palsy using multiple correspondence analysis
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Yoshimasa Sagawa, Alice Bonnefoy-Mazure, G. De Coulon, Pierre Lascombes, Stéphane Armand, Laboratoire de Cinésiologie, Willy Taillard Hopital Cantonal, Université de Genève (UNIGE), Développement, Adaptation et Handicap. Régulations cardio-respiratoires et de la motricité (DevAH), Université de Lorraine (UL), and Department of Pediatrics (Geneva University Hospitals)
- Subjects
Adult ,Male ,030506 rehabilitation ,medicine.medical_specialty ,Gait pattern ,Adolescent ,Databases, Factual ,Knee Joint ,Biomechanical and clinical parameters ,Hemiplegia ,Cerebral palsy ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,Multiple correspondence analysis ,Developmental and Educational Psychology ,medicine ,Humans ,Ankle dorsiflexion ,Spasticity ,Child ,Gait Disorders, Neurologic ,Retrospective Studies ,ddc:616 ,ddc:618 ,ddc:617 ,Equinus Deformity ,Equinus gait ,medicine.disease ,Gait ,Biomechanical Phenomena ,Clinical Psychology ,Hip extension ,Gait analysis ,Multivariate Analysis ,Physical therapy ,Female ,Hip Joint ,medicine.symptom ,0305 other medical science ,Psychology ,human activities ,030217 neurology & neurosurgery ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
International audience; Great importance has been placed on the development of gait classification in cerebral palsy (CP) to assist clinicians. Nevertheless, gait classification is challenging within this group because the data is characterized by a high-dimensionality and a high-variability. Thus, the aim of this study was to analyze without a priori, a database of clinical gait analysis (CGA) of CP patients, using multiple correspondence analysis (MCA). A retrospective search, including biomechanical and clinical parameters was done between 2006 and 2012. One hundred and twenty two CP patients were included in this study (51 females and 71 males, mean age ± SD: 14.2 ± 7.5 years). Sixteen biomechanical spatio-temporal and kinematic parameters were included in the analysis. This data was transformed by a fuzzy window coding based on the distribution of each parameter in three modalities: low, average and high. Afterward, a MCA was used to associate parameters and to define classes. From this, seven most explicative gait parameters used to characterize gait of CP patients were identified: maximal hip extension, hip range, knee range, maximal knee flexion at initial contact, time of peak knee flexion, and maximal ankle dorsiflexion in stance phase and in swing phase. Moreover, four main profiles of CP patients have been defined from the multivariate approach: an apparent equinus gait group (the most similar of the control group with diplegic and hemiplegic patients with a GMFCS 1), a true equinus gait group (the youngest group with diplegic and some hemiplegic patients with a GMFCS 1), a crouch gait group (the oldest group with a majority of diplegic and rare hemiplegic patients with a GMFCS 2) and a jump knee gait group (the greatest level of global spasticity of the lower limbs with a majority of diplegic and rare hemiplegic patients with a GMFCS 2). Thus, this study showed the feasibility of the MCA in order to characterize and classify a large database of CP patients.
- Published
- 2013
30. Are clinical measurements linked to the Gait Deviation Index in cerebral palsy patients?
- Author
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Stéphane Armand, Philippe Gorce, Yoshimasa Sagawa, Eric Watelain, Geraldo De Coulon, André Kaelin, Laboratoire d'Automatique, de Mécanique et d'Informatique industrielles et Humaines - UMR 8201 (LAMIH), Université de Valenciennes et du Hainaut-Cambrésis (UVHC)-Centre National de la Recherche Scientifique (CNRS)-INSA Institut National des Sciences Appliquées Hauts-de-France (INSA Hauts-De-France), Geneva University Hospital (HUG), Laboratoire de Cinésiologie, Willy Taillard Hopital Cantonal, Université de Genève (UNIGE), Laboratoire de Biomodélisation et Ingénierie des Handicaps - EA 4322 (HANDIBIO), and Université de Toulon (UTLN)
- Subjects
Male ,Gait deviation ,GDI ,0302 clinical medicine ,Gait (human) ,Orthopedics and Sports Medicine ,Range of Motion, Articular ,Child ,Gait ,GMFCS ,education.field_of_study ,ddc:618 ,ddc:617 ,ROM ,Rehabilitation ,fuzzy decision tree ,Gross Motor Function Classification System ,RMSE ,Biomechanical Phenomena ,CP ,root mean square error ,Female ,medicine.symptom ,Range of motion ,Algorithms ,medicine.medical_specialty ,Adolescent ,Clinical measurements ,Gait Deviation Index ,Population ,Biophysics ,FDT ,Cerebral palsy ,03 medical and health sciences ,Fuzzy Logic ,three-dimensional gait analysis ,medicine ,Humans ,Spasticity ,education ,Gait Disorders, Neurologic ,Retrospective Studies ,passive range of motion ,cerebral palsy ,business.industry ,Decision Trees ,030229 sport sciences ,medicine.disease ,AB ,Gait analysis ,Physical therapy ,business ,able-bodied individuals ,human activities ,030217 neurology & neurosurgery ,3DGA ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
Objective From a dataset of clinical assessments and gait analysis, this study was designed to determine which of the assessments or their combinations would most influence a low gait index (i.e., severe gait deviations) for individuals with cerebral palsy. Design A retrospective search, including clinical and gait assessments, was conducted from August 2005 to September 2009. Population One hundred and fifty-five individuals with a clinical diagnosis of cerebral palsy (CP) (mean age (SD): 11 (5.3) years) were selected for the study. Method Quinlan's Interactive Dichotomizer 3 algorithm for decision-tree induction, adapted to fuzzy data coding, was employed to predict a Gait Deviation Index (GDI) from a dataset of clinical assessments (i.e., range of motion, muscle strength, and level of spasticity). Results Seven rules that could explain severe gait deviation (a fuzzy GDI low class) were induced. Overall, the fuzzy decision-tree method was highly accurate and permitted us to correctly classify GDI classes 9 out of 10 times using our clinical assessments. Conclusion There is an important relationship between clinical parameters and gait analysis. We have identified the main clinical parameters and combinations of these parameters that lead to severe gait deviations. The strength of the hip extensor, the level of spasticity and the strength of the tibialis posterior were the most important clinical parameters for predicting a severe gait deviation.
- Published
- 2013
31. Percutaneous pelvic osteotomy in cerebral palsy patients: Surgical technique and indications
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Antoine Samba, Geraldo De Coulon, Federico Canavese, and Marie Rousset
- Subjects
medicine.medical_specialty ,Percutaneous ,Brief Article ,business.industry ,musculoskeletal, neural, and ocular physiology ,macromolecular substances ,medicine.disease ,Acetabular dysplasia ,Surgery ,Cerebral palsy ,body regions ,nervous system ,medicine ,Orthopedics and Sports Medicine ,Non ambulatory ,business ,Pelvic osteotomy - Abstract
To describe the surgical technique of and indications for percutaneous pelvic osteotomy in patients with severe cerebral palsy.Twenty-one non-ambulatory children and adolescents (22 hips) were consecutively treated with percutaneous pelvic osteotomy, which was used in conjunction with varus, derotational, shortening femoral osteotomy and soft tissue release, to correct progressive hip subluxation and acetabular dysplasia. The age, gender, Gross Motor Function Classification System level, side(s) of operated hip, total time of follow-up, immediate post-operative immobilization, complications, and the need for revision surgery were recorded for all patients.Seventeen patients (81%) were classified as GMFCS level IV, and 4 (19%) patients were classified as GMFCS level V. At the time of surgery, the mean age was 10.3 years (range: 4-15 years). The mean Reimers' migration percentage improved from 63% (range: 3%-100%) pre-operatively to 6.5% (range: 0%-70%) at the final follow-up (P0.05). The mean acetabular angle (AA) improved from 34.1° (range: 19°-50°) pre-operatively to 14.1° (range: 5°-27°) (P0.05). Surgical correction of MP and AA was comparable in hips with open (n = 14) or closed (n = 8) triradiate cartilage (P0.05). All operated hips were pain-free at the time of the final follow-up visit, although one patient had pain for 6 mo after surgery. We did not observe any cases of bone graft dislodgement or avascular necrosis of the femoral head.Pelvic osteotomy through a less invasive surgical approach appears to be a valid alternative with similar outcomes to those of standard techniques. This method allows for less muscle stripping and blood loss and a shorter operating time.
- Published
- 2013
32. What is the Best Configuration of Wearable Sensors to Measure Spatiotemporal Gait Parameters in Children with Cerebral Palsy?
- Author
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Carcreff, Lena, Gerber, Corinna N., Paraschiv-Ionescu, Anisoara, De Coulon, Geraldo, Newman, Christopher J., Armand, Stéphane, and Aminian, Kamiar
- Subjects
WEARABLE technology ,GAIT in humans ,CHILDREN with cerebral palsy ,ACTIVITIES of daily living ,OPTOELECTRONICS - Abstract
Wearable inertial devices have recently been used to evaluate spatiotemporal parameters of gait in daily life situations. Given the heterogeneity of gait patterns in children with cerebral palsy (CP), the sensor placement and analysis algorithm may influence the validity of the results. This study aimed at comparing the spatiotemporal measurement performances of three wearable configurations defined by different sensor positioning on the lower limbs: (1) shanks and thighs, (2) shanks, and (3) feet. The three configurations were selected based on their potential to be used in daily life for children with CP and typically developing (TD) controls. For each configuration, dedicated gait analysis algorithms were used to detect gait events and compute spatiotemporal parameters. Fifteen children with CP and 11 TD controls were included. Accuracy, precision, and agreement of the three configurations were determined in comparison with an optoelectronic system as a reference. The three configurations were comparable for the evaluation of TD children and children with a low level of disability (CP-GMFCS I) whereas the shank-and-thigh-based configuration was more robust regarding children with a higher level of disability (CP-GMFCS II–III). [ABSTRACT FROM AUTHOR]
- Published
- 2018
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33. Percutaneous pelvic osteotomy and intertrochanteric varus shortening osteotomy in nonambulatory GMFCS level IV and V cerebral palsy patients: preliminary report on 30 operated hips
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Geraldo De Coulon, Horacio Gomez, André Kaelin, Dimitri Ceroni, and Federico Canavese
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Male ,medicine.medical_specialty ,Percutaneous ,Adolescent ,Pelvic Bones/surgery ,Avascular necrosis ,Severity of Illness Index ,Cerebral palsy ,Femoral head ,Osteotomy/methods ,medicine ,Spastic ,Hip Dislocation/etiology/surgery ,Hip Dislocation ,Humans ,Orthopedics and Sports Medicine ,Child ,Pelvic Bones ,Retrospective Studies ,ddc:618 ,business.industry ,Cerebral Palsy/complications ,Cerebral Palsy ,Gross Motor Function Classification System ,medicine.disease ,Surgery ,Osteotomy ,medicine.anatomical_structure ,Hip subluxation ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Female ,business ,Pelvic osteotomy - Abstract
This study evaluated the outcome of severe cerebral palsy patients (Gross Motor Function Classification System level IV and V) treated by simultaneous percutaneous pelvic osteotomy and intertrochanteric varus shortening osteotomy for hip subluxation or dislocation between 2002 and 2011. Twenty-four patients (30 hips) with an average age of 9.4 years (5-16.5) were reviewed at a mean follow-up of 35.9 months (6-96). Percutaneous pelvic osteotomy lasted on average 30 min/patient per side (25-40) and was always performed through a skin incision of 2-3 cm. The migration percentage and acetabular angle were assessed on plain radiographs. The mean Reimers' migration percentage improved from 67.1% (42-100) preoperatively to 7.7% (0-70) at the last follow-up and the mean acetabular angle improved from 31.8° (22-48) to 15.7° (5-27). Five patients presented complications: one redislocation, one bone graft dislodgement, and three with avascular necrosis of the femoral head. This study should be considered as a pilot study. These results indicate that this combined approach is an effective, reliable, and minimally invasive alternative method for the treatment of spastic dislocated hips in severe cerebral palsy patients with an outcome similar to standard techniques reported in the literature.
- Published
- 2012
34. Full body gait analysis may improve diagnostic discrimination between hereditary spastic paraplegia and spastic diplegia: a preliminary study
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Alice Bonnefoy-Mazure, G. De Coulon, Stéphane Armand, André Kaelin, and Katia Turcot
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Male ,Pilot Projects ,Kinematics ,Spastic diplegia ,Developmental and Educational Psychology ,Child ,Gait ,ddc:616 ,ddc:618 ,ddc:617 ,Biomechanics/physiology ,Thorax ,Biomechanical Phenomena ,Clinical Psychology ,medicine.anatomical_structure ,Arm ,Diagnostic Techniques, Neurological/standards ,Female ,Gait/physiology ,Psychology ,Cerebral Palsy/diagnosis/physiopathology ,Spine/physiology ,Adult ,medicine.medical_specialty ,Adolescent ,Hereditary spastic paraplegia ,Thorax/physiology ,Diagnostic Techniques, Neurological ,Arm/physiology ,Cerebral palsy ,Pelvis ,Diagnosis, Differential ,Young Adult ,Physical medicine and rehabilitation ,medicine ,Humans ,Gait Disorders, Neurologic ,Leg/physiology ,Gait Disorders, Neurologic/diagnosis/physiopathology ,Leg ,Pelvis/physiology ,Spastic Paraplegia, Hereditary ,Cerebral Palsy ,Spastic Paraplegia, Hereditary/diagnosis/physiopathology ,medicine.disease ,Sagittal plane ,Spine ,Arm swing ,Gait analysis ,Coronal plane ,human activities - Abstract
Hereditary spastic paraplegia (HSP) and spastic diplegia (SD) patients share a strong clinical resemblance. Thus, HSP patients are frequently misdiagnosed with a mild form of SD. Clinical gait analysis (CGA) has been highlighted as a possible tool to support the differential diagnosis of HSP and SD. Previous analysis has focused on the lower-body but not the upper-body, where numerous compensations during walking occur. The aim of this study was to compare the full-body movements of HSP and SD groups and, in particular, the movement of the upper limbs. Ten HSP and 12 SD patients were evaluated through a CGA (VICON 460 and Mx3+; ViconPeak(®), Oxford, UK) between 2008 and 2012. The kinematic parameters were computed using the ViconPeak(®) software (Plug-In-Gait). In addition, the mean amplitude of normalised (by the patient's height) arm swing was calculated. All patients were asked to walk at a self-selected speed along a 10-m walkway. The mean kinematic parameters for the two populations were analysed with Mann-Whitney comparison tests, with a significant P-value set at 0.05. The results demonstrated that HSP patients used more spine movement to compensate for lower limb movement alterations, whereas SD patients used their arms for compensation. SD patients had increased shoulder movements in the sagittal plane (Flexion/extension angle) and frontal plane (elevation angle) compared to HSP patients. These arm postures are similar to the description of the guard position that toddlers exhibit during the first weeks of walking. To increase speed, SD patients have larger arm swings in the sagittal, frontal and transversal planes. Upper-body kinematics, and more specifically arm movements and spine movements, may support the differential diagnosis of HSP and SD.
- Published
- 2012
35. Talonavicular arthrodesis for the treatment of neurological flat foot deformity in pediatric patients: clinical and radiographic evaluation of 29 feet
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Geraldo De Coulon, Romain Dayer, André Kaelin, Dimitri Ceroni, Federico Canavese, and Katia Turcot
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,Arthrodesis ,medicine.medical_treatment ,Radiography ,macromolecular substances ,Cerebral palsy ,Young Adult ,medicine ,Deformity ,Humans ,Orthopedics and Sports Medicine ,Child ,Foot deformity ,Gait ,Retrospective Studies ,ddc:618 ,Flatfoot/etiology/radiography/surgery ,ddc:617 ,business.industry ,Cerebral Palsy/complications ,Cerebral Palsy ,Talonavicular arthrodesis ,Arthrodesis/methods ,General Medicine ,medicine.disease ,Flatfoot ,Surgery ,Treatment Outcome ,Patient Satisfaction ,Pediatrics, Perinatology and Child Health ,Orthopedic surgery ,Female ,medicine.symptom ,business ,Gait/physiology ,Neurological impairment ,Follow-Up Studies - Abstract
Patients with cerebral palsy, syndromes, myopathies, and other forms of neurological impairment can develop planovalgus foot deformity of variable degrees of severity. Several techniques have already been described to resolve the deformity with variable results. Talonavicular arthrodesis is a well-known technique in adult patients, but to our knowledge, it has not been described in children with neurological impairment.We performed a retrospective chart and radiographic review of 18 neurological patients (10 boys, 8 girls) with a mean age of 11.3 ± 2.6 years (range, 7 to 19 y) who underwent talonavicular arthrodesis for flat foot deformity between 1998 and 2009, at our center.Of a total of 29 feet, talonavicular arthrodesis was judged satisfactory in 28 feet, whereas 1 had unsatisfactory results according to the Yoo clinical outcome scoring scale. Subjective observations reported that 3 feet from 2 patients were painful preoperatively and none after last follow-up. Functionally, 2 of 13 patients were able to stop using braces after surgery. The significant improvement achieved postoperatively in radiographic measurement angles was maintained at last follow-up without any loss of angle correction.Talonavicular arthrodesis seems to achieve a reliable hind foot fixation in flat foot in patients with neurological impairment.Case series.
- Published
- 2011
36. Gait classification in cerebral palsy using multiple correspondence analysis
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Yoshimasa Sagawa, Stéphane Armand, G. De Coulon, Pierre Lascombes, and Alice Bonnefoy-Mazure
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medicine.medical_specialty ,Gait (human) ,Physical medicine and rehabilitation ,Multiple correspondence analysis ,business.industry ,Rehabilitation ,Biophysics ,medicine ,Jump ,Orthopedics and Sports Medicine ,medicine.disease ,business ,Cerebral palsy - Abstract
s / Gait & Posture 39S (2014) S1–S141 S25 a true equinus (RB group), a crouch (LT group) and a jump knee (LB group), points out important gait parameters and shows their relationship with clinical parameters.
- Published
- 2014
37. What are the most important clinical measurements affecting gait in patients with cerebral palsy?
- Author
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Eric Watelain, Yoshimasa Sagawa, André Kaelin, Stéphane Armand, and G. De Coulon
- Subjects
medicine.medical_specialty ,Physical medicine and rehabilitation ,Gait (human) ,business.industry ,Rehabilitation ,Biophysics ,Medicine ,Orthopedics and Sports Medicine ,In patient ,business ,medicine.disease ,Cerebral palsy - Published
- 2012
38. Are clinical parameters sufficient to model gait patterns in patients with cerebral palsy using a multilinear approach?
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Bonnefoy-Mazure, Alice, Sagawa, Yoshisama, Pomero, Vincent, Lascombes, Pierre, De Coulon, Geraldo, and Armand, Stéphane
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PEOPLE with cerebral palsy ,CEREBRAL palsy ,GAIT disorders ,BIOMECHANICS research ,REGRESSION analysis - Abstract
The aim of this study was to evaluate whether clinical parameters are sufficient using, a multilinear regression model, to reproduce the sagittal plane joint angles (hip, knee, and ankle) in cerebral palsy gait. A total of 154 patients were included. The two legs were considered (308 observations). Thirty-six clinical parameters were used as regressors (range of motion, muscle strength, and spasticity of the lower). From the clinical gait analysis, the joint angles of the sagittal plane were selected. Results showed that clinical parameter does not provide sufficient information to recover joint angles and/or that the multilinear regression model is not an appropriate solution. [ABSTRACT FROM PUBLISHER]
- Published
- 2016
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39. Plantar flexor muscle weakness and fatigue in spastic cerebral palsy patients.
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Neyroud, Daria, Armand, Stéphane, De Coulon, Geraldo, Sarah R Dias Da Silva, null, Maffiuletti, Nicola A., Kayser, Bengt, Place, Nicolas, and Sarah R Dias Da Silva
- Subjects
- *
CEREBRAL palsy , *PEOPLE with cerebral palsy , *MUSCLE weakness , *ETIOLOGY of diseases , *FATIGUE (Physiology) , *ELECTROMYOGRAPHY , *FOOT , *LEG , *MUSCLE contraction , *QUESTIONNAIRES , *CASE-control method , *SKELETAL muscle , *MUSCLE fatigue - Abstract
Background: Patients with cerebral palsy develop an important muscle weakness which might affect the aetiology and extent of exercise-induced neuromuscular fatigue.Aim: This study evaluated the aetiology and extent of plantar flexor neuromuscular fatigue in patients with cerebral palsy.Methods: Ten patients with cerebral palsy and 10 age- and sex-matched healthy individuals (∼20 years old, 6 females) performed four 30-s maximal isometric plantar flexions interspaced by a resting period of 2-3s to elicit a resting twitch. Maximal voluntary contraction force, voluntary activation level and peak twitch were quantified before and immediately after the fatiguing task.Results: Before fatigue, patients with cerebral palsy were weaker than healthy individuals (341±134N vs. 858±151N, p<0.05) and presented lower voluntary activation (73±19% vs. 90±9%, p<0.05) and peak twitch (100±28N vs. 199±33N, p<0.05). Maximal voluntary contraction force was not significantly reduced in patients with cerebral palsy following the fatiguing task (-10±23%, p>0.05), whereas it decreased by 30±12% (p<0.05) in healthy individuals.Conclusions: Plantar flexor muscles of patients with cerebral palsy were weaker than their healthy peers but showed greater fatigue resistance.What This Paper Adds: Cerebral palsy is a widely defined pathology that is known to result in muscle weakness. The extent and origin of muscle weakness were the topic of several previous investigations; however some discrepant results were reported in the literature regarding how it might affect the development of exercise-induced neuromuscular fatigue. Importantly, most of the studies interested in the assessment of fatigue in patients with cerebral palsy did so with general questionnaires and reported increased levels of fatigue. Yet, exercise-induced neuromuscular fatigue was quantified in just a few studies and it was found that young patients with cerebral palsy might be more fatigue resistant that their peers. Thus, it appears that (i) conflicting results exist regarding objectively-evaluated fatigue in patients with cerebral palsy and (ii) the mechanisms underlying this muscle fatigue - in comparison to those of healthy peers - remain poorly understood. The present study adds important knowledge to the field as it shows that when young adults with cerebral palsy perform sustained maximal isometric plantar flexions, they appear less fatigable than healthy peers. This difference can be ascribed to a better preservation of the neural drive to the muscle. We suggest that the inability to drive their muscles maximally accounts for the lower extent of exercise-induced neuromuscular fatigue in patients with cerebral palsy. [ABSTRACT FROM AUTHOR]- Published
- 2017
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40. Feasibility and reliability of using an exoskeleton to emulate muscle contractures during walking.
- Author
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Attias, M., Bonnefoy-Mazure, A., De Coulon, G., Cheze, L., and Armand, S.
- Subjects
- *
PHYSIOLOGICAL aspects of walking , *MUSCLE contraction , *ROBOTIC exoskeletons , *KINEMATICS , *RELIABILITY in engineering , *CEREBRAL palsy , *CONTRACTURE (Pathology) , *GAIT disorders , *GAIT in humans , *LEG , *NEUROLOGICAL disorders , *STROKE , *TENDONS , *WALKING , *PILOT projects , *ACTIVITIES of daily living , *QUADRICEPS muscle , *SKELETAL muscle ,RESEARCH evaluation - Abstract
Contracture is a permanent shortening of the muscle-tendon-ligament complex that limits joint mobility. Contracture is involved in many diseases (cerebral palsy, stroke, etc.) and can impair walking and other activities of daily living. The purpose of this study was to quantify the reliability of an exoskeleton designed to emulate lower limb muscle contractures unilaterally and bilaterally during walking. An exoskeleton was built according to the following design criteria: adjustable to different morphologies; respect of the principal lines of muscular actions; placement of reflective markers on anatomical landmarks; and the ability to replicate the contractures of eight muscles of the lower limb unilaterally and bilaterally (psoas, rectus femoris, hamstring, hip adductors, gastrocnemius, soleus, tibialis posterior, and peroneus). Sixteen combinations of contractures were emulated on the unilateral and bilateral muscles of nine healthy participants. Two sessions of gait analysis were performed at weekly intervals to assess the reliability of the emulated contractures. Discrete variables were extracted from the kinematics to analyse the reliability. The exoskeleton did not affect normal walking when contractures were not emulated. Kinematic reliability varied from poor to excellent depending on the targeted muscle. Reliability was good for the bilateral and unilateral gastrocnemius, soleus, and tibialis posterior as well as the bilateral hamstring and unilateral hip adductors. The exoskeleton can be used to replicate contracture on healthy participants. The exoskeleton will allow us to differentiate primary and compensatory effects of muscle contractures on gait kinematics. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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41. Wide-pulse-high-frequency neuromuscular electrical stimulation in cerebral palsy.
- Author
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Neyroud, D., Armand, S., De Coulon, G., Da Silva, S.R.D., Wegrzyk, J., Gondin, J., Kayser, B., and Place, N.
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- *
ELECTRIC stimulation , *CEREBRAL palsy , *PEOPLE with cerebral palsy , *MOTOR neurons , *NEUROREHABILITATION , *CONTROL groups , *DIAGNOSIS - Abstract
Objective The present study assesses whether wide-pulse-high-frequency (WPHF) neuromuscular electrical stimulation (NMES) could result in extra-force production in cerebral palsy (CP) patients as previously observed in healthy individuals. Methods Ten CP and 10 age- and sex-matched control participants underwent plantar flexors NMES. Two to three 10-s WPHF (frequency: 100 Hz, pulse duration: 1 ms) and conventional (CONV, frequency 25 Hz, pulse duration: 50 μs) trains as well as two to three burst-like stimulation trains (2 s at 25 Hz, 2 s at 100 Hz, 2 s at 25 Hz; pulse duration: 1 ms) were evoked. Resting soleus and gastrocnemii maximal H-reflex amplitude (Hmax) was normalized by maximal M-wave amplitude (Mmax) to quantify α-motoneuron modulation. Results Similar Hmax/Mmax ratio was found in CP and control participants. Extra-force generation was observed both in CP (+18 ± 74%) and control individuals (+94 ± 124%) during WPHF ( p < 0.05). Similar extra-forces were found during burst-like stimulations in both groups (+108 ± 110% in CP and +65 ± 85% in controls, p > 0.05). Conclusion Although the mechanisms underlying extra-force production may differ between WPHF and burst-like NMES, similar increases were observed in patients with CP and healthy controls. Significance Development of extra-forces in response to WPHF NMES evoked at low stimulation intensity might open new possibilities in neuromuscular rehabilitation. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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42. What can we learn from the relationship between gait deviations and clinical impairments when comparing two databases?
- Author
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Pouliot-Laforte, Annie, Iterbeke, Louise, Tabard-Fougère, Anne, Bonnefoy-Mazure, Alice, De Coulon, Geraldo, Desloovere, Kaat, and Armand, Stéphane
- Subjects
- *
CEREBRAL palsy , *WAVE analysis , *T-test (Statistics) , *MANN Whitney U Test , *GAIT disorders , *KINEMATICS , *GAIT in humans , *RETROSPECTIVE studies , *SPASTICITY , *DISEASE complications - Abstract
Background: Several previous studies have tried to determine the relationship between gait and clinical impairments in children with Cerebral Palsy (CP). The heterogeneity of the population and the methodology used could explain the discrepancy within the results. Recently, Papageorgiou et al. (2019) used a Statistical Parametric Mapping (SPM) analysis to investigate this relationship, allowing to test across the kinematic waveforms parameters.Research Question: Are we able to replicate the results of Papageorgiou et al. (2019) on a population of children with CP from another center?Methods: Retrospectively, youth with spastic unilateral (uCP) or bilateral (bCP) CP (3-18 years of age) who underwent a clinical gait analysis at the Geneva University Hospitals (HUG) were screened. Following Papageorgiou et al. 2019, the same inclusion and exclusion criteria as well as the same methodology were applied. Mann-Whitney-U test was used to compare the impairments score between the two centers. A Student T-Test using SPM was applied to compare the kinematic waveforms from the two centers. A canonical correlation analysis using SPM was realized to assess the relationship between clinical impairments and the combined sagittal motion of the pelvis, hip, knee and ankle.Results and Significance: A total of 211 patients were included with 131 uCP (10 [8-14] years old) and 80 bCP (11 [7-14] years old). The distribution of the Gross Motor Function Classification System levels and the proportion of previous treatment differs between centers. In both CP groups, significant differences were observed in the composite score and lower limb kinematics, reflecting less impaired patients with CP at HUG compared to Papagergiou et al. (2019). While similar associations between spasticity and kinematic were observed in both centers, the association with muscle weakness, selectivity, and range of motion differed. [ABSTRACT FROM AUTHOR]- Published
- 2022
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43. Are clinical measurements linked to the Gait Deviation Index in cerebral palsy patients?
- Author
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Sagawa, Yoshimasa, Watelain, Eric, De Coulon, Géraldo, Kaelin, Andre, Gorce, Philippe, and Armand, Stéphane
- Subjects
- *
GAIT in humans , *PEOPLE with cerebral palsy , *RANGE of motion of joints , *MUSCLE strength , *FUZZY decision making - Abstract
Abstract: Objective: From a dataset of clinical assessments and gait analysis, this study was designed to determine which of the assessments or their combinations would most influence a low gait index (i.e., severe gait deviations) for individuals with cerebral palsy. Design: A retrospective search, including clinical and gait assessments, was conducted from August 2005 to September 2009. Population: One hundred and fifty-five individuals with a clinical diagnosis of cerebral palsy (CP) (mean age (SD): 11 (5.3) years) were selected for the study. Method: Quinlan's Interactive Dichotomizer 3 algorithm for decision-tree induction, adapted to fuzzy data coding, was employed to predict a Gait Deviation Index (GDI) from a dataset of clinical assessments (i.e., range of motion, muscle strength, and level of spasticity). Results: Seven rules that could explain severe gait deviation (a fuzzy GDI low class) were induced. Overall, the fuzzy decision-tree method was highly accurate and permitted us to correctly classify GDI classes 9 out of 10 times using our clinical assessments. Conclusion: There is an important relationship between clinical parameters and gait analysis. We have identified the main clinical parameters and combinations of these parameters that lead to severe gait deviations. The strength of the hip extensor, the level of spasticity and the strength of the tibialis posterior were the most important clinical parameters for predicting a severe gait deviation. [Copyright &y& Elsevier]
- Published
- 2013
- Full Text
- View/download PDF
44. Running capacity in children with bilateral cerebral palsy: What are the biomechanical and neuromotor differences between runners and walkers?
- Author
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Pouliot-Laforte, Annie, Tabard-Fougère, Anne, Bonnefoy-Mazure, Alice, De Coulon, Geraldo, and Armand, Stéphane
- Subjects
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RUNNING , *NEUROPHYSIOLOGY , *GAIT in humans , *POSTURAL balance , *NEUROMUSCULAR system , *RETROSPECTIVE studies , *SPASTICITY , *DIAGNOSIS , *MUSCLE strength , *CEREBRAL palsy , *BIOMECHANICS - Abstract
Running is a high-level locomotor activity requiring more from joints, muscles and a more complex interaction of the neuromuscular system than walking. High-level locomotor activity has the potential to shed light on motor function deficits that lower-level activity does not reveal. Therefore, the study aimed to compare biomechanical and neuromotor function between a group of children with bilateral cerebral palsy who are able and unable to run. Retrospectively, children with bilateral cerebral palsy aged between 6 and 18 years who completed a clinical gait analysis between 2006 and 2019 were included. Participants were categorized as walkers or runners based on the presence of a double floating phase. Spasticity, selectivity, muscle weakness, and passive range of motion of the lower limbs were measured and dichotomized as «normal» or «abnormal» based on reference values. Functional tasks reflecting balance (standing on one leg) and power (single leg and two-legged jumps) were realized and evaluated as failure or success. 75 children with bilateral cerebral palsy (53 runners/22 walkers) were included. Children classified as runners were stronger (hip flexors, p = 0.006; hip abductors, p = 0.022; knee flexors, p = 0.001; dorsiflexors, p = 0.014), had greater selectivity (hip flexors, p = 0.011; dorsiflexors, p = 0.001; plantiflexors, p = 0.043) and lower spasticity at the knee extensors (p = 0.045). No differences were observed in the passive range of motion between the two groups. Children classified as runners performed better at all tasks of balance and power (p < 0.05). Flexors muscles strength and selectivity and knee extensor spasticity are key points for running ability in children with bilateral cerebral palsy. • Greater flexor muscles strength and selectivity was observed in the runner group. • Lower rectus femoris spasticity was observed in the runner group. • Range of motion was not different between the runners and the walkers. • Greater stability and power were observed in the runner group. [ABSTRACT FROM AUTHOR]
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- 2022
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45. Trunk movements during gait in cerebral palsy.
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Attias, Michael, Bonnefoy-Mazure, Alice, Lempereur, Mathieu, Lascombes, Pierre, De Coulon, Geraldo, and Armand, Stéphane
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CEREBRAL palsy , *DIAGNOSIS , *GAIT in humans , *KINEMATICS , *TORSO , *BODY movement , *RETROSPECTIVE studies - Abstract
Background Lower limb deficits have been widely studied during gait in cerebral palsy, deficits in upper body have received little attention. The purpose of this research was to describe the characteristics of trunk movement of cerebral palsy children in terms of type of deficits (diplegia/hemiplegia) and gross motor function classification system (1, 2 or 3). Methods Data from 92 cerebral palsy children, which corresponds to 141 clinical gait analysis, were retrospectively selected. Kinematic parameters of trunk were extracted from thorax and spine angles in the sagittal, transverse and coronal planes. The range of motion and the mean positions over the gait cycle were analysed. Intra-group differences between the children with diplegia or hemiplegia, gross motor function classification systems 1 to 3 and typically developing participants were analysed with Kruskal–Wallis tests and post hoc tests. Pearson correlation coefficients between the gait profile score normalised walking speed and kinematic parameters of the thorax were assessed. Findings The results revealed: 1) the range of motion of the thorax and spine exhibited more significant differences between groups than the mean positions; 2) greater levels of impairment were associated with higher thorax range of motion, and 3) the children with diplegia and gross motor function classification system 3 exhibited a greater range of motion for all planes with the exception of spine rotation. Interpretation This study confirmed that greater levels of impairment in cerebral palsy are associated with greater thorax range of motion during gait. The thorax plays an important role during gait in cerebral palsy. [ABSTRACT FROM AUTHOR]
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- 2015
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46. A descriptive analysis of the upper limb patterns during gait in individuals with cerebral palsy.
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Bonnefoy-Mazure, A., Jr.Sagawa, Y., Lascombes, P., De Coulon, G., and Armand, S.
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PEOPLE with cerebral palsy , *GAIT disorders , *HEMIPLEGICS , *ARM , *STANDARD deviations - Abstract
Patients with cerebral palsy (CP) are characterized by a large diversity of gait deviations; thus, lower limb movements during gait have been well-analyzed in the literature. However, the question of upper limb movements and, more particularly, arm movements during gait has received less attention for CP patients as a function of the disease type (Hemiplegic, HE or Diplegic, DI). Thus, the aim of this study was to investigate upper limb movements for a large group of CP patients; we used a retrospective search, including upper limb kinematic parameters and 92 CP patients (42 females and 50 males, mean ± standard deviation (SD); age: 15.2 ± 6.7 years). The diagnoses consisted of 48 HE and 44 DI. A control group of 15 subjects (7 females and 8 males, age: 18.4 ± 8.4 years) was included in the study to provide normal gait data. For the DI patients and CG, 88 arms and 30 arms were analyzed, respectively. For the HE patients, 48 affected arms and 48 non-affected arms were analyzed. The kinematic parameters selected and analyzed were shoulder elevation angles; elbow flexion angles; thorax tilt and obliquity angles; hand vertical and anterior–posterior movements; and arm angles. Several gait parameters were also analyzed, such as the gait profile score (GPS) and normalized speed. Statistical analyses were performed to compare CG with the affected and non-affected upper limbs of HE patients and with the two upper limbs of DI patients. The results show that HE and DI patients adopt abnormal upper limb movements. However, DI patients have greater shoulder, elbow, thorax and arm angle movements compared with HE patients. However, HE patients adopt different movements between their affected and non-affected arms. Thus, the patients used their upper limbs to optimize their gait more where gait deviations were more important. These observations confirm that the upper limbs must be integrated into rehabilitation programs to improve inter-limb coordination. [ABSTRACT FROM AUTHOR]
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- 2014
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47. Identification of gait patterns in individuals with cerebral palsy using multiple correspondence analysis.
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Bonnefoy-Mazure, A., Sagawa, Y., Lascombes, P., De Coulon, G., and Armand, S.
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GAIT in humans , *PEOPLE with cerebral palsy , *CEREBRAL palsy , *MEDICAL databases , *CLINICAL trials , *CORRESPONDENCE analysis (Statistics) - Abstract
Highlights: [•] We examine a large database of clinical gait analysis of patient's cerebral palsy. [•] A multiple correspondence analysis is used to analyze this database. [•] Four main profiles have been defined. [•] Apparent equinus gait, true equinus gait, a crouch gait and jump knee gait groups. [ABSTRACT FROM AUTHOR]
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- 2013
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48. Full body gait analysis may improve diagnostic discrimination between hereditary spastic paraplegia and spastic diplegia: A preliminary study
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Bonnefoy-Mazure, A., Turcot, K., Kaelin, A., De Coulon, G., and Armand, S.
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FAMILIAL spastic paraplegia , *CEREBRAL palsy , *BODY movement , *DIFFERENTIAL diagnosis , *U-statistics , *GAIT in humans , *POSTURE , *WALKING , *KINEMATICS , *DIAGNOSIS - Abstract
Hereditary spastic paraplegia (HSP) and spastic diplegia (SD) patients share a strong clinical resemblance. Thus, HSP patients are frequently misdiagnosed with a mild form of SD. Clinical gait analysis (CGA) has been highlighted as a possible tool to support the differential diagnosis of HSP and SD. Previous analysis has focused on the lower-body but not the upper-body, where numerous compensations during walking occur. The aim of this study was to compare the full-body movements of HSP and SD groups and, in particular, the movement of the upper limbs. Ten HSP and 12 SD patients were evaluated through a CGA (VICON 460 and Mx3+; ViconPeak®, Oxford, UK) between 2008 and 2012. The kinematic parameters were computed using the ViconPeak® software (Plug-In-Gait). In addition, the mean amplitude of normalised (by the patient''s height) arm swing was calculated. All patients were asked to walk at a self-selected speed along a 10-m walkway. The mean kinematic parameters for the two populations were analysed with Mann–Whitney comparison tests, with a significant P-value set at 0.05. The results demonstrated that HSP patients used more spine movement to compensate for lower limb movement alterations, whereas SD patients used their arms for compensation. SD patients had increased shoulder movements in the sagittal plane (Flexion/extension angle) and frontal plane (elevation angle) compared to HSP patients. These arm postures are similar to the description of the guard position that toddlers exhibit during the first weeks of walking. To increase speed, SD patients have larger arm swings in the sagittal, frontal and transversal planes. Upper-body kinematics, and more specifically arm movements and spine movements, may support the differential diagnosis of HSP and SD. [Copyright &y& Elsevier]
- Published
- 2013
- Full Text
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