Ann Flanagan

Long-Term Outcome Evaluation in Young Adults Following Clubfoot Surgical Release

Background The aim of this study was to evaluate the long-term outcome of a comprehensive surgical release for congenital talipes equinovarus (CTEV). Methods Gait, strength, segmental foot motion, and outcomes questionnaire data were collected on 24 adults (21.8±2.3 y) who were surgically treated for CTEV as infants. These data were statistically compared with of 48-age group matched controls (23.2±2.4 y). Results The clubfoot group was functional in activities of daily living, although most patients did experience foot pain after a day of typical activities, such as walking, standing, using stairs and doing exercise. Lower extremity gait kinematics was similar to the control group. There were differences in segmental foot motion with the hindfoot in a more plantarflexed position relative to the tibia and the forefoot dorsiflexed, and adducted relative to the hindfoot. Ankle plantarflexion and inversion strength and range of motion was reduced in the clubfoot group in association with an increase in hip power generation during the preswing and initial swing phases of the gait cycle. Conclusions Surgical correction of CTEV was successful in providing a functional plantigrade foot as the patients reached adulthood. However, limitations included foot pain, limited foot range of motion, and weakness. Level of Evidence Level III.

Evaluation of Short-Term Intensive Orthotic Garment Use in Children Who Have Cerebral Palsy

Purpose: To evaluate the effectiveness of an orthotic undergarment on gait, balance, and life skills of children who have diplegic cerebral palsy (CP). Methods: Five subjects (ages 7–13 years) with CP at Gross Motor Function Classification Scale level I wore a TheraTog™ undergarment for 12 weeks. Data collection included Vicon® Motion Analysis, Bruininks-Oseretsky Test of Motor Proficiency, and Canadian Occupational Performance Measure at baseline; in and out of the garment after 12 weeks of wear; 2 months and 4 months after garment wear. Results: Kinematic data indicated increased peak hip extension and correction of anterior pelvic tilt in stance during wear time. Composite gross motor scores on the Bruininks-Oseretsky Test of Motor Proficiency and Canadian Occupational Performance Measure scores improved significantly at the end of wear time. Conclusion: When worn for a 12-week time frame, an individualized orthotic garment can improve gait and functional skills in some children with CP.

Ankle strength and functional limitations in children and adolescents with type I osteogenesis imperfecta.

Purpose: To determine whether children with type I osteogenesis imperfecta (OI) exhibit ankle plantar flexor weakness and whether this correlates with physical function. Methods: Twenty children and adolescents with type I OI and 20 age-matched controls (age 6-18 years) participated in a single evaluation session. Data included strength assessment, Gillette Functional Assessment Questionnaire, Pediatric Outcome Data Collection Instrument (PODCI), and Faces Pain Scale—Revised. Results: Ankle plantar flexor weakness was evident in the OI group compared with the control group. Heel-rise strength correlated with ankle isometric plantar flexion strength. Limitations in PODCI subscales—sports and physical function and pain/comfort—are present in the OI group. Conclusion: Ankle plantar flexor weakness is present in children and adolescents with type I OI and correlates with function. Gillette Functional Assessment Questionnaire, PODCI, and strength assessment are valuable evaluation tools for children and adolescents with type I OI and can aid therapists in goal setting.

Gait characteristics and functional assessment of children with Type I Osteogenesis Imperfecta

The purpose of this study was to improve the evaluation process of children with type I Osteogenesis Imperfecta (OI) by providing a quantitative comparison of gait and selected functional assessments to age‐matched controls. A 14‐camera Vicon Motion Analysis System was used for gait analysis along with selected functional assessments (Pediatric Outcomes Data Collection Instrument [PODCI], Functional Assessment Questionnaire [FAQ], Faces Pain Scale‐Revised [FPS‐R]) conducted on 10 subjects with type I OI and 22 age‐matched healthy controls. The results of the OI group demonstrated abnormal gait parameters including increased double support, delayed foot off, reduced ankle range of motion and plantarflexion during third rocker, along with greater ankle power absorption during terminal stance and reduced ankle power generation during push off. The functional assessment scores of the OI group were similar to the control group for basic mobility and function, but were lower than their peers in the sports and physical function category. The evaluation of individuals with OI by means of gait analysis and selected functional assessments, along with an accurate biomechanical model of the lower extremities, is proposed to better understand and predict OI disability and improve quality of life.

One-Minute Walk and modified Timed Up and Go tests in children with cerebral palsy: performance and minimum clinically important differences.

This prospective multicenter study assessed performance and changes over time, with and without surgical intervention, in the modified Timed Up and Go (mTUG) and One‐Minute Walk tests (1MWT) in children with bilateral cerebral palsy (CP). Minimum clinically important differences (MCIDs) were established for these tools.

Brace evaluation in children with diplegic cerebral palsy with a jump gait pattern.

BACKGROUND Brace prescription for children with diplegic cerebral palsy challenges the clinician with a variety of options and little evidence for rational decisions. Previous studies have indicated that ankle-foot orthoses improve toe-walking, but it is unclear if any brace is better than another. The goal of the present study was to compare the effectiveness of hinged and dynamic ankle-foot orthoses in terms of improving gait and motor function in a homogeneous group of children with diplegic cerebral palsy exhibiting a jump gait pattern. METHODS Fifteen children (mean age, 7.5 years) with spastic diplegic cerebral palsy who were able to walk independently with a jump gait pattern and twenty children (mean age, 10.6 years) with normal gait participated in the study. Standardized Gross Motor Function Classification System scores, Pediatric Outcomes Data Collection Instrument scores, and gait data were collected, analyzed, and compared. The subjects were tested while barefoot and while wearing hinged and dynamic ankle-foot orthoses. Data were analyzed to detect differences among these conditions. RESULTS Significant improvements in gait metrics were seen during brace wear. No significant differences were seen between the two different braces used. The barefoot and braced conditions differed most significantly in terms of ankle kinematics and kinetics. Among the patients with cerebral palsy, no significant differences in the standardized outcome measurements were found between the braced and unbraced conditions or between the two braced conditions. CONCLUSIONS Our data suggest that gait improves with brace wear in children with cerebral palsy with a level-I Gross Motor Function Classification System score. The Pediatric Outcomes Data Collection Instrument and the Gross Motor Function Measure were not sensitive to brace treatment in the population studied. The hinged and dynamic braces were equally effective for improving ankle kinematics and kinetics in these relatively highly functioning children with cerebral palsy.

Psychosocial outcomes of children and adolescents with early-onset spinal cord injury and those with spina bifida.

Purpose: To describe psychosocial outcomes of children and adolescents with early-onset spinal cord injury (SCI) and spina bifida (SB) and identify differences between them. Methods: Eighty-three participants had acquired SCI before age 3 years (mean age 10.6 ± 3.8 yrs), and 54 had SB (mean age 11.7 ± 4.1 yrs). The participants completed standardized assessments of participation, quality of life (QOL), anxiety, and depression. Independent-sample t tests and Mann-Whitney tests were used to assess group differences. Results: Participants with SCI reported higher school QOL (P = .016) and lower anxiety with social concerns/concentration (P = .037) than did participants with SB. The subgroup of participants with SCI with paraplegia reported higher school (P = .014) and overall (P = .034) QOL, and they participated in more activities (P = .015) than participants with SB. Conclusions: Children and adolescents with SCI with paraplegia have greater school and overall QOL and participate in more activities than children and adolescents with SB. Children and adolescents with SB would benefit from increased support at school and in social participation.

Timed motor test for wheelchair users: initial development and application in children with spinal cord injury.

Abstract Objective: The objective of this study was to describe the development and preliminary results of reliability testing of the timed motor test (TMT), a performance-based measure of functional status for children with a spinal cord injury (SCI) who use a manual wheelchair. This study will also provide pilot data using the TMT to examine the impact of thoracolumbosacral orthoses (TLSO) on function in children with a SCI. Study Design: Cross-sectional observational study. Methods/Participants: This study enrolled 11 subjects with SCI. The TMT consisted of donning a shirt, donning pants, even transfers, uneven transfers, and propelling a wheelchair 80 feet and up a ramp of 45 feet. Nine subjects completed the TMT with and without a TLSO, and 6 subjects ( 4 of whom also completed the TMT with and without a TLSO) completed the reliability testing. Results: Except for donning pants, the intertester and intratester reliability of the TMT was fair-to-good with intradass correlation coefficients (ICCs) of 0.60 or greater. When wearing a TLSO, participants were slower at donning a shirt, donning pants, performing even and uneven transfers, and hallway propulsion (P < 0.05). There was a preference for not wearing a TLSO for dressing and transfer skills. Conclusion: ln general, the TMT for wheelchair users had fair-to-good intertester and intratester reliability. Based on these pilot data, there was an increase in time to complete several functional tasks because of the use of a TLSO as measured by the TMT in children with a SCI.